Asthma and Pregnancy

Abstract

Asthma is a chronic inflammatory condition affecting up to 10% of all women of child-bearing age. In most patients asthma can be safely treated during pregnancy. However, asthma crises or exacerbations during pregnancy can be life threatening to both the mother and the child. Uncontrolled asthma has been associated with adverse pregnancy outcomes and adverse effects to the fetus (eg, prematurity, low birth weight, increased risk of congenital malformations). Impaired oxygenation during asthma crisis in pregnancy is a major concern. Aggressive treatment of asthma during pregnancy, including the use of systemic corticosteroids if necessary, has been advocated to achieve asthma control and to avoid attacks. Pregnant asthmatics require regular and intensified monitoring. National and international guidelines recommend that antiasthmatic treatment should be maintained and intensified if necessary for the well-being of both the mother and the unborn child. Although there is consensus that the potential risks of uncontrolled asthma during pregnancy outweigh the potential risks of antiasthmatic medications the use of the lowest doses possible to achieve and maintain asthma control is recommended.

Keywords

asthma - pregnancy - maternal - perinatal

• References

• 1 Dombrowski MP, Schatz M ; ACOG Committee on Practice Bulletins-Obstetrics. ACOG practice bulletin: clinical management guidelines for obstetrician-gynecologists number 90, February 2008: asthma in pregnancy. Obstet Gynecol 2008; 111 (2 Pt 1) 457-464
• 2 Bell R, O'Neill M. Exercise and pregnancy: a review. Birth 1994; 21 (2) 85-95
• 3 García-Rio F, Pino JM, Gómez L, Alvarez-Sala R, Villasante C, Villamor J. Regulation of breathing and perception of dyspnea in healthy pregnant women. Chest 1996; 110 (2) 446-453
• 4 Pereira A, Krieger BP. Pulmonary complications of pregnancy. Clin Chest Med 2004; 25 (2) 299-310
• 5 Vatti RR, Teuber SS. Asthma and pregnancy. Clin Rev Allergy Immunol 2012; 43 (1–2) 45-55
• 6 Hardy-Fairbanks AJ, Baker ER. Asthma in pregnancy: pathophysiology, diagnosis and management. Obstet Gynecol Clin North Am 2010; 37 (2) 159-172
• 7 Milne JA. The respiratory response to pregnancy. Postgrad Med J 1979; 55 (643) 318-324
• 8 Ellegård EK. The etiology and management of pregnancy rhinitis. Am J Respir Med 2003; 2 (6) 469-475
• 9 Scadding GK, Durham SR, Mirakian R , et al; British Society for Allergy and Clinical Immunology. BSACI guidelines for the management of allergic and non-allergic rhinitis. Clin Exp Allergy 2008; 38 (1) 19-42
• 10 Hegewald MJ, Crapo RO. Respiratory physiology in pregnancy. Clin Chest Med 2011; 32 (1) 1-13 , vii
• 11 Laffey JG, Kavanagh BP. Hypocapnia. N Engl J Med 2002; 347 (1) 43-53
• 12 Cook PT. The influence on foetal outcome of maternal carbon dioxide tension at caesarean section under general anaesthesia. Anaesth Intensive Care 1984; 12 (4) 296-302
• 13 Curry R, Swan L, Steer PJ. Cardiac disease in pregnancy. Curr Opin Obstet Gynecol 2009; 21 (6) 508-513
• 14 Osman M. Therapeutic implications of sex differences in asthma and atopy. Arch Dis Child 2003; 88 (7) 587-590
• 15 Namazy JA, Schatz M. Update in the treatment of asthma during pregnancy. Clin Rev Allergy Immunol 2004; 26 (3) 139-148
• 16 Kwon HL, Belanger K, Bracken MB. Asthma prevalence among pregnant and childbearing-aged women in the United States: estimates from national health surveys. Ann Epidemiol 2003; 13 (5) 317-324
• 17 Murphy VE, Gibson PG. Asthma in pregnancy. Clin Chest Med 2011; 32 (1) 93-110 , ix
• 18 Tata LJ, Card TR, Logan RF, Hubbard RB, Smith CJ, West J. Fertility and pregnancy-related events in women with celiac disease: a population-based cohort study. Gastroenterology 2005; 128 (4) 849-855
• 19 Lin S, Herdt-Losavio M, Gensburg L, Marshall E, Druschel C. Maternal asthma, asthma medication use, and the risk of congenital heart defects. Birth Defects Res A Clin Mol Teratol 2009; 85 (2) 161-168
• 20 Lin S, Munsie JP, Herdt-Losavio ML , et al; National Birth Defects Prevention Study. Maternal asthma medication use and the risk of gastroschisis. Am J Epidemiol 2008; 168 (1) 73-79
• 21 Blais L, Forget A. Asthma exacerbations during the first trimester of pregnancy and the risk of congenital malformations among asthmatic women. J Allergy Clin Immunol 2008; 121 (6) 1379-1384 , 1384, e1
• 22 Blais L, Kettani FZ, Elftouh N, Forget A. Effect of maternal asthma on the risk of specific congenital malformations: a population-based cohort study. Birth Defects Res A Clin Mol Teratol 2010; 88 (4) 216-222
• 23 Blais L, Beauchesne MF, Lemière C, Elftouh N. High doses of inhaled corticosteroids during the first trimester of pregnancy and congenital malformations. J Allergy Clin Immunol 2009; 124 (6) 1229-1234 , e4
• 24 Katz O, Sheiner E. Asthma and pregnancy: a review of two decades. Expert Rev Respir Med 2008; 2 (1) 97-107
• 25 Murphy VE, Namazy JA, Powell H , et al. A meta-analysis of adverse perinatal outcomes in women with asthma. BJOG 2011; 118 (11) 1314-1323
• 26 Triche EW, Saftlas AF, Belanger K, Leaderer BP, Bracken MB. Association of asthma diagnosis, severity, symptoms, and treatment with risk of preeclampsia. Obstet Gynecol 2004; 104 (3) 585-593
• 27 Bracken MB, Triche EW, Belanger K, Saftlas A, Beckett WS, Leaderer BP. Asthma symptoms, severity, and drug therapy: a prospective study of effects on 2205 pregnancies. Obstet Gynecol 2003; 102 (4) 739-752
• 28 Munn MB, Groome LJ, Atterbury JL, Baker SL, Hoff C. Pneumonia as a complication of pregnancy. J Matern Fetal Med 1999; 8 (4) 151-154
• 29 Bakhireva LN, Schatz M, Jones KL, Chambers CD ; Organization of Teratology Information Specialists Collaborative Research Group. Asthma control during pregnancy and the risk of preterm delivery or impaired fetal growth. Ann Allergy Asthma Immunol 2008; 101 (2) 137-143
• 30 Dombrowski MP, Schatz M, Wise R , et al; National Institute of Child Health and Human Development Maternal-Fetal Medicine Units Network and the National Heart, Lung, and Blood Institute. Asthma during pregnancy. Obstet Gynecol 2004; 103 (1) 5-12
• 31 Murphy VE, Clifton VL, Gibson PG. Asthma exacerbations during pregnancy: incidence and association with adverse pregnancy outcomes. Thorax 2006; 61 (2) 169-176
• 32 Firoozi F, Lemière C, Ducharme FM , et al. Effect of maternal moderate to severe asthma on perinatal outcomes. Respir Med 2010; 104 (9) 1278-1287
• 33 Dombrowski MP, Schatz M. Asthma in pregnancy. Clin Obstet Gynecol 2010; 53 (2) 301-310
• 34 Wegmann TG, Lin H, Guilbert L, Mosmann TR. Bidirectional cytokine interactions in the maternal-fetal relationship: is successful pregnancy a TH2 phenomenon?. Immunol Today 1993; 14 (7) 353-356
• 35 Saito S, Nakashima A, Shima T, Ito M. Th1/Th2/Th17 and regulatory T-cell paradigm in pregnancy. Am J Reprod Immunol 2010; 63 (6) 601-610
• 36 Hancox RJ, Cowan DC, Aldridge RE , et al. Asthma phenotypes: consistency of classification using induced sputum. Respirology 2012; 17 (3) 461-466
• 37 Namazy JA, Schatz M. Asthma and pregnancy. J Allergy Clin Immunol 2011; 128 (6) 1384-1385 , e2
• 38 Bidad K, Heidarnazhad H, Pourpak Z, Ramazanzadeh F, Zendehdel N, Moin M. Frequency of asthma as the cause of dyspnea in pregnancy. Int J Gynaecol Obstet 2010; 111 (2) 140-143
• 39 Novembre E, Bernardini R, Bertini G, Massai G, Vierucci A. Skin-prick-test-induced anaphylaxis. Allergy 1995; 50 (6) 511-513
• 40 Ebo DG, Stevens WJ, De Clerck LS. Latex anaphylaxis. Acta Clin Belg 1995; 50 (2) 87-93
• 41 Sorri M, Hartikainen-Sorri AL, Kärjä J. Rhinitis during pregnancy. Rhinology 1980; 18 (2) 83-86
• 42 Stevenson DD. Aspirin sensitivity and desensitization for asthma and sinusitis. Curr Allergy Asthma Rep 2009; 9 (2) 155-163
• 43 Schatz M, Dombrowski MP, Wise R , et al. Asthma morbidity during pregnancy can be predicted by severity classification. J Allergy Clin Immunol 2003; 112 (2) 283-288
• 44 Schatz M, Harden K, Forsythe A , et al. The course of asthma during pregnancy, post partum, and with successive pregnancies: a prospective analysis. J Allergy Clin Immunol 1988; 81 (3) 509-517
• 45 Gluck JC. The change of asthma course during pregnancy. Clin Rev Allergy Immunol 2004; 26 (3) 171-180
• 46 Barron WM, Leff AR. Asthma in pregnancy. Am Rev Respir Dis 1993; 147 (3) 510-511
• 47 Schatz M. Interrelationships between asthma and pregnancy: a literature review. J Allergy Clin Immunol 1999; 103 (2 Pt 2) S330-S336
• 48 Beckmann CA. Peak flow values by gestation in women with asthma. Clin Nurs Res 2008; 17 (3) 174-181
• 49 Kwon HL, Belanger K, Bracken MB. Effect of pregnancy and stage of pregnancy on asthma severity: a systematic review. Am J Obstet Gynecol 2004; 190 (5) 1201-1210
• 50 Murphy VE, Gibson PG, Talbot PI, Kessell CG, Clifton VL. Asthma self-management skills and the use of asthma education during pregnancy. Eur Respir J 2005; 26 (3) 435-441
• 51 Powell H, McCaffery K, Murphy VE , et al. Psychosocial outcomes are related to asthma control and quality of life in pregnant women with asthma. J Asthma 2011; 48 (10) 1032-1040
• 52 Urbano FL. Review of the NAEPP 2007 Expert Panel Report (EPR-3) on Asthma Diagnosis and Treatment Guidelines. J Manag Care Pharm 2008; 14 (1) 41-49
• 53 Powell H, Murphy VE, Taylor DR , et al. Management of asthma in pregnancy guided by measurement of fraction of exhaled nitric oxide: a double-blind, randomised controlled trial. Lancet 2011; 378 (9795) 983-990
• 54 Barnes N, Greening A. Management of asthma in pregnancy. Lancet 2012; 379 (9821) e43 , author reply e43
• 55 From the Global Strategy for Asthma Management and Prevention GIfAGAfhwgo., Global Initiative for Asthma (GINA) 2011. http://www.ginasthma.org/ . Accessed June 1, 2012
• 56 McCallister JW, Benninger CG, Frey HA, Phillips GS, Mastronarde JG. Pregnancy related treatment disparities of acute asthma exacerbations in the emergency department. Respir Med 2011; 105 (10) 1434-1440
• 57 Martinez FD, Wright AL, Taussig LM, Holberg CJ, Halonen M, Morgan WJ ; The Group Health Medical Associates. Asthma and wheezing in the first six years of life. N Engl J Med 1995; 332 (3) 133-138
• 58 Robison RG, Kumar R, Arguelles LM , et al. Maternal smoking during pregnancy, prematurity and recurrent wheezing in early childhood. Pediatr Pulmonol 2012; 47 (7) 666-673
• 59 Kulig M, Luck W, Lau S , et al. Effect of pre- and postnatal tobacco smoke exposure on specific sensitization to food and inhalant allergens during the first 3 years of life. Multicenter Allergy Study Group, Germany. Allergy 1999; 54 (3) 220-228
• 60 Bakhireva LN, Jones KL, Schatz M , et al; Organization of Teratology Information Specialists Collaborative Research Group. Safety of leukotriene receptor antagonists in pregnancy. J Allergy Clin Immunol 2007; 119 (3) 618-625
• 61 Sarkar M, Koren G, Kalra S , et al. Montelukast use during pregnancy: a multicentre, prospective, comparative study of infant outcomes. Eur J Clin Pharmacol 2009; 65 (12) 1259-1264
• 62 Rocklin RE. Asthma, asthma medications and their effects on maternal/fetal outcomes during pregnancy. Reprod Toxicol 2011; 32 (2) 189-197
• 63 Tata LJ, Lewis SA, McKeever TM , et al. Effect of maternal asthma, exacerbations and asthma medication use on congenital malformations in offspring: a UK population-based study. Thorax 2008; 63 (11) 981-987
• 64 Olesen C, Thrane N, Nielsen GL, Sørensen HT, Olsen J ; EuroMAP Group. A population-based prescription study of asthma drugs during pregnancy: changing the intensity of asthma therapy and perinatal outcomes. Respiration 2001; 68 (3) 256-261
• 65 Wendel PJ, Ramin SM, Barnett-Hamm C, Rowe TF, Cunningham FG. Asthma treatment in pregnancy: a randomized controlled study. Am J Obstet Gynecol 1996; 175 (1) 150-154
• 66 Vogt H, Lindström K, Bråbäck L, Hjern A. Preterm birth and inhaled corticosteroid use in 6- to 19-year-olds: a Swedish national cohort study. Pediatrics 2011; 127 (6) 1052-1059
• 67 Christensson C, Thorén A, Lindberg B. Safety of inhaled budesonide: clinical manifestations of systemic corticosteroid-related adverse effects. Drug Saf 2008; 31 (11) 965-988
• 68 Ernst P, Suissa S. Systemic effects of inhaled corticosteroids. Curr Opin Pulm Med 2012; 18 (1) 85-89
• 69 Sawicki E, Stewart K, Wong S, Paul E, Leung L, George J. Management of asthma by pregnant women attending an Australian maternity hospital. Aust N Z J Obstet Gynaecol 2012; 52 (2) 183-188
• 70 Källén B, Rydhstroem H, Aberg A. Congenital malformations after the use of inhaled budesonide in early pregnancy. Obstet Gynecol 1999; 93 (3) 392-395
• 71 Norjavaara E, de Verdier MG. Normal pregnancy outcomes in a population-based study including 2,968 pregnant women exposed to budesonide. J Allergy Clin Immunol 2003; 111 (4) 736-742
• 72 Källén B, Rydhstroem H, Aberg A. Asthma during pregnancy—a population based study. Eur J Epidemiol 2000; 16 (2) 167-171
• 73 Tegethoff M, Greene N, Olsen J, Schaffner E, Meinlschmidt G. Inhaled glucocorticoids during pregnancy and offspring pediatric diseases: a national cohort study. Am J Respir Crit Care Med 2012; 185 (5) 557-563
• 74 Stenius-Aarniala B, Piirilä P, Teramo K. Asthma and pregnancy: a prospective study of 198 pregnancies. Thorax 1988; 43 (1) 12-18
• 75 Bakhireva LN, Jones KL, Schatz M, Johnson D, Chambers CD ; Organization Of Teratology Information Services Research Group. Asthma medication use in pregnancy and fetal growth. J Allergy Clin Immunol 2005; 116 (3) 503-509
• 76 Czeizel AE, Rockenbauer M. Population-based case-control study of teratogenic potential of corticosteroids. Teratology 1997; 56 (5) 335-340
• 77 Rodríguez-Pinilla E, Martínez-Frías ML. Corticosteroids during pregnancy and oral clefts: a case-control study. Teratology 1998; 58 (1) 2-5
• 78 Hasford J, Virchow JC. Excess mortality in patients with asthma on long-acting beta2-agonists. Eur Respir J 2006; 28 (5) 900-902
• 79 Eltonsy S, Forget A, Blais L. Beta2-agonists use during pregnancy and the risk of congenital malformations. Birth Defects Res A Clin Mol Teratol 2011; 91 (11) 937-947
• 80 Lim A, Stewart K, König K, George J. Systematic review of the safety of regular preventive asthma medications during pregnancy. Ann Pharmacother 2011; 45 (7-8) 931-945
• 81 Huff RW. Asthma in pregnancy. Med Clin North Am 1989; 73 (3) 653-660
• 82 Littenberg B. Aminophylline treatment in severe, acute asthma. A meta-analysis. JAMA 1988; 259 (11) 1678-1684
• 83 Demoly P, Piette V, Daures J-P. Treatment of allergic rhinitis during pregnancy. Drugs 2003; 63: 1813-1820
• 84 Werler MM. Teratogen update: pseudoephedrine. Birth Defects Res A Clin Mol Teratol 2006; 76 (6) 445-452
• 85 Spector SL ; Antileukotriene Working Group. Safety of antileukotriene agents in asthma management. Ann Allergy Asthma Immunol 2001; 86 (6, Suppl 1) 18-23
• 86 Keleş N. Treatment of allergic rhinitis during pregnancy. Am J Rhinol 2004; 18 (1) 23-28
• 87 Cox L, Nelson H, Lockey R , et al. Allergen immunotherapy: a practice parameter third update. J Allergy Clin Immunol 2011; 127 (1, Suppl) S1-S55
• 88 Shaikh WA, Shaikh SW. A prospective study on the safety of sublingual immunotherapy in pregnancy. Allergy 2012; 67 (6) 741-743
• 89 Blaiss MS ; National Institute of Health. Management of asthma during pregnancy. Allergy Asthma Proc 2004; 25 (6) 375-379
• 90 Sperling RS, Engel SM, Wallenstein S , et al. Immunogenicity of trivalent inactivated influenza vaccination received during pregnancy or postpartum. Obstet Gynecol 2012; 119 (3) 631-639
• 91 The safety of inactivated influenza vaccine in adults and children with asthma. N Engl J Med 2001; 345 (21) 1529-1536
• 92 Makris MC, Polyzos KA, Mavros MN, Athanasiou S, Rafailidis PI, Falagas ME. Safety of hepatitis B, pneumococcal polysaccharide and meningococcal polysaccharide vaccines in pregnancy: a systematic review. Drug Saf 2012; 35 (1) 1-14
• 93 Morales E, Romieu I, Guerra S , et al; INMA Project. Maternal vitamin D status in pregnancy and risk of lower respiratory tract infections, wheezing, and asthma in offspring. Epidemiology 2012; 23 (1) 64-71
• 94 Martinussen MP, Risnes KR, Jacobsen GW, Bracken MB. Folic acid supplementation in early pregnancy and asthma in children aged 6 years. Am J Obstet Gynecol 2012; 206 (1) 72-77 , e1–e7
• 95 Bekkers MB, Elstgeest LE, Scholtens S , et al. Maternal use of folic acid supplements during pregnancy, and childhood respiratory health and atopy. Eur Respir J 2012; 39 (6) 1468-1474
• 96 Grubbs S, Brundage SC. Preconception management of chronic diseases. J S C Med Assoc 2002; 98 (6) 270-276
• 97 Kattan M, Kumar R, Bloomberg GR , et al. Asthma control, adiposity, and adipokines among inner-city adolescents. J Allergy Clin Immunol 2010; 125 (3) 584-592
• 98 Lowe A, Bråbäck L, Ekeus C, Hjern A, Forsberg B. Maternal obesity during pregnancy as a risk for early-life asthma. J Allergy Clin Immunol 2011; 128 (5) 1107-1109 , e1–e2
• 99 Pali-Schöll I, Renz H, Jensen-Jarolim E. Update on allergies in pregnancy, lactation, and early childhood. J Allergy Clin Immunol 2009; 123 (5) 1012-1021
• 100 Dezateux C, Stocks J, Dundas I, Fletcher ME. Impaired airway function and wheezing in infancy: the influence of maternal smoking and a genetic predisposition to asthma. Am J Respir Crit Care Med 1999; 159 (2) 403-410
• 101 Majithia R, Johnson DA. Are proton pump inhibitors safe during pregnancy and lactation? Evidence to date. Drugs 2012; 72 (2) 171-179
• 102 Matok I, Levy A, Wiznitzer A, Uziel E, Koren G, Gorodischer R. The safety of fetal exposure to proton-pump inhibitors during pregnancy. Dig Dis Sci 2012; 57 (3) 699-705
• 103 Pasternak B, Hviid A. Use of proton-pump inhibitors in early pregnancy and the risk of birth defects. N Engl J Med 2010; 363 (22) 2114-2123
• 104 Mylonas I. Antibiotic chemotherapy during pregnancy and lactation period: aspects for consideration. Arch Gynecol Obstet 2011; 283 (1) 7-18
• 105 Pasternak B, Hviid A. Use of acyclovir, valacyclovir, and famciclovir in the first trimester of pregnancy and the risk of birth defects. JAMA 2010; 304 (8) 859-866
• 106 Menezes AM, Hallal PC, Matijasevich AM , et al. Caesarean sections and risk of wheezing in childhood and adolescence: data from two birth cohort studies in Brazil. Clin Exp Allergy 2011; 41 (2) 218-223
• 107 Davidson R, Roberts SE, Wotton CJ, Goldacre MJ. Influence of maternal and perinatal factors on subsequent hospitalisation for asthma in children: evidence from the Oxford record linkage study. BMC Pulm Med 2010; 10: 14
• 108 Pistiner M, Gold DR, Abdulkerim H, Hoffman E, Celedón JC. Birth by cesarean section, allergic rhinitis, and allergic sensitization among children with a parental history of atopy. J Allergy Clin Immunol 2008; 122 (2) 274-279
• 109 Magnus MC, Håberg SE, Stigum H , et al. Delivery by cesarean section and early childhood respiratory symptoms and disorders: the Norwegian mother and child cohort study. Am J Epidemiol 2011; 174 (11) 1275-1285
• 110 van Nimwegen FA, Penders J, Stobberingh EE , et al. Mode and place of delivery, gastrointestinal microbiota, and their influence on asthma and atopy. J Allergy Clin Immunol 2011; 128 (5) 948-955 , e1–e3