What are the treatment options for bronchitis in pregnancy?

From the Guidelines

Bronchitis during pregnancy should be managed with caution, prioritizing the health and safety of both the mother and the fetus, and the most recent guidelines recommend a step-wise approach to treatment, starting with symptomatic relief and considering the use of antibiotics only when necessary. When considering treatment options, it's essential to weigh the benefits and risks of each medication, taking into account the gestational age and the severity of symptoms. For symptomatic relief, albuterol has been shown to be effective in reducing the duration and severity of cough in patients with uncomplicated acute bronchitis 1. Additionally, dextromethorphan and guaifenesin may be used for cough and as an expectorant, respectively, as they are generally considered safe in pregnancy. For bacterial bronchitis, antibiotics like amoxicillin, amoxicillin-clavulanate, or azithromycin are preferred options during pregnancy, but their use should be guided by clinical judgment and balanced with the potential risks to the fetus 1. Some key considerations for managing bronchitis in pregnancy include:

• Avoiding NSAIDs like ibuprofen, especially in the third trimester
• Avoiding decongestants containing pseudoephedrine in the first trimester
• Using inhaled bronchodilators like albuterol under medical supervision for wheezing
• Seeking medical attention if experiencing high fever, difficulty breathing, chest pain, or if symptoms worsen after 7-10 days
• Implementing prevention strategies such as frequent handwashing, avoiding sick contacts, staying hydrated, and getting recommended vaccines like the influenza vaccine, which is safe during pregnancy. It's also important to note that monoclonal antibodies are not likely to cross the placenta in sufficient quantities to cause fetal harm and should be continued during pregnancy if required for asthma control in the mother 1. Overall, the management of bronchitis during pregnancy requires a thoughtful and individualized approach, taking into account the unique needs and circumstances of each patient.

From the FDA Drug Label

Pregnancy Teratogenic Effects Pregnancy Category C Albuterol has been shown to be teratogenic in mice when given subcutaneously in doses corresponding to 1.25 times the human nebulization dose (based on a 50 kg human). There are no adequate and well-controlled studies in pregnant women. Albuterol should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.

A reproduction study in CD-1 mice with albuterol (0.025,0.25, and 2.5 mg/kg subcutaneously, corresponding to 0.125,1.25, and 12.5 times the maximum human nebulization dose, respectively) showed cleft palate formation in 5 of 111 (4.5%) fetuses at 0.25 mg/kg and in 10 of 108 (9.3%) fetuses at 2.5 mg/kg.

During worldwide marketing experience, various congenital anomalies, including cleft palate and limb defects, have been rarely reported in the offspring of patients being treated with albuterol. Some of the mothers were taking multiple medications during their pregnancies No consistent pattern of defects can be discerned, and a relationship between albuterol use and congenital anomalies has not been established.

Bronchitis treatment in pregnancy should be approached with caution.

• Albuterol can be used during pregnancy, but only if the potential benefit justifies the potential risk to the fetus 2.
• There are no adequate and well-controlled studies in pregnant women, and albuterol has been shown to be teratogenic in mice.
• Azithromycin may be used to treat acute bacterial exacerbations of chronic bronchitis in pregnant women, but its safety and efficacy in this population have not been established 3.
• The decision to use either medication should be made on a case-by-case basis, taking into account the severity of the bronchitis and the potential risks and benefits to the mother and fetus.

From the Research

Bronchitis Treatment in Pregnancy

• The treatment of bronchitis in pregnancy is not directly addressed in the provided studies, but general guidelines for respiratory illnesses in pregnancy can be applied 4, 5.
• For acute bronchitis, evidence suggests that it is a self-limiting disease and symptom relief and patient education are recommended for management 6.
• The use of antibiotics in acute bronchitis is not supported by evidence, as they do not contribute to the overall improvement of the condition and may expose patients to antibiotic-related adverse effects 6, 7.
• In pregnant women, the management of respiratory illnesses, including bronchitis, should take into account the physiological and anatomical changes of pregnancy and the potential risks and benefits of treatment options 5.
• The safety of medications used to treat bronchitis in pregnancy should be carefully considered, and antibiotics should only be used when necessary and with caution 4, 5.