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Asthma in Pregnancy

Key Points

  • Asthma symptoms include breathing difficulty, wheezing and cough
  • 5-10% of pregnant women can be expected to have asthma
  • Pregnancy can worsen asthma
  • Asthma if not treated properly may harm both the mother and the unborn child
  • Asthma in pregnancy should be managed under specialist care
  • Safe and effective drugs are available for treatment of asthma in pregnancy

Pregnancy is a unique phase in a woman’s life. Biological processes in pregnancy lead to physical, emotional and behavioral changes. Nevertheless, most women tolerate and even happily endure this period. But if a woman suffering from asthma becomes pregnant, she may face a difficult time. There are also genuine concerns about the impact of asthma and its treatment on the expectant mother and the unborn child. Asthma being so common, 5-10% of pregnant women can be expected to have this disease. It is fairly well established that asthma in women is more severe.

How is asthma diagnosed?

Asthma is diagnosed mainly by the symptoms but should be confirmed by a lung function test called “spirometry” . This test involves blowing into a machine to find out if the airways are narrowed. Spirometry also tells us how bad asthma is. An asthmatic woman should have a spirometry test in the first trimester for assessment and planning of treatment. The test may be required again if asthma control is poor.

Very often doctors do not write the diagnosis on the prescription or inform the patient and a woman with breathlessness may not be even aware that she has asthma. Unrecognized asthma puts both the mother and the child at a great risk. A correct diagnosis is essential for planning correct treatment and a woman with breathlessness must get a consultation and investigations with an asthma specialist to find out if she has the disease.

The interaction between asthma and pregnancy

Why a woman with asthma needs to take special care during pregnancy? The reason is that pregnancy can aggravate asthma. On the other hand, asthma as well as the drugs used for its treatment may also harm both the mother and the unborn child. Management of asthma in pregnancy requires specialized monitoring and care to ensure that both the mother and the unborn child tide over this period safely and with least discomfort.

The developing baby in the womb takes its oxygen from the air you breathe. If you are not getting enough oxygen, as may happen during an asthma attack, the baby will be deprived of its oxygen supply putting its life in danger. The baby may be born before time, before it is mature and thus will be physically underdeveloped and underweight requiring specialized care to survive through the early period after birth. A pregnant woman with uncontrolled or poorly controlled asthma is also more likely to have serious complications of pregnancy called preeclampsia or hypertension. These conditions not only harm the mother but also put the unborn baby at risk. The more severe the asthma, greater is the risk to the developing baby. Therefore, asthma must be controlled as best as possible and especially during pregnancy for the sake of both the mother and the child.

While asthma and its treatment can affect the mother and the child, pregnancy can also affect asthma. It is generally seen that about one-third of women will continue to have the same severity of asthma as it was before the pregnancy, one-third will worsen and one-third will find that their asthma has improved.  Quite often, a similar pattern is followed in a subsequent pregnancy. In those in whom asthma worsens during pregnancy, it is more likely to happen during the later stages, and sometimes, during delivery. A coordinated approach is required between the asthma specialist and the obstetrician to manage pregnancy and delivery.

Sometimes, asthma may start for the first time during pregnancy. Since breathlessness is a common symptom in normal pregnancy, especially during the later stages, there may be a genuine confusion in the diagnosis and breathlessness due to asthma may be mistaken for breathlessness due to pregnancy. If in doubt, a specialist consultation must be sought to diagnose asthma and prevent worsening of symptoms by starting proper treatment.

Treatment of asthma during pregnancy

Going into pregnancy with a controlled asthma is likely to greatly improve chances of a trouble-free period. It is advisable to take necessary medicine to control asthma and then plan the pregnancy. Therefore, a consultation with an asthma specialist is advisable for planning a pregnancy. A patient should be acquaint herself fully and be informed about the risks of investigations and treatment as well as the risks of uncontrolled asthma.

If symptoms of asthma do occur during pregnancy, it is far safer both for the mother and the developing fetus to treat than to leave it untreated. Very effective treatment is available for asthma today. The development of inhaled forms of drugs has proved to be a boon for asthma patients. Using inhalers, much smaller doses are required and thus side-effects are greatly reduced. Furthermore, inhaled drugs have their effect faster than drugs taken by mouth. Many of these drugs have a proven safety record during pregnancy and are approved for use. The aim of treatment is to use a combination of inhaled drugs to prevent symptoms, ensure good sleep and the ability to carry out daily routine activities without any side effects. In pregnancy, the additional objective is to ensure a trouble-free period culminating in the birth of a normal healthy child. Your doctor will tailor your treatment according to your needs. It is very important that the inhalers be used correctly or else the beneficial effect may not be there. Your doctor is the best person to train you in the correct method of using an inhaler.

Certain precautions are required in treatment of asthma during pregnancy.  Only drugs that are approved for use in pregnancy should be taken. If you are planning a pregnancy or are pregnant, you should inform your doctor so that only approved drugs with a safe record are given. Self-medication can be risky and is strongly discouraged. Uncomplicated asthma does not usually require antibiotics. Chest radiographs and computed tomogram (CT) scans are, as a rule, not advised during pregnancy other than under exceptional circumstances that only the doctor can decide.

The fetal movements should be monitored daily after 28 weeks and your obstetrician will monitor the fetal growth. It is necessary to avoid asthma triggers- such as exposure to smoke, dust, irritants, and polluted air that make asthma worse. Medical advice should be sought promptly for colds as and when they occur. The harmful effects of smoking are well known and smoking during pregnancy greatly increases the risks for the developing child besides increasing the severity of asthma. Many patients with asthma have allergic rhinitis (sneezing and runny nose) or gastric reflux disease casing heartburn. These conditions also need to be treated and this should improve the control of asthma too. It is also important not to undertake too much exertion. Doctor’s advice should be sought for any exercise.

Sometimes, a pregnant woman may stop or decrease her asthma medications fearing that these may harm the developing child. This may lead to a relapse of symptoms and can pose a risk for both the mother and the unborn child. The risks of uncontrolled asthma are far more than the side effects of asthma drugs. Once asthma is controlled, your doctor may reduce some of the medicines but this should not be done without the doctor’s advice.  Never stop taking or reduce your medicines without talking to your doctor and always consult before using any medicine when you are pregnant.

The outcome of pregnancy with asthma

Going into pregnancy with an uncontrolled asthma or not taking adequate treatment carries the risk of harmful effects both for the mother and the developing child. If pregnancy is planned and asthma is treated in the right way, a woman with asthma can have a good control of the disease during pregnancy. She has as much chance of delivery of a healthy baby as a woman who does not have asthma.