Asthma is one of
the most common potentially life-threatening condition
complicating pregnancy. It is also called
asthma. The incidence of asthma is increasing
steadily and it is estimated
that asthma currently affects 4% to 8% of pregnant women. In
rare cases asthma may occur for the first time during pregnancy.
In general well controlled asthma is not associated with a
higher risk of adverse pregnancy outcomes.
In fact the most common cause of worsening asthma in
pregnancy is due to noncompliance with medicines.
It is seen that
about one third of the pregnant women with asthma experience
worsening of their
asthma symptoms during pregnancy.
One third of the asthmatic women feel better during pregnancy.
exacerbations are more frequent at the beginning of the third
trimester of pregnancy
and improves a few weeks before
10 % of the
pregnant women suffering from asthma seek emergency care during
Oxygen is vital
for the well being of the mother and the fetus. Every pregnant
woman needs a proper treatment to maintain normal lung functions
and oxygen level to maintain proper oxygen supply to the fetus.
should receive education about maintenance and rescue
medication, how to measure PEFR by peak flow meter, proper use
of inhalers, asthma prevention, and adherence of
plan. Patient should also learn when the asthma is worsening and
when to contact the doctor.
is the preferred method for pulmonary function testing during
outpatient visits. However, peak expiratory flow measurement
with a peak flow meter is also adequate.
Effect of Asthma on
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mimicking asthma during pregnancy:
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Goals of asthma control during pregnancy:
The American College of
Obstetricians and Gynecologists (ACOG) has issued a practice
bulletin for management of asthma during pregnancy. The new
recommendations appear in the February issue of Obstetrics &
Gynecology 2008. They are:
Prevent hypoxic episodes in
mother there by maintaining adequate fetal oxygenation.
functions by spirometer preferred.
Avoid and controlling asthma
to maintain normal pulmonary functions.
Control day time
and nocturnal symptoms.
activity levels including exercise.
exacerbations of asthma.
department visit or hospitalization.
effects of medications to mother and child.
Give birth to a
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Things to do to control asthma during pregnancy:
Identify and control
exposure to tobacco smoke (active or passive).
treatment of asthma.
Ask for a
written Asthma action plan from your doctor.
worsening of asthma and go for prompt treatment.
regularly scheduled asthma medication during labor and
PEFR of the patient should be measured regularly.
When to seek emergency medical help?
seek medical help in emergency
department or hospital if any of the following occur:
If therapy does
not provide rapid improvement.
If there is
worsening of asthma symptoms.
exacerbation is severe.
If fetal kick
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feeding and asthma medications:
medication enter breast milk but their concentration is too
small to produce any adverse effect to the baby. So it is safe
to breast feed the baby during inhaled asthma medication.
Safety of asthma medication during pregnancy:
asthma medications have been usually found safe during
pregnancy but recent study shows that oral steroid and
theophylline can cause increased incidence of premature birth.
Incidence of premature birth can increase up to three fold when
oral steroid is taken or two or more medications are taken
Some studies have shown that theophylline can cause increased
incidence of premature birth. When two medications are taken
specially theophylline and oral steroid the risk of premature
birth increases three fold.
But recent studies
have given clean chit to theophylline but it is necessary to
measure serum theophylline levels during pregnancy. Since
protein binding decreases during pregnancy, this may result in
increased free drug levels with normal doses. It is recommended
to take theophylline in lower doses.
No adverse effect has been noted on fetus or infant on motherís
For pregnant women with asthma, recommended rescue
therapy is inhaled albuterol (Salbutamol).
Oral corticosteroid has shown to increase the risk of premature
birth in some studies. This risk increases three fold when they
are given with theophylline. Oral corticosteroids used by mother
are not a contraindication to breast feeding.
steroids are safe during pregnancy and lactation. For persistent
asthma during pregnancy, first-line controller therapy consists
of inhaled corticosteroids. During pregnancy, budesonide is the
preferred inhaled corticosteroid. Though systemic absorption can
occur, low plasma levels achieved by inhalation make it unlikely
that fetal effects will be seen.
Ipratropium is used less frequently for asthma, but is devoid of
any adverse effect.
Animal and human studies suggest little potential for fetal
There is not sufficient data for this new drug, which is similar
to Cromolyn sodium.
Leukotriene receptor antagonist like zafirlukast and
montelukast are probably safe in pregnancy but use should be
limited to special circumstances, where they are viewed
essential for asthma control.
not be used in pregnancy.
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Immunotherapy during pregnancy, is it safe?
A number of
reports have appeared describing immunotherapy without apparent
adverse effects on human pregnancy. Anaphylaxis during pregnancy
is a potential risk for mother and fetus.
Patients already receiving immunotherapy and are near
maintenance dose or are benefited by it are advised to continue
immunotherapy. However it is generally advised not to begin
immunotherapy during pregnancy.
Influenza vaccination during pregnancy:
is a killed virus vaccine. No adverse outcome to the fetus has
been noted in two studies including 245 women.
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Safety of different commonly used chemical agents during
Tannic acid is some times used to denature environmental cat or
dust mite antigen. There is no published data on exposure to
this agent during pregnancy, so its better to avoid.
Benzyl benzoate is an ascaricide used to clear
dust mites from an environment. Teratogenicity tests have been
negative in rats and mice. No human studies reported, itís
better to avoid.
Boric acid is used as insecticide in eliminating cockroaches.
Feeding boric acid to pregnant rats has not shown any adverse
effect in the course of pregnancy or on fetus. An evaluation of
253 pregnancies with early exposure to boric acid was unable to
identify a significant increase in the incidence of birth
defects in the offspring.
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Can my child inherit asthma from me?
Though asthma is
in most cases a heredity disease but not all the offspring of a
asthmatic mother develop asthma. Smoking during pregnancy
increases the likelihood of fetus developing asthma later on.
Is asthma contraindication for pregnancy?
Asthma should in
no way considered a contraindication to pregnancy, and when
asthma is properly controlled, pregnant women with asthma can
maintain a normal pregnancy with little or no increased risk to
themselves or their fetus.
Is there chances of having acute asthma attack during
attack is very rare in labour due to endogenous steroid
production. Asthma medication should be continued as usual
during labour. Caesarean section should be reserved for acute
severe asthma patients or patients with usual obstetric
Can Caesarean section increase my risk of having acute
Studies and data
suggest there is increased risk of postpartum exacerbation of
asthma in women having Caesarean section. Many factors such as
postoperative pain with diaphragmatic splinting, hypoventilation
and atelectasis may be responsible for deteoration of asthma.
section is planned in patients with
severe asthma so chances of
acute attack is higher after words.
Can I breast feed my infant as I am on asthma medication?
Women with asthma
are encouraged to breast feed. The safety of older asthma
medications including steroid and theophylline tablets has
been documented in many studies.
steroids inhalers are also found to be safe during lactation.
medications should be used in line with manufacturer's
Please consult your doctor if you are having asthma and want to
conceive or already pregnant. This article is intended to help
you understand asthma and pregnancy better but cannot replace
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