Terbutaline for Preterm Labor in Twin Pregnancy

Preterm labor is a common complication in multiple pregnancy. One of the drugs used to control preterm labor is terbutaline. You may hear it referred to by its trade names: Brethine, Bricanyl or Brethaire. While the use of the drug has successfully prevented the premature birth of many babies, its use is somewhat controversial. Terbutaline is from a class of drugs known as beta-adrenergic receptor agonists. These drugs act to relax smooth muscles. In the case of preterm labor, terbutaline specifically works to relax the uterus to keep it from contracting. Contractions are one of the symptoms of preterm labor, indicating that the uterus is preparing for childbirth. By relaxing the uterine muscle, delivery can be delayed, gaining valuable time to prepare the babies to survive outside the womb. Terbutaline can be injected, delivered intravenously (IV), taken orally, or administered by a pump. In the short-term, terbutaline can be effective in reducing contractions and preventing the onset of preterm birth. However, there are concerns about its use as a long-term solution.

•  Terbutaline is used “off-label” in pregnancy. Terbutaline is approved by the FDA for treating asthma, not for pregnancy. Its use may be considered investigational or experimental by some insurance companies, and expenses may not be covered.
• The drug can produce side effects for the mothers. Some are mere annoyances, while others can be dangerous. The side effects may make mothers restless, jittery, or dizzy or give them headaches. It can produce increases in heart rate or blood sugar, or sometimes result in tremors or seizures.
• The drug crosses the placenta and there are some concerns about how it affects babies. It can cause an increase in the babies’ heart rates and decrease blood sugar levels. It is being investigated in connection with autism research.
• Other options for controlling preterm labor are available, but they may be more expensive or require a mother to remain hospitalized while she takes them.

If you experience preterm labor during your pregnancy with multiples, talk to your doctor about your options. Be sure you understand all of the issues associated with your care so that you can determine if terbutaline is the best treatment for your situation.