Managing asthma during pregnancy

Abstract

Purpose Pregnant women with asthma have many concerns about their respiratory health, as well as the health of their baby. A woman's respiratory system experiences many physiological changes during pregnancy and when a diagnosis of asthma is present, the clinical effect of pregnancy on asthma is variable. Regardless of disease years, when asthma patients become pregnant, both patients and healthcare providers want to know how pregnancy affects asthma and how asthma may affect pregnancy outcomes. This article will review how to optimally manage asthma during pregnancy using an evidence‐based approach that recognizes the patient's changing needs. Data sources Literature collected from sources identified through searches of PubMed and CINAHL covering the periods from 1996 to 2012. Conclusion With the implementation of evidence‐based management and treatment, pregnant patients who have asthma can be positioned to better control their symptoms and avoid unwanted complications that may affect the health of their baby. Implications for practice Pregnant patients with asthma may be cared for in a variety of healthcare settings ranging from primary care to specialty care to the emergency department. Consequently, it is imperative that healthcare providers across the array of clinical venues be proficient on how to optimize the asthma outcomes of their pregnant patients.

Medications used disproportionately during pregnancy: Priorities for research on the risks and benefits of medications when used during pregnancy

“…29 Given this, guidelines recommend that women requiring pharmacological management continue their asthma medication during pregnancy. 30,31 It is therefore concerning that a number of asthma medications (ATC R03) were identified as being used relatively less among pregnant women. This includes a number of inhaled corticosteroids (ATC R03BA, R03AK), which are the most effective preventive asthma medications, 32 and are likely to have low teratogenic potential because they are inhaled.…”

“…Those with the largest associations were insulin (isophane human; RR = 10.4, 95% CI = 9.6-11.3), methyldopa (RR = 9.2, 95% CI = 8.4-10.2), ordinary salt combinations, an antacid, (RR = 7.6, 95% CI = 7.0-8.3) and folic acid (RR = 7.0, 95% CI = 6.7-7.4). The majority of medications which were significantly more commonly dispensed to pregnant women compared to matched control women had a risk categorisation of A or were T A B L E 1 Characteristics for the pregnancy cohort (concessional beneficiaries) and the whole population of pregnancies (concessional and general beneficiaries) conceived from 1 January 2006 and resulting in birth in NSW on or before 31 Stratification by age identified no additional category B, C or D medications that were more likely to be dispensed to pregnant women than women of childbearing age. Stratification by trimester, however, revealed significantly higher risk of a prochlorperazine (category C) dispensing during trimester 1 (RR = 1.4, 95% CI = 1.4-1.5) compared to the matched period among the control women (see Table S3).…”

“…Similarly, untreated or under-treated maternal asthma is strongly associated with an increased risk of adverse perinatal outcomes, which are mitigated when asthma is well controlled 29. Given this, guidelines recommend that women requiring pharmacological management continue their asthma medication during pregnancy 30,31. It is therefore Two hundred six medications used among the control group of women of childbearing age were not available for this analysis due to data custodianimposed restrictions (see Tables S1 and S2 for included and excluded medications).…”

Anti-asthma Drugs Formoterol and Budesonide (Symbicort) Induce Orofacial Clefts, Gastroschisis and Heart Septum Defects in anIn VivoModel

“…Chronic poorly controlled asthma during pregnancy leads to maternal hypoxemia, which directly or indirectly reduces the supply of the fetus with oxygen (5,6). Therefore, untreated asthma increases the risk of congenital malformations, low birth weight, preterm birth and perinatal mortality (1,(7)(8)(9)(10)(11).…”

“…Asthma medication mainly includes inhaled corticosteroids and bronchodilators (3,6,(12)(13)(14)(15)(16). The administration of corticosteroids during pregnancy has been associated with congenital malformations in children in some epidemiological studies (1,(17)(18)(19), while no association has been reported by others (9,10,(20)(21)(22)(23)(24)(25).…”