How to Manage Asthma in Pregnancy?- is one of the very first question from expecting women with Asthma. Managing asthma in pregnancy is crucial for the health of both the mother and the baby. Asthma is a chronic condition that affects the airways, causing symptoms like wheezing, shortness of breath, chest tightness, and coughing. During pregnancy, hormonal and physical changes can influence asthma symptoms, making it essential to monitor and manage the condition effectively. Let’s find the way to deal with it with some of experience and guidence from experts.
Table of Contents
Understanding Asthma and Its Impact During Pregnancy
What Is Asthma?
Chronic inflammation and shortening of the airways are signs of asthma, a lung disease that makes it hard to breathe. Several things can cause it, such as allergens, respiratory infections, cold air, exercise, and worry. Managing asthma involves avoiding triggers, monitoring symptoms, and using medications as prescribed.
Asthma and Pregnancy
It is a real frearful pregnancy journey with Asthma. Asthma affects a large number of pregnant women globally, with an estimated 8-13% developing asthma during pregnancy. However, the prevalence of asthma during pregnancy varies by region. For example, in Australia, about 13% of pregnancies are affected by asthma, while in the United States, the figure is closer to 5% (Source: Asthma in Pregnancy Toolkit).
The progression of asthma symptoms during pregnancy can vary significantly:
| Symptom Changes | Percentage of Women Affected |
| Symptoms improve | 33% |
| Symptoms worsen | 33% |
| Symptoms remain unchanged | 33% |
Source: Asthma & Allergy Foundation of America
Potential Complications of Uncontrolled Asthma During Pregnancy
Not taking care of asthma well during pregnancy can cause major problems for both the mother and the baby. Here’s a more in-depth look at the main risks:
1. Preterm Birth
Asthma attacks can significantly stress the body, which can trigger preterm labor. During an asthma episode, the body suffers shortness of breath, low oxygen levels, and an elevated heart rate. These variables can cause early contractions, resulting in a preterm birth (born before 37 weeks). According to study, women with poorly controlled asthma are more likely to give birth prematurely, which increases the risk of complications such as respiratory distress syndrome (RDS) and other newborn health difficulties.
Risk Factors:
- Frequent asthma attacks
- Inconsistent use of asthma medications
- Severe asthma symptoms during pregnancy
2. Low Birth Weight
Asthma that isn’t under control makes the lungs less good at getting oxygen to the body, which can directly affect the baby’s oxygen flow. This lack of oxygen can slow down fetal growth, which raises the risk of having a baby with a low birth weight. Babies who were born with a low birth weight are more likely to have health problems, such as breathing, eating, and keeping their body temperature stable.
Risk Factors:
- Low oxygen levels are caused by asthma attacks that happen often or get extremely severe.
- Inconsistent or poor use of medications, which makes it impossible to control asthma
- Chronic inflammation and narrowed lungs make it harder for oxygen to get to the cells.
3. Preeclampsia
Preeclampsia is a condition that can happen to pregnant women. Body parts like the liver and kidneys get hurt and blood pressure goes up. Preeclampsia is more likely to happen to women whose asthma is not under control. There isn’t a clear link between asthma and preeclampsia, but it is thought that the general inflammation that comes with asthma may make high blood pressure and blood vessel problems worse during pregnancy. If you don’t treat preeclampsia, it can get worse and cause organ failure or even cases where both the mother and the baby’s lives are in danger.
Risk Factors:
- Chronic inflammation from untreated asthma
- When asthma attacks happen, the circulatory system is under more stress.
- Lack of control over asthma symptoms
4. Developmental Issues
If you don’t take care of your asthma properly, it can prevent your baby from getting enough oxygen, which could affect their growth. Not getting enough oxygen during important parts of pregnancy, especially in the first and second trimesters, can slow the growth of the baby’s brain and organs. Babies born to mothers whose asthma isn’t well managed may have a higher chance of having delays in development, problems with their brains, and problems with their bodies growing.
Risk Factors:
- Persistent asthma symptoms affecting oxygenation to the fetus
- Long-term exposure to inflammation and stress in the body
- Untreated asthma attacks impacting fetal development during sensitive stages of growth
Safe Asthma Treatments During Pregnancy
Managing asthma during pregnancy is essential to ensuring both the health of the mother and the baby. Fortunately, several asthma medications are considered safe during pregnancy when used appropriately. The goal is to minimize exposure to the baby while effectively managing asthma symptoms. Below are the main types of medications used to treat asthma during pregnancy.
1. Inhaled Medications
Inhaled medications are the cornerstone of asthma treatment during pregnancy because they deliver medication directly to the lungs, which helps avoid systemic exposure and reduces the risk to the baby.
Inhaled Corticosteroids (ICS)
Budesonide is the most widely studied inhaled corticosteroid (ICS) for pregnant women and is considered safe when used at low to moderate doses. ICS medications are the first line of treatment for persistent asthma because they reduce inflammation in the airways.
Other ICS options like fluticasone and beclomethasone have also been used during pregnancy. However, these medications haven’t been studied as extensively in pregnant women as budesonide, so it is recommended to use them cautiously and under a doctor’s supervision.
Short-Acting Beta Agonists (SABAs)
SABAs are used for quick relief from acute asthma symptoms by relaxing the muscles around the airways. Albuterol is the most commonly used SABA and is considered safe during pregnancy. It acts quickly to relieve shortness of breath, wheezing, and chest tightness. Another option is levalbuterol, which is a derivative of albuterol.
Long-Acting Beta Agonists (LABAs)
LABAs, like salmeterol, are used in combination with ICS for better asthma control. They are long-acting medications that help to open the airways and prevent asthma attacks. However, LABAs should not be used alone because they can increase the risk of severe asthma complications, especially if asthma is not adequately controlled with ICS.
2. Leukotriene Receptor Antagonists (LTRAs)
Montelukast is an LTRAs that helps prevent asthma symptoms by blocking leukotrienes, which are chemicals in the body that cause inflammation and constriction of the airways. Montelukast can be used to control asthma, especially if there is allergic rhinitis (allergic reactions in the nose).
While research suggests that montelukast does not show an increased risk of birth defects, the safety data on LTRAs during pregnancy is limited. Therefore, montelukast should only be used if the potential benefits outweigh the risks and under the supervision of a healthcare provider.
3. Oral Medications
Oral corticosteroids like prednisone may be prescribed for short-term use during severe asthma flare-ups when inhaled medications are not effective. However, some studies suggest that oral corticosteroids taken during the first trimester may increase the risk of cleft lip in the baby. The evidence is mixed, and the risks must be carefully considered by the healthcare provider. Oral steroids should not be taken unless they are really needed.
4. Biologic Therapies
Biologic treatments, like omalizumab (Xolair), are used to treat asthma that is very bad. These medicines work on parts of the immune system that cause inflammation. However, research on the safety of biologics during pregnancy is still limited. Experts agree that biologic treatments can be continued, or even started during pregnancy, if necessary, to prevent severe asthma symptoms and complications. Still, they should only be used after careful consideration of the risks and benefits.
This table presented below provides an overview of the medications commonly used to manage asthma during pregnancy, indicating their safety and the cautions associated with their use.
| Medication Type | Medication | Considered Safe | Caution |
| Inhaled Corticosteroids (ICS) | Budesonide | Yes | Low to moderate doses only |
| Fluticasone | Yes | Limited data during pregnancy | |
| Beclomethasone | Yes | Limited data during pregnancy | |
| Short-Acting Beta Agonists (SABAs) | Albuterol | Yes | Use only as needed |
| Levalbuterol | Yes | Use only as needed | |
| Long-Acting Beta Agonists (LABAs) | Salmeterol | Yes (with ICS) | Use in combination with ICS only |
| Leukotriene Receptor Antagonists (LTRAs) | Montelukast | Yes (with caution) | Use only if necessary, limited safety data |
| Oral Medications | Prednisone | Yes (short-term use) | Risk of cleft lip in first trimester |
| Biologic Therapies | Omalizumab (Xolair) | Yes (if necessary) | Limited safety data |
Managing Asthma Triggers During Pregnancy
Asthmatic women like me gets devasted especially in first pregnancy. Identifying and avoiding asthma triggers is crucial during pregnancy. Common triggers include:
Allergens
Pollen, pet dander, mold, and dust mites can irritate the airways, leading to asthma flare-ups. Pregnant women may be more sensitive to these allergens.
Respiratory Infections
Colds and the flu can increase inflammation in the airways and worsen asthma symptoms. These infections make breathing even more difficult.
Air Pollution
Smoke and fumes from traffic, factories, or chemicals can irritate the lungs and trigger asthma attacks by making the airways more inflamed.
Weather Conditions
Cold air or high humidity can irritate the airways, especially in women with asthma. Sudden temperature changes can also trigger breathing problems.
Strong Odors
Perfumes and cleaning products can release chemicals that irritate the lungs and lead to asthma symptoms, particularly in sensitive individuals.
Exercise
On the other hand, exercise can sometimes make asthma worse, especially when the air is dry or cold. This is because activity can make airways narrow, which can make you wheeze or feel like you can’t breathe.
Monitoring and Regular Check-ups
Women with asthma need to make sure that they have regular pregnancy visits so that both the mother’s and baby’s health are carefully watched. Because asthma can change during pregnancy, it’s important for doctors to keep an eye on how the condition changes. This kind of visit lets providers:
- Monitor lung function: Simple tests, such as a spirometry test, can be used to see how well the lungs are working. This helps keep track of asthma control and find problems early on.
- Adjust treatments as needed: As the pregnancy progresses, asthma symptoms may improve, worsen, or remain unchanged. Depending on the severity, healthcare providers may adjust the medications or treatment plan to ensure optimal asthma control, while avoiding any harm to the baby.
Asthma Action Plan
Having Asthma was one of my biggest concern while planning baby. An Asthma Action Plan is an essential tool that pregnant women with asthma should develop with their healthcare provider. There are clear steps in this plan to help you deal with your asthma symptoms and know when to act. A well-thought-out action plan can:
- Outline a daily medication regimen: The plan specifies which medications to take and when, ensuring that the mother stays on top of controlling asthma symptoms without over- or under-medicating. It helps avoid triggers, manage flare-ups, and keep asthma well-controlled.
- Provide instructions for handling worsening symptoms: Asthma can sometimes worsen, especially during pregnancy. The action plan will outline how to respond to worsening symptoms such as increased shortness of breath, wheezing, or coughing. It also includes advice on when to seek medical help or go to the emergency room.
- Include emergency contact information: The action plan will list emergency contacts such as the mother’s healthcare provider, nearest hospital, or asthma specialist. This ensures that if symptoms become severe or difficult to manage, the mother knows exactly who to call and where to go for urgent care.
FAQs About Asthma and Pregnancy
Can asthma affect pregnancy?
Yes, uncontrolled asthma can lead to complications like preterm birth, low birth weight, and developmental issues for the baby.
Is it safe to use an inhaler during pregnancy?
Yes, inhalers are safe for asthma control during pregnancy, but consult your doctor before starting or changing medication.
What are the risks of untreated asthma during pregnancy?
Untreated asthma can cause preterm birth, low birth weight, preeclampsia, and developmental delays. Proper management is essential.
What triggers asthma during pregnancy?
Asthma triggers include allergens, infections, air pollution, weather changes, and strong odors. Managing these triggers helps control symptoms.
Is montelukast safe during pregnancy?
Montelukast is considered safe when necessary but should be used under the guidance of a healthcare provider.
Conclusion
Taking care of asthma in pregnancy is important for both the mother and the baby’s health. Women who have asthma can have a safe and healthy pregnancy as long as they get the right care, make changes to their lifestyle, and are closely watched. Before making any changes to your asthma management plan, you should always talk to your doctor first. Also, make sure to closely follow your asthma action plan to avoid problems.
By understanding what triggers asthma, how asthma treatments work, and how medications like montelukast can help, you can ensure a smoother pregnancy while controlling asthma effectively.
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