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| |  WAM: Inhaled Corticosteroid Use Safe During Pregnancy By W. A. Thomasson Special to DG News CHICAGO, IL -- July 16, 2001 -- Use of inhaled corticosteroids during pregnancy does not retard growth of the fetus, according to results of a 280-birth registry study. These results, presented during the World Asthma Meeting by Michael Schatz, MD, and his colleagues at Kaiser-Permanente in San Diego, California, United States, were derived from the Registry for Asthmatic and Allergic Pregnant Patients (singleton births only). Since 1996, consenting asthmatic or allergic patients have been enrolled in the Registry, conducted under the auspices of the American Academy of Allergy and Immunology and the American College of Allergy and Immunology. The patients are enrolled by their allergists, usually during the early months of pregnancy. As Dr. Schatz noted, there are data suggesting that asthmatic patients -- perhaps especially those who are poorly controlled -- have less favorable pregnancy outcomes than do non-asthmatic women. There are also data showing that oral corticosteroids can reduce the fetus’s intrauterine growth rate and increase the risk of babies being small for gestational age (SGA) - that is, whose birth weight is in the lowest 10 percent of babies born after the same length of pregnancy. "The main result [of the study]," Dr. Schatz said, is that, "the incidence of [SGA births] in this total cohort of patients on inhaled steroids managed by allergists was 7.1 percent. The 95 percent confidence interval goes from 3.5 percent to 10.6 percent." Since the expected frequency of such births in the general population is, by definition, 10 percent, Dr. Schatz’ study provides almost 95 percent certainty that there is no adverse effect on birth weight. Examination of effects among women taking different drugs revealed no great variation, although the study was not powered to reliably detect such differences. Stratification by dose showed a lower birth weight and a higher proportion of SGA infants among the 25 percent of women taking the highest doses. However, neither effect reached statistical significance. Furthermore, as Dr. Schatz noted, these data have not been adjusted for other known risk factors, such as smoking, emergency room visits, and use of oral steroids. Examination of these factors in the study as a whole showed that the expected trends did not reach statistical significance. Concomitant studies employing the registry are examining congenital malformations that may be associated with inhaled steroid use. However, as Dr. Schatz noted, these malformations are rare and many years’ data will be required to give meaningful results. Dr. Schatz mentioned, however, that he has seen data from studies using other techniques that at least suggest inhaled steroids are likely to be safe in this respect as well.
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