MANAGING ASTHMA DURING PREGNANCY

FCAAIA Notes: Pregnant?  Congratulations! It is important to take care of your baby’s health, but don’t forget about your own.  Many women are afraid to take any mediation during pregnancy. Unfortunately, some doctors encourage their patients to STOP medication during pregnancy. But, what is worse, the treatment or the disease?  It is clear that poorly controlled maternal asthma during pregnancy is dangerous to the fetus.

During pregnancy one third of women with asthma get better, one third get worse, and one third stay the same.  It tends to be the same from one pregnancy to the next.  During pregnancy, asthma tends to improve as one nears delivery.

Take care of your self (and by extension your baby) during pregnancy.  Speak with one of our allergists about what medications to use during pregnancy to keep you and your baby healthy.

(Source: http://www.medscape.com/viewarticle/824983?nlid=57756_281&src=wnl_edit_medp_aimm&uac=112079PK&spon=38 May 27, 2014. For Medscape articles: User name: FCAAIA, Password: Allergies)

Hello. I am Dr. Suzanne Beavers, with the Centers for Disease Control and Prevention (CDC) National Asthma Control Program. I am speaking to you as part of the CDC Expert Commentary series on Medscape. Today, I would like to discuss how clinicians can provide evidence-based care for expectant mothers with asthma.

Asthma affects 4%-8% of pregnant women and is among the diseases most commonly seen during pregnancy. Well-controlled asthma in the expectant mother helps ensure sufficient fetal oxygenation and leads to the same fetal prognosis as a pregnancy without asthma. Conversely, poorly controlled asthma may be associated with risks for preterm delivery, low infant birth weight, preeclampsia, and perinatal mortality. Therefore, guidelines-based asthma care is essential to ensure that the expectant mother has minimal or no asthma exacerbations, few or no limitations on her activities, and minimal or no adverse effects from her medication.

Healthcare providers should inform expectant mothers with asthma that about one third of all pregnant patients with asthma will have worsening symptoms during pregnancy, one third will have the same symptoms as they had pre-pregnancy, and one third will have fewer symptoms than they did before becoming pregnant. The reasons for worsening asthma during pregnancy include limited rib-cage expansion caused by a growing fetus; respiratory infections; hormonal changes during pregnancy; and gastroesophageal reflux disease, which can develop or worsen during pregnancy.

The American College of Obstetricians and Gynecologists and the National Asthma Education and Prevention Program (NAEPP) guidelines both state that it is better for a pregnant woman to be treated with asthma medications than to have asthma symptoms. Well-controlled asthma, with as few as possible maternal hypoxic episodes, is associated with better outcomes for both the mother and fetus. As such, the goals of asthma management in the pregnant patient are very similar to those in the nonpregnant patient: namely, to limit asthma exacerbations and enable the patient to have a normal quality of life.

To achieve control of asthma during pregnancy, the healthcare provider needs to follow a stepwise approach of medication management, using the NAEPP guidelines titled Managing Asthma During Pregnancy: Recommendations for Pharmacologic Treatment. These guidelines may be found online, and we have provided a link to them at the bottom of this page. Short-acting bronchodilators should be used as a rescue medication for pregnant women having an asthma exacerbation or acute asthma symptoms. Albuterol is the short-acting bronchodilator of choice for pregnant women.

Inhaled corticosteroids are the standard of care for the treatment of persistent asthma during pregnancy and for prevention of exacerbations. Budenoside is the preferred inhaled corticosteroid for pregnant women, as the only inhaled corticosteroid classified as pregnancy category B. No available data suggest that other inhaled corticosteroids are unsafe during pregnancy. Long-acting bronchodilators may also be used for asthma control if a patient is not adequately controlled on inhaled corticosteroids alone.

The NAEPP guidelines also recommend monthly monitoring of pulmonary function during pregnancy. Spirometry is recommended for initial assessment and can be used for subsequent monitoring. Peak flow meters also can be used for patient monitoring. In the later stages of pregnancy, patients should be asked about fetal activity.Ultrasound monitoring may also be considered for patients with moderate to severe asthma.

Patient education during pregnancy is particularly important for expectant mothers with asthma. The patient should be counseled to quit smoking if she is a smoker and to avoid exposure to environmental tobacco smoke to reduce health risks to herself and the fetus. Healthcare providers should counsel the patient on proper inhaler technique. Pregnant women with asthma should have an asthma action plan, including guidance for asthma management when there are no symptoms, as well as what to do during an exacerbation. Providers should also counsel patients to limit exposure to other environmental triggers, such as dust mites, pollen, and pet dander. Limiting exposure to environmental triggers may reduce the patient’s need for medication.

Please follow the link above for the rest of the interview.

Skip to content