What are the potential birth defects and health risks of using Symbicort during pregnancy?

Patient

Q: Hello! We are in the process of adopting a baby and the agency has presented us with the following case to consider: Birthmother has taken Tylenol PM nightly as needed to sleep (mostly in the 5th and 6th month of pregnancy) and has also used a Symbicort inhaler daily as needed for bronchitis (again mostly in the 5th and 6th month but it could have been used the entire pregnancy). She smoked a pack of cigarettes a day until she found out she was pregnant in her second month, and she has been smoking half a pack of cigarettes daily since then. Can you tell me the potential birth defects and health risks this baby faces? Thank you!

Doctor

A:   Symbicort is only recommended for use during pregnancy when benefit outweighs risk, it falls under category C in which a condition of teratogenicity or birth malformations have been noticed in testing animals such as mice, however not in humans.
Tylenol Pm falls into category B and should not be considered harmful or teratogenic. Certainly the most dangerous risk factor of the birthmother is smoking during pregnancy; this can bring complications of the pregnancy itself.
They have about 30% higher odds of being born prematurely, are more likely to be born with low birth weight (less than 2500 grams or 5.5 pounds), increasing their risk for illness or death. Weigh an average of 200 grams less than infants born to women who do not smoke and are 1.4 to 3.0 times more likely to die of Sudden Infant Death Syndrome (SIDS).

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