Pregnant women with asthma are not necessarily ‘high risk’ patients. In fact, asthma can follow a curious pattern in pregnant patients. One third of women experience no change in their asthma during pregnancy, one third actually notice an improvement when they are pregnant, and one third may experience a flare-up of their asthma during this time. Since there is no index to predict which way a patient will react, it is necessary to closely follow every pregnant asthma patient.
Most people are well aware of the myriad changes a body goes through during pregnancy – even the lungs go through interesting and intelligent alterations to adapt to the developing baby. In fact, one of the most confounding aspects of taking care of a pregnant patient is that it is normal for her to be short of breath. This makes it difficult to discern a ‘normal’ breathlessness from a problem that requires medication.
The Pregnant Body
A woman’s body adjusts gradually as the pregnancy develops. Since a pregnant patient is carrying more weight, the lungs need to accommodate to the additional work of breathing caused by the weight gain. A pregnant woman breathes a little faster than normal, which is perfectly healthy. The body is raising what is called the minute ventilation.
As the belly grows, it alters the shape of the bottom part of the chest. The chest is separated from the belly by a swathe of muscle called the diaphragm, which is a vital muscle that helps you to breathe. As the belly gains in girth, it pushes upwards against the diaphragm, preventing deep breaths and consequently increasing the respiratory rate. To make the chest a little bigger, the ribs splay outwards like bucket handles, letting the patient breathe a little deeper.
Remember, just because you have asthma does not mean that your baby will too – in fact, it’s more likely that he will not. You should be able to use your usual medications now that the baby is born, but always check with your doctor. Not only is it safe for the baby to breast-feed, breast-feeding is also beneficial to your newborn baby’s immune system. As your body recovers from the pregnancy and all the changes that happened in the lungs and chest normalize, your breathing will return to normal.
Can pregnancy ever trigger asthma for the first time?
Some women develop asthma for the first time during pregnancy. In some of the women who appear to have asthma for the first time, if you go into some detail in the medical history, you find that they probably had some previous asthma, it just was very mild or very intermittent, so it wasn’t noticed until now because the pregnancy seemed to make it worse.
Also, about a third of people with asthma may get worse during pregnancy and anywhere from a quarter to a third may find their asthma gets better during pregnancy. These changes that occur during pregnancy revert most of the time after delivery, or at least within the three months postpartum. So it does appear that it was really the pregnancy that did it.
Asthma warning symptoms are the same when you are pregnant as when you are not. If you notice any of the following, visit your doctor immediately:
- You are finding your usual tasks increasingly difficult because of your breathing.
- You find yourself reaching for your inhaler more than you are used to.
- You are awakened by coughing at night.
- You hear yourself wheeze on the telephone.
The main message here is – do not ignore symptoms, and talk with your doctor about any changes in your breathing. Your doctor may recommend a peak flow meter. This simple device measures airflow when you blow into it, and can be an important tool for monitoring asthma. Talk to your doctor about whether it is right for you.
Women with poorly treated asthma who are pregnant are at increased risk of suffering from uterine hemorrhage and vaginal bleeding. But the most frequent complication for the mother is a condition that can lead to premature delivery, or the need to induce delivery, sometimes before the fetus is viable.
Risks to the mother or poorly-treated asthma during pregnancy
The risks include :
- hypertension, and
- pre-eclampsia – which is a condition of rapidly progressing high blood pressure, and swelling from the retention of fluid.
- Also, women with asthma can have severe asthma attacks during pregnancy, which can result in adverse outcomes for the baby. Complications for the baby may include an increased risk of premature birth, low birth weight, and stillbirth
Guidelines For Prescribing Newer Asthma Drugs During Pregnancy
A joint committee of the American College of Obstetricians and Gynecologists (ACOG) and the American College of Allergy, Asthma and Immunology (ACAAI) convened to provide guidance for physicians on asthma management in pregnant patients, particularly with regard to the use of newer asthma and allergy medications. The committee’s recommendations include:
- A stepped approach, beginning with inhaled ß 2-agonists for mild, intermittent asthma and including inhaled cromolyn for mild persistent asthma; inhaled corticosteroids for moderate persistent asthma; and inhaled plus oral corticosteroids for severe persistent asthma (Table 1).
- Use of either beclomethasone or budesonide if inhaled corticosteroids are initiated during pregnancy.
- Consideration of inhaled salmeterol instead of, or in addition to, theophylline for asthma that is not controlled by inhaled corticosteroids.
- Avoidance of oral decongestants during the first trimester.
In general, the committee preferred inhaled medications (because they have fewer systemic effects) and time-tested drugs (because of greater experience with their use during pregnancy). Physicians are advised to limit medication use as much as possible during the first trimester, although birth defects related to most asthma drugs are uncommon.
Managing Asthma during pregnancy
There are two basic approaches that are both important in optimizing the mother’s health. First identify and avoid triggering factors that can worsen asthma; particularly dust mites, animal dander or mold. And then, since, most patients with persistent asthma can’t avoid enough of the triggering factors to have that suffice, to be on appropriate therapy. This is important because of their health and because there are risks from uncontrolled asthma to the baby’s health. Our study adds strength to the safety profile of the inhaled steroids, which are clearly the most effective preventative medicine relative to asthma.