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Topic of the Month: May 2006: Managing asthma during pregnancy
During pregnancy, a woman's asthma symptoms can worsen, improve or remain the same. It is extremely important for a pregnant woman with asthma to manage her asthma for her health and her baby's health. Uncontrolled asthma can be a threat to maternal well-being as well as fetal growth and survival. For the 30% of women whose asthma becomes worse during pregnancy, asthma attacks can happen at any time. The period of greatest incidence appears to be in the third trimester, from weeks 24 to 36. In the last month of pregnancy, asthma crises are usually neither more frequent, nor more severe.
Studies show, however, maternal asthma that is well managed during pregnancy does not increase the risk of maternal or infant complications. Frequently, asthma and allergies are under treated by both physicians and patients during pregnancy. This may be due to the fear of adverse effects medication may have on the fetus. Asthma medications and pregnancy
The National Asthma Education Prevention Program (NAEPP) recommends three specific drugs: Budesonide (inhaled-corticosteroid), Albuterol (short-acting Beta2 agonist), and Salmeterol (long-acting Beta 2 agonist). Patients whose symptoms are well controlled with another inhaled corticosteroid before pregnancy may continue that drug during pregnancy. Oral corticosteroids are not preferred in the treatment of asthma during pregnancy. However, they can be used to treat severe asthma attacks during pregnancy. Their potential risks are still less than the possible risks of severe uncontrolled asthma. Asthma management Successful asthma management can reduce adverse perinatal outcomes: preeclampsia (a serious condition marked by high blood pressure, which can cause seizures in the mother or fetus), preterm birth, low birth weight and oral clefts. These risks are linked to asthma severity; the more severe the asthma, the greater the risk, as opposite better-controlled asthma is tied to decreased risks. Women receiving allergen immunotherapy should continue their treatment during their pregnancy if it was started before the pregnancy began. However, it is not recommended to begin immunotherapy during pregnancy. Other important aspects of asthma management during pregnancy are the need to identify and limit the exposure to asthma triggers (allergens such as dust mites, pollens, indoor molds and irritants such as, tobacco smokes, wood-burning stoves or fireplaces, perfumes, cleaning agents, or sprays). Assessment and monitoring of asthma includes objective measurement of pulmonary function. Measurement of peak expiratory flow (PEF) with a peak flow meter is generally sufficient.
Women with other conditions that can worsen asthma, such as allergic rhinitis, sinusitis, and gastroesophageal reflux should have those conditions treated as well. Such conditions often become more troublesome during pregnancy. Consult with your allergist/immunologist about how to properly manage these conditions.
The AAAAI's How the Allergist/Immunologist Can Help: Consultation and Referral Guidelines Citing the Evidence provide information to assist patients and health care professionals in determining when a patient may need consultation or ongoing specialty care by the allergist/immunologist. Patients should see an allergist/immunologist if they:
Additional Resources
This topic was reviewed on 5/1/2006 by Stuart Friedman, MD, FAAAAI, Patients & Consumers Web Editor |
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© 1996-2008 · All Rights Reserved · American Academy of Allergy Asthma & Immunology |
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Uncontrolled asthma causes a decrease in the amount of oxygen in the mother's blood. Decreased oxygen in her blood can lead to decreased oxygen in the fetal blood. A fetus requires a constant supply of oxygen for normal growth and development. Decreased oxygen can lead to impaired fetal growth and survival. 
Inhaled corticosteroids are the preferred choice of medication for the treatment of persistent asthma. Studies and observations of hundreds of pregnant women with asthma have demonstrated that most inhaled asthma medications are appropriate for patients to use while pregnant. Women should visit their allergist/immunologist to receive proper treatments during pregnancy. 
Asthma control during pregnancy 
When to see an allergy/asthma specialist