Asthma inhalers
Asthma is a very common condition with up to 1 in 6 adults being
affected (47). It is usually well managed with inhaled beta agonists
and/or inhaled corticosteroids, that have minimal systemic absorption.
Despite there being several papers available for the effects of
salbutamol in natural pregnancy, we were unable to identify any studies
on the effect salbutamol may have on ART outcomes (48, 49). Garne et al.
studied the use of anti-asthma medications (short-acting and long-acting
beta agonists, and inhaled corticosteroids) in a case-control study and
found that first trimester use of inhaled beta-2 agonists (salbutamol)
was statistically associated with an increased risk of cleft palate,
gastroschisis and renal dysplasia although the overall risk was low
(48). It is not clear whether the asthma medications are associated with
this risk or if it is the underlying medical condition however, no
significant association was seen with the use of inhaled
corticosteroids, which suggests the former. Nonetheless, uncontrolled
asthma can have devastating consequences in women and therefore until
sufficient evidence is available on the risks of beta-2 agonists and the
risks associated with alternative medications, women are to continue
treatment as per guidelines (50).