Asthma in Pregnancy

Roughly 7% of the general population has asthma. Asthma is one of the most common chronic illnesses that occurs in pregnancy. Asthma can range from occasional problems with wheezing to chronic airway obstruction that occurs regularly. Some women take occasional medications while others take a daily medication including rescue inhalers and breathing treatments. Signs that you have asthma can include:

• Trouble breathing
• Wheezing
• Tightness in your chest
• Chronic cough

Approximately one-third of the women with asthma will find that they a worsening of their asthmatic condition in pregnancy. The other two-thirds will either stay the same or find that their symptoms are much the same as they were before pregnancy.

In general there are few increased risks from having well controlled asthma while pregnant. The biggest risk comes if your asthma is not well controlled. In this case you are at an increased risk of preterm labor, small for gestational age baby or a baby who is low birth weight. These complications all carry their own additional risks to the baby.

The first goal will be prevention of asthmatic symptoms. If you do not yet know what triggers your asthma, you will want to try to begin to figure this out by keeping a diary of symtpoms. It might be outdoor allergens, pets, dust, etc. Or you may not have a specific trigger that is easily identifiable. Working with your doctor or midwife and whomever has been previously treating your asthma you will decide on a care plan which may include medications to treat or prevent your asthma.

Some women will have symptoms of asthma in labor. If this happens you will be treated just as any other asthma attack.

As far as pain relief in labor goes, there are a few medications that are better than others, for example, your practitioner will probably choose fentanyl over morphine as an IV medication. Though if you are not planning a natural childbirth, an epidural may be your best choice for pain medication in labor. In general, having asthma is not a reason to have a scheduled cesarean.

While certainly there are medications that are safer than others, not being able to breathe is a life threatening situation for you and your baby.

The National Asthma Education and Prevention Program has guidelines on managing asthma in pregnancy. The guidelines recommend certain medicines for pregnant women, with others added if symptoms become more severe, noting that the lowest dose and frequency possible is always preferable and that an asthma specialist is critical on the team:

• Mild, intermittent asthma (symptoms fewer than 2 twice a week): A rescue inhaler.
• Mild, persistent asthma (symptoms fewer than 7 days a week): Daily low dose inhaled steroid,
• Moderate, persistent asthma (intermittent daily symptoms): Daily low dose inhaled steroid plus a long-acting bronchodilator, or daily medium-dose inhaled steroid
• Severe, persistent asthma (symptoms all day): Daily, high dose, inhaled treatment and possibly treatment with oral steroids

Together with your practitioner and your asthma team you can find the right medication regimen for your type of asthma and symptoms to protect you and your baby.

_Sources

_{Managing Asthma During Pregnancy: Recommendations for Pharmacologic Treatment. National Asthma Education and Prevention Program. Accessed 1/6/10.}

_{Williams Manual of Obstetrics: Pregnancy Complications. 22nd Edition. McGraw-Hill. 2007.}