Labetalol and Carboprost may precipitate Asthma during pregnancy

A new study published in the journal Obstetrics & Gynecology finds that asthma diagnosis is associated with the specific use of antihypertensive (labetalol) and uterotonic (Carboprost) medications in the women hospitalized for delivery complicated by postpartum hemorrhage or preeclampsia.

"Given their (antihypertensive and uterotonic medications) association with status asthmaticus, these drugs should be used cautiously in women with asthma," warn the authors.

Whitney A. Booker, Columbia University in New York City, and colleagues conducted the study to determine whether asthma diagnosis is associated with the use of specific uterotonic and antihypertensive medications for women hospitalized for delivery complicated by postpartum hemorrhage or preeclampsia.

The authors used perspective, an administrative database, to estimate whether women hospitalized for delivery complicated by postpartum hemorrhage or preeclampsia received uterotonics and antihypertensive medications differentially based on the absence or presence of asthma from 2006 to 2015.

Given that carboprost and intravenous (IV) labetalol may be associated with asthma exacerbation, adjusted models for receipt of these medications were created with adjusted risk ratios with 95% CIs as measures of effect. Risk for status asthmaticus based on receipt of carboprost and IV labetalol was analyzed.

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Overall, 4.2 percent of the 5,691,178 women had preeclampsia and 2.5 percent had postpartum hemorrhage.

Key Findings:

• Carboprost was used less frequently in patients with asthma compared with patients with no asthma (11.4% vs 18.0%) in comparison with IV labetalol, which was used more commonly when a diagnosis of asthma was present (18.5% vs 16.7%).


• In unadjusted analysis, the presence of asthma was associated with a 37% decrease in the likelihood of carboprost use and an 11% increase in the likelihood of labetalol use.


• In adjusted analysis, the presence of asthma was associated with a 32% decrease in the likelihood of carboprost use (adjusted risk ratio 0.68, 95% CI 0.62–0.74) compared with a 7% decrease in labetalol use (adjusted risk ratio 0.93, 95% CI 0.90–0.97).


• The risk for status asthmaticus was significantly increased with the use of IV labetalol compared with other antihypertensive medications (6.5 vs 1.7/1,000 delivery hospitalizations).

"There may be an opportunity to reduce the use of β-blockers and carboprost among patients with asthma. Given their association with status asthmaticus, these drugs should be used cautiously in women with asthma," concluded the authors.

For more information log on to 10.1097/AOG.0000000000002685