All women with asthma must have their condition closely reviewed when they become pregnant to reduce the risk of complications, experts say today.
A review in The Obstetrician & Gynaecologist (TOG), published today (6 September 2013), says that the severity of asthma during pregnancy remains unchanged, worsens or improves in equal proportions.
Control for women with severe asthma is more likely to deteriorate in about 60% of cases, compared to just 10% of women who have mild asthma.
But Chris Brightling, professor of respiratory medicine and honorary consultant physician, University Hospitals of Leicester, England, and co-author of the paper, says all women with asthma need to be closely reviewed throughout pregnancy, irrespective of disease severity.
“Asthma is a widespread condition and poor management during pregnancy can lead to adverse maternal and foetal outcomes,” he said.
“Good asthma management to maintain tight control is vital and standard therapy may be safely used in pregnancy to achieve this along with close surveillance from midwives, obstetricians and for women with severe asthma a respiratory physician.”
Asthma affects around 10% of pregnant women, making it the most common chronic condition in pregnancy.
National guidelines recommend the management and treatment for asthma in pregnant women should be the same as for non-pregnant women and men, with the intensity of antenatal maternal and foetal surveillance to be based on the severity of their condition.
Previous studies have suggested that poor asthma control is associated with hypertension in pregnancy, a higher frequency of caesarean section and low birth weight but Prof Brightling and fellow authors say there are either no or minimal additional risks in most women with well-controlled asthma.
Although some mothers-to-be and healthcare providers express concern about the potential adverse effects that asthma drugs can have on both the women and their babies, the authors conclude that it is safer for women to continue using their medication than risk uncontrolled asthma.
Asthma does not usually affect labour or delivery – about one-fifth of women experience an exacerbation during labour – and within a few months of giving birth, their asthma severity usually reverts to pre-pregnancy levels.
Jason Waugh, TOG editor-in-chief added: “Education is key for anyone, especially pregnant women, to manage their asthma. This includes understanding the condition and its treatment options, trigger avoidance, asthma control, adequate use of devices and the importance of adherence to medication.
“Any women who have concerns about their asthma management and management during pregnancy should contact their GP or midwife for further advice.”
Goldie MH, Brightling CE. Asthma in pregnancy. The Obstetrician & Gynaecologist 6 September 2013; doi.org/10.1111/tog.12048
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