Asthma and pregnancy: interactions and management

Key points

• Asthma is one of the most common diseases complicating pregnancy.

• Pregnancy influences the control of asthma; its effect may be beneficial or detrimental.

• Asthma during pregnancy should be treated according to its severity in a step-wise manner and as aggressively as asthma in nonpregnant patients.

• It is safer for pregnant women with asthma to be treated with asthma medications than to have asthma symptoms and exacerbations.

• Uncontrolled and severe asthma is associated with adverse pregnancy outcomes for both mother and foetus.

• Frequent monitoring, severity-based pharmacotherapy, and prevention and prompt treatment of exacerbations are very important for the safe delivery of a healthy baby.

• Breastfeeding is strongly recommended for asthmatic females; it is associated with a reduction in the development of atopy in children, and the use of asthma medications is safe during breastfeeding.

• Integrated care (obstetrics and pulmonary), patient education, compliance with treatment and avoidance of triggering factors are key issues in the management of a pregnant asthmatic patient.

Educational aims

• To describe interactions between asthma and pregnancy.

• To present management guidelines and discuss the use of specific asthma medications during pregnancy.

Summary Asthma is one of the most common diseases complicating pregnancy. It can lead to significant morbidity for both mother and foetus. Pregnancy may also affect asthma control and severity. Therefore, pregnant asthmatic patients should receive integrated obstetric and respiratory care.

The focus of asthma treatment remains the control of symptoms and maintenance of normal lung function of the mother. However, during pregnancy, the safe delivery of a healthy baby is an additional goal. It is safer for pregnant women with asthma to be treated with asthma medications than for them to have asthma symptoms and exacerbations.

Asthma treatment during pregnancy follows the same step-wise approach as normal, and studies have shown that first-line asthma medications (such as inhaled glucocorticosteroids and ß₂-agonists) are not associated with an increased incidence of foetal abnormalities. Moreover, inhaled glucocorticosteroids have been shown to prevent exacerbations of asthma in pregnancy and should be used in persistent asthma to control the disease and prevent exacerbations. If acute exacerbations develop, they should be treated promptly and aggressively in order to avoid foetal hypoxia.

Good pregnancy and asthma outcomes are achieved through integrated obstetric and respiratory care, close monitoring, meticulous tailoring of pharmacotherapy, patient education and reassurance. This review describes interactions between asthma and pregnancy and briefly presents treatment guidelines.