Well-controlled asthma is rarely affected adversely by pregnancy.
Some women deteriorate, some improve, and some stay unchanged.
Good asthma management should cope with any exacerbation.
breathlessness related to the baby’s size at the end
of pregnancy is common. Except in the most severe cases,
asthma is no bar to a normal delivery and caesarean section
should be no more common than in the non-asthmatic population.
Medications for asthma have been shown to be extremely
safe. With the exception of very high doses of prednisolone
for long periods of time, asthma medication of all types
has not been associated with any increase in the rate of
foetal malformation. Untreated asthma is more likely to
cause a problem. In particular, attacks of asthma may reduce
the amount of oxygen available to the foetus. Hence it is
important to be meticulous with asthma control during pregnancy.
If maintenance treatment with inhaled steroids was necessary
before the pregnancy, it should be continued. The dose should
be the minimum necessary to control symptoms and maintain
normal or best lung function. Beclomethasone and budesonide
have a long safety record in pregnancy. Currently, the approved
product information for budesonide indicates it should not
be giving during lactation.
Likewise, although asthma medications do enter breast
milk, the concentrations are usually so small that they
do not have any adverse effect on the baby.
If there is a strong genetic predisposition to atopic
disease, then advice about primary prevention measures (encouragement
of breast feeding, delayed introduction or avoidance of
possible dietary triggers and control of the home environment
to reduce allergen exposure) should be given. Cigarette
smoking should be avoided.
Peak flow monitoring and regular medical checks of the
asthma during the pregnancy can provide reassurance to both
the patient and the doctor delivering the baby.
Reprinted with permission from the National Asthma Campaign
“Asthma Management Handbook 1998”.