Inhaled corticosteroids (ICS) are the preferred asthma treatment during pregnancy. Studies suggest that they are not linked to impaired obstetric outcomes or an increased risk of congenital malformations when used at clinically relevant doses in pregnant women. However, these studies focused on a narrow range of short-term adverse outcomes in the offspring, and long-term systemic effects of corticosteroid inhalation cannot be ruled out.

This study assessed the association between use of ICS for asthma during pregnancy and the offspring’s risk of a wide range of diseases, categorised according to major chapters of the International Classification of  Diseases, 10th Revision (ICD-10), during early childhood. Data on the offspring (live singletons) of pregnant women with asthma during pregnancy (prevalence=6.3%; n=4083 mother-child pairs), from the Danish National Birth Cohort (births: 1996-2002; prospective data) were evaluated. Of the 1231 users of ICS, 79.9% were on budesonide, 17.6% fluticasone, 5.4% beclomethasone, and 0.9% on other/unspecified glucocorticoids.

The offspring median age at end of follow-up was 6.1 (range: 3.6 to 8.9) years. The study did not find an associated between ICS and offspring disease risk in most categories, except for offspring endocrine, metabolic and nutritional disorders (hazard ratio 1.84; 95% CI, 1.13 to 2.99). When repeating analyses with the major subgroup that used budesonide only, association estimates were of similar magnitude.

The researchers state that this is the first comprehensive study of the potential effects of ICS during pregnancy on offspring health, covering a large spectrum of paediatric diseases. They note that the data were mostly reassuring, supporting the use of ICS in this group. However, the risk of endocrine and metabolic disorders in the offspring requires further attention, as does the risk of diseases in diagnostic categories for which there were only a small number of cases.