CONTINUING inhaled corticosteroids during early pregnancy was not linked to worse maternal or neonatal outcomes in women with asthma.
The nationwide cohort study included 6,105 pregnancies among women aged 15–50 years who had asthma and received at least two inhaled corticosteroid prescriptions before pregnancy. Of these, 2,108 women, or 34.5%, continued treatment during the first trimester, while 3,997 discontinued it.
After adjustment for baseline differences, inhaled corticosteroids in pregnancy were not associated with statistically significant increases across the maternal outcomes assessed. These included preeclampsia, gestational diabetes, obstructed labor, antepartum hemorrhage, premature rupture of membranes, and preterm birth.
Gestational diabetes occurred at rates of 145.6 per 1,000 pregnancies among continuers and 131.9 per 1,000 among discontinuers. The weighted risk ratio was 1.05, with a 95% confidence interval of 0.90–1.22. Preterm birth rates were also similar at 131.4 versus 128.6 per 1,000 pregnancies, respectively, producing a weighted risk ratio of 0.95.
No statistically significant differences emerged for neonatal hypoxia or asphyxia, low birth weight, or congenital malformations. For congenital malformations, rates were 57.6 per 1,000 pregnancies with continuation and 42.2 per 1,000 with discontinuation. Although several point estimates were higher among continuers, all confidence intervals crossed the null.
Despite the reassuring outcomes, almost two thirds of eligible women had no recorded inhaled corticosteroid prescription during the first trimester. Continuation was more common among women with markers of greater asthma severity, including prior use of combination inhaled corticosteroid and long acting β agonist therapy, short acting β agonists, high dose oral corticosteroids, and frequent respiratory visits.
Results remained consistent when researchers examined maternal age and previous asthma exacerbations and conducted multiple sensitivity analyses. These included restricting the cohort to singleton or first pregnancies and adjusting for available lifestyle factors.
The findings support continuing inhaled corticosteroids in pregnancy when clinically indicated, while emphasizing individualized assessment of asthma severity, exacerbation history, and treatment needs.
However, the observational design cannot establish causality. Prescription records also could not confirm medication use, and the analysis included only pregnancies resulting in live births. Residual confounding, exposure misclassification, and selection bias therefore remain possible.
Reference
Suh B et al. Inhaled corticosteroids continuation in the first trimester and pregnancy outcomes in women with asthma. JAMA Netw Open. 2026;9(8).
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