Many women who suffer from asthma or allergic asthma worry about how their disease will affect pregnancy. First and foremost, most fear permanent damage to the child. Many pregnant women also wonder whether their asthma medication could harm the baby. Here’s what you should know about asthma during pregnancy.
Asthma in pregnancy: medications are important
Many women worry that asthma could harm their unborn child. The good news right away is that scientists have largely been able to dispel these concerns. Studies show that asthmatics do not have an increased risk of complications during pregnancy compared with non-asthmatics. However, this is only the case if the disease is well controlled with medication. So there is no reason to take the disease lightly before or during pregnancy or to stop taking the medication. Because what also otherwise healthy women during the nine months to create – weight gain, shortness of breath and heartburn, for example – that makes itself particularly unpleasantly noticeable in asthmatics.
Untreated asthma: consequences for the baby
The basic prerequisite for a complication-free pregnancy with asthma is optimal medication and the prevention of asthma attacks. To this end, all known triggers, for example allergens such as pollen, dust mites or animal hair, but also cigarette smoke or polluted air, must be consistently avoided. Poorly treated asthma causes a drop in the oxygen content of the mother’s blood. Because the unborn child is also supplied with maternal blood, the oxygen content is also lower here. But because the fetus needs a constant oxygen level for healthy growth and survival, asthma-related fluctuations in oxygen supply can significantly reduce the baby’s birth weight. In addition, poorly controlled asthma and asthma attacks can promote complications and premature birth. Therefore, it is especially important during pregnancy to treat asthma or allergic asthma appropriately. An asthma attack during pregnancy is always considered an emergency because it puts the baby’s oxygen supply at risk. In addition, contractions of the uterus may occur during the attack. Therefore, an emergency physician should always be called and treatment should be given in the hospital.
Asthma medications during pregnancy
Although medications should be avoided as much as possible during pregnancy, experts give the all-clear regarding asthma medications: numerous studies have failed to demonstrate the risk of increased malformations following asthma medications. This also applies to cortisone, which experts still consider indispensable in many cases. The risk from uncontrolled asthma is many times higher than the risk from targeted and controlled asthma therapy. However, during pregnancy, the drugs are preferably given as aerosols and sprays to avoid, as far as possible, the transfer of the active substance into the bloodstream of the child. However, to control severe cases of asthma, the doctor may prescribe cortisone tablets after careful consideration.
What medications are available?
In addition to cortisone-containing sprays, which are intended to curb chronic inflammation of the airways, so-called beta2-sympathomimetics such as salbutamol are primarily given as a spray to dilate the bronchial tubes for asthma during pregnancy. Despite many years of use, no negative consequences for unborn children have been observed with this medication either. Theophylline can also be used as an asthma medication during pregnancy, provided that the physician regularly determines the blood level of the drug. In the case of leukotriene antagonists, there is too little experience to date, which is why these agents should be used with restraint in pregnant women, i.e. only if better researched agents have not led to success. By the way: If allergic asthma is already treated by hyposensitization (specific immunotherapy) at the beginning of pregnancy, this therapy can usually be continued. However, treatment should not be started during pregnancy.
Does asthma get worse or better during pregnancy?
The question of whether asthma itself gets worse or better during pregnancy is best answered as “both.”Extensive studies have shown that symptoms worsened in 37 percent of all patients, improved in 29 percent, and remained constant in about 34 percent. Experience shows that worsening often occurs at the end of the second and beginning of the third trimester. In contrast, the situation often improves in the last four weeks of pregnancy. One reason for worsening of the asthma condition during pregnancy appears to be the reflux of stomach acid into the esophagus. This causes heartburn and triggers asthma attacks in some women. Improvement in asthma, on the other hand, is attributed to an increase in the body’s own cortisone production.
Regular lung function tests advisable
During pregnancy, asthmatics must not only attend gynecologic screenings but also consistently monitor their underlying disease. This includes lung function tests at the beginning and, if lung function is limited, at least every four weeks during pregnancy. If the asthma is particularly severe, the intervals should be much shorter. Peak flow should be measured and recorded daily. An arterial blood gas analysis is recommended as part of screening examinations to detect any risk to the mother and baby early. Regular ultrasound examinations throughout the child’s pregnancy provide information about the child’s growth and development.
Asthma: natural birth or cesarean section?
In principle, asthma does not mean the exclusion of a natural birth. The question of whether the child should be born by cesarean section or vaginally is also in this case a personal decision rather than a medical necessity. Even if the disease worsens during pregnancy, the risk of miscarriage or premature birth does not increase. This was the conclusion of a study involving a total of 873 pregnant women with mild asthma, 866 with moderate to severe asthma, and 881 without asthma. Again, the complication rate was comparable in all three groups. However, women with severe asthma delivered more often by cesarean section. An epidural analgesic during vaginal birth reduces oxygen consumption and respiratory minute volume, which reduces the risk of seizures. Birth is also simplified by adequate fluids and appropriate pain management. All medications that release histamine must be avoided. Regular medications should continue to be taken during delivery. If oxygen saturation is below 95 percent, oxygen is given to the mother.
Complaint-free mother, healthy baby
The goal of all measures is to deliver a healthy baby and avoid all complications for the mother. Therefore, regular asthma control also includes a written therapy plan, which makes it clear how the medication can be changed in an emergency and what measures can be taken in the event of an asthma attack. The emergency measures that were in place before pregnancy are especially applicable now. Patients should see a doctor or hospital immediately in any case if:
- The treatment does not work at all
- The treatment lasts only a short time
- The complaints increase
- The child moves less than usual or not at all
To keep mother and child healthy, research is constant. Among the latest findings is that allergy sufferers apparently easier to get pregnant than healthy women. The reason for this lies in an altered ratio of certain immune cells to each other. This makes it easier for the embryo to implant in the uterus – even in women with asthma.
