- •Asthma is the most common chronic condition seen in pregnancy and affects as many as 8.8% of pregnant women. Asthma control worsens in 30%-40% of these women.
- •Women who have asthma and become pregnant are at increased risk of preterm birth, intrauterine growth restriction, and other complications.
- •Asthma in pregnancy is a condition often undertreated by general practitioners. Also, women with asthma who become pregnant often stop asthma medications or take less of their asthma medications, particularly inhaled corticosteroids.
- •Clinicians should monitor the patient with asthma regularly with spirometry, peak expiratory flow rate (PEFR), and questionnaires, such as the Asthma Control Test (ACT).
- •Medication regimens should be individualized to each expectant mother, and the clinician should titrate and add medications to optimally control the expectant mother’s asthma symptoms.
- •Patient education regarding compliance with medication regimen and optimizing environments to avoid triggers should happen at every visit.
- A.Identify factors/behaviors that increase risk of asthma worsening in pregnant women.
- B.Discuss the methods of assessment for the pregnant patient with asthma.
- C.Compare/contrast the different medications used in the management of the pregnant patient with asthma.
Who Will Worsen?
Benign dyspnea of pregnancy
Chronic obstructive pulmonary disease
Congestive heart failure
Gastroesophageal reflux disease
Interstitial lung disease
Vocal chord dysfunction
Pulmonary embolus or amniotic embolus
Panic or anxiety
Asthma Medication and Pregnancy
Leukotriene Receptor Antagonists
ICS + LABA
- Asthma Algorithm
- Effect of pregnancy on maternal asthma symptoms and medication use.Obstet Gynecol. 2010; 115: 559-567
- The hypothalamic-pituitary-adrenal axis in pregnancy: challenges in disease detection and treatment.Endocr Rev. 2005; 26: 775-799
- Asthma in pregnancy: don't lose control.Curr Allergy Clin Immunol. 2009; 22: 4-9
- Current guidelines for the management of asthma during pregnancy.Immunol Allergy Clin North Am. 2006; 26: 93-102
- Maternal asthma and pregnancy outcomes: a retrospective cohort study.Am J Obstet Gynecol. 2001; 184: 90-96
- Asthma during pregnancy and clinical outcomes in offspring: a national cohort study.Pediatrics. 2013; 132: 483-491
- Asthma and pregnancy.Semin Respir Crit Care Med. 2012; 33: 630-644
- Effect of maternal asthma on the risk of specific congenital malformations: a population-based cohort study.Birth Defects Res A Clin Mol Teratol. 2010; 88: 216-222
- Severe asthma exacerbations during pregnancy.Obstet Gynecol. 2005; 106: 1046-1054
- Asthma during pregnancy: mechanisms and treatment implications.Eur Respir J. 2005; 25: 731-750
- Asthma in pregnancy: management strategies.Curr Opin Pulm Med. 2013; 19: 13-17
- Emerging infections and pregnancy.Emerg Infect Dis. 2006; 12: 1638-1643
- Management of asthma during pregnancy.Ther Adv Respir Dis. 2013; 7: 87-100
- Revisiting the accuracy of peak flow meters: a double-blind study using formal methods of agreement.Respir Med. 2005; 99: 592-595
- [Diagnostic value of peak flow variability in patients with suspected diagnosis of bronchial asthma in general practice].Dtsch Med Wochenschr. 2009; 134: 2053-2058
- Global guidelines for asthma management: summary of the current status and future challenges.Pol Arch Med Wewn. 2010; 120: 511-517
- Review of the NAEPP 2007 Expert Panel Report (EPR-3) on asthma diagnosis and treatment guidelines.J Manag Care Pharm. 2008; 14: 41-49
- Acute asthma in pregnancy.Crit Care Clin. 2004; 20: 731-745
- Cessation of asthma medication in early pregnancy.Am J Obstet Gynecol. 2006; 195: 149-153
- Barriers to anti-inflammatory medication use in childhood asthma.Ambul Pediatr. 2003; 3: 181-190
- A population-based prescription study of asthma drugs during pregnancy: changing the intensity of asthma therapy and perinatal outcomes.Respiration. 2001; 68: 256-261
- Management of asthma in pregnant women by general practitioners: a cross sectional survey.BMC Fam Pract. 2011; 12: 121
- Safety of bronchodilators and corticosteroids for asthma during pregnancy: what we know and what we need to do better.J Asthma Allergy. 2013; 6: 117-125
- ACOG practice bulletin: clinical management guidelines for obstetrician-gynecologists number 90, February 2008: asthma in pregnancy.Obstet Gynecol. 2008; 111: 457-464
- NAEPP expert panel report. Managing asthma during pregnancy: recommendations for pharmacologic treatment—2004 update.J Allergy Clin Immunol. 2005; 115: 34-46
- Medical therapy for asthma: updates from the NAEPP guidelines.Am Fam Phys. 2010; 82: 1242-1251
- Relative perinatal safety of salmeterol vs formoterol and fluticasone vs budesonide use during pregnancy.Ann Allergy Asthma Immunol. 2014; 112: 459-464
- Montelukast use during pregnancy: a multicentre, prospective, comparative study of infant outcomes.Eur J Clin Pharmacol. 2009; 65: 1259-1264
- Safety of leukotriene receptor antagonists in pregnancy.J Allergy Clin Immunol. 2007; 119: 618-625
- Acute presentation of the pregnant patient.Clin Med. 2015; 15: 372-376
In compliance with national ethical guidelines, the authors report no relationships with business or industry that would pose a conflict of interest.