Pregnancy / Childbirth

Asthma in pregnancy - symptoms and treatment

It is estimated that asthma can occur even in pregnancy in 7 to 9% of pregnant women. In addition to the obvious danger to the mother, this condition is also very dangerous for the child himself - pregnant women with asthma are at increased risk for many pregnancy complications. As a result, appropriate diagnostics and appropriate therapeutic management in this group of patients acquires particular importance.

What is asthma in pregnancy and how does it manifest itself?

Asthma is a heterogeneous (varied in clinical picture) disease that is usually characterized by chronic airway inflammation. Among the defining symptoms can be mentioned among others wheezing, shortness of breath, chest tightness, and a dry, paroxysmal cough. It is worth noting that the listed symptoms are of varying severity and usually occur periodically (for example, as a result of contact with an allergen in the case of allergic asthma or excessive stress and strong emotions, or physical exertion in non-allergic asthma).

Asthma and an increased risk of pregnancy complications

Asthma, especially the uncontrolled one (characterized by the necessity of frequent use of rescue medication and waking from sleep due to coughing or shortness of breath), which is severe, poses a number of significant threats to the pregnant woman and her unborn child. These include:

  • Miscarriage - premature termination of pregnancy before the end of the 22nd week of pregnancy.
  • Premature delivery - premature termination of pregnancy before the end of the 37th week of pregnancy.
  • Vomiting pregnant women - a condition that significantly reduces the comfort of a pregnant woman and can lead to significant dehydration and serious electrolyte disturbances.
  • Gestational diabetes - a condition diagnosed based on OGTT and usually requires insulin therapy.
  • Preeclampsia - combines hypertension and renal dysfunction (proteinuria).
  • Low birth weight - defined as mass below 2,500 grams.
  • Low Apgar score - The 10-point Apgar score indicates the very good condition of a newborn baby.

Pregnancy and asthma

In the previous paragraph, we discussed the effect of asthma on pregnancy. However, it should be remembered that pregnancy itself also affects the course of asthma - one third of the pregnant women get worse, one third stays the same, and one third improve.

It is worth noting that in patients with pre-existing uncontrolled asthma characterized by severe course, their condition deteriorates much more frequently during pregnancy. It is therefore crucial to improve disease control and its effective treatment before the planned conception. The mechanisms responsible for these changes have not been fully understood. It is believed that pregnancy hormones and the modulating effect of pregnancy on the mother's immune system play a large role in them.

Asthma treatment and pregnancy and breastfeeding

Emergency and chronic asthma treatment in pregnancy does not differ from the regimen used in other patients. The same basic medicines are:

  • Short-acting inhaled beta-mimetics. These drugs dilate the bronchial tubes and temporarily relieve the symptoms of the disease such as shortness of breath or wheezing.
  • Inhaled glucocorticosteroids - form the basis for the treatment of chronic asthma.
  • Long-acting inhaled beta-mimetics - like inhalational GKS, which must always be given, are part of chronic treatment.
  • Theophylline, cromones - used as second-line drugs.

It is also worth knowing that the same drugs can be used without any restrictions during breastfeeding.

In summary, women with asthma can safely get pregnant and give birth to a healthy child. However, it should be remembered that this disease predisposes them to numerous pregnancy complications. As a result, they should be in the group of patients particularly often controlled by gynecology and pulmonologist.

Bibliography:Internal Szczeklik 2018/19.Obstetrics and gynecology of Grzegorz H. Bręborowicz.