Asthma in pregnancy

Question 1

Does pregnancy exacerbate asthma? When do most exacerbations of asthma occur in pregnancy?

Answer 1

No - asthma is not consistently affected by pregnancy

24-36 weeks - more likely to occur in those with severe asthma

Question 2

How common is asthma in pregnant women?

Answer 2

2-4% affected

Question 3

What are the complications of poor control of asthma during pregnancy?

Answer 3

1. Prolonged maternal hypoxia may lead to FGR and fetal brail injury
2. Association between HTN/GDM and asthma in pregnancy (but asthma is not a RF for PET)

Question 4

How does maternal asthma affect management of labour and delivery?

Answer 4

Labour/delivery are sually not affected by asthma and attacks but parenteral steroid cover may be needed for those on regular steroids

AVOID bronchoconstrictors e.g. ergometrine or prostaglandin F2alpha (in severe asthma)

Regional anaesthesia favoured over GA - to decrease bronchospasm risk, provide analgesia, reduce oxygen consumption and minute ventilation

Question 5

What is the inheritance risk of asthma for the fetus?

Answer 5

6-30%

Question 6

What is the prognosis with asthma postpartum?

Answer 6

• No increased risk of exacerbations in postpartum period
• Those whose asthma was exacerbated in pregnancy will return to normal in 3 months after birth

Question 7

List some features of life-threatening asthma.

Answer 7

• Peak expiratory flow rate <35% of predicted
• pO2 <8 kPa
• pCO2 >4.6 kPa
• Silent chest
• Cyanosis
• Bradycardia
• Arrhythmia
• Hypotension
• Exhaustion
• Confusion

Question 8

What is the management of asthma in pregnancy? What is the management of exacerbations?

Answer 8

Conservative:

• Encourage smoking cessation.

Medical:

• Improve asthma care.
• Ensure patient education regarding condition and adequate use of medications.
• Ensure optimal control and response to therapy throughout pregnancy.

Exacerbations:

• Manage exacerbations aggressively and avoid delays in treatment.
• Manage acute attacks as in non-pregnant individual.

Question 9

Are asthma medications safe in pregnancy?

Answer 9

SABA - safe

Theophylline - safe but monitor levels as metabilism may be altered during pregnancy. BTS: Check blood levels of theophylline in pregnant women with acute severe asthma and in those critically dependent on therapeutic theophylline levels.

LABA - no risk of fetal malformations, no FGR, limited systemic absorption

Inhaled corticosteroids - safe, no risk of fetal malformations or perinatal morbidity in large studies

Oral corticosteroids - some unconfirmed evidence of increased risk of fetal cleft lip/palate in 1st trimester use. BTS: Use steroid tablets as normal when indicated during pregnancy for women with severe asthma. Steroid tablets should never be withheld because of pregnancy. Women should be advised that the benefits of treatment with oral steroids outweigh the risks.

LTRA - reassuring data that it is safe

Question 10

What advice should you give to pregnanyt women who want to stop asthma treatment from fear of effects of drugs on the fetus?

Answer 10

It is safer to take asthma drugs in pregnancy than to leave asthma uncontrolled.

Most drugs are safe in pregnancy.

Question 11

BTS - 2019

Answer 11

Question 12

Is asthma medication safe for use during breastfeeding?

Answer 12

Yes - Encourage women with asthma to breastfeed. Use asthma medications as normal during lactation, in line with manufacturers’ recommendations.