Pulmicort During Pregnancy: Is It Safe?

What does the evidence say about pulmicort during pregnancy?

1. Studies on inhaled corticosteroids as a class, which includes budesonide (Pulmicort), haven't found a higher overall chance of birth defects, and one recent study found that using an inhaled corticosteroid for asthma was linked to a lower chance of preterm delivery compared with leaving asthma unmanaged. 1
2. Asthma affects an estimated 4 to 8 percent of pregnancies overall, with US-specific rates closer to 8.4 to 8.8 percent, and inhaled corticosteroids are considered the preferred controller medication because they're safe to use during pregnancy. 2
3. Uncontrolled asthma during pregnancy has been linked to preeclampsia, preterm labor, low birth weight, and other complications, and severe flares can require hospital care or breathing support for the mother, which is a key reason providers favor staying on a working controller inhaler. 2
4. Among inhaled corticosteroids, budesonide, the drug in Pulmicort, is generally preferred during pregnancy because it has a more established safety record than newer inhaled steroids like ciclesonide or mometasone, and it was historically the one inhaled steroid the FDA classified in the relatively reassuring Category B versus Category C for the others. 3
5. A study of the Pulmicort Turbihaler found estimated infant doses of roughly 7 to 14 nanograms per kilogram a day depending on the maternal dose, and nursing infants tested afterward had undetectable blood levels of the drug. 4

Is pulmicort safe in each trimester?

• First trimester. If Pulmicort is already part of your asthma plan, the general guidance is to keep using it rather than stop out of worry: inhaled corticosteroids as a class haven't been linked to a higher overall chance of birth defects, and budesonide specifically has more pregnancy safety data behind it than several other inhaled steroids.
• Second trimester. Some people notice asthma symptoms shift, better or worse, as the second trimester progresses. This is a good point to check in with your provider on whether your Pulmicort dose and inhaler technique still match how you're feeling, rather than adjusting on your own.
• Third trimester. Staying on your controller inhaler through delivery helps keep your breathing steady during labor, when a flare is the last thing you want to manage. If you're planning to breastfeed afterward, a study of the Pulmicort Turbihaler found undetectable drug levels in nursing infants' blood.