Asthma is most common long-term medical condition encountered during pregnancy

3-8% of pregnant women have asthma

severity changes

  • in general:

    • 1/3 wores

    • 1/3 better

    • 1/3 stable

  • severe more likely to eperience worsening of symptoms compared to those with mild

  • deterioration most likely in 2nd and 3rd trimesters

  • most common exacerbations:

    • viral repiratory infecctions

    • non-adherence to inhaled corticosteroids

  • pregnancy has no effect on FEV1

maternal / foetal complications

  • when well controlled - little or no increase risk of adverse outcomes

  • higher risks of:

    • pre-eclampsia

    • haemorrhage

    • IUGR

    • pre-term delivery

    • low birth wieght

    • increase perinatal mortality

Assessment of current control

| | Well controlled asthma | not well controlled | very poorly controlled asthma |

|—|—|—|—-|

| frequency | ≤ 2d/wk |>2d /wk | throughout day |

| nocturnal symptoms | ≤ 2/month | 1-3 /wk | ≥ 4/wk |

| intereference with normal activity | none | some | extreme |

| use of SABA | ≤2d/wk | >2 d/wk | several time/day |

| FEV1 | > 80% | 60-80%| \<60% |

|exacerbations requiring use of oral corticosteroids| 0-1 in past 12mo | ≥ 2 in past 12 mo ||

Management

like any other person with asthma

  • personalised plan

  • SABA and LABA used as normal during pregnancy

    • evidence of safety for LABA limited

      • need sto be used in conjucntion with ICS

  • ICS

    • integral part of treatment

    • safe in pregnancy

    • reduce risk of asthma exacerbations

    • improve lung functionduring pregnancy

  • oral corticosteroids

    • shouldn’t be witheld because of pregnancy

      • prednsione mostly inactive (88%) when crosses placenta

        • foetal exposure lmited

    • first trimester associated iwth small risk of congenital malformations

      • primarily cleft palate

    • some association with pre-eclampsia, pre-term labour, low birth weight

      • these studies done in women taking long term cortico steroids compared to short course

  • Breastfeeding

    • can carry on as normal

    • only small amounts enter mild

  • Theophyline adn cromoglycates

    • no associated with congenital malformations

    • therapeutic range may be lower in pregnant women

  • Leukotriene receptor inhibitors

    • safety data limited

    • not recommended to be initialted

  • contine their usual asthma regime