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How Does Asthma Affect Pregnancy

Is It Safe To Take Asthma Medicine During Pregnancy

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Asthma symptoms that dont stop or that get worse can be a risk to your and your baby. If you were taking asthma medicine before pregnancy, dont stop taking it without talking to your provider first.

If youre diagnosed with asthma during pregnancy, talk to your provider about the best way to treat or manage it.

If youre already getting allergy shots, you can keep taking them during pregnancy. But if you arent getting allergy shots, dont start taking them when youre pregnant because you could have a serious allergic reaction called anaphylaxis.

Are Asthma Medicines Safe When You’re Breastfeeding

Asthma medicines do get into your breast milk, but the amounts are very low and are safe for the baby. If you take high doses of certain asthma medicines, like theophylline, your baby may become irritable or have trouble sleeping. To help prevent this, take your asthma medicines 3 or 4 hours before the next feeding. Your provider and your babys provider can help you adjust your medicine schedule so you and your baby can get the health benefits of breastfeeding.

Last reviewed: November, 2013

How Should I Prepare Before Pregnancy If I Have Asthma

Many healthcare providers recommend a preconception appointment before you start trying to get pregnant. This appointment is a chance to talk to your provider about any medical conditions you might have and your general health. Many people use this appointment to make a game plan for how they will want to treat their medical conditions like asthma during pregnancy. Its a chance to prepare with your provider for the upcoming pregnancy. Remember, you shouldnt stop taking any of your medications during pregnancy without first talking to your healthcare provider.

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How Does Asthma Affect The Body

Asthma is a chronic respiratory condition that causes your airways in the lungs to become narrow, resulting in inflammation and difficulty breathing. It also causes symptoms like wheezing, coughing, breathlessness, and chest tightness. Sometimes, it can even be life-threatening. There is no cure for asthma you can only try to reduce the frequency of asthma attacks and alleviate the symptoms.

Asthma Exacerbations And Healthcare Utilisation During Pregnancy

How does asthma affect pregnancy?

Asthma exacerbations are a significant clinical problem during pregnancy. Up to 45% of pregnant women with asthma have moderatesevere exacerbations requiring medical intervention during pregnancy . In addition to the adverse effect on maternal health, exacerbations are a key contributor to adverse perinatal outcomes in asthma. Exacerbations, oral steroid use and severe asthma are associated with preterm delivery, possibly due to maternal hypoxia, the effects of maternal inflammation and/or changes in uterine smooth muscle function . In addition, women with exacerbations of asthma are three times more likely to have a low birth weight baby compared to asthmatic women without exacerbations , suggesting that prevention of exacerbations during pregnancy may also lead to improvements in perinatal outcomes.

These studies demonstrate the potential for asthma status to markedly change during pregnancy and from trimester to trimester. Typically, approximately at least one-third of women with asthma report a worsening in their usual symptoms, one-third have no change and one-third have an improvement . It is also recognised that women with mild disease are still at risk of severe exacerbations during pregnancy, and for this reason, regular monitoring of asthma during pregnancy is recommended .

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When Should A Pregnant Woman With Asthma Seek Emergency Medical Treatment

Even with a proper asthma management plan in place, a pregnant woman should know about certain warning signs that may point to an asthma attack, such as:

  • Current medicine does not give rapid improvement of symptoms.

  • Improvement from medicines does not last as long as it had before.

  • Breathing becomes harder.

  • Fetal kick count decreases. This may indicate fetal distress.

Always talk with your healthcare provider about what asthma attack warning signs to look for and when to seek emergency care.

Emergency Department Management Of Asthma Exacerbations During Pregnancy

Recent data from a relatively small retrospective study of 39 women showed that pregnant women with asthma were less likely to be prescribed OCS at the time of exacerbation than nonpregnant women with asthma and where OCS were not prescribed at the first medical encounter, there was a delay in their prescription of 5.8days . OCS were prescribed during 87.5% of first-trimester exacerbations but only 70.6% of second-trimester and 66.7% of third-trimester exacerbations. While this may indicate an increasing reluctance to prescribe steroids as pregnancy progresses, it is possible that the severity of exacerbations in the third trimester was different from exacerbations earlier in pregnancy. This study also found that pregnant women were equally likely to fill their OCS prescription in the community after exacerbation as the nonpregnant women , implying that the change in OCS use in pregnancy may be more related to prescribing habits than reduced use by pregnant women themselves, consistent with studies performed in the emergency department setting.

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Asthma is a lung disease that causes your airways to tighten up, making it hard for you to breathe. Theres no cure for asthma. Even if you have asthma and feel healthy, asthma flares can happen at any time.

Most people with asthma can keep the disease under control and avoid serious health problems. If youre pregnant, its really important to work with your health care provider to manage your asthma and get medical care, if needed.

Frequently Asked Asthma Questions

Allergies, Asthma and Pregnancy
How is asthma diagnosed?

It is often not easy for a doctor to make a diagnosis of asthma, as symptoms often come and go. Thats why you should always talk with a doctor preferably a board-certified allergist or pulmonologist who is familiar with asthma diagnosis and treatment guidelines.

Your doctor will act like a skilled detective to combine the following information to determine whether asthma or some other cause is responsible for your symptoms:

  • Your family and symptom history
  • Physical exam
  • Medical tests
How is asthma treated?

Asthma medications play a central role in a treatment plan. Some medications prevent or reduce airway inflammation others interrupt the allergic reaction that triggers symptoms others relieve coughing and wheezing, making it easier to breathe.

Your doctor will work with you to find the right combination of medicines to manage your asthma and adjust the type and amount based on your symptoms. The goal of asthma treatment is to have you feel your best with the least amount of medicine.

What if I cant afford asthma medication?

Asthma inhalers and other types of respiratory medications vary in price. Some are less costly, and some are very expensive. If you cannot afford the cost of your asthma inhaler or other respiratory medication you can:

What is severe asthma?

Severe asthma is asthma that, despite all that you do:

Learn about eosinophilic asthma, a subtype of asthma that is often severe visit eosasthma.org and link to eosasthma.org

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What Asthma Complications Can Occur During Pregnancy

Asthma is a serious and potentially life-threatening condition. This does not mean you cant enjoy a healthy pregnancy and delivery. The key to remember is that healthy breathing is vital to a healthy pregnancy! Your unborn baby depends on you for a constant fresh air supply. Asthma symptoms such as coughing, wheezing, shortness of breath, or gasping for air are warning signs that your babys air supply may be at risk.

If asthma symptoms are ignored or left untreated, expectant mothers are at increased risk of complications. One of these complications is pre-eclampsia. Pre-eclampsia is a group of symptoms including high blood pressure, ankle swelling, and kidney problems. Pre-eclampsia may compromise the growth and health of your baby. It may also progress to seizures and other serious consequences. These may include excessive vomiting, vaginal bleeding, and premature or complicated labor.

For your unborn baby, poorly controlled asthma symptoms can be dangerous. They may cause slowed growth, preterm birth, low birth weight, low oxygen levels at birth, or even loss of life.

How Is Asthma Controlled During Pregnancy

The good news is that asthma complications during pregnancy can be prevented. It is crucial to have good asthma control to protect you and your baby. Asthma symptoms can be treated and, in most cases, prevented during pregnancy.

You will need a written Asthma Action Plan. You develop this plan with your asthma specialist and your obstetrician.

Along with taking medications as prescribed, environmental control is key to managing asthma. Expectant moms must be extra careful to avoid anything that might lead to an asthma flare. It is important to practice allergen and irritant avoidance measures. This may include staying inside on high pollen days and keeping your windows closed. It may help to install dust mite covers on mattresses and pillows. It is also important to get rid of mold from the home and workplace

Even when you are not having asthma symptoms, it is possible unhealthy breathing. Check your breathing levels at home each day using a handheld peak flow meter. At asthma care appointments your breathing levels should be checked using a spirometer. Seek expert obstetric and asthma care throughout pregnancy.

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Are Asthma Inhalers And Medications Safe During Pregnancy

Most asthma medications including inhalers are safe to take during pregnancy. In fact, its essential to continue the treatment plan that your doctor recommends to reduce the risk of potential pregnancy complications.

If your symptoms are moderate to severe, youll be given one of the several asthma medications that are considered safe during pregnancy. Inhalers like budesonide and albuterol are the treatments of choice. Very little of the medication in the inhaler makes it from your lungs into your bloodstream.

Anti-leukotriene medications like montelukast are also generally considered safe in most cases.

If these medications arent controlling your asthma, your doctor may recommend long-acting beta agonists or possibly theophylline. For severe asthma attacks, your doctor may also prescribe oral corticosteroids .

If you started getting allergy shots before pregnancy, youll likely be able to continue. However experts dont recommend starting allergy shots if youre already pregnant.

Your Asthma Action Plan During Pregnancy

How does asthma affect your pregnancy?

In pregnancy, just as before you were pregnant, you need an action plan for your asthma. Let your health-care provider know as soon as you know you are pregnant. Together, the two of you should review your current action plan and make changes if necessary. You may find that your symptoms have changed or that your sensitivity to certain triggers is different. Be sure to tell him or her all the medications you are taking, not just your asthma medications.

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Etiologic Factors In Asthma

Asthma results from a complex and poorly defined interaction of genetic predisposition and environmental stimulation. The basic mechanism for nonspecific bronchial hyperresponsiveness is unknown. Airway inflammation is the most popular hypothesis.

Implicated stimuli include the following:

  • Allergens, including pollens, house-dust mites, cockroach antigen, animal dander, molds, and Hymenoptera stings

  • Irritants, including cigarette smoke, wood smoke, air pollution, strong odors, occupational dust, and chemicals

  • Medical conditions, including viral upper respiratory tract infections, sinusitis, esophageal reflux, and Ascaris infestations

  • Drugs and chemicals, including aspirin, nonsteroidal anti-inflammatory drugs, beta blockers, radiocontrast media, and sulfites

What Are The Risks Of Having Asthma During Pregnancy

Controlling any medical conditions you may have during pregnancy is important to both your health and the health of your baby. Uncontrolled asthma can increase the chance of complications for mother and baby. Low birth weight and premature delivery are just two examples of possible complications that can happen if you dont control your asthma during pregnancy.

Uncontrolled asthma during pregnancy can cause a decrease in the amount of oxygen in your blood. This means that theres also less oxygen available for your baby. Less oxygen could lead to impaired fetal growth and survival. Poor control of asthma is a greater risk to your baby than treating your asthma. With good asthma control, you should be able to expect a normal pregnancy.

The goals of asthma treatment during pregnancy are the same as treatment at any other time in your life. Asthma control means that you:

  • Have minimal symptoms during the day.
  • Sleep all night without asthma symptoms.
  • Are able to perform normal activities.
  • Rarely need to use your reliever inhaler .
  • Have normal or near normal lung function.

Its safer for you to treat your asthma with asthma medications than to have an asthma episode.

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Which Medications Should Not Be Used During Pregnancy

  • Antihistamines and decongestants: These medications are used to relieve stuffy, runny, or itchy nose, itchy or watery eyes, and other minor allergy symptoms. Although some decongestants might carry a small risk of birth defects when used early in pregnancy, their safety in pregnancy has not been fully studied.
  • Epinephrine and other related medications: If possible, avoid regular use of epinephrine and other related medication as they may pose a higher risk to the fetus. Epinephrine may be given as an injection to treat a severe asthma attack or a life-threatening allergic response. If this situation occurs, treating your reaction effectively and quickly is important to decrease the risk of oxygen deprivation to the fetus.
  • Aspirin and other nonsteroidal antiinflammatory drugs : These medications are used to relieve headaches, muscle pain, inflammation, and fever. They are not recommended during late-term pregnancy.
  • Heartburn and gastroesophageal reflux disease are common in pregnancy. They can often be treated without medications by elevating the head of the bed, avoiding overeating, avoiding food triggers, and not eating within two to three hours before bedtime. If medications are needed to control heartburn and GERD, avoid regular use of antacids that contain bicarbonate and magnesium.

Outcomes And Complications Of Asthma In Pregnancy

Asthma during Pregnancy – Causes, Symptoms & Treatment

Although women with mild asthma are unlikely to have problems, patients with severe asthma are at greater risk of deterioration. The deterioration risk is highest in the last portion of a pregnancy. An increase in asthma exacerbations and in the need for medication is common during the second and third trimesters among women with more severe underlying disease.

In fact, severe and/or poorly controlled asthma has been associated with numerous adverse perinatal outcomes, including the following:

  • Low birth weight

  • Neonatal hypoglycemia, seizures, tachypnea, and neonatal intensive care unit admission

This risk of giving birth to a small or preterm infant appears to be small and may be minimized by good control of asthma. Studies have indicated that low-birth-weight infants are more common in women with daily symptoms or low expiratory flow than in women without asthma. In addition, active asthma management during pregnancy has been shown to reduce the risk of neonatal hospitalization and gestational diabetes.

Asthma can also lead to the following morbidities in pregnant women:

  • Respiratory failure and the need for mechanical ventilation

  • Barotrauma

  • Complications of steroid use

Death can also occur.

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What Should I Do About An Asthma Attack When Im Pregnant

Asthma attacks most often occur toward the end of pregnancy. If you have an asthma attack, treating it promptly with your prescribed medication helps ensure that your baby continues to get a steady flow of oxygen.

If the medicine doesnt do the trick, call your doctor or head to the nearest emergency room immediately. Asthma attacks sometimes trigger early uterine contractions, but the contractions usually stop when the attack does .

Can Asthma Be Prevented

Asthma cant be prevented entirely, but there are some practical ways to reduce the risk of an asthma attack and live well with asthma.

  • Get vaccinated for influenza: flu and other respiratory viruses are common triggers for asthma.
  • Manage any allergies: asthma and allergies are closely linked, so treating allergic rhinitis and avoiding or managing any allergy triggers will help with your asthma.
  • Live smoke-free: quit smoking if you smoke, and avoid any second-hand smoke .
  • Eat well: a balanced diet helps you to maintain a healthy weight. Being overweight or obese makes asthma harder to manage.
  • Care for yourself: mental health and asthma are linked, so let a trusted friend or your doctor know if you have been feeling sad or anxious, or dont enjoy things as much as before.
  • See your doctor regularly: asthma needs to be regularly assessed and managed, and your medication needs may change over time. Ensure your asthma action plan is up to date by checking in with your doctor regularly.

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How Is Asthma Managed During Labor And Delivery

Most expectant mothers with asthma deliver healthy, full-term babies . Most do not experience any breathing problems during labor or delivery. Do not stop any of your medications when labor starts unless directed otherwise by your healthcare provider. Your physician may direct you to bring a bronchodilator with you into the delivery or birthing room.

Depending on your health at the time you go into labor, your healthcare provider may give you oxygen through a mask. You may alse be given intravenous fluids to keep you well hydrated. Your physician will monitor contractions, your breathing and heart rate. They will also check the babys heart rate and other vital signs.

If have trouble breathing during labor or delivery, the health care provider can give you medications. Inhaled medications may be given through an oxygen mask. They may also give intravenous medications with the intravenous fluids.

What Are The Negative Effects Of Asthma Attacks On Pregnancy And Fetal Outcome

Asthma In Pregnancy: What To Do and What To Avoid

Asthma attacks can have a number of negative effects on pregnancy outcome. Poor asthma control is linked to preterm birth, low birth weight, and stillbirths in the fetus and hypertension in pregnant women. Women who become pregnant while being treated for asthma should not stop using their medication unless they are specifically told to do so by their health-care provider.

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