title: Relative perinatal safety of salmeterol vs formoterol and fluticasone vs budesonide use during pregnancy.
abstract: BACKGROUND
  Recent asthma guidelines endorse the safety of long-acting β2-agonists (LABAs) and of mild and moderate doses of inhaled corticosteroids (ICSs) when required to control asthma during pregnancy, yet do not state a preferred medication within each class.
  
  
  OBJECTIVE
  To estimate the relative perinatal safety with the use of salmeterol and formoterol (LABAs) and that of fluticasone and budesonide (ICSs) during pregnancy.
  
  
  METHODS
  A subcohort of pregnancies from asthmatic women was selected from health care administrative databases of Quebec, Canada. Low birth weight (LBW) was defined as weight less than 2,500 g, preterm birth (PB) as delivery before 37 weeks of gestation, and small for gestational age (SGA) as a birth weight below the 10th percentile. The effect of treatment with salmeterol vs formoterol and fluticasone vs budesonide on the outcomes was determined with generalized estimating equation models.
  
  
  RESULTS
  The LABA and ICS subcohorts were composed of 547 (385 salmeterol and 162 formoterol users) and 3,798 (3,190 fluticasone and 608 budesonide users) pregnancies, respectively. No statistically significant differences were observed for LBW (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.44-1.88), PB (OR, 1.11; 95% CI, 0.56-2.23), and SGA (OR, 1.16; 95% CI, 0.67-2.02) newborns between women exposed to salmeterol vs formoterol or between women exposed to fluticasone vs budesonide (LBW: OR, 1.08; 95% CI, 0.76-1.52; PB: OR, 1.07; 95% CI, 0.78-1.49; and SGA, OR: 1.10; 95% CI, 0.85-1.44).
  
  
  CONCLUSIONS
  This study does not provide evidence of greater perinatal safety for one LABA or one ICS over the other.
authors.affiliation: Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada; Pharmacy Department, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada.
authors.forename: Benoit
authors.initials: B
authors.lastname: Cossette
authors.affiliation: Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada; Pharmacy Department, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada; Centre de recherche Clinique Étienne-Le Bel, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada; Endowment Chair, AstraZeneca in Respiratory Health, Montréal, Québec, Canada.
authors.forename: Marie-France
authors.initials: MF
authors.lastname: Beauchesne
authors.affiliation: Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada; Research Center, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada.
authors.forename: Amélie
authors.initials: A
authors.lastname: Forget
authors.affiliation: Research Center, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada; Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Catherine
authors.initials: C
authors.lastname: Lemière
authors.affiliation: Centre de recherche Clinique Étienne-Le Bel, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada; Faculty of Medicine, Université de Sherbrooke, Sherbrooke, Québec, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Larivée
authors.affiliation: Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada; Department of Obstetrics and Gynecology and Research Center, Centre hospitalier universitaire Ste-Justine, Montréal, Québec, Canada.
authors.forename: Evelyne
authors.initials: E
authors.lastname: Rey
authors.affiliation: Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada; Centre de recherche Clinique Étienne-Le Bel, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada; Endowment Chair, AstraZeneca in Respiratory Health, Montréal, Québec, Canada; Research Center, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada. Electronic address: lucie.blais@umontreal.ca.
authors.forename: Lucie
authors.initials: L
authors.lastname: Blais
mesh_terms: D000293:Adolescent; D058666:Adrenergic beta-2 Receptor Agonists / Q000009:adverse effects* / Q000627:therapeutic use; D000328:Adult; D000420:Albuterol / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000730:Androstadienes / Q000009:adverse effects* / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000009:adverse effects / Q000627:therapeutic use; D019819:Budesonide / Q000009:adverse effects* / Q000627:therapeutic use; D002170:Canada; D004983:Ethanolamines / Q000009:adverse effects* / Q000627:therapeutic use; D005260:Female; D000068298:Fluticasone; D000068759:Formoterol Fumarate; D006801:Humans; D007230:Infant, Low Birth Weight; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D047928:Premature Birth / Q000453:epidemiology; D000068299:Salmeterol Xinafoate; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D058666:Adrenergic beta-2 Receptor Agonists; D000730:Androstadienes; D018927:Anti-Asthmatic Agents; D001993:Bronchodilator Agents; D004983:Ethanolamines; D019819:Budesonide; D000068299:Salmeterol Xinafoate; D000068298:Fluticasone; D000420:Albuterol; D000068759:Formoterol Fumarate