Continuation of Inhaled Corticosteroids Appears Safe During Pregnancy: JAMA
A nationwide cohort study found that continued inhaled corticosteroid (ICS) use during early pregnancy was not associated with increased maternal or neonatal risks. Despite frequent discontinuation of ICS therapy, the findings support current guidelines recommending continued ICS use during pregnancy to maintain asthma control. The study also emphasizes the importance of individualized risk assessment and avoiding unnecessary discontinuation of effective asthma therapy. The study was published in JAMA Network Open by Bohyun S. and colleagues.
To analyze the maternal and infant health outcomes, the researchers used a large population-based mother-infant health care claims database in South Korea among live births from April 1, 2010, to December 31, 2022. Among the total of 3,909,084 pregnancies, 6,105 women aged between 15 to 50 years who had a diagnosis of asthma and at least two prescriptions of ICS within six months before the final menstrual period were selected. The participants were classified as ICS continuers (taking at least one ICS prescription in the first trimester) and discontinuers (no prescription of ICS in the first trimester).
Log-binomial regression models based on propensity score overlap weights were applied to adjust for baseline confounders and estimate weighted risk ratios (RRs) with 95% confidence intervals for maternal health outcomes including preeclampsia, gestational diabetes, obstructed labor, antepartum hemorrhage, premature rupture of membranes, and preterm birth as well as infant health outcomes such as low birth weight, hypoxia, and congenital anomalies. Data analyses were performed from April 28 to November 10, 2025.
Key findings:
- Among 6,105 women with prepregnancy ICS use, only 2,108 (34.5%; mean age 33.2 ± 4.4 years) continued ICS therapy into the first trimester, whereas 3,997 women (65.5%; mean age 32.9 ± 4.2 years) discontinued their medication.
- Risk per 1,000 pregnancies was 145.6 among continuers versus 131.9 among discontinuers, yielding no statistically significant increase (weighted RR 1.05; 95% CI, 0.90–1.22).
- Preterm birth rates reached 131.4 per 1,000 pregnancies in the continuation group compared to 128.6 per 1,000 in the discontinuation group (weighted RR 0.95; 95% CI, 0.82–1.11).
- Low birth weight occurred at rates of 77.5 per 1,000 pregnancies among continuers versus 58.3 per 1,000 among discontinuers (weighted RR 1.11; 95% CI, 0.89–1.39).
- Congenital malformation risks per 1,000 pregnancies were 57.6 for continuers compared to 42.2 for discontinuers, showing no significant association with ICS continuation (weighted RR 1.22; 95% CI, 0.94–1.56).
In summary, using inhaled corticosteroids during the first trimester of pregnancy is safe and poses no additional risks of complications for the pregnant woman or the newborn. The identification of a substantial number of pregnant women stopping their use shows the need to tackle unfounded safety concerns in antenatal care settings. The strong findings from a national population clearly confirm current clinical recommendations, which indicate that the use of inhaled corticosteroids is the safest option.
Reference:
Suh B, Cho Y, Choi E, et al. Inhaled Corticosteroids Continuation in the First Trimester and Pregnancy Outcomes in Women With Asthma. JAMA Netw Open. 2026;9(8):e2630781. doi:10.1001/jamanetworkopen.2026.30781
