Staying on inhaled steroids appears safe in early pregnancy

Clinical takeaway: Continue inhaled corticosteroids during pregnancy when clinically indicated; concerns about fetal harm alone should not prompt discontinuation, although treatment should be individualized to maintain asthma control.

Asthma affects an estimated 3% to 12% of pregnant women, and about 20% experience an exacerbation. Despite guidelines recommending continued therapy, fears about medication-related harm often lead women to stop inhaled corticosteroids (ICSs), potentially exposing mother and fetus to the risks of poorly controlled asthma.

The nationwide cohort included 6,105 live-birth pregnancies in South Korea among women with asthma who had received at least two ICS prescriptions before pregnancy. Only 2,108 women, or 34.5%, continued treatment during the first trimester; 3,997, or 65.5%, discontinued it.

Continuation was not associated with a statistically significant difference in any assessed maternal outcome after adjustment for demographic, obstetric, clinical, and asthma-severity factors; all 95% confidence intervals crossed 1.0. Gestational diabetes occurred in 145.6 versus 131.9 per 1,000 pregnancies among continuers and discontinuers, respectively, while preterm birth occurred in 131.4 versus 128.6 per 1,000. No significant differences were observed for preeclampsia, obstructed labor, antepartum hemorrhage, or premature rupture of membranes.

Neonatal outcomes also did not differ significantly between groups, with all 95% confidence intervals crossing 1.0. Low birth weight occurred in 77.5 versus 58.3 per 1,000 infants, and congenital malformations occurred in 57.6 versus 42.2 per 1,000. Neonatal hypoxia or asphyxia was likewise not significantly associated with continued treatment.

Results remained consistent across subgroup and sensitivity analyses. Still, prescriptions may not reflect actual use, residual confounding is possible, and restricting the cohort to live births excluded miscarriages and stillbirths.

“These findings support continuing ICS therapy during pregnancy when clinically indicated,” the authors concluded.

Source: Suh B, et al. (2026 Aug 24) JAMA Netw Open. Inhaled Corticosteroids Continuation in the First Trimester and Pregnancy Outcomes in Women With Asthma