How Can I Reduce Asthma’s Impact On My Baby
Good asthma control is the key to a successful pregnancy. To lessen the impact of your condition on your unborn baby:
- Have an asthma plan. Work with your asthma doctor to find the right kind and amount of medication for you to take.
- Recognize your asthma triggers. Keep a diary of what makes your asthma worse, and find ways to avoid those triggers.
- Receive coordinated care. Make sure your asthma doctor and your pregnancy provider coordinate your care.
Approach Of The Patient With Difficult
The practical approach of a patient with suspected difficult-to-treat asthma should consist of a systematic analysis focused on a correct diagnosis, treatment adherence, and detection of endogenous and exogenous triggers and aggravating factors. An algorithm for such an approach is given in Figure 36-1. The first crucial step is to confirm that the patient really has asthma, to exclude alternative diagnoses and to ensure proper inhalation technique and treatment adherence. Detailed history taking, physical examination, and diagnostic tests are needed to guarantee a thorough evaluation of the patient to identify factors that offer room for therapeutic intervention in order to improve asthma control.
Possible endogenous and exogenous risk factors need to be examined. Possible exogenous triggers include sensitization and exposure to allergens and influence of drugs that can interfere with asthma control or induce asthma attacks . The search for exogenous risk factors should focus on signs of gastroesophageal reflux, chronic rhinosinusitis, psychosocial problems, recurrent bacterial infections, symptoms of sleep apnea, and hormonal influences . Especially chronic rhinosinusitis and psychosocial problems have been associated with frequent asthma exacerbations. Current and past smoking habits as well as passive smoking at home or at work need to be questioned, since smoking has been associated with relative steroid resistance.
Controlling Asthma During Pregnancy
Asthma symptoms can improve, stay the same or get worse during pregnancy. In fact, up to 45 percent of pregnant women with asthma have an asthma attack during their pregnancy. To effectively manage your asthma during pregnancy, your healthcare team will work with you to:
These steps are important to ensure that your baby gets plenty of oxygen. Asthma flare-ups during pregnancy can cause decreased oxygen in blood, which means less oxygen reaches the baby. This put the baby at higher risk for premature birth, low birth weight and poor growth. In addition to these, women with asthma are also slightly more likely than women without asthma to have high blood pressure, often called pre-eclampsia, and have a cesarean delivery. Babies who are born too small and too soon are more likely to have newborn health problems. They can have trouble breathing and lasting disabilities, such as intellectual disabilities and cerebral palsy.
These three steps can help you have an easy pregnancy and healthy baby:
Monitor Your Asthma
Avoid Asthma Triggers
By limiting your contact with allergens and other asthma triggers, you may need to take less medicine to control your symptoms. The key is to control your asthma symptoms by avoiding your asthma triggers and taking your asthma medication as instructed by your healthcare team.
Take Asthma Medication
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Are Asthma Medicines Safe To Use During Pregnancy
Is It Safe to Use Asthma Inhalers or Corticosteroids While Pregnant?
During pregnancy, doctors may consider some asthma medicines to be safer than others, so your medicines may change. Work with your doctors to find the besttreatment for you. These include:
- Short-acting inhaled bronchodilators
- Anti-leukotriene agents like montelukast
- Some inhaled corticosteroids, like budesonide
Long-acting beta agonists are not considered first-line treatments for pregnant women with asthma. But doctors may consider them if your asthma is not well-controlled by the above medicines.
If your asthma is very severe, oral steroids, such as prednisone, may be necessary for the health of you and baby.
Asthma symptoms may get worse, stay the same, or get better during pregnancy. Talk to your health care provider to make sure the medicines you are taking are still the right choice. Update your Asthma Action Plan as needed.
Remember: It is better for you and your baby if you maintain asthma control .
Possible Complications For The Fetus
Lack of oxygen to the fetus from the mother can lead to many health problems in the fetus:
Intrauterine growth retardation. This is poor fetal growth in the womb. It causes the fetus to be smaller than normal for its gestational age.
Neonatal hypoxia. This is when the fetus does not get enough oxygen.
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A Consequence Of Asthma In Pregnancy
If the asthmatic pregnant woman does not undergo the necessary checks, various complications can arise due to insufficient oxygen. The woman shares the oxygen circulating in her blood with the fetus, so a reduction of the same affects both.
Asthma in pregnancy, as research published in the Revista de Asma points out, can cause women the following disorders:
- Hyperemesis gravidarum: consists of the prolonged appearance of vomiting episodes. This is not your typical first trimester morning sickness. In this case, the episodes are frequent and cause weight loss.
- Preeclampsia: also known as gravidaric toxemia. It is a syndrome characterized by an increase in the mothers blood pressure, edema due to water retention, and protein loss through the urine .
- Gestational hypertension: the increase in blood pressure values.
- Premature birth: Although asthma does not frequently occur during delivery, labor may come early due to this condition.
In the unborn child, on the other hand, asthma during pregnancy can cause:
- Intrauterine growth retardation: the consistent lack of oxygen slows the development of the fetus, which may be smaller than average based on gestational age.
- Underweight at birth: associated with limited intrauterine growth, the baby is born underweight.
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What Should I Do To Avoid Asthma Attacks During Pregnancy
Keep Your Asthma Well-Controlled
Avoiding asthma triggers is always important, but is even more important during pregnancy. Pregnant women with asthma should increase avoidance measures to gain greatest comfort with the least medicine.
- Stay away from people who are sick with respiratory infections.
- Reduce your exposure to allergens like dust mites, animal dander, pollen, mold, and cockroaches
Stop Smoking Cigarettes/Tobacco
Giving up cigarette smoking is;important for any pregnant woman. Smoking may worsen;asthma and harms;the health of the growing fetus as well.
Regular exercise is important to health. Talk to your doctor for the best advice about exercising during pregnancy. Swimming is a great exercise for people with asthma. Using quick-relief medicine 10 to 15 minutes before exercise may help you tolerate recommended exercise.
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Taking Asthma Medicines When Youre Pregnant
The medicines used to treat asthma are safe in pregnancy. They won’t harm your baby. This includes reliever inhalers; preventer inhalers; long-acting and combined relievers; theophylline; and steroid tablets.
There are more risks to both you and your baby if you don’t take your medicines and your asthma gets worse, says Dr Andy Whittamore. This is because when asthma isnt controlled there may not be enough oxygen getting to your baby.
If youre already taking a leukotriene receptor antagonist , such as Montelukast,;its safe to continue taking it during pregnancy.
If youve been taking steroid tablets in the weeks leading up to your due date, make sure you tell your midwife and the hospital staff.; They should keep a closer eye on your asthma.
And if youre still taking steroid tablets when you go into labour, your birth team will need to make sure you continue to take these medicines during labour. Its really important these medicines are not stopped suddenly.
If youre worried about taking your medicines when youre pregnant talk to your GP, asthma nurse or midwife. You can also talk about medicines and any potential side effects during your asthma review.
Maternal Asthma Medication Use And The Risk Of Selected Birth Defects
Asthma, a disease that affects the lungs, is a common disease during pregnancy, affecting about 4%12% of pregnant women.1,2 About 3% of pregnant women use asthma medications, including bronchodilators or anti-inflammatory drugs.3 Currently, guidelines recommend that women with asthma continue to use medication to control their condition during pregnancy.4 However, the safety data on using asthma medications during pregnancy are limited.
Recently, researchers used data from the National Birth Defects Prevention Study to examine maternal asthma medication use during pregnancy and the risk of certain birth defects. The results were published in Pediatrics. You can read the abstract hereexternal icon.
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Can Pregnant Mothers Use Asthma Medications
Your doctor will provide you with guidance on the medications and other treatment options that you can use during your pregnancy. Most asthma medicines are generally safe during pregnancy. However, your doctor will likely tell you not to take sulfonamides during your last trimester to avoid your baby being born with jaundice. Your doctor will also likely tell you not to take any tetracyclines during your pregnancy, as they could cause skeletal or dental deformities in your baby.
Do not immediately stop taking your asthma medication when you learn you are pregnant. Talk to your doctor. An abrupt change in your medication regimen could put you and your baby at risk of a severe asthma attack.
Asthma Medications Are Safe During Pregnancy
Asthma medications;are extremely safe and appropriate for use during pregnancy. Most asthma medications are inhaled, which delivers medication directly to the airways where it is needed, so a small dose can often be enough.
Asthma medication is not dependent on circulation through the bloodstream and, to some extent, bypasses the baby.
Discuss any concerns you have with your doctor before stopping any asthma medications, to make sure your asthma is controlled throughout your pregnancy. You can put your baby at risk if you stop taking your asthma medications, because if you have an asthma attack, your baby may suffer from a reduced oxygen supply. Remember, if you cant breathe then neither can your baby.
Asthma medication will not harm your baby, and taking prescribed medications is safer for you and your baby than having poorly-controlled asthma.
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Asthma Treatment And Pregnancy
Pregnant women manage asthma the same way non-pregnant women do. Like all people with asthma, pregnant women should have an asthma action plan to help them control inflammation and prevent and control asthma attacks. Part of a pregnant woman’s action plan should also include recording fetal movements. You can do this by noting whether fetal kicks decrease over time. If you notice less fetal activity during an asthma attack, contact your doctor or emergency help immediately to get instructions.
Things to think about for asthma in pregnant women include the following:
Medicines For Asthma During Pregnancy
During gestation, it is important to choose the medicines to be taken together with your doctor. Not all drugs are harmless to the mother and baby, which is why medical care is essential.
Most asthma medicines are harmless to pregnant women. In fact, it is believed that uncontrolled asthma is more dangerous than the possible side effects of drugs. This aspect is reported in an article published in the Colombian Revision de Neumología.
In some cases, allergy injections are used to reduce asthma attacks. If the expectant mother has started to undergo these injections before becoming pregnant, she will need to continue the treatment. It is contraindicated to start therapy after conception.
Finally, the asthmatic mother can safely breastfeed; in fact, it is not recommended to abandon therapy during this phase.
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Pregnancy And Asthma: How To Keep Yourself And Your Baby Safe
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When youre carrying the newest member of your family in your belly, you have a monumental responsibility to keep yourself and your little one safe and healthy. While no research indicates that women can develop asthma as a direct result of being pregnant, if you have asthma, you could find your symptoms worsening during your pregnancy. Ensure your OBGYN knows about your history with asthma and how you currently manage your condition so that they can provide you with additional guidance during your pregnancy. What follows are answers to some of the most common questions that pregnant mothers ask about the complications of their asthma during their pregnancy.
Is Asthma Dangerous During Pregnancy
In an expecting mother, untreated or uncontrolled asthma might be associated with respiratory signs at night, intermittent or chronic hypoxemia in the mother, which may lead to hospitalization or visit to the emergency room. Placenta praevia, complications during labor, chronic respiratory failure, preeclampsia, oligohydramnios, hypertension, intubations or even death might occur as well.
These pregnancies are more frequently associated with bleeding experienced by the mother and gravidarum hyperemesis. The frequency is twice as high in asthmatic women than the healthy ones.
There has also been an increase of C-section among uncontrolled patients with a severe form of this condition.
If the illness isn`t treated while pregnant, asthma might be decompensated with acute and chronic asthma, severe on occasion, which may lead to acute respiratory failure, and in time, chronic respiratory failure, with the occurrence of hypoxia , as well as hypoxemia , placental conditions might appear with changes in the quality and amount of amniotic liquid, and with side effects regarding the fetus. When it comes to the baby, if this disease is left untreated in the mother, it can lead to insufficient brain or organ development, and mental retardation at birth, which sometimes might even become irreversible.
Is It Safe To Use An Inhaler While Pregnant
Yes, it is safe to use an inhaler during pregnancy. Actually, the doctor who supervises your pregnancy will most likely recommend you one to maintain your condition under control.
Although lots of women who experience this illness give birth to babies that are perfectly healthy, uncontrolled attacks of asthma may prevent the little one from receiving sufficient oxygen, so an inhaler is âkind ofâ a-must. Uncontrolled asthma attacks may increase the risk of:
- High blood pressure.
Which Medications Treat And Manage Asthma During Pregnancy
Most people with asthma take at least two medications: one for long-term prevention and control of asthma symptoms and one for quick “rescue” in case of an attack. The long-term medications are taken daily, even if there are no symptoms.
During pregnancy, inhaled corticosteroids are the mainstay for long-term control. Long-term medications are sometimes combined into single preparations, such as an inhaled steroid and a long-acting beta-agonist.
Rescue medications are taken only when symptoms appear. Inhaled short-acting beta-agonists are usually the first choice for fast relief of symptoms.
Control and Preventive Medications
Inhaled corticosteroids: Corticosteroids prevent symptoms by preventing the swelling and mucus secretion that go along with inflammation. They help prevent severe asthma attacks. They are the most popular long-acting asthma drugs for pregnant women because they work well and are considered to be safe in pregnancy. They cause few side effects. Examples include budesonide and beclomethasone .
Leukotriene inhibitors: These drugs work by blocking a substance that is produced by cells in your body that causes swelling and spasm of airways. These drugs are considered safe during pregnancy, but in general they do not work for as many people as inhaled steroids. Examples are montelukast , zafirlukast , and zileuton .
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Asthma Exacerbations And Healthcare Utilisation During 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 .
Changes In Asthma Severity
About one-third of pregnant women with asthma will see their asthma symptoms get worse. Another third will stay the same. The last third will see their asthma symptoms improve.
Most women with asthma whose symptoms changed in any way during pregnancy will return to their pre-pregnancy condition within three months after giving birth.
If your asthma symptoms increase or decrease during one pregnancy, you may be likely to experience the same thing in later pregnancies. It is difficult to predict how asthma will change during pregnancy.
Because of this uncertainty, work with your doctors to follow your asthma closely. This way, any change can be promptly matched with an appropriate change in treatment. This calls for good teamwork between you, your obstetrician, your primary care physician, and your asthma specialist.
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