Asthma During Pregnancy: Risks and Precautions for Mothers and Babies

Asthma is a chronic respiratory condition characterized by inflammation and narrowing of the airways, leading to recurrent episodes of wheezing, coughing, chest tightness, and shortness of breath. This condition affects people of all ages globally and is more likely to occur in individuals with a family history of asthma or allergies. The prevalence of asthma has been increasing in recent decades, particularly in urban areas, with environmental factors such as air pollution and allergens playing a role in the escalation of the manifestation.

The Centers for Disease Control and Prevention reports that asthma impacts 4–12 percent of women during their childbearing years, with bronchial asthma (BA) being the prevalent chronic condition during pregnancy, affecting 4% to 8% of the populace. Recent studies indicate that approximately 40% of individuals experience exacerbated asthma symptoms throughout pregnancy.

While asthma cannot be cured completely, it can be managed effectively. Asthma can vary in severity, typically managed through a combination of medications, such as bronchodilators and anti-inflammatory drugs, and avoidance of triggers. In addition to medicine regimen, asthma treatment also involves patient education, regular monitoring of symptoms, and the development of an individualized asthma action plan. With proper treatment and control, most individuals with asthma can lead active and fulfilling lives. However, it is crucial for individuals with asthma to work closely with healthcare professionals to optimize their management and minimize the impact of the condition on their daily activities.

Asthma in Pregnant women

The impact of pregnancy on asthma can vary among women, with approximately one-third experiencing improved symptoms, one-third experiencing worsened symptoms, and one-third experiencing no change. Women with chronic asthma are more likely to experience worsening asthma during pregnancy, while those with mild asthma may experience improvement or no change. Asthma symptoms are most likely to worsen during weeks 24 to 36, and about 10% of women experience symptoms during labor and delivery. Hormonal changes during pregnancy can affect the nose, sinuses, and lungs, causing congestion and shortness of breath. However, these symptoms usually return to pre-pregnancy status within three months of delivery.

Risks and Complications

Asthma is a chronic respiratory condition that can pose unique risks during pregnancy. If asthma is well-controlled, there is no significant risk, but asthma, if left uncontrolled, can lead to complications for both mother and the baby. In cases of uncontrolled asthma, the amount of oxygen in the blood can decrease, which can affect the baby's oxygen supply, leading to impaired fetal growth and survival. It can also lead to high blood pressure, toxemia, premature delivery in the mothers, and stillbirths. However, good asthma control during pregnancy can result in a normal pregnancy. 

Maternal risks: increased likelihood of preeclampsia, gestational diabetes, preterm birth, and cesarean section. 

Fetal risks: intrauterine growth restriction, low birth weight, and an increased risk of asthma and respiratory issues in childhood.

Treating and Managing Asthma during Pregnancy

Asthma symptoms can vary in severity regardless of pregnancy, so it's crucial to work with your allergist to develop a treatment plan based on the severity of your asthma and your experience with asthma medication during pregnancy. The goals of asthma treatment during pregnancy are the same as treatment at any other time, including-

• Minimal or no symptoms during the day, 

• No asthma symptoms at night, 

• Ability to perform normal activities, 

• Minimal use of rescue inhalers,

• Normal or near-normal lung function.

Most asthma treatments are not harmful to your growing baby. In fact, your baby will have better health outcomes if you can breathe easily. 

Overview of the Asthma treatment during pregnancy-

• In most cases, inhaled medication is preferred as it has a more focused effect, and only a minimal amount enters the bloodstream.

• Time-tested medication is preferred, when appropriate, because there is more experience with its use during pregnancy.

• It is preferable to limit medication during the first trimester when the baby is developing; however, medication-related congenital disabilities are rare, accounting for no more than one percent of all birth defects.

• In general, the same medication used during pregnancy is appropriate during labor, delivery, and nursing.

• Remember that medication should not replace avoidance of triggers. Reducing exposure to irritants and triggers is the safest way to minimize medication dependence.

Fortunately, most asthma patients who receive asthma treatment do well during labor and delivery. Still, they need careful monitoring, especially those who enter labor and delivery with severe asthma or other risk factors. 

Necessary Precautions for Pregnant Women with Asthma

Pregnant women with asthma should take certain precautions to ensure the well-being of both and avert clinical adversities:

• Continue taking prescribed medications, including inhalers and controller medications, as your healthcare provider advises. 

• Regularly communicate with your healthcare provider about your condition and update them on any changes in symptoms or medication needs. 

• Identify and avoid asthma triggers and allergens, such as dust mites, pollen, pet dander, tobacco smoke, strong odors, and respiratory irritants.

• Maintain good prenatal care by following a healthy lifestyle and attending regular prenatal check-ups. 

• Monitor asthma symptoms closely and be aware of any changes. Regularly using a peak flow meter to measure lung function can help track asthma control and identify any worsening signs. 

• Develop an asthma action plan in consultation with the healthcare provider highlighting steps to take in case of asthma exacerbations or worsening symptoms. 

The bottom line

In conclusion, if you have asthma and are expecting a baby, it is essential to prioritize your self-care and manage your asthma symptoms during pregnancy. Remember to follow your asthma management plan and avoid triggers and irritants. Consult with your healthcare provider to find the most effective strategies for ensuring a healthy pregnancy while managing your asthma. By taking these steps, you can help minimize the risks associated with uncontrolled asthma and enjoy a safe and healthy pregnancy.