Asthma Pregnancy

Asthma is one of the most common potentially life-threatening condition complicating pregnancy. It is estimated that currently, asthma affects 4% to 8% of pregnant women and is increasing steadily. In general well controlled asthma is not associated with a higher risk of adverse pregnancy outcomes and it seldom occur for the first time during pregnancy.

The most common cause of asthma in pregnancy is due to non-compliance with medicines. It is seen that during pregnancy, about one third of the asthmatic pregnant women experience their asthma symptoms and condition worsen. However, one third of the asthmatic women feel better during pregnancy.

Asthma exacerbation are more frequent at the beginning of the third trimester of pregnancy and improves a few weeks before labor. It also shows that during pregnancy 10% of the pregnant women suffering from asthma seek emergency care.

Oxygen is important for the well being of the mother and the fetus. Every pregnant woman needs a proper treatment to maintain normal lung functions and oxygen level to maintain proper oxygen supply to the fetus.

Asthma patient should receive education about maintenance and rescue medication such as how to measure PEFR by peak flow meter, the proper use of inhalers, asthma prevention and adherence of asthma action plan. Patient should also learn more about when the asthma is worsening and when to contact the doctor.

Spirometry is the preferred method for pulmonary function testing during outpatient visits. However, peak expiratory flow measurement with a peak flow meter is also sufficient.

Effect of Asthma on mothers:

1. Pre eclampsia.
2. Placenta previa.
3. Gestational hypertension.
4. Prolonged hospital stay.
5. Fetal complications include:
6. Increased risk of perinatal mortality
7. Intrauterine growth retardation.
8. Low birth weight.
9. Neonatal hypoxia.
10. Other diseases mimicking asthma during pregnancy:
11. Mechanical obstruction
12. Laryngeal obstruction
13. COPD
14. Pulmonary edema
15. Pulmonary embolism Amniotic fluid embolism
16. Upper airway cough (Rhinitis, sinusitis, reflux)
17. Goals of asthma control during pregnancy:
18. The American College of Obstetricians and Gynecologists (ACOG) has issued a practice bulletin for management of asthma during pregnancy.
19. The new recommendations appear in the February issue of Obstetrics & Gynecology 2008 includes
20. Prevent hypoxic episodes in mother there by maintaining adequate fetal oxygenation.
21. Monitor lung functions by Spirometry preferred.
22. Avoid and controlling asthma triggers.
23. Patient education
24. Individualized pharmacotherapy to maintain normal pulmonary functions.
25. Control day time and nocturnal symptoms.
26. Maintain normal activity levels including exercise.
27. Prevent acute exacerbation of asthma.
28. No emergency department visit or hospitalization.
29. Avoid adverse effects of medications to mother and child.
30. Deliver to a healthy child.