By: Laurie Edwards for Uterus1
For the first time in over a decade, the National Asthma Education and Prevention Program issued updated guidelines for pregnant women with asthma. The guidelines are based on the premise that asthma medications are safer for unborn babies than acute asthma exacerbations are, and also urge close monitoring of women with asthma throughout their pregnancy.
Taking into account the many new medications on the market and their effect on both women and babies during pregnancy, the guidelines are published in this month’s issue of the Journal of Allergy and Clinical Immunology.
Asthma is a disease that affects more than 20 million Americans, and serves as one of the most frequent serious complications for pregnancies. Pregnant women with asthma are at increased risk of infant death, premature birth, low birth weight and elevated blood pressure that causes preeclampsia, which can result in the mother or the child having seizures.
There is a direct correlation between the level of risk and the degree to which asthma affects women; the more severe the asthma, the greater the associated risk.
“Simply put, when a pregnant patient has trouble breathing, her fetus also has trouble getting the oxygen it needs. There are many ways we can help pregnant women control their asthma, and it is imperative that providers and their patients work together to do so,” said Dr. William W. Busse, professor of medicine at the University of Wisconsin Medical School and chair of the NAEPP panel responsible for establishing the new guidelines.
The NAEPP’s approach towards controlling asthma is similar to its treatment plan for children and women who are not pregnant: when asthma is more severe, medications are increased and when asthma is less severe, medication is decreased.
The difference for pregnant women is that their condition can often alter the severity of their asthma, so close monitoring – from twice a month to every week, depending on the case – is recommended.
A recent study by the National Institute of Child Health and Development Maternal-Fetal Medicine Units Network found that 30 percent of pregnant women experience a worsening of their asthma.
Interestingly, 23 percent of asthma patients in the same study noted an improvement in their condition while pregnant, underscoring the unpredictability of the disease during pregnancy.
“We cannot predict who will worsen during pregnancy, so the new guidelines recommend that patients with persistent asthma have their asthma checked at least monthly by a health care provider,” said Dr. Mitchell Dombrowski, fellow NAEPP panel member and chief of obstetrics and gynecology at Detroit’s St. John Hospital.
Important guidelines concerning medication include the suggestion that all asthma patients carry albuterol, a fast-acting “rescue” inhaler, at all times throughout their pregnancy. Women whose symptoms occur at least twice a week should take daily medicine to prevent the exacerbations; inhaled corticosteroids are the best medicines to keep this inflammation at bay. Thus far, studies have found no adverse affects on fetuses when these drugs are used.
For patients whose asthma does not respond to corticosteroids, another option is to use long-acting drugs called beta agonists, whose job it is to prevent exacerbations and inflammation from beginning.
For those with the most severe cases of asthma, strong oral steroids such as prednisone may be necessary. While there is conflicting data as to their safety, but consensus is that severe exacerbations are undoubtedly harmful to the fetus and that in such instances, oral steroids may pose the lesser risk.
Lastly, the NAEPP identified a key way to manage asthma during pregnancy: Being aware of triggers such as allergens, infections and other health problems and avoiding them if at all possible.