FCAAIA Notes: It is generally accepted that during pregnancy, one third of women with asthma improve, on-third stay the same and one-third worsen. There tends to be improved control as the woman approaches term. Outcomes tend to be the same from pregnancy to pregnancy. Many women feel they must stop all their medications during pregnancy. In fact, some are told to stop all their medications. However, poorly controlled asthma is a much greater risk to mother and fetus than are the medications used to control asthma. As with all patients, we aim to control asthma with as little medication as it takes to do so. While we have preferences for some medication over others, most asthma medications pose no increased risk to the pregnancy.
If you are pregnant and ANYONE other than your allergist tells you to stop your medications, check with your allergist before doing so.
(Source: http://www.medscape.com/viewarticle/829016?src=wnl_edit_jrl&uac=112079PK September 20, 2014 For Medscape articles: User name: FCAAIA, Password: Allergies)
Pregnancy may be complicated by new onset or preexisting asthma. This article reviews the recognition and management of asthma during pregnancy, as well as general principles of asthma medication use during pregnancy.
Asthma is one of the most common potentially serious medical problems to complicate pregnancy, and asthma may adversely affect both maternal quality of life and perinatal outcomes. Optimal management of asthma during pregnancy is thus important for both mother and baby. This article reviews the management of asthma during pregnancy and the safety of asthma medications.
Recent US national surveys, between 2000 and 2003, report that the prevalence of asthma during pregnancy is about 8.8%. This is supported by a recent study from the UK which demonstrated that the prevalence of asthma during pregnancy was about 8.3% between 2000 and 2008. It has been shown that the course of asthma may worsen, improve, or remain unchanged during pregnancy, and the overall data suggest that these various courses occur with approximately equal frequencies. This conclusion was reinforced by several studies using measures of asthma severity, such as symptoms, pulmonary function, and medication use. Asthma also appears to be more likely
to be more severe or to worsen during pregnancy in women with more severe asthma before becoming pregnant [Belanger et al. 2010].
One of the largest controlled studies that have evaluated outcomes of pregnancy described 36,985 women identified as having asthma in the Swedish Medical Birth Registry. These outcomes were compared with the total of 1.32 million births that occurred during the years of the study (1984–1995). Significantly increased rates of preeclampsia [odds ratio (OR) 1.15], perinatal mortality (OR 1.21), preterm births (OR 1.15) and low birth weight infants (OR 1.21), but not congenital malformations (OR 1.05), were found in pregnancies of patients with asthma versus control women. The risks appeared to be greater in patients with more severe asthma, which was confirmed in a more recent Swedish Birth Registry. A recent metaanalysis, derived from a substantial body of literature spanning several decades and including very large numbers of pregnant women (over 1,000,000 for low birth weight and over 250,000 for preterm labor), indicates that pregnant women with asthma are at a significantly increased risk for a range of adverse perinatal outcomes, including low birth weight, small for gestational age, preterm labor and delivery, and preeclampsia, as well as other neonatal and maternal outcomes.
Mechanisms postulated to explain the possible increased perinatal risks in pregnant women with asthma demonstrated in previous studies have included hypoxia and other physiologic consequences of poorly controlled asthma, medications used to treat asthma, and pathogenic or demographic factors associated with asthma but not actually caused by the disease or its treatment, such as abnormal placental function.
Several prospective studies have shown that the pregnant woman with asthma of mild to moderate severity can have excellent maternal and fetal outcomes. In contrast, suboptimal control of asthma or more severe asthma during pregnancy may be associated with increased maternal or fetal risk.
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