Asthma and Pregnancy

Majority of asthmatics develop the disease during childhood or during early adulthood. Therefore when female patients become pregnant, they have several concerns and apprehensions on how asthma will affect their pregnancy and the unborn child, and how pregnancy will affect their asthma. The purpose of this article is to allay such concerns and apprehensions and advise expectant mothers how to manage their pregnancy and asthma so that both the mother and the unborn child are safe.

It is reassuring to know that studies show having asthma does not increase the chances of birth defects or of having a pregnancy. Further studies show that control of asthma can be achieved during pregnancy with little or no risk to the mother or the baby.

Most women with asthma do well during pregnancy. The basic management remains the same: a review of your asthma history thoroughly, identification of your asthma triggers and an objective assessment of your lung function (spirometry). The treatment is then tailored according to the severity of asthma. Since uncontrolled asthma threatens your well-being and that of your baby, you and your doctors share a common goal throughout your pregnancy — to keep you healthy and breathing normally.

What You Need to Know:

To help control your asthma, it’s important to know what may trigger an asthma attack for you. These “triggers” can include any allergen or irritant such as: molds, pollens, animal danders, strong odors, aerosol sprays and exercise.

Avoid cigarette smoking or exposure to second-hand smoke as it is a major asthma trigger and is associated with significant risks for an unborn baby.

It is helpful to know the early warning signs of an asthma episode so it can be treated immediately. These warning signs may be experienced before your asthma symptoms begin and can vary with each person.

Shortness of breath can be common in many pregnant women, especially in the latter half. Therefore, it is important to know the difference between the expected shortness of breath in pregnancy and that in asthma. It is also necessary not to confuse fatigue with shortness of breath.

Using a Peak Flow Meter daily can help you monitor changes in your asthma.

Asthma Medication:

Ideally, it would be best to avoid all medications during pregnancy. However, it is more important that your asthma be controlled to assure your baby’s oxygen supply and decrease your health risk. If you do not take the prescribed medicines, your asthma may actually worsen and cause harm both to you and to the unborn child. Therefore, it is necessary to continue your asthma medication as before in consultation with your doctor. You should always inform your Obstetrician about your asthma and the treatment that you are taking.

If it is necessary to prescribe anti-inflammatory medication, your doctor will use the least amount necessary to prevent or control your asthma. Review your medications and only take those prescribed by your doctor. Even some simple “over-the-counter” medications, available without a prescription, can be harmful to your baby. Ask your doctor about any medication you are considering taking.

There were some concerns that steroids could be harmful during pregnancy. However, studies have shown that inhaled steroids are quite safe when taken in the recommended doses. Regular intake of your inhalers is important – prevention of acute attacks is an important goal of treatment, perhaps even more so in pregnancy.

You can read about the drugs used in the treatment of asthma on this site.

Management of Severe Asthma Episodes:

A small percentage of women with asthma may experience an asthma episode severe enough to require hospitalization. It is important for this treatment to relieve your respiratory distress and ensure that you and your baby receive adequate oxygen. Your treatment may include frequent nebulized treatments, oxygen, intravenous corticosteroids and/or theophylline.

Management During Labor and Delivery:

It is important for you to discuss the use of anesthesia with your doctor in advance of your delivery date. This is especially important in the case of a cesarean section. It is also necessary to plan the availability of asthma medication. You may choose to bring your own medication including inhalers to the hospital, or perhaps the hospital will provide it.

If a cesarean section is required, you may need intravenous theophylline if you have been on theophylline. You may need intravenous corticosteroids if you are steroid- dependent or have been on steroid tablets during the past year.

An epidural block or local anesthesia is preferred to general anesthesia. If you receive anesthesia of this form, you may be able to use your inhaled medication as directed by your physician. Your baby may be monitored with a fetal monitor to make sure that he or she is not experiencing distress.

It is important to plan ahead and discuss these decisions and potential problems with your doctors. This will help decrease complications and fears which may arise once labor begins.

Asthma Medications and Breastfeeding:

Research shows that breastfeeding for the first 6-12 months of life may help prevent or delay the development of certain allergies. The decision to breastfeed should be based on you and your baby’s individual needs.

In general, when breastfeeding the use of most asthma medications does not affect your baby or interfere with your milk production. Of course, it is important to discuss your use of any medications with the doctor caring for your baby. The medications listed above for use during pregnancy are generally used while breastfeeding without problems. The following list of medications offers some additional information that can be discussed with your doctor:

  • Steroid Tablets
    Although this medication passes through breast milk in trace amounts (even at high dosages), it has not been associated with problems.
  • Theophylline
    This medication passes through breast milk in trace amounts but has occasionally been associated with jitteriness, feeding difficulties and vomiting in a nursing baby.
  • Antihistamines
    These medications pass through breast milk in small amounts and have not been associated with problems.

We hope this information is reassuring and helpful for you during this special time. Although you may have to pay more attention to your asthma care, it is definitely worthwhile for you and your baby! As always, review your questions and concerns with your physician.

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