Almost 8 percent pregnant women suffer from asthma during pregnancy and need proper medication to avoid delivery complications and retarded fetal growth.
Asthma is an inflammatory lung disease that is characterized by narrowing of the airways leading to reversible obstruction of airflow and bronchospasm. Asthma may not necessarily aggravate during pregnancy. It is possible that some women may experience an improvement in the symptoms while others may experience no change in symptoms.
AdvertisementWhile it is possible that certain factors like estrogen or progesterone mediated bronchodilation or descent of fetus may improve the symptoms of asthma during pregnancy, the symptoms are likely to worsen in situations of increased stress, gastro esophageal reflux and increased occurrence of bacterial respiratory tract infection. It has been observed that asthma symptoms usually increase during the sixth month of gestation, however, the exacerbations tend to decrease during the final month of pregnancy.
Studies indicate an increase in the number of hospitalization rates in pregnant women with asthma making it all the more crucial to control asthma with proper medication during pregnancy. Pregnant women with severe asthma are more likely to experience the worsening of the symptoms and have high chances of complications as compared to women with mild asthma. The chances of exaggeration of asthma leading to hospitalization also depend upon the severity of diseases before pregnancy. Studies have proved a significant relationship between an increase in asthma severity and decreased fetal growth. A pregnant woman with asthma is more likely to experience adverse complications like -
• Preterm delivery,
• Infant being small for gestational age,
• Congenital malfunctions,
• Placenta previa
• and Cesarean delivery.
Pregnant women with asthma may also suffer from hypertensive disorders, antepartum and postpartum hemorrhage, membrane related disorders, gestational diabetes and preterm delivery. Thus emphasis needs to be placed on controlling the asthma in such patients.
In order to control the symptoms it is necessary to identify the factors that aggravate the disease. Patients with asthma should try to reduce their exposure to animal dander, dust, mites and other environmental triggers. Gastro esophageal disease is also known to exacerbate asthma. Patients with this disease should avoid food and drink within 3 hours of bedtime and are advised to take smaller meals.
Asthma can be treated with two categories of medication: Controller medications that prevent asthma and Rescue medications that prevent the symptoms of asthma. Controller medication includes Inhaled Corticosteroids (ICSs) which control the inflammation of airways and are preferred controller therapy for pregnant women. Corticosteroids like Budesonide are preferred during pregnancy because of their proven efficacy and safety.
For patients whose asthma symptoms cannot be controlled by ICSs alone, Long Acting Beta Agonists (LABAs) are preferred as add on therapy. Though they have certain side effects associated with them they are safer for pregnant women as compared to other add on therapies like Theophylline, Cromolyn or Leukotriene Modifiers.
On the other hand Rescue medications include short acting beta agonists (SABA) such as albuterol that are comparatively safer as no significant relationship is found between SABAs use and congenital malformations, preterm delivery rate or infant growth restriction.
Careful monitoring of the asthma helps control the symptoms and is recommended for all pregnant patients with asthma. Fetal evaluation helps predict the progression of the fetal growth and thus is extremely important. Asthma exacerbation often results in uterine contractions but rarely leads to emergency cesarean delivery. Once asthma symptoms are controlled, the contractions subside.
The asthma medications should be continued during labor and delivery. The use of theophylline, antihistamines, ICSs, beta agonists and cromolyn are safe for women who are breastfeeding as only a small amount of asthma medications enter breast milk.
It is crucial for pregnant women to recognize the factors that aggravate the asthma symptoms and identify the proper medication to control asthma for the health of the fetus.