Asthma in pregnancy: one more piece of the puzzle

Asthma is the most common respiratory disorder complicating pregnancy, and is associated with a range of adverse maternal and perinatal outcomes. There is strong evidence however, that the adequate control of asthma can improve health outcomes for mothers and their babies. Despite known risks of poorly controlled asthma during pregnancy, a large proportion of women have sub- optimal asthma control, due to concerns surrounding risks of pharmacological agents, and uncertainties regarding the effectiveness and safety of different management strategies. A recent retrospective study showed that step up therapy with low-dose ICS/LABA or high dose ICS presents the same risk profile in terms of major congenital malformations. These results are consistent with asthma management guidelines and provide scientific evidence to help physicians and mothers make evidence-based treatment decisions during pregnancy, particularly when a step up to higher doses of ICS or addition of a LABA is required. These reassuring results should encourage women to continue their asthma medications when required to control their asthma during pregnancy and increase the likelihood of healthy pregnancies and newborns. This commentary focuses on some critical issues of this recent work and to the need of future study to evaluate the safety during pregnancy of novel molecules recently introduced for asthma treatment.