Advair During Pregnancy: Is It Safe?

What does the evidence say about advair during pregnancy?

1. Studies looking at fluticasone, whether inhaled, used as a nasal spray, or applied to skin, haven't found an increased chance of birth defects above the general population's baseline rate of about 3%. 1
2. Asthma that isn't well controlled during pregnancy can raise the chance of preterm delivery, low birth weight, and other complications, and using an inhaled corticosteroid like fluticasone for control may lower the chance of preterm delivery compared with leaving asthma unmanaged. 1
3. Small studies haven't suggested higher rates of preterm delivery or low birth weight with salmeterol use during pregnancy, and only a small amount of the inhaled medication reaches the bloodstream. 2
4. If asthma was well controlled with salmeterol before pregnancy, guidance supports continuing the same regimen during pregnancy rather than switching medications. 3
5. In a study of 4,538 pregnant women with asthma, standard-dose use of inhaled corticosteroids and long-acting beta-agonists together, the same combination found in Advair, wasn't linked to adverse fetal outcomes, though high-dose inhaled corticosteroid use was linked to a significantly higher rate of congenital anomalies. 4

Is advair safe in each trimester?

• First trimester. A large cohort study found standard-dose inhaled corticosteroids and long-acting beta-agonists like the ones in Advair weren't linked to adverse fetal outcomes, though high-dose inhaled corticosteroid use was linked to a higher rate of congenital anomalies, one more reason to stick with your prescribed dose rather than increasing it on your own.
• Second trimester. Asthma control can shift as pregnancy progresses, so flag any change in symptoms to your provider rather than adjusting the inhaler dose yourself.
• Third trimester. There's no established need to stop or change Advair before delivery if it's keeping asthma controlled. Uncontrolled asthma late in pregnancy raises the risk of complications like preterm delivery, so continued control is usually the priority.