ASTHMA DURING PREGNANCY: EXACERBATIONS, MANAGEMENT, AND HEALTH OUTCOMES FOR MOTHER AND INFANT

FCAAIA Notes: In pregnancy, about 1/3 of mothers with asthma get worse, 1/3 get better, and 1/3 remain the same.  The pattern tends to be the same from one pregnancy to the next.  The control often improves in the last trimester. The health of the mother is paramount during pregnancy.  Guidelines for the treatment of asthma in pregnancy have been around for a long time and are reviewed and updated regularly.

Poorly controlled asthma is more of a risk to the fetus than the medications used to treat it.  Although we have traditions “favorites”, all the inhaled and nasal steroids, inhaled rescue medications, and oral antihistamines are thought to be safe with no greater risk to the baby than placebo.

(Source: http://www.medscape.com/viewarticle/882640?nlid=116927_3821&src=WNL_mdplsfeat_170725_mscpedit_aimm&uac=112079PK&spon=38&impID=1396587&faf=1 July 25, 2017. For Medscape articles: User name: FCAAIA, Password: Allergies)

Abstract

One in 10 pregnant women worldwide has asthma and of these, 10% will have a severe exacerbation requiring oral corticosteroids (OCSs) in pregnancy. This review of recent publications in the field will describe the effects of exacerbation on maternal and neonatal health, the use of asthma medications during pregnancy, and will suggest novel management approaches for asthma in pregnancy. Pregnancy results in unpredictable changes in the disease; therefore, regular monitoring of symptoms is recommended. Uncontrolled asthma is frequently described in cohorts of pregnant women with asthma, and some recent studies show associations with adverse perinatal outcomes, as previously demonstrated with exacerbations.

Guidelines for the management of asthma recommend the continued use of inhaled corticosteroids (ICSs) in pregnancy, with budesonide having a particularly good safety profile.

Recent data suggest small effects of asthma and/or asthma medication use on congenital malformations; however, there is less data available on the safety of ICS/long-acting β agonist combinations, which are increasingly used for maintenance treatment. Novel management strategies are needed to address the complex needs of pregnant women with asthma. These include medication nonadherence and the presence of numerous comorbidities which can affect asthma, such as rhinitis, cigarette smoking, obesity, and mental health issues. Inflammation-based management has been shown to be effective in reducing exacerbations in pregnancy and may also improve perinatal outcomes. The involvement of a multidisciplinary team and the assessment of comorbidities have potential to improve the health of mothers and their offspring.

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