Inhaled corticosteroids during pregnancy: A review of methodologic issues

Breton, Marie-Claude; Martel, Marie-Josée; Vilain, Anne; Blais, Lucie

doi:10.1016/j.rmed.2008.01.008

Cited by 11 publications

(3 citation statements)

References 42 publications

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“…Inhaled corticosteroids (ICS) represent a cornerstone in the management of asthma. Asthma guidelines recommend that pregnant asthma patients should be treated with ICS to the same degree as non-pregnant women (1). The lack of toxicity of ICS in the treatment of asthma during pregnancy has been reported in systematic reviews (2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

Fetal Concentrations of Budesonide and Fluticasone Propionate: a Study in Mice

Zaidi

Chen

Lee

et al. 2019

AAPS J

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The study goal was to evaluate the transplacental transfer of two corticosteroids, budesonide (BUD) and fluticasone propionate (FP), in pregnant mice and investigate whether P-glycoprotein (P-gp) might be involved in reducing BUD transplacental transfer. Pregnant mice (N = 18) received intravenously either low (104.9 μg/kg) or high (1049 μg/kg) dose of [ 3 H]-BUD or a high dose of [ 3 H]-FP (1590 μg/kg). In a separate experiment, pregnant mice (N = 12) received subcutaneously either the P-gp inhibitor zosuquidar (20 mg/kg) or vehicle, followed by an intravenous infusion of [ 3 H]-BUD (104.9 μg/kg). Total and free (protein unbound) corticosteroid concentrations were determined in plasma, brain, fetus, placenta, kidney, and liver. The ratios of free BUD concentrations in fetus versus plasma K (fetus, plasma, u, u) 0.42 ± 0.17 (mean ± SD) for low-dose and 0.38 ± 0.18 for high-dose BUD were significantly different from K = 1 (P < 0.05), contrary to 0.87 ± 0.25 for FP, which was moreover significantly higher than that for matching high-dose BUD (P < 0.01). The BUD brain/plasma ratio was also significantly smaller than K = 1, while these ratios for other tissues were close to 1. In the presence of the P-gp inhibitor, K (fetus, plasma, u, u) for BUD (0.59 ± 0.16) was significantly increased over vehicle treatment (0.31 ± 0.10; P < 0.01). This is the first in vivo study demonstrating that transplacental transfer of BUD is significantly lower than FP's transfer and that placental P-gp may be involved in reducing the fetal exposure to BUD. The study provides a mechanistic rationale for BUD's use in pregnancy.

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Section: Introductionmentioning

confidence: 99%

Fetal Concentrations of Budesonide and Fluticasone Propionate: a Study in Mice

Zaidi

Chen

Lee

et al. 2019

AAPS J

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“…it is safer for pregnant women with asthma to be treated with asthma medications than it is for them to have asthma symptoms and exacerbations." [2] While inhaled corticosteroids (ICS) are considered the cornerstone therapy in the management of persistent asthma during pregnancy [9,10], beta 2 -agonists have a crucial role in asthma management [2]. During pregnancy, short-acting beta 2 -agonists (SABA) are used as reliever medications for all asthma types (mild, moderate, or severe), while long-acting beta 2 -agonists (LABA) are used in cases of moderate to severe persistent asthma, in combination with low or medium doses ofICS [2,11].…”

Section: Introductionmentioning

confidence: 99%

Beta2-agonists use during pregnancy and perinatal outcomes: A systematic review

Eltonsy

Kettani

Blais

2014

Respiratory Medicine

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“…1 Inhaled corticosteroids (ICSs) are recognized as the first-line controller therapy, and the same doses are recommended during pregnancy and under other circumstances. 1 In a recent literature review, 3 we identified 15 studies that investigated the risk of congenital malformations in association with the use of ICSs during pregnancy. [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18] In 6 of these studies, [4][5][6][15][16][17] ICS users were compared with women with asthma who did not use any ICS during pregnancy, whereas in the other studies, ICS users were compared with the general population, women without asthma, or users of theophylline.…”

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confidence: 99%