Asthma: Management during Pregnancy

Abstract

Asthma is one of the most common diseases complicating pregnancy. Uncontrolled asthma can produce serious maternal and fetal complications; prompt initiation of effective treatment, both pharmacologic and nonpharmacologic, is critical. With attentive and appropriate management most asthmatics can anticipate a pregnancy outcome similar to an average uncomplicated pregnancy. In patients with severe asthma there remains a higher incidence of preterm delivery and low infant birth weights. The physiologic changes of pregnancy do not alter spirometry and peak expiratory flow rates, which can be employed to monitor the severity of asthma during pregnancy. Early fetal monitoring with sonography provides a benchmark for progressive fetal growth. Sequential sonographic evaluations are indicated if asthma is moderate or severe or if growth retardation is suspected. Patients with anything more than mild occasional asthma should be treated with anti-inflammatory agents (inhaled steroids or cromolyn/nedocromil). Long-acting beta-2 agonists and/or theophylline can then be added. Only 10% of women with asthma have an exacerbation during labor. Patients receiving recent oral corticosteroids should receive stress dose steroids during labor and for 24 hours postpartum.

Key Words:

asthma - pregnancy - pharmacotherapy