Asthma During Pregnancy

Women with asthma tend to worry about how pregnancy will affect their breathing and if asthma medicines will harm the baby. Asthma affects 4–12 percent of women in their childbearing years. Keeping asthma well-controlled may help reduce the chance of complications. Most methods for controlling asthma are not harmful to the developing baby, and the baby will develop better if his mother is breathing easily.

How will Pregnancy Affect Asthma?

Asthmatics who become pregnant can find their asthma severity staying the same, improving (about 23%) or deteriorating (about 30%). Severe asthma is more likely to deteriorate. Women who have asthmatic symptoms around the time of their periods are more likely to have deteriorating asthma during pregnancy. The course of asthma is similar in successive pregnancies. The control of asthma may also vary according to the stage of pregnancy. Worsening of asthma is more likely to occur in the second and third trimesters, especially around the sixth month. With good medication and monitoring one should achieve good control of asthma during pregnancy.

During pregnancy, exacerbations of asthma which require medical intervention occur in about 10-20% of women, with approximately 6% requiring admission to hospital. Women who are pregnant often feel short of breath, and this can be difficult to differentiate from asthma.

Most women with asthma whose symptoms changed in any way during pregnancy will return to their pre-pregnancy condition within three months after giving birth.

Potential Complications

Asthma is one of the most common medical concerns that occurs during pregnancy.

Preeclampsia can harm the woman and the fetus. Estimated to occur in at least 5–8 percent of all pregnancies, the condition can progress rapidly without treatment. Symptoms of preeclampsia include high blood pressure, protein in the urine, swelling, sudden weight gain, headaches, abdominal pain, nausea and vomiting and changes in vision. Early diagnosis and treatment is important. Without treatment, preeclampsia can be life-threatening to the woman and the unborn baby. However, with the correct treatment, most women make a full recovery. Preeclampsia may increase the risk that a child will develop asthma, along with eczema and allergies.

Other potential complications of poorly controlled asthma during pregnancy include restricted growth, low birth weight, and premature birth. A woman may also need to have a cesarean delivery. The complications result from the baby not getting enough oxygen in the womb. This can occur when asthma symptoms regularly impede a woman’s breathing. Premature birth and low birth weight may lead to other childhood health problems.

Asthma Drugs in Pregnancy

Maintaining optimal asthma control is important during pregnancy. Inhaled short-acting beta agonists are safe to prescribe throughout pregnancy. Long-acting beta agonists need not be stopped in the first trimester and can be used in the second and third trimesters if needed to maintain adequate asthma control. Inhaled corticosteroids are safe to use during pregnancy and breastfeeding. Oral corticosteroids, at the doses used to treat asthma exacerbations, do not appear to pose a significant risk to the mother or child.

Pregnant women tend to overestimate the risk of using asthma drugs, but they are often unaware of the greater risks of uncontrolled asthma. They put themselves at unnecessary risk of acute exacerbations by discontinuing or reducing therapy. Women with asthma should be advised to continue to take their treatment while breastfeeding. Spacing the dose and feed time may be necessary when using oral corticosteroids.

Asthma control means that the asthmatic has minimal (or no) symptoms during the day, sleeps all night without asthma symptoms, is able to perform normal activities, rarely needs to use a reliever inhaler (also called a rescue inhaler and has normal or near normal lung function.

Lactation

Asthma control in the postpartum period is important for the same reasons as it is in healthy, non-pregnant women and the exacerbation risk is similar in the two groups of women.

Systemic absorption of inhaled drugs is generally minimal and causes little harm to the infant. The infant's exposure is 10 to 1000 times less than during pregnancy. The amount ingested through the mother's milk is far below the therapeutic level for an infant – mostly under 3% of a therapeutic dose per kilogram body weight.

Allergy Shots During Pregnancy

If the pregnant lady is already receiving allergy shots (immunotherapy), she can continue if she is not having reactions.

As an extra precaution, though, the allergist may cut the dosage of the allergy extract to reduce the chance of a severe allergic reaction, or at a minimum keep the dose the same. But the dose should not be increased during pregnancy since that increases the chance of a reaction.

Flu Shots

People with asthma should get flu (influenza) shots. Pregnancy does not change that recommendation. In fact, the flu may be particularly severe in pregnant women. Influenza vaccine can be given during any trimester of pregnancy. September and October are generally good times to be vaccinated each year. Earlier vaccination (e.g., in July or August) can be considered for people who are in the third trimester of pregnancy during those months.

Asthma Attacks During Labor

When asthma is under control, asthma attacks almost never occur during labor and delivery. Also, most women with well-controlled asthma are able to perform breathing techniques during their labor without difficulty.

Preventing Complications

Strategies to prevent asthma complications during pregnancy include seeing the doctor regularly, taking medication as prescribed, getting a flu shot, as the flu can trigger an asthma flare-up, avoiding asthma triggers, including quitting smoking, reducing stress, eating small meals and not lying down immediately afterward to reduce the risk of heartburn, which can worsen asthma symptoms, recognizing early signs of a flare-up and seeing the doctor when this happens.

Pregnant women with asthma should increase avoidance measures to gain greatest comfort with the least medicine. They should stay away from people who are sick with respiratory infections. They also should reduce the exposure to allergens like dust mites, animal dander, pollen, mold, and cockroaches.

Regular exercise is important to health. Swimming is a great exercise for people with asthma. Using quick-relief medicine 10 to 15 minutes before exercise may help the pregnant woman tolerates recommended exercise. When breastfeeding, drinking extra liquids to avoid dehydration is also important (as it is for all people with asthma).

COVID-19 Vaccines

The World Health Organization recommends pregnant women are prioritized for COVID-19 vaccines and booster doses. It is safe to get vaccinated at any point during pregnancy.

Pregnant women who have been fully vaccinated against COVID-19, can have a booster dose 4-6 months after last vaccination. They are eligible for a second booster (fourth) dose 4 – 6 months after having the first booster dose. Evidence continues to build showing that COVID-19 vaccination is safe, effective, and beneficial to both pregnant women and their babies. Experts believe the benefits of getting vaccinated against COVID-19 far outweigh any potential risks.