Asthma in Pregnancy
Asthma is both the most common serious medical condition and lung disease that can complicate pregnancy. It causes the airways to constrict, thus making it more difficult to breathe. It has been shown that 8 percent of all pregnant women have asthma; and in well-controlled asthma, pregnant women rarely have complications as a result. Asthma is a disease of the lungs characterized by obstructions of the airways due to spasm of the smooth muscles surrounding the airways. This will cause an accumulation of mucus, swelling and inflammation which produces difficulty with breathing and oxygenation for the body. The main symptoms of asthma can include a tightening of the chest, wheezing, shortness of breath, coughing and chest pain. The symptoms of asthma are usually brought on by certain triggers such as allergens, exercise, infections, stress and environmental factors. In pregnancy, the severity of asthma varies and is extremely difficult to predict. The predicament is that one third of women will stay stable, one third may worsen, and one third may get better. If symptoms worsen, it often occurs in the last trimester of the pregnancy. In most cases it is less severe during the last month of the pregnancy, and labor and delivery usually does not make symptoms worse. In women who see improvement of symptoms during pregnancy, it typically occurs gradually throughout the pregnancy. If the symptoms worsen in the first pregnancy, it usually is similar in subsequent pregnancies.
What are the effects on the pregnant woman?
Asthma that is poorly controlled in pregnancy can produce serious side effects in the mother including:
- High blood pressure
- Increased nausea and vomiting in early pregnancy
- Increased vaginal bleeding
- Premature labor and possible delivery
- If severe enough, death has sometimes occurred
- Increased risk of Cesarean section
What are the risks for the baby?
- Decreased oxygen to the baby especially during severe attacks
- Poor growth leading to small infants at birth
- Increased risk of fetal death
- Premature birth
- Low APGAR scores at birth
How is asthma managed in pregnancy?
Asthma is a condition that has to be monitored during the pregnancy. If a woman is already on asthma medications before getting pregnant, the medications should be reviewed by her physician to ensure they are safe during the pregnancy. The patient may need to be followed not only by her obstetrician but also by her physician who manages her asthma. In severe asthma, she may need to be seen by a pulmonologist frequently throughout the pregnancy. The patient should learn to recognize warning signs of asthma to try to avoid worsening of symptoms. The newest guidelines from the National Institute of Health (NIH) recommend that asthma medications are safer than letting symptoms worsen. It is a fairly accepted idiom that if a woman is having difficulty breathing, the fetus has trouble getting the oxygen it needs. The key recommendations from the NIH include the following:
- Albuterol, a short acting medication, should be used for quick relief therapy for symptoms.
- If symptoms occur two days a week or two nights a month, daily medication is needed to control the persistent asthma. Corticosteroid inhalants are the preferred therapy.
- If a patient has uncontrolled, persistent asthma on inhaled corticosteroids, she should either increase the dosage or add a long-acting medication.
- Severe asthma may require oral corticosteroids.
During the pregnancy, if the symptoms of asthma are severe, fetal monitoring of growth and well-being may be needed. Ultrasounds can monitor growth and non-stress testing during the last trimester may be helpful. Only the obstetrician can decide if these tests are needed depending on the status of the pregnancy and the asthma. Lung function testing may be recommended by the physician managing the asthma.
If questions about the safety of asthma in pregnancy arise, discuss them with your physician.