Asthma and Pregnancy

Breathing for Two

A tiny new life somersaults inside. Filled with hopes and dreams for your baby’s future, you watch what you eat and drink. You get plenty of rest and exercise.

However, for many expectant mothers, asthma — one of the most common complications of pregnancy — presents special challenges.

How pregnancy affects asthma

There is no way to predict how pregnancy will affect your asthma symptoms. Some expectant mothers find that asthma symptoms improve during pregnancy; others say they worsen or remain the same. As pregnancy progresses, there is less room inside your body to take a full, deep breath. Normal activities such as climbing stairs may leave you short of breath, but they should not make you cough, wheeze, or experience lower breathing levels. (Use a handheld peak flow meter to check.)

Learn the difference between breathing changes due to pregnancy and symptoms of asthma. If breathing symptoms improve after using your bronchodilator inhaler, symptoms are most likely due to asthma and should be reported immediately to your obstetrician or other health care provider.

How asthma affects pregnancy

While asthma is a serious, potentially life-threatening condition, you can enjoy a healthy pregnancy and delivery. The key to remember is that healthy breathing is vital to a healthy pregnancy! Your unborn baby depends on you for a constantly fresh air supply. Your asthma symptoms such as coughing, wheezing, shortness of breath, or gasping for air are signs that your baby’s air supply may be at risk.

When asthma symptoms are ignored or left untreated, expectant mothers are at increased risk of pre-eclampsia (a group of symptoms including high blood pressure, ankle swelling, and kidney problems that may compromise the growth and health of the baby and progress to seizures and other serious consequences), excessive vomiting, vaginal bleeding, and premature and complicated labor.

For the unborn child, poorly controlled asthma symptoms can cause slowed growth, preterm birth, low birth weight, low oxygen levels at birth, and even loss of life.

The good news is that asthma symptoms can be treated and, in most cases, prevented during pregnancy. You will need a written Asthma Action Plan. Avoid or remove allergens and irritants from your home and workplace. Use medications as prescribed.

Even when you are not having noticeable symptoms, it is possible to have unhealthy breathing levels. Check breathing levels at home each day using a handheld peak flow meter and at asthma care appointments using a spirometer. Seek expert obstetric and asthma care throughout pregnancy.

However, the risks to both mother and baby associated with poorly controlled asthma are greater than the risks of taking asthma medications as prescribed.Many expectant mothers steer clear of all asthma and allergy medications, fearing harm may come to their unborn child.

The goal is to use medications to prevent inflammation and to treat symptoms when they first begin. This approach minimizes risks and maximizes benefits to both mother and child.

The U.S. Food and Drug Administration (FDA) classifies medications for use during pregnancy in categories A-D and X. Most asthma medications fall into category C and can be used during pregnancy when the benefits outweigh the potential risks. [NOTE: In December 2014, FDA updated this labeling policy. Read more here.]

Inhaled budesonide is the only inhaled corticosteroid to receive category B status, meaning “there is no evidence of harm to the fetus.”

Many medications sold with or without a prescription can be used during pregnancy under physician supervision whereas a few others are known to be unsafe.

Herbal and dietary supplements are not well studied in expectant mothers and should not be used without supervision from a physician or other health care provider.

Before using any medication or supplements, discuss benefits and risks with your obstetrician or other health care provider. All care, including medication use, must be coordinated with your obstetrician.

  Ask the Allergist: Asthma and Allergy Medications During Pregnancy 

 

Managing asthma during labor and delivery

I have asthma symptoms with exercise, so what can I expect to happen during labor and delivery?

Most expectant mothers with asthma delivering full-term babies experience no breathing problems during labor or delivery. Unless directed to do otherwise by your physician or other health care provider, do not discontinue use of any prescribed medication once labor begins. Your physician may direct you to bring a bronchodilator with you into the delivery or birthing room.

Depending on your health at the time you go into labor, your physician or other health care provider may give you an external supply of oxygen through a mask worn on your face and intravenous fluids to keep you well hydrated. Your physician will monitor contractions, your breathing and heart rate, the baby’s heart rate, and other vital signs.

Should you begin having trouble breathing during labor or delivery, the physician or other health care provider can deliver inhaled medications through the same mask as used for oxygen and intravenous medications with the intravenous fluids.