Asthma in Pregnancy Overview

Pregnancy is an exciting time in a woman's life. Changes in your body may be matched by changes in your emotions. You don't know what to expect from day to day. You may feel tired, uncomfortable, or cranky one day and energetic, healthy, and happy the next. The last thing you need is an asthma attack.

Asthma is one of the most common medical conditions in the US and other developed countries. If you have asthma, you know what it means to have an exacerbation (attack). You may wheeze, cough, or have difficulty breathing. Remember that the fetus (developing baby) in your uterus (womb) depends on the air you breathe for its oxygen. When you have an asthma attack, the fetus may not get enough oxygen. This can put the fetus in great danger.

If you took medication for your asthma before you became pregnant, especially if your asthma was well controlled, you may be tempted to stop taking your medication out of fear that it might harm the fetus. That would be a mistake without the advice of your health care provider. The risk to the fetus from most asthma medications is tiny compared to the risk from a severe asthma attack. Moreover, women with asthma that is uncontrolled are more likely to have complications during pregnancy. Their babies are more likely to be born preterm (premature), to be small or underweight at birth, and to require longer hospitalization after birth. The more severe the asthma, the greater the risk to the fetus. In rare cases, the fetus can even die from oxygen deprivation.

How pregnancy may affect your asthma is unpredictable. About one third of women with asthma experience improvement while they are pregnant, about one third get worse, and the other third stay about the same. The milder your asthma was before pregnancy, and the better it is controlled during pregnancy, the better your chances of having few or no asthma symptoms during pregnancy.

If asthma control deteriorates during pregnancy, the symptoms tend to be at their worst during weeks 24-36 (months 6-8). Most women experience the same level of asthmatic symptoms in all their pregnancies. It is rare to have an asthma attack during delivery (10%). In most cases, symptoms return to "normal" within 3 months after delivery.

The important thing to remember is that your asthma can be controlled during pregnancy. If your asthma is controlled, you have just as much chance of a healthy, normal pregnancy and delivery as a woman who does not have asthma.

Your asthma action plan

In pregnancy, just as before you were pregnant, you need an action plan for your asthma. Let your health care provider know as soon as you know you are pregnant. Together, the two of you should review your current action plan and make changes if necessary. You may find that your symptoms have changed, or that your sensitivity to certain triggers is different. Be sure to tell him or her all the medications you are taking, not just your asthma medications.

Symptoms and triggers of asthma

Symptoms of asthma during pregnancy are the same as those of asthma at any other time. However, each woman with asthma responds differently to pregnancy. You may have milder symptoms or more severe symptoms, or your symptoms may be pretty much what they are when you aren't pregnant.

In general, asthma triggers are the same during pregnancy as at any other time. Like the situation with asthma symptoms, during pregnancy sensitivity to triggers may be increased, decreased, or stay about the same. These differences are attributed to changes in hormones during pregnancy. Common triggers of asthma attacks include the following:

• Respiratory infections such as a cold, flu, bronchitis, and sinusitis: Both bacterial and viral infections can trigger an asthma attack.
• Cigarette smoke (firsthand or secondhand)
• Gastroesophageal reflux disease (GERD), or regurgitation of stomach contents up the esophagus or "food pipe"
• Smoke from cooking or wood fires
• Emotional upset
• Food allergies
• Allergic rhinitis (hay fever or seasonal allergies)
• Changes in weather, especially cold, dry air
• Exercise
• Strong smells, sprays, perfumes
• Allergic reactions to certain chemicals
• Allergic reaction to cosmetics, soaps, shampoos
• Allergic reaction to irritants, such as dust/dust mites, molds, feathers, pet dander, etc.

Severe asthma attacks

If you have asthma and are pregnant, you should be extra vigilant about your symptoms. Keep in mind that your symptoms may be worse than usual. You may have an attack that is more severe than you are used to. Don't go by how your asthma has been in the past, go by your symptoms now. If you are having chest tightness or difficulty catching your breath, go to the nearest hospital emergency department. There you can be given oxygen and "rescue" medications that are safe for you and your baby. Do not plan to travel to remote areas with difficult access to health care facilities.

Treatment of asthma in pregnancy

The best way to treat asthma is to avoid having an attack in the first place. Avoid exposure to your asthma triggers. This might improve your symptoms and reduce the amount of medication you have to take.

• If you smoke, quit. Smoking can harm you and your fetus. Avoid being around others who are smoking; secondhand smoke can trigger an asthma attack. Secondhand smoke also can cause asthma and other health problems in your children.
• If you have symptoms of gastroesophageal reflux (for example, heartburn), avoid eating large meals or lying down after eating.
• Stay away from people who have a cold, the flu, or other infection.
• Avoid things you are allergic to.
• Remove contaminants and irritants from your home.
• Avoid your known personal triggers (cat dander, exercise, whatever sets you off).

Use of asthma medication during pregnancy

Asthma medications usually are taken in the same stepwise sequence you would take them in before pregnancy.

When your health care provider considers your use of a drug during pregnancy, he or she reflects on the following questions:

• Is the drug necessary?
• What information is available to assess the effect of the drug on the fetus?
• What is the effect of the drug on the pregnancy, including labor, delivery, and breastfeeding?
• Does the dose or dosing interval of the drug need to be altered because of the pregnancy?
• Do the risks of the drug outweigh the benefits?

Pregnancy outcome

Asthma attacks can have a number of negative effects on pregnancy outcome. Poor asthma control is linked to preterm birth, low birth weight, and stillbirths in the fetus and hypertension in pregnant women. Women who become pregnant while being treated for asthma should not stop using their medication unless they are specifically told to do so by their health care provider.