Asthma in Pregnancy

- One third of asthmatic patients will experience an improvement in their symptoms during pregnancy, one third will suffer a worsening and one third notice no change.

- In those that deteriorate, the peak severity is between weeks 24 and 36 after which symptoms improve with attacks being very unusual in labour because of endogenous steroid production.

- No adverse outcomes have been demonstrated with the use of inhaled β2 agonists, inhaled steroids, theophyllines or magnesium during pregnancy. Oral steroids do not have convincing evidence of harm and the British Thoracic Society concludes that the detriment to mother and foetus by not adequately treating acute severe asthma outweighs the potential, unproven risk of systemic steroids in pregnancy.

- Uncontrolled asthma during pregnancy is associated with hyperemesis, hypertension, pre-eclampsia, premature delivery and low birthweight babies. Emphasis is therefore on maintaining good control with the patient's pre-pregnancy medications, regular clinical review and rapid treatment of acute severe asthma with drug therapy as for the non-pregnant patient.


Reference
British Thoracic Society/Scottish Intercollediate Guidelines Network. 101 British Guideline on the Management of Asthma: a National Clinical Guideline. NHS QIS, May 2008, revised June 2009. Online at www.sign.ac.uk/pdf/sign101.pdf  (Accessed 30 October 2009)