Asthma in Pregnancy – Risks, Symptoms & Treatment

Having asthma in pregnancy can make pregnant women worry if their condition could in any way harm their babies. Asthma is a long-term inflammatory disease of the lungs that constricts the airways due to swelling and results in an attack in the form of chest tightness, shortness of breath, or coughing. It is variable and recurring in nature. In fact, pregnancy is a time when asthma symptoms may even improve. Asthma is also one of the most common complications which can be controlled and reduced effectively. In this article, we discuss symptoms, causes, how the condition affects pregnancy, what to do if you experience an asthma attack in pregnancy, and tips for navigating pregnancy with asthma. Scroll down!

Asthma and Pregnancy

According to the Cleveland Clinic, about 40% of women experience worsening of asthma during pregnancy, while the remaining 60% either don’t notice changes or actually have their symptoms improved (1). Thus, the condition could improve, stay the same, or deteriorate during the gestation period. But three months after delivery, your condition will return to the condition it was before pregnancy. If the condition does deteriorate, it happens mostly in the third trimester, which could result in premature delivery. Such adverse results can be avoided by controlling the disease under the guidance of your doctor.

It is also important to note that the chances of asthma during pregnancy 2nd trimester are similar to the chances of asthma during the 3rd trimester.

Asthma Symptoms When Pregnant

The symptoms of asthma when pregnant are the same symptoms experienced in general. The symptoms can either be regular or may appear occasionally as asthma attacks, where you go from being perfectly fine to suddenly having a problem with breathing.

According to Brown University Health, a pregnant woman with asthma may experience any of the following (2):

• Shortness of breath
• Chest tightness
• Coughing, which could go from mild to severe
• Wheezing, which appears as a coarse or shrill sound when your airway is partially blocked

Different Causes of Asthma

1. Hormonal Changes

Hormonal fluctuations can sometimes dry out the sinuses, causing them to become inflamed. This could make your nose feel stuffy, making breathing difficult.

2. Environmental Triggers

Asthma can happen as a result of exposure to various agents or could be more frequent during the night time. A few of the agents which trigger an attack are:

• Dust
• Animal hair or feathers
• Pollen
• Respiratory tract infections
• Smoke
• Physical strain

3. Temperature or Weather

Sometimes attacks could be caused by fluctuations in temperature or weather conditions, making you more susceptible during the night. This is due to sudden changes in the temperature or humidity of the air you breathe in.

4. Stress

Attacks have also been found to occur when there is stress, anxiety or, in the case of very sensitive individuals, a fit of laughter.

5. Acid Reflux

Surprisingly, acid reflux caused during pregnancy can also make the pre-existing condition worse (3). It’s when the stomach acid travels up the oesophagus tube towards your throat.

How Does Asthma Affect Your Pregnancy?

The effect of asthma depends on your exposure to a trigger, duration of your attack and quickness with which you respond to it. When an asthma attack hits, it constricts your bronchial tubes and decreases the airflow into your lungs substantially. In such cases, the oxygen level in the blood depletes, and all the cells in the body become hypoxic (receiving less oxygen). This, in turn, reduces the amount of oxygen which reaches your growing baby. When under such stress, the quickness of your medical response determines how long your baby is exposed and the influence of stress on the baby.

According to the Asthma and Allergy Foundation of America, a few of the complications from uncontrolled asthma are possible and include (4):

• preeclampsia
• pregnancy-induced hypertension
• uterine haemorrhage
• preterm labour
• premature labour
• congenital anomalies

Such risks and complications can be reduced drastically by controlling the disease and being vigilant when an attack hits. It has been observed that more women with the condition had preterm labour than those without the condition.

Diagnosis of Asthma During Pregnancy

The diagnostic process for asthma in pregnancy is similar to the general diagnosis. Taking your pregnancy into consideration, your doctor will only recommend you tests that are safe for you and your developing baby. The diagnosis may follow as (1):

• Taking note of medical history, symptoms experienced, and when they tend to worsen.
• Physical examination.
• Spirometry, which is a test that measures the airflow throughout your lungs
• If needed, your doctor may prescribe you some blood tests or imaging procedures to understand whether any other conditions are triggering your asthma.

Asthma Treatment and Management During Pregnancy

Asthma treatment and pregnancy is simple. Consult your OB/GYN to discuss the medications and treatment you followed prior to when you conceived. All asthma medicines have been declared safe for ingestion during pregnancy and do not affect your baby in any way whatsoever. Stopping the medications can put your baby at risk (1). Treating a mild symptom of an asthma flare-up early on can help prevent it developing into a severe asthma attack (1). If you are concerned about the baby inheriting asthma, it can be closely monitored and checked for symptoms via an ultrasound.

According to the guidelines released by the Australian National Council in 2014, management of asthma for pregnant women has been regarded as the same as for non-pregnant women with asthma. The main focus of asthma management in pregnancy would be (5):

• Prevention of exposure to attacks during the day and night due to fluctuations in temperature and humidity.
• Maintaining a normal pulmonary status and healthy non-strenuous activities.
• Minimising the exposure to attacks.
• Using therapies with minimal side effects during pregnancy.

It is not sufficient to maintain your own health, but constant checks on the growing baby are also required to make sure a healthy flow of oxygenated blood is maintained. It has been found that most drugs are safe for the growing baby, transmitting very few side effects. The following table gives a list of drugs which have been studied for their safety and complication-imparting consensus.

No medicine has been tested to be entirely safe during pregnancy, but it is highly recommended that you continue with your treatment so as to reduce the triggers and nullify any complications due to an attack.

How to Prevent Asthma Attacks During Pregnancy?

Asthma can be minimised or prevented greatly during pregnancy if the following measures are taken:

1. Avoid Triggers

The main step in minimising asthmatic attacks during pregnancy would be to identify your trigger. Triggers may differ from one individual to another. A few of the triggers could be –

• Dust – Let somebody else do the dusting and make sure you cover your face with a dupatta or a mask when someone is dusting so as not to breathe in any minute particles.
• Dust mites – These are mostly found in dust and are very common on bedspreads or sofa cushions. Make sure you wash and change the linen every week.
• Animal hair or feathers – Avoid coming in contact with pets or any animal fur, which could be a trigger for you.
• Pollen – During the spring season, minimise going out as much as you can or cover your face to trap the tiny pollen seeds. Make sure to stay away from fields of flowers or not get caught in a windy situation, which would carry these pollen grains.
• Fluctuating temperatures or weather – Most women become susceptible to attacks during the night. Due to the drop in temperature and change in humidity, the sensitive nasal tract is affected, and an attack is instigated. If you are influenced by such factors, make sure you take extra precautions as the night approaches to gradually adapt your body to accept the change. Avoid entering or exiting a stuffy room because the sudden change in temperature could act as a trigger. Use a face mask during such conditions.

2. Maintain a healthy and calm environment

Practice yoga, eat healthy foods and be positive. In case there is an onset of an attack, keep your medications and your inhaler in an easily accessible area known to all your family members. This makes it easier for them to assist you during an attack. Sit (do not lie down), keep calm, concentrate on drawing in deep, full breaths and do not get tense. If the condition persists, consult your doctor immediately.

3. Vaccination During Pregnancy

Vaccination is highly necessary to protect you and your baby from developing severe infection. Vaccinations for whooping cough (pertussis), respiratory syncytial virus (RSV), and influenza (flu) are recommended during pregnancy to prevent complications from arising, including breathing issues (6).

FAQs

1. Will asthma medications harm my newborn baby?

No. Most of the asthma medications prescribed for non-pregnant women have been deemed safe for pregnant women as well. The treatment, though, would need to be checked and planned according to how pregnancy influences the disease condition.

2. What do I do if my asthma gets worse during pregnancy?

If you are among the one-third whose asthma worsens during pregnancy, then consult your doctor. Explain your condition to them and plan out a routine for your treatment. As mentioned before, asthma can be controlled via medications which are considered pregnancy-safe. Your doctor will draw up a treatment plan for asthma during your pregnancy by changing a few of your medications. It is essential that you follow this plan until you deliver.

3. How does asthma affect labour and birth?

The occurrence of an asthma attack during labour is very rare because your body is already releasing adrenaline and cortisone during the birthing process. This negates the asthma attack to a large extent. However, if you’re not comfortable, consult your doctor and bring your inhaler along just in case.

4. What if I get an asthma attack during labour?

It is very rare that a woman gets an asthma attack during her labour. If you have this concern, you can inform your doula or birthing doctor in advance so that medical arrangements for conditions like these are already taken care of.

There needs to be no fear regarding asthma and pregnancy. With proper precautions, it can be easily managed. If you opt to go through a Caesarean, it is advised to use a spinal anaesthetic over a general anaesthetic because you are awake and any complications can be caught early and controlled effectively. It is also safe to use any pain relievers available for all asthmatic women.

Also Read: 

Bronchitis during Pregnancy
Trouble Breathing in Pregnancy
Breathing Exercises for Pregnant Women

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Sources References

1. Cleveland Clinic – Asthma & Pregnancy

2. Brown University Health – Asthma During Pregnancy

3. NHS – Asthma and pregnancy

4. Asthma and Allergy Foundation of America – Asthma During Pregnancy

5. National Library of Medicine – Managing asthma in pregnancy

6. National Asthma Council Australia – Pregnancy and asthma