Worried about your asthma during pregnancy? What are the risks?

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Expert:Barbara Cockrill Gootkind, MD, Pulmonologist at Brigham and Women’s Hospital 

Asthma is one of the most common medical conditions experienced by pregnant women. Most women with asthma during pregnancy will have perfectly healthy pregnancies and newborns. However, asthma is associated with an increased risk of certain complications during pregnancy. Remember this: controlling asthma during pregnancy provides the best chance for a healthy outcome for both mother and child.

Some pregnant women mistakenly think that they should stop taking medications to protect their baby’s health. While this approach may be appropriate for some medical conditions (check with your doctor!) this is not the case for pregnant women with asthma. You should not discontinue asthma medication without speaking to your doctor first. Your doctor will usually give you the go-ahead to continue your normal asthma-controlling routine.How does asthma impact a pregnancy?

What is asthma?

Asthma is an inflammatory condition. Pregnancy is associated with minor suppression of the immune system. This suppression serves to protect the baby from the mother’s immune system. Pregnant women’s bodies react differently to this pregnancy-related change:

  • about one-third of women note an improvement in their asthma symptoms during pregnancy
  • one-third of patients experience a worsening of their asthma symptoms, typically in the third trimester.
  • one-third of pregnant women with asthma will have no change in their asthma symptoms. 

A pregnant woman should make sure her medical providers are aware of any history of asthma. Most women with asthma during pregnancy don’t need special treatment. But if a patient experiences worsening asthma symptoms, it’s very important for her to seek medical attention. Careful management of asthma during pregnancy can markedly decrease the risk of complications.  

Risks of not treating asthma during pregnancy

Lack of treatment increases the risk of the following:

  • Babies of mothers with asthma are more likely to be born premature and can suffer from poor fetal growth and low birthweight.
  • Pregnant women with uncontrolled asthma are more likely to suffer from miscarriage, anemia, depression, preeclampsia and a pulmonary embolism.  
  • A severe asthma attack puts additional stress on both mother and baby due to lack of oxygen.
  • C-sections are also more common in women with asthma. 

Managing your asthma

Most asthma medications are safe to take during pregnancy, although it’s always a good idea to speak with your health care provider. Many women remain on the same medications that they used before becoming pregnant.  The worst thing you can do is stop taking your medications without checking in with your provider! You should also inquire about having an influenza vaccine. Most pregnant women should have a flu shot if they have not already had one for the year.

Don’t smoke

If you smoke, stop!  Women who smoke may find that pregnancy gives them an extra incentive to quit. Cigarette smoke—both from smoking yourself and from second-hand smoke—increases the risk of an asthma attack.  In addition, smoking during pregnancy is associated with an increased risk of premature birth, low birth weight and Sudden Infant Death Syndrome (SIDS). This is true even with patients who do not have asthma.  

If you experience worsening asthma symptoms or difficulty breathing, especially if associated with decreased fetal kicking, you should contact your provider or seek emergency treatment.

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