Asthma inhalers
Asthma is a very common condition with up to 1 in 6 adults being affected (47). It is usually well managed with inhaled beta agonists and/or inhaled corticosteroids, that have minimal systemic absorption. Despite there being several papers available for the effects of salbutamol in natural pregnancy, we were unable to identify any studies on the effect salbutamol may have on ART outcomes (48, 49). Garne et al. studied the use of anti-asthma medications (short-acting and long-acting beta agonists, and inhaled corticosteroids) in a case-control study and found that first trimester use of inhaled beta-2 agonists (salbutamol) was statistically associated with an increased risk of cleft palate, gastroschisis and renal dysplasia although the overall risk was low (48). It is not clear whether the asthma medications are associated with this risk or if it is the underlying medical condition however, no significant association was seen with the use of inhaled corticosteroids, which suggests the former. Nonetheless, uncontrolled asthma can have devastating consequences in women and therefore until sufficient evidence is available on the risks of beta-2 agonists and the risks associated with alternative medications, women are to continue treatment as per guidelines (50).