By Kathleen MacNaughton, R.N
Asthma and pregnancy may not seem like a winning combination to an expectant mother. Don’t worry, though. If you have asthma and are thinking of becoming pregnant or just found out that you are expecting, rest assured. If you continue to manage your asthma well, there is no reason that asthma in pregnancy will keep you from having a normal, healthy baby.
However, asthma during pregnancy can cause serious complications – for both you and your infant – if it is not controlled properly. So, it’s important that you take a proactive approach to your asthma and your pregnancy, so that everyone stays healthy.
How Pregnancy Can Affect Asthma
The effect of pregnancy on asthma is kind of unpredictable. Studies have shown that slightly over a third of women will have their asthma symptoms worsen during pregnancy. Another third will stay the same, and slightly under a third of women will actually experience improvement in their asthma in pregnancy. There is no way to know which will happen to you, so the important thing is to work closely with your allergy specialist to keep things under control throughout your pregnancy.
Experts aren’t sure why some women’s asthma symptoms get worse. But typically, if things do get worse, it’s during the end of the second trimester or beginning of the third trimester. The increase in symptoms could be because as the baby grows, the womb presses on the diaphragm, making breathing more difficult. Or, the compaction in the abdominal area may lead to gastroesophagel reflux (GERD for short), which can worsen asthma symptoms. Stress may also play a role.
We don’t know why some women feel better with their asthma in pregnancy, either. But experts theorize that it might have to do with an increase in the hormone cortisol that occurs during pregnancy.
The good news is that if you’ve been pregnant before, then you probably know what to expect in the future with pregnancy and asthma, because it’s usually the same each time. Also, no matter what happens during your pregnancy, don’t worry too much about having a safe delivery – as long as you’ve kept your asthma under control. Only about 1 in 10 women have asthma symptoms during labor and delivery.
How Asthma Can Affect Pregnancy
If asthma is well–controlled, it shouldn’t affect your pregnancy. But, if asthma during pregnancy is not kept under control, then high blood pressure and a condition called pre–eclampsia could result. Pre–eclampsia causes fluid retention and leaking of protein into the urine, which can lead to a number of health problems. Although usually the woman will recover after the delivery, her condition could progress to seizures, which can threaten both mom and baby’s lives.
How Asthma Can Affect Your Unborn Baby
Again, as long as your asthma is under control, your baby will not be affected by it. However, if your asthma is poorly controlled, you will likely have less oxygen in your blood. And, since your baby receives oxygen from you, this could mean your baby is not getting enough oxygen. Lack of oxygen can affect fetal growth and development, because fetuses require a constant supply of oxygen and nutrients in order to thrive.
Keep You & Baby Healthy by Staying in Control with Asthma
As you can see, keeping your asthma in pregnancy under control is the key to mother and baby’s health. Since control is a realistic goal for most asthmatics, there is no reason why this should not be possible for most pregnant women too. Here are the steps you need to take to stay in control of asthma during pregnancy:
- Partner with your medical team to manage your asthma. A pregnant woman with asthma needs to have regular prenatal care from an obstetrician, starting as soon as you suspect you are pregnant. The doctor can use ultrasound, fetal heart monitoring and other measures to assess your baby’s health. But you will also need to stay in touch with your allergist or pulmonologist, especially if control begins to slip, so that adjustments can quickly be made in your asthma management plan. Don’t rely on your obstetrician for asthma management. Ideally, spirometry or at least a peak flow reading should be done monthly. That way, treatment can be stepped up or down as needed.
- Keep taking your asthma medication, as well as allergy medication, if prescribed. The best way to keep asthma under control is to use the medication your doctor has prescribed. Studies show that most inhaled asthma medicines, especially inhaled steroids and albuterol, are safe to take during pregnancy.
- Asthma treatment guidelines recommend budesonide, in particular, as there is the most data regarding its safety. The guidelines also recommend that pregnant women who have nasal allergy symptoms be treated with an inhaled nasal steroid, because it acts only on the nasal membranes. If oral antihistamines are preferred, then Claritin or Zyrtec are recommended.
- You might still be worried about the effect medicines can have on your baby. However, the bottom line is that uncontrolled asthma is much riskier for your baby than asthma and allergy medicines.
- If you are taking allergy shots when you become pregnant, it is also safe to continue taking them, as long as your allergist monitors the dose carefully to avoid any allergic reactions. Pregnant women should not start allergy shots during the pregnancy, however.
As mentioned earlier, very few pregnant asthmatic women have difficulty with asthma symptoms or asthma attacks during labor and delivery. But just in case, it’s a good idea to have an up–to–date Asthma Action Plan to guide you and your healthcare team, so that quick action can be taken. It’s also important that fetal monitoring be done during labor. For low–risk moms with good asthma control, 20 minutes of electronic fetal monitoring right after you get to the hospital in labor is usually sufficient.
Asthma’s Effect on Your Newborn Infant
Many new mothers have concerns about whether breastfeeding is safe for their babies, considering they are taking medication. Breastfeeding has many benefits for both you and your baby, both physically and emotionally. Medicines can be passed from mother to baby through breast milk. But there has been no evidence that asthma or allergy medicines are harmful to a nursing infant. So, in most cases, the same medicines that can be taken safely during pregnancy can also be used when nursing. Check with your allergist if you have any concerns, however.
Also, if you can, schedule your medications to be taken at least 15 minutes after you nurse your baby and 3 to 4 hours before the next feeding to lower any risk even further.
New mothers may also worry that they have passed asthma on to their babies. This is actually a valid concern, as one of the main risk factors for developing asthma in children is having a parent with asthma, especially with first–born babies. But you can take measures to help protect your child, such as:
- Stop smoking and/or keep your child from regular exposure to secondhand tobacco smoke.
- Keep your home as allergen–free as you can.
- Keep your baby’s weight within a healthy range.
- Live in a place where air quality is good, such as limited car exhaust fumes and smog.
- Manage your stress, since maternal distress can increase asthma risk in children.
Pregnancy can be a joyous time for the expectant mother. But it can also be an anxious time, if you worry that everything you do might harm your fetus. The good news is that asthma in pregnancy, as long as you stay in control, should cause little reason to worry. With good medical care and a solid asthma management plan, you and your baby should be able to stay healthy during your pregnancy and beyond.