A critical appraisal of the potential harmful effects of terbutaline sulfate use in pregnancy.

Beta2-adrenergic agonist medications such as albuterol and terbutaline are often prescribed during pregnancy to treat conditions such as asthma, pulmonary disease, preterm labor, or acute non-reassuring fetal heart rate abnormalities during labor. Recently a review article questioned the safety of beta2-adrenergic agonist use in pregnancy, postulating a "biologically plausible" link between the use of these agents and autism spectrum disorder in offspring of mothers exposed to these drugs. While it is imperative to determine any harmful effects of any medication during pregnancy, it is important to weigh the risks and known benefits of treatment versus nontreatment of conditions such as preterm labor with medications such as terbutaline, given the known rates of morbidity and mortality associated with prematurity. The purpose of our review and commentary is to explain how and why beta2-adrenergic agonists are used to treat preterm labor and to discuss the merits of the conclusions drawn by the Witter clinical commentary.