Asthma During Pregnancy

Asthma is one of the most common diseases that can occur during pregnancy without any special side effects for the mother and fetus, but in some cases, the symptoms in pregnancy become so severe that not only bothers the mother but also becomes serious and dangerous conditions for the fetus.

Asthma can cause narrowing of the airways due to swelling and excess mucus production, both of which make breathing difficult and can lead to wheezing, coughing, and shortness of breath. About 30% of women suffering from this disease report that their condition worsens with pregnancy.

What is Asthma?

It is an inflammatory disease of the airways to the lungs that makes it difficult to breathe and can make some physical activities challenging or even impossible. Normally, with each breath taken, air passes through the nose or mouth, into the throat and airways, and eventually into the lungs.

Many small airways in the lungs help carry oxygen from the air to the bloodstream. Asthma symptoms occur when the lining of the airways becomes swollen, and the muscles around them tighten. The mucosa then fills the airways and reduces the amount of air it can pass through. This condition can cause an asthma attack.

It is classified into four general categories, from the least to the most severe. While pregnancy can exacerbate, improve, or alleviate asthma, research shows that the severity of it during pregnancy is related to the severity of pre-pregnancy asthma. People with severe asthma are more likely to have worse symptoms.

If asthma gets better, the improvement is generally gradual as the pregnancy progresses. If asthma gets worse, the increase in symptoms is more noticeable in the first and third trimesters of pregnancy.

Some women may experience worse asthma signs and symptoms early in pregnancy because they stop taking their medication after becoming pregnant.

Signs And Symptoms

The signs and symptoms of asthma can vary. The most common symptom is wheezing or a whistling sound along with breathing. Other symptoms include:

• Tightness or pain in the chest
• Coughing
• Shortness of breath
• Sleep disturbances because of coughing or trouble breathing

Sometimes symptoms or attacks can be caused by elements such as allergens, exercise, illness, or climate change.

What causes symptoms?

Several factors can make asthma worse.

Allergens

About 7 out of 10 people with asthma have allergies. An allergy is a reaction to something you touch, eat, or breathe that causes sneezing, skin rashes, or difficulty breathing. Allergens are the things that cause allergy symptoms and may also cause asthma symptoms. Common allergens include pollens, molds, animal dander, dust mites, and cockroaches.

In these cases, contact with allergens should be limited. If a woman receives allergy vaccines before pregnancy, she can continue during pregnancy. But if a woman has not received allergy vaccines, she should not start taking them when she becomes pregnant because it can cause a serious allergic reaction called anaphylaxis.

Irritants

Irritants are things in the environment that can damage the lungs and trigger symptoms, including air pollution, cigarette smoke and smoke from wood stoves or fireplaces, cold air, and pungent odors such as paint or perfume.

Infections

Infections such as colds, flu, or viral pneumonia can cause symptoms in some people.

Exercise

Exercise can cause symptoms in some people. If this illness is under control, women can probably exercise without problems. But if exercise during pregnancy aggravates the symptoms, she should consult a doctor. Other things include:

• Cigarette smoke (firsthand or secondhand)
• Gastroesophageal reflux disease (GERD), or regurgitation of stomach contents up the esophagus or “food pipe”
• Smoke from cooking or wood fires
• Food allergies
• Emotional upset
• Changes in the weather, especially cold, dry air
• Allergic reactions to certain chemicals
• Allergic reaction to cosmetics, shampoos, and soaps
• Allergic reaction to irritants, such as dust, molds, feathers, pet dander, etc.

Complications

If asthma is not controlled or well-controlled during pregnancy, it can negatively affect the health of the mother and baby. This disease can reduce the amount of oxygen in the blood; it can also cause a decrease in oxygen in the baby’s blood and cause complications or growth retardation. If left uncontrolled, it can cause the following side effects:

• Preeclampsia
• Premature birth
• Poor intrauterine growth
• Low birthweight

The treatment goals during pregnancy are the same as treatment at any other time in life. control means:

• Have minimal (or no) symptoms during the day
• Sleep all night without symptoms
• Are able to perform normal activities
• Rarely need to use your reliever inhaler
• Have normal or near-normal lung function

Is it safe to take asthma medication during pregnancy?

Any medication the mother takes during pregnancy can affect the health of the developing fetus. Taking anti-asthma medications during pregnancy, such as glucocorticoids, can cause concern. These concerns include low birth weight, preterm birth, and preeclampsia. But in general, most medications can be used safely during pregnancy.

Therefore, taking anti-asthma medications during pregnancy is less risky than experiencing asthma attacks. If the mother has difficulty breathing, the baby will not be able to get enough oxygen.

If the mother needs anti-asthma medications to control asthma symptoms during pregnancy, her doctor will prescribe the least dangerous medications for the condition. In this case, it is necessary to take the prescribed medicine according to the doctor’s instructions and never stop taking it arbitrarily and change the dose. The obstetrician will monitor the symptoms during the prenatal visits.

How do prevent complications?

Taking care of the mother is the best way to take care of the baby. For example:

• Keep prenatal appointments: See the doctor regularly during pregnancy.
• Take medication as prescribed: If the mother is concerned about her medications, she should consult her doctor.
• Don’t smoke: Smoking exacerbates asthma, and pregnancy can cause both mother and baby problems.
• Avoid and control triggers: Avoid exposure to cigarette smoke and other possible irritants such as dust and animal dander.
• Control gastroesophageal reflux disease (GERD): GERD is a chronic gastrointestinal disease that causes acid reflux and heartburn that worsens asthma symptoms. If you have GERD, you may be able to relieve symptoms by raising your head in bed, eating smaller meals, waiting at least three hours after meals before lying down, and avoiding foods that seem to cause heartburn.
• Recognize warning signs: You must know the early signs and symptoms of worsening asthma, such as coughing, chest tightness, shortness of breath, or wheezing.

Diagnosis

It can be difficult to diagnose. The doctor takes a health history, performs a physical examination, and listens to breathing to find out the patient’s condition.

A lung function test called spirometry may also be done. This is a test that looks at how well the lungs are working. This device measures the amount of air that is inhaled in and out. It also measures breathing speed. When a woman is pregnant, natural changes in the body can cause shortness of breath. This test can help your doctor determine if shortness of breath is a common pregnancy complication or is due to asthma.

Controlling Asthma During Pregnancy

Asthma symptoms can improve, remain constant, or worsen during pregnancy. Up to 45% of pregnant women get the disease during their pregnancy. For effective management during pregnancy, the health care team works closely with the mother to:

• Control daytime and nighttime symptoms
• Maintain lung function and normal activity level
• Prevent attacks

These three steps can help the mother have an easy pregnancy and a healthy baby.

Monitor

The health care team should monitor the mother’s lungs during pregnancy and adjust asthma medications as needed. Tell the doctor if symptoms improve or get worse. For example, many women experience shortness of breath during pregnancy, but the health care team can help the mother determine if the shortness of breath is associated with a worsening of asthma or normal shortness of breath that many women experience during pregnancy.

Avoid Triggers

By limiting contact with allergens and other irritants.

Take Medication

There are many safe medications to take during pregnancy, so talk to the doctor. If asthma medications were used before pregnancy, they should not be discontinued without consulting the doctor. It is important to have asthma medications during labor.

What is an asthma attack?

When the symptoms gradually worsen, it is known as an exacerbation or asthma attack. Breathing becomes increasingly difficult because the airways become swollen and the bronchial tubes narrow. Symptoms include:

• Hyperventilation
• Cough
• Wheezing
• Increased heart rate
• Agitation
• Shortness of breath
• Confusion
• Blue lips

Although the worsening of symptoms can end quickly, patients should contact their doctor immediately as it can be life-threatening. The longer the symptoms worsen, the more they affect your breathing ability. This is why exacerbations often require an emergency visit. Exacerbations can be prevented by taking medications that help manage symptoms.

Giving birth

Women with asthma can expect a normal birth. Before giving birth, she should talk to her doctor about how asthma may affect her delivery. Attacks do not usually occur during childbirth.

Breastfeeding

Asthma medications enter breast milk, but their very low concentrations do not harm the baby. This is why a mother can breastfeed her baby.

Is maternal asthma transmitted to the baby?

The cause of asthma remains unknown, although having a parent or sibling with asthma increases a child’s risk of developing it. Protecting babies from secondhand smoke during and after pregnancy reduces the risk of developing asthma. Doctors also recommend breastfeeding for the first six months to reduce the baby’s risk of asthma and allergies.

The bottom line

Asthma is a condition that inflames the lungs and makes it difficult to breathe. The disease can affect both adults and children in different forms and at different levels.

There are several medications used to treat asthma. The most common treatments are bronchodilators. Asthma during pregnancy can affect the health of both mother and fetus. If a woman is infected and the disease is effectively controlled, she will not be at risk of experiencing complications during pregnancy.

Lifestyle changes can help reduce symptoms. This can include diet changes, exercise, or stress management. Talk to your doctor to identify the type of asthma and the best treatment and management options.

Arjang Naim, MD prescribes medications and strategies to control asthma during pregnancy checkups.

Additional questions