Asthma in pregnancy

Many women who have asthma or allergic asthma are concerned about how their condition will affect pregnancy. First and foremost, most fear permanent damage to the child. Many pregnant women also wonder whether their asthma medication could harm the baby . Here’s what you should know about asthma during pregnancy.

Asthma in pregnancy: medication is important

Many women worry that asthma could harm their unborn child. The good news first: Scientists have largely dispelled these concerns. Studies show that asthmatics do not have an increased risk of complications during pregnancy compared to non-asthmatics; however, only if the disease is well controlled with medication.

So, there is no reason to take your illness lightly before or during pregnancy or to stop taking your medication. What otherwise causes problems for healthy women during the nine months – weight gain, shortness of breath and heartburn, for example – is particularly noticeable in asthmatics.

 

Untreated asthma: consequences for the baby

The essential requirement for an uncomplicated pregnancy with asthma is optimal medication and the avoidance of asthma attacks. All known triggers, such as allergens such as pollen, house dust mites or animal hair, cigarette smoke, or polluted air, must be consistently avoided.

Poorly treated asthma causes the oxygen levels in the mother’s blood to drop. The oxygen content is lower here because the unborn child is also supplied with maternal blood. However, because the fetus needs constant oxygen levels to grow and survive healthy, fluctuations in oxygen supply caused by asthma can significantly decrease the baby’s birth weight.

In addition, poorly controlled asthma and asthma attacks can lead to complications and preterm birth. Therefore, It is particularly important to treat asthma or allergic asthma appropriately during pregnancy.

An asthma attack during pregnancy is always considered an emergency because it endangers the child’s oxygen supply. The uterus may also contract during the seizure. Therefore, an ambulance should always be called, and hospital treatment should occur.

Asthma medications during pregnancy

Even if medication should be avoided during pregnancy as far as possible, experts give the all-clear regarding asthma medication: numerous studies have not been able to prove the risk of increased deformities after asthma medication. This also applies to cortisone, which experts still consider indispensable in many cases.

The risk from uncontrolled asthma is many times higher than the risk from targeted and controlled asthma therapy. However, the drugs are preferably given as aerosols and sprays during pregnancy to avoid the transfer of the active substance into the child’s bloodstream as far as possible. However, after careful consideration, the doctor can also prescribe cortisone tablets to get severe cases of asthma under control.

 

What medications are there?

In addition to sprays containing cortisone, intended to curb chronic inflammation of the airways, so-called beta2 sympathomimetics such as salbutamol are primarily used for asthma during pregnancy, which expands the bronchi. Despite long-term use of this drug, no negative consequences for unborn children have been observed.

Theophylline can also be used as an asthma drug during pregnancy, provided the doctor regularly determines the blood level of the drug.

There is not enough experience with leukotriene antagonists, which is why these drugs should be used with caution in pregnant women, i.e. only if better-researched medications have not been successful.

By the way, If allergic asthma is already being treated by hyposensitization (specific immunotherapy) at the beginning of pregnancy, this therapy can usually be continued. However, treatment should not be started during pregnancy.

Does asthma get worse or better during pregnancy?

The question of whether asthma itself worsens or improves during pregnancy is best answered with “as well as”. Extensive studies have shown that the symptoms worsened in 37 per cent of all patients, improved in 29 per cent and remained constant in around 34 per cent.

Experience has shown that deterioration often occurs at the end of the second and beginning of the third trimester. In the last four weeks of pregnancy, on the other hand, the situation often improves.

One reason for the worsening of asthma during pregnancy is the backflow of stomach acid into the oesophagus. This causes heartburn and triggers asthma flare-ups in some women. On the other hand, an improvement in asthma is attributed to increased cortisone production.

Regular lung function tests are advisable.

During pregnancy, asthmatics not only have to attend gynaecological check-ups, but they also have to monitor their underlying disease consistently. This includes lung function tests at the beginning and – if the lung function is impaired – at least every four weeks during pregnancy. If the asthma is particularly severe, the intervals should be significantly shorter. Peak flow should be measured and recorded daily.

An arterial blood gas analysis is recommended as part of preventive medical check-ups to identify any risk to mother and child at an early stage. Regular prenatal ultrasound examinations provide information about the child’s growth and development.

 

Asthma: natural birth or cesarean section?

In principle, asthma does not mean that a natural birth can be ruled out. In this case, too, the question of whether the child should be delivered by caesarean section or vaginally is more of a personal decision than a medical necessity.

Even if the disease gets worse during pregnancy, the risk of miscarriage or premature birth does not increase. This resulted from a study in which 873 pregnant women with mild asthma, 866 with moderate to severe asthma and 881 without asthma took part. Here, too, the complication rate was comparable in all three groups. However, women with severe asthma were more likely to give birth by caesarean section.

An epidural pain reliever during a vaginal delivery reduces oxygen consumption and minute ventilation, which reduces the risk of seizures. Sufficient fluids and appropriate pain management also make childbirth easier. All drugs that release histamine must be avoided. Regular medication should also be taken during the birth. The mother is given oxygen if the oxygen saturation is below 95 per cent.

Complaint-free mother, healthy child

All measures aim to bring a healthy child into the world and to avoid all complications for the mother. That is why regular asthma checks also include a written therapy plan that clarifies how the medication can be changed in an emergency and what measures can be taken during an asthma attack. The emergency measures already in force before the pregnancy are now particularly applicable.

In any case, patients should see a doctor or go to a hospital immediately if:

• the treatment is not working at all
• the treatment is short-lived
• the complaints increase
• the child moves less than usual or not at all

Constant research is carried out to ensure that mother and child remain healthy. One of the latest findings is that allergy sufferers can get pregnant more quickly than healthy women. The reason for this lies in an altered relationship between specific immune cells. This makes it easier for the embryo to nest in the uterus – even in women with asthma.