Managing asthma during pregnancy; protecting you and your unborn child!
You just found out—-you’re pregnant! Many questions and concerns may be going through your mind with this news. If you have asthma, the first few questions that may come to mind for the mother-to-be are: 1) will my asthma affect my baby? 2) will my asthma medications affect my baby? And, 3) how will asthma affect me during my pregnancy?
Asthma will affect about 8% of pregnant women.
- Women with severe asthma are more likely to worsen, while those with mild asthma are more likely to improve or remain unchanged.
- The change in the course of asthma in an individual woman during pregnancy tends to be similar on successive pregnancies.
- Asthma attacks are most likely to occur during the weeks 24 to 36 of gestation, with less than 10% becoming symptomatic during labor and delivery.
- The changes in asthma noted during pregnancy usually return to pre-pregnancy status within 3 months of delivery.
Is your asthma controlled?
- Good news! Well controlled asthma appears to have no adverse effects on the developing fetus.
Is your asthma NOT controlled?
- Bad news! Uncontrolled asthma can affect the you and your unborn child.
Definition of uncontrolled asthma:
- When day time asthma symptoms occur more often than twice a week.
- When night time asthma symptoms occur more often than twice a month
- When asthma interferes with exercise.
- When use of albuterol (quick rescue inhaler for asthma) is more than twice a week.
Serious complications to the mother:
Increased risk of:
- High blood pressure
- Premature labor and delivery
- rarely death.
Complications for the baby:
Increased risk of
- Stillbirth (born dead)
- Fetal growth retardation (too small)
- Premature birth (born before 37 weeks gestation)
- Low birth weight (too light)
- Low APGAR score at birth: A simple assess of the newborn that assesses Activity, Pulse, Grimace, Appearance and Respiration. 10 is the maximum score with scores <6 requiring intervention and scores <3 require immediate life-saving measures.
Generally, asthma medications used in pregnancy are chosen based on these criteria:
- Inhaled medications are generally preferred because they have a more localized effect in the lung when inhaled with only very small amounts entering the bloodstream.
- When appropriate, older medications that have been used frequently are preferred since there is more experience with their use during pregnancy.
- Medication use is limited in the 1st trimester as much as possible when the fetus is forming. Birth defects from medications are rare (<1% of all birth defects are attributable to all medications).
- The same medications used during pregnancy are generally appropriate during labor and delivery and when breastfeeding.
Pregnancy Categories for Medications:
Most pregnant women are concerned about the risk of medications taken during pregnancy. The Food and Drug Administration (FDA) has developed a category to assist health care workers in identifying potential risks of medications causing birth defects when taken during pregnancy. The assigned categories are A, B, C, D, X, N.
- Categories A or B are generally considered safe. Unfortunately, no asthma medications are category A and only a few are category B primarily because it is very difficult to adequately study pregnant women in a scientific fashion that is ethical.
- Many medications used for asthma are category C which means animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug despite potential risks.
- Category D is evidence of human fetal risk, but benefits may still outweigh risk.
- Category X is definite risks that outweigh benefits and should be avoided.
- Category N is “not rated” by FDA yet.
With this in mind, category B asthma medications are the inhaled cortisone budesonide (marketed as Pulmicort®) and the asthma/allergy medications montelukast (Singulair®) or zafirlukast (Accolate®). Other inhaled corticosteroid medications have not been proven unsafe and therefore, if asthma has been controlled on a different product, it may be continued. More recently, Flovent® is now recognized as a good alternative to Pulmicort®.
Asthma Care During Pregnancy:
- Avoid asthma triggers (smoke, other air pollution, allergens)
- Medications: careful balance of daily controller medications and quick relief medications.
- Influenza vaccine: recommended for all pregnant women
- Allergy shots: Although allergy immunotherapy injections are not started or the dose increased during pregnancy, the injections can be continued at the same dose throughout pregnancy.
- Fetal monitoring: especially important as the pregnancy progresses.
- Early recognition of other disorders that may complicate asthma:
- GE reflux: which is common during pregnancy
- Sinus infections: 4 times increased risk of sinus infections in pregnant women
- Vocal cord dysfunction: difficulty breathing primarily on inspiration related to closure of the vocal cords (when they should be opening)
Ideally, the obstetrician works closely with the asthma specialist to develop an asthma treatment plan specifically for each mother that includes a careful balance of medications (prevention and quick relief) along with avoidance measures as appropriate. The most common oversight is being too wary of the risks of medications. Remember, if Mom can’t breathe, neither can the developing baby!
At Family Allergy & Asthma Care of Montana, we care for the whole family (even the unborn one)!
This information is solely for informational purposes and not intended as a substitute for consultation with a medical professional.