Drugs/vaccination during pregnancy

Question

Dear team,
I am 30 years old, suffer from CF (DeltaF508), have a very good lung condition (FEV1 115%), in exchange I have an insulin-dependent diabetes mellitus.

Now I got to know yesterday, that I am pregnant in the 5th week (absolute desired child, husband is not a CF-carrier).

Now I want to know: I take acetylcysteine 600, ipratropium bromide for inhalation, salbutamol for inhalation, acetylcysteine for inhalation as well as basal insulin and insulin lispro, unfortunately at the moment also 10mg prednisolon, as for about 5 days my bronchi are a bit "closed".
Am I allowed to take all those drugs without any problems? I stopped mannitol for inhalation.
As now the autumn is coming and I am working at an ENT-doctor's office, I actually planned to get a flu shot. Does this make sense, respectively from which week of pregnancy on this would be o.k.?
Many thanks for your efforts
CM

Answer

Dear CM,
at first I want to congratulate you to your motherhood, and your and your husband to your parenthood! I wish you and your family all the best!

You asked two questions. First it deals with the usage of drugs during pregnancy, second you want to get informed about a flu shot during pregnancy.
Before I will come back to answering the questions, I want to urgently recommend that you are followed-up continuously by your CF doctor in charge and a gynecologist. It is very important to build up a communication between your CF doctor and the gynecologist, then the care can be performed optimally together and questions can be answerd competently.
Now to your first question in that you wanted to know if you could take the listed drugs uncritically:
- acetylcysteine: in case the basis inhalation therapy and a sufficient intake of fluids appear insufficient, acetylcystein (oral or inhalative) can also be used during pregnancy
- ipratropium bromide: is allowed to be used during pregnancy as a bronchi-widening drug
- salbutamol: is medication of first choice during the whole pregnancy among the short-acting β2-sympathomimetics. At the end of pregnancy, if applicalbe, tocolysis and β2-specific effects on the fetus have to be taken into account
- human insulin (all preparations): in case of underlying diabetes, during pregnancy one has especially to pay attention to a well adjusted bood sugar level, therefore the usage of insulin is urgently recommended
- prednisolon: in case a systemic or local treatment with prednisolon is necessary, this can also be performed during pregnancy. However, it has exactly to be checked, if the necessity of this treatment is given indeed. In case it can not be discontinued, then it should be tried to keep the maintenance dosage between week 8 and 11 in possible under 10mg/d
- mannitol (for inhalation): as a very new drug, the experience with inhalation during pregnancy is correspondingly small. Therefore it is said in the package insert, that the usage of mannitol (Bronchitol®) should be avoided during pregnancy
[translators' comment: A link to a German website on drug security and pregnancy was given here].

Please always discuss your therapy with your CF doctor in charge!

An answer to your question on the flu shot can be found at the German Standing Committee on Vaccination (STIKO). There it can be read, that the flu vaccination is recommended especially for pregnant women from the 4th month of pregnancy on. In case of an increased health risk due to an underlying disease of the pregnant woman, like e.g. asthma, diabetes or hypertension, the vaccination should be done already in the first third of pregnancy. CF also belongs to the group of severe underlying diesases, therefore also in this case the vaccination should be brought forward as described here.

I hope to have answered you questions and stay with best regards,

Yours
Dr. med. Christina Smaczny

18.11.2013