Asthma occurs in 8-9% of pregnant women and allergic diseases are present in 20 % of woman of childbearing age. It is important for pregnant women with asthma to be monitored very closely because their asthma severity may change during pregnancy. In one third of women asthma symptoms worsen, in one third they improve, and in the remaining one third of women, the course of asthma stays the same. Exacerbations of asthma are very common in pregnancy partially because of physiologic/hormonal/mechanical changes, and also secondary to discontinuation of medications because of concerns regarding side effects either by the mother, or by the clinician. Pregnant women are also very susceptible to viral infections, especially influenza. Asthma exacerbations, and poorly controlled asthma have been associated with negative outcomes for the infant, prematurity, increased perineal mortality, low birthweight, and a for the mother (pre-eclampsia). However, if asthma is kept well controlled during pregnancy, the risks to the mother and baby are minimal!
Management of Asthma During Pregnancy
The management of asthma during pregnancy is very similar to the appropriate management of any person with persistent asthma with the possible exception that the pregnant women with asthma should be followed very closely by her asthma specialist. The components of care include the avoidance of triggers factors, medications, as well as appropriate education in multiple areas including what to do if an exacerbation should occur. The same goals should be pursued including few to no asthma symptom, good exercise tolerance, minimal need for bronchodilators (e.g. albuterol), prevention of exacerbations, and no increased risk for mother or baby. Even though concerns have been raised about using any medication during pregnancy, the advantages of treating asthma in pregnancy appropriately with medications for good control closely outweighs any potential for side effects. Poorly controlled asthma is a much greater risk to the baby than any medication.
Management of other allergic conditions during pregnancy
Pregnant women with asthma frequently have other allergic conditions including allergic rhinitis. There is also an increased risk for sinusitis in pregnant women. In some cases, nasal symptoms may begin during pregnancy because of the pregnancy associated hormones. One name for this is “vasomotor rhinitis of pregnancy” (pregnancy rhinitis). Treatment of rhinitis during pregnancy depends on the cause and may include antihistamines, as well as preventative nasal sprays. Some women may be on allergy shots prior to pregnancy. The general recommendation would be to continue at the same dose, assuming that you have reached the maintenance dose. Allergy shots are generally not started during pregnancy.
