Pregnancy and Asthma
- Chris Woolston, M.S.
- Posted March 11, 2013
Pregnant women don't just eat for two -- they also breathe for two. If you have asthma, remember that your baby is counting on you for oxygen. When you're struggling for air, your baby is feeling your pain very directly. That's why controlling your condition is more important than ever. By keeping your asthma in check, you can give your baby an excellent start.
Will my asthma put my baby at risk?
As recently as the 1970s, women with asthma had good reason to worry about getting pregnant. Compared with other women, they were more likely to die during pregnancy, have stillbirths, or miscarry. Even during successful births, the babies often tended to be premature and smaller than normal.
Asthma treatments have come a long way in the last 30 years, and today's mothers-to-be have little to fear. In the majority of cases, you and your doctor can set up a game plan to keep you breathing easily throughout your pregnancy and beyond. And once your asthma is under control, it poses almost no threat to you or your baby.
To be on the safe side, your obstetrician may want to check your baby with a heart-rate monitor shortly after you go into labor. If you've had severe asthma symptoms during your pregnancy, the doctor may decide to monitor the baby regularly throughout your third trimester. He or she may also order ultrasound imaging to see if the baby is growing at a normal rate.
Most women with asthma have smooth, unremarkable deliveries. Be sure to bring your asthma medications to the hospital to have on hand in case you have a bad attack during labor.
Will asthma medications hurt my baby?
It's a basic rule of pregnancy: The fewer chemicals in the body, the better. But this is no time to put away your inhaler. Although no asthma medication comes with an absolute guarantee of safety -- scientists rarely test drugs on pregnant women -- several have an excellent track record. Guidelines issued by the National Asthma Education and Prevention Program (NAEPP) emphasize that uncontrolled asthma is much more hazardous to your baby than controlling your asthma with appropriate medications.
What medications should I take?
At the very least, you'll need some sort of bronchodilator medication that can open your airways and stop an attack. The NAEPP recommends keeping albuterol, a short-acting inhaled medication, on hand at all times. This drug has few side effects and can quickly restore your breathing capacity. Letting an attack go untreated can cut off a fetus's air supply, possibly increasing the risk of death or brain damage.
In addition to bronchodilators, women who have persistent asthma symptoms need daily medications to ease the inflammation in their airways. According to the NAEPP, inhaled corticosteroids are your best bet. The organization notes that budesonide has the most safety data regarding its use during pregnancy, but that doesn't mean that other inhaled corticosteroids are necessarily unsafe.
Alternative medications suggested by the NAEPP are leukotriene receptor antagonists, cromolyn, or theophylline. If women with persistent asthma don't find relief with these medications, new guidelines recommend either increasing the dose of inhaled corticosteroid or adding a long-acting beta agonist. Your doctor will help you decide the right course for your condition.
For severe persistent asthma, preferred medical treatment is a high-dose inhaled corticosteroid and salmeterol, plus oral corticosteroid if needed, according to the American Congress of Obstetricians and Gynecologists.
In general, asthma medicines taken through an inhaler are safer than pills. While pills deliver medication to your entire body -- including your fetus -- inhaled drugs go straight to your airways. But if your asthma is severe, you may need a daily dose of corticosteroid pills. There is conflicting data on the safety of oral corticosteroids during pregnancy but one thing is clear -- severe, uncontrolled asthma poses a definite risk to both mother and baby.
No matter how safe your medications may be, you don't want to take more than necessary. A peak-flow meter -- a small, handheld device that measures the force of your breath -- can help you and your doctor determine just how much medication you need. If the meter shows that your asthma is under control, your doctor may be able to cut down your doses.
What else should I do to control my asthma?
You can breathe easier and reduce your need for medications by avoiding the everyday irritants that can trigger an attack. Above all else, stay away from cigarettes and secondhand smoke. You should also try to control dust mites, a very common cause of allergic asthma attacks. Try washing your bed linens and blankets once a week, encasing pillows and mattresses in airtight, zippered covers, and removing carpet from the bedroom.
If you're allergic to a pet, take a serious look at your need to have an animal companion. If you can't live without one, keep it out of your bedroom and, if possible, bathe it regularly and wash your hands after petting it. You can help control pollen allergies by keeping your windows closed during pollen season. You might also try installing a special allergy filter in your air conditioner, though their effectiveness in reducing allergies has not been proven. If you're allergic to molds, clean damp areas frequently and use a dehumidifier to keep the air dry.
How will pregnancy affect my asthma?
The swarm of hormones that comes along with pregnancy can actually help relax your airways and reduce your asthma symptoms. About one-third of women with severe asthma say their condition improves noticeably during pregnancy. Another one-third of women -- often those with mild asthma -- seem to get worse while they're carrying a baby. Whatever the case, you can generally expect your asthma to return to "normal" (its previous state) shortly after your baby is born.
Keep in mind that many pregnant women feel short of breath, especially as a growing fetus starts pressing against their diaphragm. A peak-flow meter can help you tell the difference between a normal bout of breathlessness and an asthma attack.
American Academy of Allergy, Asthma, and Immunology
American Congress of Allergy, Asthma, and Immunology
American Lung Association
Asthma and Allergy Foundation of America
New Guidelines Issued for Management of Asthma During Pregnancy, American College of Obstetricians and Gynecologists. 2008.
National Asthma Education and Prevention Program. Expert Panel Report: Managing Asthma During Pregnancy, Recommendations for Pharmacologic Treatment. 2004 Update. Journal of Allergy & Clinical Immunology. http://www.nhlbi.nih.gov/health/prof/lung/asthma/astpreg.htm
National Heart, Lung, and Blood Institute. New Treatment Guidelines for Pregnant Women with Asthma. January 2005. http://www.nih.gov/news/pr/jan2005/nhlbi-11.htm
National Heart, Lung and Blood Institute. Guidelines for the Diagnosis and Management of Asthma (EPR-3). July 2007. http://www.nhlbi.nih.gov/guidelines/asthma/index.htm