The effect of pregnancy on asthma Asthma Asthma is a disease of diffuse airway inflammation caused by a variety of triggering stimuli resulting in partially or completely reversible bronchoconstriction. Symptoms and signs include dyspnea... read more varies; deterioration is slightly more common than improvement, but most pregnant women do not have severe attacks.
The effect of asthma on pregnancy also varies, but severe, poorly controlled asthma increases risk of (1 General reference The effect of pregnancy on asthma varies; deterioration is slightly more common than improvement, but most pregnant women do not have severe attacks. The effect of asthma on pregnancy also varies... read more )
Maternal morbidity and mortality
Also, cesarean delivery Cesarean Delivery Cesarean delivery is surgical delivery by incision into the uterus. Up to 30% of deliveries in the US are cesarean. The rate of cesarean delivery fluctuates. It has recently increased, partly... read more is required more often in patients with asthma.
General reference
1. Abdullah K, Zhu J, Gershon A, Dell S, To T: Effect of asthma exacerbation during pregnancy in women with asthma: a population-based cohort study. Eur Respir J 55(2):1901335, 2020. doi:10.1183/13993003.01335-2019
Treatment of Asthma in Pregnancy
Inhaled bronchodilators and corticosteroids
For an acute exacerbation, addition of IV methylprednisolone, followed by oral prednisone
Pregnancy does not usually change treatment of asthma Treatment Asthma is a disease of diffuse airway inflammation caused by a variety of triggering stimuli resulting in partially or completely reversible bronchoconstriction. Symptoms and signs include dyspnea... read more (1 Treatment references The effect of pregnancy on asthma varies; deterioration is slightly more common than improvement, but most pregnant women do not have severe attacks. The effect of asthma on pregnancy also varies... read more ). Women are taught strategies to help manage asthma, including how to minimize exposure to triggers and how to serially measure pulmonary function (usually with a handheld peak flow meter).
Inhaled bronchodilators and corticosteroids are first-line maintenance therapy for asthma in pregnant women. Budesonide is the preferred inhaled corticosteroid. Based on available data, inhaled budesonide does not appear to increase the risk of congenital malformations in humans (2 Treatment references The effect of pregnancy on asthma varies; deterioration is slightly more common than improvement, but most pregnant women do not have severe attacks. The effect of asthma on pregnancy also varies... read more ).
For an acute exacerbation, in addition to bronchodilators, methylprednisolone 60 mg IV every 6 hours for 24 to 48 hours may be used, followed by oral prednisone in a tapering dose. Women who are currently receiving or have recently required systemic corticosteroids should receive intravenous corticosteroids during labor and for 24 hours after delivery to prevent adrenal crisis.
Treatment references
1. Bonham CA, Patterson KC, Strek ME: Asthma outcomes and management during pregnancy. Chest 153(2):515-527, 2018. doi:10.1016/j.chest.2017.08.029
2. Källén B, Rydhstroem H, Aberg A: Congenital malformations after the use of inhaled budesonide in early pregnancy. Obstet Gynecol 93(3):392-395, 1999.