18. Asthma and Pregnancy
"It is very important not to stop any necessary asthma medications due to a possible pregnancy without speaking to your doctor because an asthma attack in early pregnancy due to stopping medications can also be very dangerous to you, and your baby."
Asthma is a common medical condition. As such, many women have asthma during pregnancy. Pregnancy may affect asthma and asthma may affect the outcomes of pregnancy. The following is meant to be an overview of asthma during pregnancy.
The Effects of Pregnancy on Asthma
The effects of pregnancy on asthma vary among women. Approximately one-third of women with asthma improve during pregnancy, one-third worsen, and one-third stay the same. Interestingly, pregnant women aren’t likely to experience asthma exacerbations, or shortness of breath, coughing, and wheezing, during labor. Additionally, the changes in physiology during pregnancy do not significantly alter spirometry (testing of lung function) values in asthmatic patients, so spirometry remains an excellent technique to detect and manage pregnant women with asthma.
Asthma has been shown to increase the risk of fetal growth restriction, preterm birth and perinatal mortality. However, this is most likely related to the quality of asthma control, and if well-controlled, women with asthma tend to have similar pregnancy to those without asthma. Thus, the key is having the asthma well-controlled!
Management of Asthma during Pregnancy
Asthma is managed similarly in pregnant and non-pregnant patients, and is primarily based on the severity of the asthma. For women with mild asthma (rare exacerbations and symptoms), usually an inhaled bronchodilator (relaxes and opens the lungs) like albuterol are used as needed. For those who need this “rescue inhaler” more than a few times a week, usually an inhaled glucocorticoid (steroid) is recommended daily or twice daily. For those with even more severe symptoms, additional inhalers and even oral medications are used to keep symptoms under control.
Safety of Asthma Medications in Pregnancy
The inhaled bronchodilators and the inhaled steroids are considered safe in pregnancy in all trimesters, so they are used liberally for pregnant women with asthma. For this reason, if someone has asthma and only requires inhaled medications, they can typically continue the same medications in pregnancy. The oral medications tend to be considered safe as well, but someone who requires oral medications should check with their asthma doctor or OBGYN, ideally prior to getting pregnant. It is very important not to stop any necessary asthma medications due to a possible pregnancy without speaking to your doctor because an asthma attack in early pregnancy due to stopping medications can also be very dangerous to you, and your baby.
Although asthma is a very common condition found in pregnancy, there are many ways to treat symptoms, so it usually will have a minimal impact on the health of your pregnancy. The key is to have tight control during pregnancy, minimizing any chances of an asthma exacerbation.
Dr. Nathan S. Fox is a board certified Obstetrician/Gynecologist with the subspecialty certification in Maternal Fetal Medicine. Dr. Fox completed medical school and residency in Obstetrics and Gynecology at Mount Sinai School of Medicine and his fellowship in Maternal Fetal Medicine at Weill Cornell Medical College. To learn more check out www.mfmnyc.com and www.healthfulwoman.com