妊娠期支气管哮喘患者用药安全性研究进展

妊娠期用药分为A、B、C、D、X 5类.支气管哮喘（哮喘）治疗药物分为控制药物和缓解药物.吸入性糖皮质激素为妊娠期哮喘控制的一线药物,使用中低剂量安全,该类药物首选布地奈德（B类）.妊娠期哮喘缓解的一线药物是短效β2受体激动剂,首选药物为沙丁胺醇（C类）.全身性糖皮质激素可增高妊娠期高血压及先兆子痫发生率,妊娠早期应用还会增加胎儿唇裂和腭裂发生率.白三烯受体调节剂、色甘酸钠和奈多罗米钠对母婴相对安全,但均不作为首选药物.妊娠期轻度持续哮喘患者可选用低剂量茶碱,但应用时需检测血药浓度,亦不作为首选.单独应用长效β2受体激动剂对胎儿的生长发育无明显影响,但对母体的安全性仍有待于进一步确认.未控制的哮喘可致孕妇缺氧,对其和胎儿均有很大危害,且风险远高于应用哮喘治疗药物.妊娠期哮喘治疗应首先评估利弊,选择适当药物,确保母婴安全.

Advances in safe medication for bronchial asthma during pregnancy

Medications in pregnancy can be divided into five categories （A, B, C, D, X ）. Bronchial asthma medications involve controller medication and relief medication. Inhaled corticosteroids are recommended as first-line controller medications for pregnant women with asthma. Low to medium dose of these drugs is generally safe and budesonide （category B） is considered to be the first choice. Short-acting β2-agonists are recommended as first-line relief medications for pregnant women with asthma and albuterol （ category C） is the first choice. Systemic corticosteroids during pregnancy could cause elevated incidence of hypertension in pregnancy and preeclampsia. Besides, systemic corticosteroids in first trimester of pregnancy could induce occurrence of fetal cleft lip and cleft palate. Leukotriene modifier, cromolyn, and nedocromil have generally been established as safe to mothers and infants, but none of them is the first choice. Low dose theophylline for mild persistent asthma during pregnancy can be chosen, but serum concentrations must be monitored, and theophylline is not the first choice either. The use of long-acting β2-agonists during pregnancy alone has no marked effect on fetal growth and development while the safety to mothers remains to be further investigated. Poor asthma control can lead to hypoxia in pregnant women and it can cause much harm to the mothers and infants. It appears that the risk of consequences of poorly controlled asthma is higher than the adverse effects of asthma medications. In a word, asthma therapy in pregnancy should firstly weight the advantages and disadvantages. Choice of appropriate medication is critical for ensuring maternal and infant health.