Dr. Monica Kraft, formerly of Duke University and the University of Arizona, is a healthcare educator and System Chair at Icahn School of Medicine at Mount Sinai Health System. In the following article, Monica Kraft discusses asthma and pregnancy: evaluation methods, and management approaches
It’s not uncommon for young, non-smoking individuals with a history of asthma to present with worsening symptoms while they are pregnant, according to research found in The New England Journal of Medicine. Even simple tasks like cleaning the house can exacerbate symptoms, and many women are scared to use inhalers prescribed pre-pregnancy.
Since asthma during pregnancy is common, Monica Kraft, formerly of Duke University and the University of Arizona, says that many medical professionals around the world are seeking to understand how to evaluate the severity and manage the disease in this arena.
The Most Common Medical Condition
Recent surveys conducted throughout the United States show that roughly 8% of all pregnant women report symptoms of asthma, making it perhaps the most common condition that could cause serious consequences during pregnancy.
A number of studies show those with asthma are more at risk of several pregnancy complications, including:
- preterm birth
- preeclampsia
- infants with intrauterine growth restriction
- babies with low birth weight
- perinatal death
- infants with malformations
compared to those without asthma.
Monica Kraft, formerly of Duke University and the University of Arizona, explains that poor asthma control throughout pregnancy increases these risks. So, improved management that results in good asthma control could mean better outcomes for the mothers and their babies.
Moreover, maternal asthma doesn’t just affect pregnancy outcomes; pregnancy itself can impact asthma’s course.
Approximately 1/3 of women may find that the severity of their asthma symptoms worsens, another third, find that the condition improves during pregnancy. The last third do not note any impact of asthma on their pregnancy. Predictors of worsening of asthma with pregnancy are not entirely understood.
Monica Kraft on Diagnosing and Evaluating the Severity
In most cases, Monica Kraft, formerly of Duke University and the University of Arizona, says that diagnosing asthma in pregnancy is straightforward since most patients have a history of the condition prior to pregnancy. However, doctors state the necessity of diagnostic testing for those whose response to therapy is atypical or who didn’t suffer from asthma before pregnancy.
Typically, Monica Kraft, formerly of Duke University and the University of Arizona, says that those without a history will be diagnosed with the following conditions instead of asthma:
- Dyspnea
- Reflux or postnatal drip
- Laryngeal dysfunction
- Hyperventilation
- Pulmonary embolism or edema
- Bronchitis
Professionals specializing in treating asthma during pregnancy dictate the parameters defining accurate diagnosis. According to Monica Kraft, formerly of Duke University, asthma in pregnancy can be diagnosed if there’s a 12% or more improvement in the forced expiratory volume in one second (FEV1) or the forced vital capacity (FVC) after the inhaling albuterol.
Managing Asthma Throughout Pregnancy
Once an asthma diagnosis has been established, patients must be educated about the relationship between asthma and pregnancy and self-treatment techniques like proper inhaler usage and controlling environmental triggers.
Monica Kraft, formerly of Duke University and the University of Arizona, says that appropriate management of the typical asthma triggers (i.e., gastroesophageal reflux, rhinitis, and sinusitis) helps control the condition and limit the potential negative effects on mothers and their unborn children.
Doctors prescribing asthma medications will divide treatments into two — long-term controllers and rescue therapy.
The former prevents the manifestations of asthma and often includes:
- Inhaled corticosteroids (e.g., fluticasone, beclomethasone, or budesonide)
- Long-acting B-agonists (e.g., salmeterol or formoterol)
- Leukotriene-receptor antagonists (e.g., montelukast, or zafirlukast)
The latter provides immediate relief of symptoms. Normally, this involves inhaling short-acting B-agonists such as albuterol.
Monica Kraft, formerly of Duke University and the University of Arizona, reports that data on the potential downsides of asthma treatments in pregnancy is mostly observational. Researchers report that the findings are reassuring. Most studies prove that taking asthma medications while pregnant doesn’t increase perinatal risks.
Currently, the most extensively studied rescue therapy is albuterol, and the most researched long-term controller is inhaled corticosteroid.
Pregnant women on controller therapy should attend monthly appointments to assess asthma control. To make life easier, assessments are often included with routine obstetrical visits.
Typical Recommendations
Even though uncontrolled asthma can increase the risk of negative perinatal outcomes, pregnant women with well-controlled asthma typically experience good outcomes.
The best recommendations for those pregnant and suffering from asthma are provided on a case-by-case basis by medical professionals. Typically, Monica Kraft, formerly of Duke University and the University of Arizona, reports that this involves proper education surrounding potential outcomes, inhaler techniques, and personalized action plans.
Experts advise those with newly diagnosed or worsening asthma control during pregnancy should attend weekly or biweekly follow-up appointments to ensure that exceptional asthma control has been achieved.
Once stable, patients can expect to meet once a month throughout their pregnancy.
