Asthma is one of the most common potentially life-threatening condition complicating pregnancy. The incidence of asthma is increasing steadily and it is estimated that asthma currently affects 4 of pregnant women. In rare cases asthma may occur for the first time during pregnancy. In general well controlled asthma is not associated with a higher risk of adverse pregnancy outcomes.
In fact the most common cause of worsening asthma in pregnancy is due to noncompliance with medicines.
It is seen that about one third of the pregnant women with asthma experience worsening of their asthma symptoms during pregnancy.
One third of the asthmatic women feel better during pregnancy.
Asthma exacerbations are more frequent at the beginning of the third trimester of pregnancy and improves a few weeks before labor.
10 % of the pregnant women suffering from asthma seek emergency care during the pregnancy.
Oxygen is vital for the well being of the mother and the fetus. Every pregnant woman needs a proper treatment to maintain normal lung functions and oxygen level to maintain proper oxygen supply to the fetus.
Asthma patient should receive education about maintenance and rescue medication, how to measure PEFR by peak flow meter, proper use of inhalers, asthma prevention, and adherence of asthma action plan. Patient should also learn when the asthma is worsening and when to contact the doctor.
Spirometry is the preferred method for pulmonary function testing during outpatient visits. However, peak expiratory flow measurement with a peak flow meter is also adequate.
Effect of Asthma on mothers:
Pre eclampsia.
Placenta previa.
Gestational hypertension.
Prolonged hospital stay.
Fetal complications include:
Increased risk of perinatal mortality
Intra uterine growth retardation.
Low birth weight.
Neo natal hypoxia.
The American College of Obstetricians and Gynecologists (ACOG) has issued a practice bulletin for management of asthma during pregnancy. The new recommendations appear in the February issue of Obstetrics & Gynecology 2008. They are:
1. Prevent hypoxic episodes in mother there by maintaining adequate fetal oxygenation.
2. Monitor lung functions by Spirometry preferred.
3. Avoid and controlling asthma triggers.
4. Patient education
Individualized pharmacotherapy to maintain normal pulmonary functions.
1. Control day time and nocturnal symptoms.
2. Maintain normal activity levels including exercise.
3. Prevent acute exacerbations of asthma.
4. No emergency department visit or hospitalization.
5. Avoid adverse effects of medications to mother and child.
