Table 1 Recommendations for treatment of asthma and allergies in pregnancy

Inhaled bronchodilators (e.g. Albuterol, Formoterol and Salmeterol)

Human data generally reassuring for short acting and long-acting bronchodilators

Theophylline

Reassuring human data; serum levels must be monitored very closely to avoid toxicity

Systemic corticosteroids

Human data from smaller case control studies show increase in oral clefts. Larger prospective studies show increase in low birth weight, preterm birth, preeclampsia and intrauterine growth retardation.

Inhaled corticosteroids

Human data mainly reassuring. There may be an increased risk of malformations seen with higher doses.

Leukotriene Receptor Antagonist (e.g. Montelukast, Zafirlukast)

Human data are generally reassuring

5-Lipoxygenase-Inhibitor

Generally avoided during pregnancy due to the available less reassuring animal data.

Omalizumab

Increased risk of low birth weight and preterm birth; likely severity of asthma may confound to these observations.

Oral antihistamines (e.g. Azelastine, Cetirizine, Chlorpheniramine, Dexchlorpheniramine, Fexofenadine, Diphenhydramine, Hydroxyzine, Loratadine)

Human data are generally reassuring.

Hydroxyzine should be used cautiously during first trimester based on animal data. Fexofenadine (an active metabolite of Terfenedine): no reports of increased congenital malformations, however, no epidemiologic studies in human pregnancy available.

Oral and Nasal Decongestants (e.g. Oxymetazoline, Phenylephrine, Phenylpropanolamine, Pseudoephedrine)

Should be avoided during pregnancy:

Oxymetazoline has been associated with possible uteroplacental insufficiency at higher doses. Phenylephrine has been associated with clubfoot and eye/ear malformations. Phenylpropanolamine associated with congenital malformations, gastroschisis and ventricular septal defect. Pseudoephedrine associated with gastroschisis, hemifacial microsomia and small intestinal atresia in some case–control studies.

Intranasal Antihistamines (e.g. Azelastine, Olapatadine)

Animal studies are reassuring.

Intranasal Corticosteroids (e.g. Budesonide, Fluticasone, Triamcinolone, Mometasone)

Substantial reassuring data for inhaled corticosteroids. Risk of increased malformations at high dose, but severity of allergic rhinitis may be a confounding factor for these outcomes.