asthma and pregnancy

Asthma and Pregnancy

Asthma and Your Baby


It is not always the case that your asthma will affect your pregnancy or the health of your unborn child. In fact studies have shown that up to a third of pregnant asthmatic women suffered absolutely no complications related to their condition. Strangely enough another third in the studies showed that for some unknown reason, asthma and pregnancy actually complemented each other when compared to previous gestation periods. Only a third found that pregnancy caused their asthma to worsen. For that unfortunate third of the women, extra care would have to be taken when compared with standard management of their asthma. However even in these women, there was no adverse side effects related to the health of the baby during pregnancy.


Asthma Symptoms – First Trimester and Beyond


asthma and pregnancyAfter 12 weeks into pregnancy when the baby is growing rapidly, you will have a very good idea of how pregnancy and asthma are affecting each other. It’s generally the rule that if the first 3 months of the pregnancy go okay then the remaining six months should not present any problems. Unfortunately the reverse is true. So if you do have asthma related problems within the first three months then is likely that these problems will continue for the whole nine months.


Medication during Pregnancy – What to Avoid


Although asthma is treated in the same way during pregnancy as at other times, care should be taken in the first few weeks to avoid any additional medication unless specifically advised to by your doctor. You need to be aware of any other substances such as cough mixtures, cold and flu remedies etc., that might contain drugs that could aggravate your asthma in normal circumstances, but even more so when pregnant. There are medications on the market used in the treatment of asthma that should be avoided completely during pregnancy such as:


  • Phenylpropanolamine
  • Phenylephrine
  • Potassium iodide
  • tetracycline
  • Aminoglycoside side antibiotics
  • Trimethoprim
  • Codeine
  • Sulphonamides
  • Ciprofloxacin
  • Adrenaline (except under medical supervision)


If you are already taking any prescription medication it would be best to check for any of these ingredients on the label and also discuss this list with your doctor if you are concerned. In the case that you are prescribed antibiotics then a penicillin or erythromycin based course would be a less dangerous option than a tetracycline (minocycline, achromycin, terramycin, aureomycin, doxycycline etc) or an aminoglycoside (gentamycin, neomycin, tobramycin, amikasin, netilmycin, kanamycin etc.) Aminoglycosides have been associated with severe damage to the inner ears of the baby, and long-term hearing problems. Tetracyclines can cause yellowing of the teeth, inhibit bone development and growth, and cause damage to the baby’s liver.


Allergic, Hereditary and Genetic Asthma during Pregnancy


Sadly, there is a lack of decent information about the hereditary nature of asthma and this leads to a lot of confusion. Another factor is that it is commonly believed that asthma can worsen with the onset of pregnancy. Some forms such as allergic asthma can be genetically inherited and if you have atopic asthma in your family, then no doubt you’ll be conscious of the fact that it can worsen as pregnancy develops. It is also possible that you can pass atopic asthma to on to your children.


Current research has shown that the gene which causes atopy seems to be passed down via the mother’s line rather than the fathers. So if you are concerned about passing this on to your baby it will be influenced by your own family rather than your partner’s. Having said that, even if the gene is passed on, your child has an 80 per cent chance of not developing the associated asthma.


Asthma in the Pregnant Mother


Breathlessness is not necessarily anything to be worried about as it is a natural side effect of being pregnant and does not always indicate an asthma attack. Anxiety over natural breathlessness can actually cause your asthmatic symptoms to worsen and develop into wheezing. So it’s important to try and remain calm. There is extra strain on your body now, and so it is natural to get out of breath as your weight increases.


A word of encouragement. Studies have shown asthma can actually improve during pregnancy and labour. The reasons are not completely understood but it probably has something to do with an increase in the amount of cortisone being produced as a result of your changing physiological condition.


Although rare, it has been known that asthma can occur for the first time in a woman’s life when she becomes pregnant. This could be due to increased sensitivity to certain substances, in a way similar to a temporary allergy. In these rare cases the symptoms usually disappear following childbirth.


Can Asthma Harm my Baby?


There is not much harm done to the unborn baby even when the mother does suffer from an asthma attack. Attacks can last from just a few minutes to several days. It is more than likely that you will suffer from smaller bouts of wheezing and bronchiospasms, which occur as a result of inflamed muscles lining the bronchioles, the air passages in the lungs.


It takes a very severe and prolonged asthma attack resulting in low blood oxygen levels – hypoxia – to cause serious complications such as intrauterine growth restriction or a premature birth.


Avoid Situations that Trigger Attacks


If you have been suffering from asthma for any length of time you will no doubt be aware that there are certain circumstances that trigger attacks. Now that you are pregnant, it would be best to rethink previous episodes, where you were, what triggered the attack and do what you can to avoid repeating the experiences. As stated earlier, pregnancy can actually reduce the severity and frequency of asthma attacks but is still best to maintain best health, a good diet and plenty of rest – and steer clear of known stress inducing situations.


Medical Considerations in Pregnancy when Asthmatic


In the case of a severe asthma attack you’ll need urgent medical assistance usually incorporating a bronchodilator and possibly oxygen to stop your blood oxygen levels falling too low, leading to a state of hypoxia in your child. At the onset of an attack be sure to use your normal medication. But if you believe that an acute attack is imminent then you should call for help.


If you only suffer from mild asthma and is unlikely that you will require any medication. However, some women experience an increase in symptoms during pregnancy, and although this is usually not the case there are medications available that are regarded as safe for a pregnant woman as opposed to non-pregnant one. Steroids often prescribed as there is little transfer from your bloodstream into your baby when they are inhaled.


If symptoms persist, and you are concerned, your doctor may wish to measure your peak expiratory air flow rate and generally check your lung function. If the medical professionals suspect possible IUGR then your obstetrician will no doubt monitor your baby by ultrasound to see if everything is ok.


Inhaled bronchodilators and inhaled anti inflammatory steroids seem to have NO detrimental effects on breast milk. But if you were previously using antihistamines you may find that these cause problems with your baby such as insomnia, lack of appetite and general irritability. They’ve also been shown to decrease breast milk production and are generally avoided by pregnant women.


During Labor


Luckily, the pain relief and medication often given in labor reduces the chances of bronchospasm. So if you do feel asthma symptoms developing during childbirth it is unlikely that they will become severe. Nevertheless it is likely that your peak flow rate will be measured and to protect against dehydration you will probably be put on an intravenous fluid drip. As odd as it may sound, your asthma could actually worsen after birth when you are no longer pregnant and you could need more medication than you did before, but hopefully not for too long as your physiology returns to normal.


Lifestyle Tips for the Pregnant Asthmatic Woman


The fitter you become prior to pregnancy and the higher the level of fitness you maintain during it, the more able your lungs will be to expand and clear any secretions from your chest and sinuses. Regular cardiovascular exercise will be a great help in this respect but be advised that it would be best not to take any medication before you begin training. And try not to expose yourself to cold air. If you do, bronchospasm is much more likely, so you are better off training in a gym or health club than outside during winter.


Once you’ve had your baby you may find that the extra workload and possible stress could have an affect on your asthma, increasing the frequency of attacks. This will obviously wear you down to some extent, but it is still important to try and push yourself safely and get some exercise.


I shouldn’t have to say this but avoid smoking yourself and never expose yourself or your baby to smoky environments.


Try to guard against any chest infections as this will put a big strain on you just after giving birth.


If you kept a diary of whatever triggered to your asthma attacks prior to pregnancy, then keep it close to hand and avoid any foods that you know can bring on symptoms. The better your diet the better your health. So try to consume plenty of dark green vegetables, whole grains, beans, lentils, fish, seeds, dried fruits, citrus fruits, healthy oils etc. These are rich in B vitamins, magnesium and a host of antioxidants that boost health and protect against infection.


Talk to your doctor about complementary therapies that may help improve your asthmatic condition. There are doctors that recommend physiotherapy and acupuncture as ways of reducing coughing. If you have given birth via a caesarean section your midsection is going to be quite tender for some time and the less you cough the less stress it will place on your abdominal muscles.