Asthma & Pregnancy: Management

Reviewed by Kanao Otsu, MD, MPH
Watching for asthma symptoms and peak flow monitoring can help you and your health care provider monitor your asthma during your pregnancy. It is important to identify and treat asthma symptoms before they become worse.

Asthma symptoms can range from mild to severe. It is important to identify and treat your asthma when the symptoms are still mild. This can help decrease the amount of inflammation and reduce the risk of a more serious episode. Common asthma symptoms include:

  • Coughing
  • Shortness of breath
  • Tightness in the chest
  • Wheezing.

Shortness of breath, unrelated to asthma, often occurs during pregnancy, so it is important to tell your provider if you experience this symptom. The peak flow meter can help you distinguish the normal shortness of breath with pregnancy from shortness of breath as an asthma symptom. A peak flow meter measures the peak expiratory flow —how much air you blow out after a maximum inhalation. It reveals how well your lungs are working. Sometimes peak flows can decrease hours, or even a day or two, before other asthma symptoms start. Ask your doctor about using a peak flow meter to help monitor your asthma.


Asthma Action Plan for your Pregnancy

It is important to treat asthma symptoms and low peak flow numbers to ensure you and your baby receive enough oxygen. An asthma action plan is a written plan, customized by your doctor to help you manage asthma episodes. Your action plan is based on changes in asthma symptoms and peak flow numbers. It will give you information about when and how to use long-term control medicine and quick-relief medicine. If you know what to watch for and what steps to take, you will be able to make timely and appropriate decisions about managing your asthma during your pregnancy.


Severe Asthma Episodes During Pregnancy

A small number of pregnant women with asthma may have an asthma episode severe enough to be hospitalized. A severe asthma episode is a true medical emergency, and you should seek medical assistance right away. You and your baby can be closely monitored during your hospital stay. Your treatment may include oxygen, frequent inhaled medications and IV steroids.


Asthma Management During Labor and Delivery

It is important to continue long-term control medicines through the labor and delivery process. Have quick-relief medicines available also. Bring your own medicine to the hospital, so the health care provider will know the current medication and dosage that has been prescribed by your doctor. Plan ahead, so you have your medication information available.

Talk with your health care provider before your delivery date about pain relief options during labor and birth. Epidurals are commonly used to reduce pain during labor and can also be used if a cesarean birth becomes necessary. Regional anesthesia (either an epidural or spinal) is most commonly used for cesareans; general anesthesia is rarely used and only during emergencies. Electronic fetal heart monitoring is done during labor and birth to keep track of the heart rate of your baby and the strength and duration of the contractions of your uterus. Your baby’s heart rate is a good way to tell whether your baby is doing well or may have some problems.

If a cesarean birth is required, you may need IV steroids. This is considered if you are steroid-dependent or have been on steroid tablets in the past 4-6 weeks.

It is important to plan ahead and discuss these decisions and potential problems with your health care providers. This will help decrease fears and problems that may arise once labor begins.


Breastfeeding When You Have Asthma

Research shows that breastfeeding for the first 6-12 months of life may help prevent or delay the development of certain allergies. The decision to breastfeed should be based on you and your baby's special needs.

In general, when breastfeeding, the use of most asthma medicines does not affect your baby or interfere with your milk production. It is important to discuss your use of any medicines with the health care provider caring for your baby. The medicines listed earlier for use during pregnancy are generally used while breastfeeding without problems. Remember, your bloodstream absorbs less medicine with inhaled medicine; therefore, less medicine passes into your breast milk. Medication exposure to the infant can be decreased by nursing prior to taking your asthma medication.

The following list of medicines offers some additional information that can be discussed with your doctor:

  • Leukotriene Modifiers: The leukotriene modifiers are excreted in breast milk. Because of the potential for adverse effects, these medicines should not be taken while you are breastfeeding.

  • Oral Steroids: Oral steroids pass through breast milk in trace amounts. Even at high dosages, they have not been associated with problems.

  • Theophylline: This medicine passes through breast milk in trace amounts. This has been associated with irritability and insomnia in some infants.


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