Asthma and Pregnancy: Which Asthma Medications Are Safe to Use While Pregnant?

Pregnancy can be an exciting time, but it can also come with challenges — especially if you have asthma. In fact, up to nearly half of pregnant women with asthma experience flare-ups at some point during pregnancy.

It’s natural to feel concerned about taking asthma medications while you’re expecting. But skipping treatment can raise the risk of serious complications, including high blood pressure and preterm birth. By effectively managing your asthma symptoms, you can help safeguard your health and support the well-being of your unborn baby.

The good news is that many asthma medications are considered safe to use while pregnant. Below, we’ll cover what you should know about common asthma treatments during pregnancy.

Short-acting beta agonists

Short-acting beta agonists (SABAs) are fast-acting medications used to relieve sudden asthma symptoms. Often called rescue inhalers, they work by relaxing the muscles around your airways to help you breathe more easily. They can also be used to prevent asthma symptoms brought on by exercise.

SABAs are first-choice medications for relieving asthma symptoms during pregnancy. Albuterol (ProAir) is the most commonly used and studied, meaning it’s a safe choice. Levalbuterol (Xopenex) is another safe SABA option.

Keep in mind that SABAs are only used as needed for sudden symptom flare-ups. They don’t address the underlying inflammation that causes asthma. To effectively manage your asthma symptoms, you may also need a daily maintenance medication.

EXPERT PICKS: WHAT TO READ NEXT

• How to save: Asthma inhalers don’t need to break the bank. Explore ways to save on Advair, Pulmicort, and more with the asthma inhaler savings guide.

• Is it safe? Worried about using albuterol during pregnancy? Here’s why it’s safe and often recommended.

• Asthma inhaler guide: Here’s a breakdown of the different types of asthma inhalers, how they work, and more.

Inhaled corticosteroids

Inhaled corticosteroids (ICS) are a key part of daily asthma maintenance. They reduce inflammation in the airways, helping to prevent symptoms and flare-ups. Unlike SABAs, you use an ICS inhaler every day, even if you don’t have symptoms.

ICS are considered first-choice maintenance medications for managing asthma during pregnancy. When used at low to moderate doses, research hasn’t found an increased risk of complications, such as low birth weight or birth defects.

Budesonide (Pulmicort) is the most studied ICS in pregnancy and so is usually considered safest. Other options, such as fluticasone (Flovent) and beclomethasone (Qvar), are also considered safe but haven’t been studied as extensively. 

It’s generally assumed safest to continue whichever ICS you were taking before pregnancy — especially if it worked well to keep your asthma symptoms at bay. 

Long-acting beta agonists

Long-acting beta agonists (LABAs) help keep your airways open by relaxing the surrounding muscles. If you’re still having frequent asthma symptoms with an ICS, your prescriber may add on a LABA.

LABAs shouldn’t be used to treat asthma without an ICS, as doing so can lead to severe asthma complications. LABAs are usually combined with an ICS in a single inhaler for convenience and safety. Common examples include Symbicort (budesonide / formoterol) and Advair (fluticasone / salmeterol).

Understanding and Treating Your Asthma: What to Ask Your Doctor

Written by Mandy Armitage, MD

There’s limited research on LABAs during pregnancy. But they’re generally considered safe when combined with an ICS to help prevent or reduce asthma symptoms.

Leukotriene receptor antagonists

Leukotriene receptor antagonists (LTRAs) are oral medications that help manage asthma symptoms triggered by allergies. They work by blocking leukotrienes, which are chemical compounds that cause inflammation, airway tightening, and mucus production.

LTRAs are typically added onto an ICS, especially if your asthma symptoms are made worse by allergic rhinitis (seasonal allergies, or hay fever).

Montelukast (Singular) is the most commonly used LTRA. In studies, it didn’t show an increased risk of major birth defects. But research on its safety during pregnancy is limited. So your prescriber may only recommend montelukast if the potential benefits outweigh the risks for you. Zafirlukast (Accolate) is another LTRA option, but it’s not prescribed as often.

Which asthma medications should be used with caution during pregnancy?

Some asthma mediations don’t have much safety data available on their use during pregnancy. Nevertheless, there are many situations where the benefit of using these medications outweighs the risks, such as with severe asthma.

Talk to your healthcare team before stopping or changing any asthma medications during pregnancy. They can discuss the benefits and potential risks of your treatment plan.

Oral corticosteroids

Oral corticosteroids, such as prednisone, are used to reduce airway inflammation when asthma remains severe despite other treatments like ICS, LABA, or SABA medications. They’re typically prescribed for short-term use during asthma flare-ups.

Oral corticosteroids may carry some risks during pregnancy, but the evidence is mixed. Some studies suggest there is an increased risk of cleft lip if taken during the first trimester. Other studies, though, haven’t found this risk. 

There’s also some evidence linking corticosteroids to complications like preeclampsia, preterm birth, and low birth weight. But it’s unclear if these are a result of severe asthma or the medication itself.

Despite potential risks, oral corticosteroids can be life-saving in severe asthma flare-ups. In such a case, it would be more risky to both mother and baby not to take steroids than to take them. 

Allergy shots (allergen immunotherapy)

Allergy shots (allergen immunotherapy) can improve asthma symptoms triggered by allergens. If you started allergy shots before pregnancy and are tolerating them well, your healthcare team will likely recommend continuing them.

However, allergy shots aren’t usually started during pregnancy. This is because there’s a \ risk of having a serious allergic reaction (such as anaphylaxis), though this is rare.

Biologic medications

Biologics are injectable medications that come from living sources. For asthma, biologics target specific parts of the immune system to reduce inflammation. They’re typically added on to treat moderate-to-severe asthma when standard treatments aren’t enough. Currently, six biologics are approved for asthma, including:

• Omalizumab (Xolair)

• Dupilumab (Dupixent)

• Benralizumab (Fasenra)

• Mepolizumab (Nucala)

• Reslizumab (Cinqair)

• Tezepelumab (Tezspire)

Research on biologics during pregnancy is limited. But experts involved in a recent survey agreed that biologics can be continued, or even started during pregnancy when necessary, to manage severe asthma and prevent complications. One possible exception is Tezspire, which may not be recommended in the third trimester.

Biologics do carry a small risk of serious allergic reactions, especially when first starting treatment. For this reason, your prescriber may not recommend starting a biologic during pregnancy unless it’s needed. But if you were already using a biologic before becoming pregnant, they may recommend continuing it.

What else can you do to manage asthma during pregnancy?

Managing asthma during pregnancy can help you and your unborn baby stay healthy. The American Lung Association recommends the following:

• Avoid asthma triggers, such as pollen, dust, cigarette smoke.

• Take asthma medication as directed by your prescriber.

• Monitor your symptoms and report them to your healthcare team.

• Get a flu shot.

• Practice belly breathing exercises to prepare for delivery.

Frequently asked questions

Why trust our experts?

Written by:

Sarah Lobello Pearson, PharmD

Sarah Pearson is a practicing pharmacist with over 10 years of experience in the field. She received her doctorate in pharmacy from the University of Georgia in Athens, GA.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Sophie Vergnaud, MD

Sophie Vergnaud, MD, is the Senior Medical Director for GoodRx Health. An experienced and dedicated pulmonologist and hospitalist, she spent a decade practicing and teaching clinical medicine at academic hospitals throughout London before transitioning to a career in health education and health technology.

Our editorial standards

Meet our experts