Asthma in pregnancy varies a great deal from woman to woman. During pregnancy a third of women find their asthma worsens, while the rest improve or remain the same.
The absolute point to remember about asthma and pregnancy is that uncontrolled asthma can be harmful for your baby. This is because during a serious attack, oxygen levels in the body are reduced and this reduces the amount available for your baby. This can result in low birth weight, premature birth and increased perinatal mortality. The pregnant mother with severe asthma may suffer from high blood pressure, vaginal haemorrhage and have labour complications.
Although avoiding triggers is difficult, if not impossible at times, it does make sense to try to be extra careful to avoid an attack. If you smoke then quit now because this also reduces the oxygen available to your child.
Some women find that their asthma improves with pregnancy. This is because progesterone, one of the hormones produced at this time, has a relaxing effect on smooth muscle. This is the type of muscle wrapped around the airways which causes chest tightness. Also, there are other huge hormonal changes and the immune system is affected greatly so that the baby and placenta are not rejected. Cortisone levels increase which may have an effect on suppressing the inflammatory processes usually taking place in the lungs. Antibodies become less numerous and less active in producing white blood cells. This is especially true of antibody IgG that is connected to prolonged asthma attacks. Levels of IgE, which is the antibody most closely linked to asthma, vary greatly from one pregnant woman to another - some having low levels and others have high.
Some mothers unfortunately have worse asthma while pregnant. This is generally between the 24 and 36 weeks of the pregnancy. There could be a number of reasons for this:
You may be worried about taking medicine and not without cause. However, you need to weigh up the benefits and risks. A severe asthma attack, which reduces oxygen levels, can injure the unborn baby. Taking medication, which is not considered harmful, is a better option.
Think twice about all drugs taken while pregnant - not only asthma medication but other prescribed medications, herbal products, tobacco, alcohol, marijuana, etc. Sometimes antibiotics may be needed to treat chest infections. Some like penicillin (if no allergy) are considered safe, however tetracycline should not be prescribed at all.
Check with your doctor or pharmacist about the safety of all medications that you take. Even if you have not confirmed you are actually pregnant, still let your doctor know.
If the drugs you are taking are not mentioned below it does not mean they are unsafe. Check with your pharmacist or doctor to see if they are okay.
Cromolyn Sodium is a non-steroidal anti-inflammatory medication. It can be safely used during pregnancy as both human and animal studies have shown. It should be the preferred choice because of its extremely low side-effects. However, it may not be sufficiently effective and inhaled corticosteroids are still needed.
Nedocromil sodium is a non-steroidal anti-inflammatory medication and works in a similar way to Cromolyn Sodium. Animal studies have been favourable, but human trials have yet to be conducted. For this reason, Cromolyn Sodium would still be the preferred choice, before inhaled corticosteroids.
Inhaling steroid preventer drugs like beclomethasone, fluticasone and budesonide are considered to be safe during pregnancy. Drugs pass from mother to baby through the bloodstream and so less of these medications enter the bloodstream, going instead to the lungs. Beclomethasone is the preferred option as it has had the widest human research.
As a group, the Beta-2 agonists have had extensive human use with no evidence of foetal injury. However, some animal studies where bronchodilators were given in high doses showed some effect. Terbutaline is often preferred due to negative animal studies. Salbutamol is also considered safe.
Adrenaline-based drugs such as relievers should be used strictly on an "as needed" basis because adrenaline constricts blood vessels and therefore may reduce blood flow and oxygen to the foetus. Bearing this in mind, it is also dangerous to prolong asthma attacks because this can also reduce the amount of oxygen getting to the foetus.
If a more aggressive approach is needed theophylline has also had extensive favorable human experience. Some asthmatics may be able to restrict their use of theophylline to the times when asthma plays up. It is important to monitor the level of theophylline in the bloodstream for both effectiveness and toxicity.
It is recommended that theophylline levels do not exceed 12 mg/L, since babies born to mothers with higher levels have found to have rapid heartbeat, vomiting and twitching.
If you have asthma, you may also suffer from allergic nasal symptoms. To relieve this discomfort during pregnancy, antihistamines such as chlorpheniramine and tripelennamine are considered safe. If necessary, intranasal cromolyn or beclomethasone can also be taken to control nasal symptoms.
Medications used for treating asthma or nasal problems that should be avoided during pregnancy include:
These include epinephrine (adrenaline) and isoproterenol as animal studies have shown abnormal embryo development. Human studies have raised questions concerning their safety. A better alternative is B-2 agonists.
Before the actual birth, the doctor, midwife and nurses should be informed that you are asthmatic. Generally, asthmatics should continue their normal asthma medication during labour. It is important that if you are steroid dependent that you are given supplemental steroids to cope with the stress of labour.
Epidurals and normal painkillers are considered safe for asthmatics. However, if an operation is performed it is important that the anaesthetist knows that you are asthmatic. This is incase you have a reaction or an asthma attack while under general anaesthetic.
Women with asthma should be encouraged to breast feed and there is nothing to stop you from doing so. Most of the commonly used drugs are safe for breast-feeding - the inhaled corticosteroids and bronchodilators are only present in minute quantities in the breast milk. However, anti-histamines and theophylline can make the baby irritable and unable to sleep.
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