Do I Need To See My Asthma Specialist More Frequently Now That I Am Expecting?

Yes, while you are pregnant, you should see your asthma specialist more frequently than before. In my practice, for example, I ask my pregnant patients with asthma to schedule a monthly visit, about as often as they visit the obstetrician. Some women may require more frequent appointments, and some less.

Now that you are pregnant, you and your asthma doc-tor have an extra point to think about and to take into consideration. The special extra concern is, of course, the health and well-being of the developing fetus. One of the goals of prenatal care for mother and child is the maintenance of a healthy pregnancy to term. Term refers to the time at which the pregnancy is sufficiently advanced to permit the birth of a healthy, fully developed infant, and is defined as anytime after 37 weeks of gestation.

A baby’s due date is calculated so that it falls exactly 40 weeks after the first day of the mother’s last menstrual period. The developing infant is carried in the mother’s uterus (or womb). The intrauterine environment is an ideal environment for the fetus, with controlled temperature, oxygen, nutrients, and stimuli.

The fetus’s oxygen is supplied via the mother’s blood-stream through the placenta. The mother’s blood oxy-gen, in turn, reflects her lung function. The overriding principle of asthma treatment in pregnancy is the pro-vision of adequate oxygen to the developing fetus by careful yet aggressive treatment of maternal asthma. The risks of uncontrolled asthma to the mother and infant are far greater than the possible or potential risks of prescribed medication.

The outcome of pregnancy for a woman who has well-controlled asthma can be expected to be no different from the outcome of a woman without asthma. The emphasis is on well-controlled asthma. The goals of asthma treatment in pregnancy parallel those of asthma treatment in general (Table 55). Adherence to prescribed medication is emphasized along with continued lung function and symptom monitoring.

Avoidance of known asthma triggers is encouraged as much as possible. Influenza vaccination, as mentioned in Question 81, is recommended for pregnant women who have no contraindication to the vaccine, especially for those who will be in their third trimester of pregnancy during the fall and winter influenza season. Influenza vaccination is safe in pregnancy.

The vaccine should not be administered if the patient is allergic to eggs or is allergic to any of the constituents of the vaccine.

Asthma and Pregnancy: Key Points

In pregnancy, about one third of women with asthma experience a worsening of their asthma and an increased medication requirement, another third have no significant change in their asthma, and about one third have asthma that is less symptomatic or improved.
Most asthma exacerbations in pregnancy tend to occur between the 24th and the 36th weeks of pregnancy.
Flares are rare during the last 4 weeks of pregnancy, and during labor and delivery.
Poorly controlled asthma in pregnancy is associated with potentially serious complications for both mother and baby, including:

  • Dangerous maternal blood pressure changes (preeclampsia)
  • Premature birth
  • Intrauterine growth retardation
  • Low birth weight

Uncontrolled asthma in pregnancy poses a greater risk to mother and fetus than any medicine indicated in asthma treatment.
Well-controlled asthma in pregnancy does not place the mother or infant at increased risk.
Asthma treatment goals in pregnancy include:

  • Avoidance of asthma triggers (allergic and non-allergic)
  • Absence of asthma symptoms, without restricted activity
  • Restful sleep, uninterrupted by any asthma symptoms
  • Optimized peak flow (PEF) and lung function (FEV1) measurements
  • Adherence to prescribed asthma medicines
  • Avoidance of cigarette smoke (both maternal smoking and “passive or secondhand”)
  • Influenza vaccination for women (who have no absolute contraindication to the vaccine)