Vol. 15 •Issue 2 • Page 34
Patient Primer
Asthma Control During Pregnancy
As if you don’t have enough to worry about: eating the right foods, getting enough exercise, finishing the baby’s room, picking the perfect name, and imagining what it will take to fit into those favorite jeans again. All that stress, and no cocktails allowed.
But as a pregnant woman with asthma, you have to worry about breathing. You’ve always had to manage your disease, but now you’re breathing for two.
Asthma Rx
Mothers-to-be are often wary of medication, and with good cause. Many medications are harmful to babies, and the risks of taking them outweigh the benefits, but asthma meds don’t fall into this category. Uncontrolled asthma deprives a fetus of its most basic necessity: oxygen. This deprivation is associated with premature birth, low birth weight, pre-eclampsia, growth retardation, and possibly death.
Inhaled corticosteroids help prevent asthma exacerbations by reducing inflammation. They’re considered safe during pregnancy and help maintain long-term control of asthma symptoms. Budesonide is the preferred inhaled corticosteroid for pregnant women because there are more safety data on this drug than others.
If your asthma can’t be controlled by low doses of inhaled corticosteroids, your physician might recommend you add a long-acting beta-agonist to your medication plan. Data on the safety of long-acting beta-agonists are insufficient, but for women who can’t control their asthma with just inhaled corticosteroids, the benefits may outweigh the risks.
While asthma control is ideal, some women still might have asthma exacerbations during pregnancy. Quick-relief medication is necessary to treat an asthma attack, and albuterol is the preferred short-acting beta-agonist for pregnant women.
No link has been shown between short-acting beta-agonists like albuterol and harm to the fetus during pregnancy or the baby during breastfeeding. Albuterol has more safety data for use by pregnant women than any other short-acting beta-agonist.
Not all asthma medications are recommended for use during pregnancy. Oral corticosteroids are associated with an increased risk that the baby will develop cleft lip. Pre-eclampsia, preterm birth and low birth weight are also linked to oral corticosteroid use.
Epinephrine is sometimes used to treat severe asthma attacks or allergic reactions. This medication shouldn’t be used regularly during pregnancy, as it may harm the fetus. If you do have a life-threatening attack or reaction, getting epinephrine quickly is crucial to prevent oxygen deprivation of the fetus.
Beyond medication
There’s more to asthma management than just medicine. During pregnancy, it’s important to re-evaluate your triggers and living environment to prevent exacerbations. Asthma is commonly triggered by dust mites, mold, pet hair, cold air and exercise. Women who have identified viral infections as a trigger of their asthma should get an influenza vaccine after the first three months of pregnancy.
And if you have exercise-induced asthma, discuss an exercise plan with your physician so that you don’t have to sacrifice the benefits of exercise to avoid asthma symptoms.
Editor’s note: Information adapted from the National Asthma Education and Prevention Program, the American Academy of Allergy, Asthma & Immunology, and the American Lung Association.
Lauren Constance Everingham is editorial assistant of ADVANCE. She can be reached at [email protected].
