Asthma, one of the most common conditions that can affect a pregnancy, complicates as many as 8 percent of pregnancies. Asthma is a lung condition with a myriad of symptoms, including shortness of breath, persistent cough, wheezing, and tightness in the chest. Symptoms can be mild to severe and can occur intermittently or up to several times per day. Breathing is difficult because of swelling to the airways in the lungs, secretion of mucus, or muscle spasms of airways.
Proper diagnosis of asthma in pregnancy is critical for appropriate treatment. Left untreated, asthma can lead to complications in pregnancy including premature birth and low birth weight and all the problems that accompany premature delivery including life-long disabilities.
Women who are asthmatic before pregnancy should consult with their health care provider to discuss their current asthma treatment plan and how the demands of pregnancy may alter both their asthma and treatment. Statistics show that about one third of women with asthma will actually have fewer asthma symptoms in pregnancy, while a third will experience no change in symptoms and the final third will experience worsening of symptoms. Understanding the nature of your asthma before you become pregnant will greatly reduce the problems that may arise in pregnancy.
Asthma sufferers are well acquainted with “triggers” for an asthma attack. Nearly 70 percent of asthma patients also are allergic to many common allergens in the environment including pollen, dust mites, animal dander, and mold, among others. Avoiding these contaminants can spare many asthmatics an attack. Women who have more severe allergies may receive allergy shots on a routine basis. Pregnant women may continue getting their allergy shots if their regimen was started before they became pregnant. However, it is not advisable for pregnant women to begin allergy shots for the first time during pregnancy because of the slight risk of anaphylaxis, which is a serious allergic reaction.
Besides common allergens, many asthma patients will find that their condition is exacerbated by other factors like smoke, air pollution, infections, and cold air. Obviously asthmatics and pregnant women should not smoke tobacco and should try to avoid second-hand smoke and other air pollutants. During flu season, asthmatic women should receive a flu shot to avoid illness which may worsen asthma symptoms. Exercise during pregnancy is encouraged to stay healthy and avoid excessive weight gain. Pregnant women with asthma should consult with their health care provider to see if they should take asthma medication before exercising to prevent worsening of their symptoms.
Pregnant women are encouraged to take the appropriate amounts of asthma medications that relieve their symptoms. Pregnant women should never stop taking previously prescribed asthma medication for fear of risk to the fetus. Experts agree that the greatest risk to baby is for a woman to not get adequate oxygen during pregnancy. While many women worry that their medications can harm their unborn baby, most specialists agree that poorly controlled asthma is a much greater risk than the risk of taking medication for asthma.
Medications traditionally prescribed for asthma should be continued during pregnancy, including inhalers and bronchodilator sprays like albuterol. This medication is known as a rescue medication because it is quick acting and is used to open airways; generally this medicine is used on an as needed basis. Asthma patients with more persistent symptoms may need steroid medications like budesonide (brand name Advair), salmeterol (brand name Serevent), or prednisone, which are used in various strengths and doses to keep symptoms at bay. Some of these medicines are inhaled, and others are taken orally.
Your health care provider will be able to monitor and adjust medications as needed throughout your pregnancy by regularly monitoring lung function with physical exam and sometimes with a hand held machine called a peak flow meter. Often times, care for pregnant women with asthma is shared between an obstetrical provider and an asthma specialist. Evaluating your pulmonary function on a regular basis will help your health care provider make adjustments to your medications. Always be sure to let your provider know if you experience an improvement or worsening of symptoms.
Pregnant women with asthma who experience mild symptoms and are well controlled with medication will require routine monitoring. However pregnant women with more severe asthma and those whose symptoms are not well controlled will require more monitoring to follow the development of their fetus. Ultrasounds are routine in pregnancy, but asthmatics usually need additional ultrasounds particularly after 32 weeks of pregnancy to monitor fetal well being and growth. Fetal heart rate testing also known as a non-stress test may be required on a scheduled basis.
Asthma therapy in pregnancy is important and improves the odds of having a healthy pregnancy. Therapy is most successful when the pregnant woman follows the treatment plan closely and receives regular medical care. Pregnant women with asthma can breathe a sigh of relief that with close monitoring by a qualified medical professional, they can enjoy a healthy and successful pregnancy.
Dr. Hardy is a solo physician in practice with Atlantic Ob/Gyn with locations in Chesapeake and Va. Beach. Call 757-463-1234 or visit www.atlanticobgyn.com.