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Semin Respir Crit Care Med 2017; 38(02): 160-173
DOI: 10.1055/s-0037-1600906
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA

Asthma during Pregnancy: Exacerbations, Management, and Health Outcomes for Mother and Infant

Vanessa E. Murphy
1   Priority Research Centre Grow Up Well, University of Newcastle, Newcastle, New South Wales, Australia
,
Megan E. Jensen
1   Priority Research Centre Grow Up Well, University of Newcastle, Newcastle, New South Wales, Australia
2   Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
,
Peter G. Gibson
2   Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales, Australia
3   Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, New South Wales, Australia
› Author Affiliations
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Publication History

Publication Date:
22 May 2017 (online)

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Abstract

One in 10 pregnant women worldwide has asthma and of these, 10% will have a severe exacerbation requiring oral corticosteroids (OCSs) in pregnancy. This review of recent publications in the field will describe the effects of exacerbation on maternal and neonatal health, the use of asthma medications during pregnancy, and will suggest novel management approaches for asthma in pregnancy. Pregnancy results in unpredictable changes in the disease; therefore, regular monitoring of symptoms is recommended. Uncontrolled asthma is frequently described in cohorts of pregnant women with asthma, and some recent studies show associations with adverse perinatal outcomes, as previously demonstrated with exacerbations. Guidelines for the management of asthma recommend the continued use of inhaled corticosteroids (ICSs) in pregnancy, with budesonide having a particularly good safety profile. Recent data suggest small effects of asthma and/or asthma medication use on congenital malformations; however, there is less data available on the safety of ICS/long-acting β agonist combinations, which are increasingly used for maintenance treatment. Novel management strategies are needed to address the complex needs of pregnant women with asthma. These include medication nonadherence and the presence of numerous comorbidities which can affect asthma, such as rhinitis, cigarette smoking, obesity, and mental health issues. Inflammation-based management has been shown to be effective in reducing exacerbations in pregnancy and may also improve perinatal outcomes. The involvement of a multidisciplinary team and the assessment of comorbidities have potential to improve the health of mothers and their offspring.

Keywords

asthma - exacerbation - pregnancy - perinatal - inhaled corticosteroid - exhaled nitric oxide - management