Asthma in Pregnancy

The natural history of asthma in pregnancy is extremely variable. Pregnancy can affect the course of asthma & asthma can affect pregnancy outcomes. Severe asthma is more likely to worse during pregnancy than mild asthma, but some patients with very severe asthma may experience improvement, whilst symptoms may deteriorate in some patients with mild asthma. Uncontrolled asthma is associated with many maternal & fetal complications, including hyperemesis, hypertension, pre-eclampsia, vaginal haemorrhage, complicated labour, intrauterine growth restriction, preterm birth, increased perinatal mortality and neonatal hypoxia.

Counseling to be offered to the pregnant women with asthma regarding the importance & safety of continuing their asthma medications during pregnancy& monitor pregnant women with asthma closely so that any change in course can be matched with an appropriate change in treatment.

Management of Acute Asthma in Pregnancy

The management of asthma in pregnancy may be affected by concerns about harmful effects of medications on the fetus. Available studies give little cause for concern regarding treatment side effects and maternal & fetal risks of uncontrolled asthma are much greater than the risks from using conventional asthma medications for management of acute asthma.

• Acute severe asthma in pregnancy is an emergency & should be treated vigorously in hospital.
• Give drug therapy for acute asthma as for the non-pregnant patient including repeated doses of inhaled b2 agonists, steroid tablets & intravenous aminophylline if needed.
• Deliver oxygen immediately to maintain saturation above 95 per cent.
• Continuous fetal monitoring is recommended for severe acute asthma.

Drug Therapy in Pregnancy

In general, the medicines used to treat asthma are safe in pregnancy. No significant association has been demonstrated between major congenital malformations or adverse perinatal outcome to b2 agonists, inhaled steroids & theophylline. For women requiring therapeutic levels of theophylline to maintain asthma control, measurement of theophylline level is recommended. Since protein binding decrease in pregnancy, resulting in increased free drug levels, a lower therapeutic range is probably appropriate.

Steroid Tablets

The balance of evidence suggests that steroid tablets are not teratogenic. Data from many studies have failed to demonstrate an association between first trimester exposure to steroid tablets and oral cleft. Even if the association is real, the benefit to the mother and the fetus of steroids for treating a life-threatening disease justify their use in pregnancy.

Use steroid tablets as normal when indicated during pregnancy for severe asthma. Steroid tablets should never be withheld because of pregnancy.

Management During Labour

Acute attacks of asthma are very rare in labour due to endogenous steroid production. Women with asthma may safely use all forms of pain relief in labour. In some studies there is an association between asthma and increased caesarian section rate, but this may be due to planned caesarian sections. Prostaglandin E2 may safely be used for labour indications. Although ergometrine may cause bronchospasm particularly in association with general anaesthesia, this is not a problem encountered when syntometrine (syntocinnon/ergometrine) is used for postpartum haemorrhage prophylaxis.

• Advise women to continue their usual asthma medications in labour
• If anaesthesia is required, regional blockade is preferable to general anaesthesia
• Women receiving steroid tablets at a dose exceeding prednisolone 7.5 mg per day for more than two weeks prior to delivery should receive parenteral hydrocortisone 100 mg 6-8 hourly during labour

Drug Therapy In Breast Feeding Mother

The risk of atopic disease in the offspring of women with asthma is increased up to three folds. This risk reduced by breast-feeding. The medicine used to treat asthma, including steroid tablets, have been shown in early studies to be safe to use in nursing mothers.

• Encourage women with asthma to breast-feed
• Use asthma medications as normal during lactation

Source :
British Guideline on the Management of Asthma, Scottish Intercollegiate Guidelines Network, The British Thoracic Society.

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Topics:

• Pregnancy, Parenting & Baby Care
• Women's Health