Asthma can be affected by the hormonal changes of pregnancy in various ways. Approximately one third of women get worse, one third improve, and one third notice no change in their asthma control. Monitoring of pregnant women with asthma is by symptoms and spirometry with measurement of FeV1. Poor asthma control during pregnancy may be associated with low birth weight and prematurity.
It is important for pregnant women to NOT discontinue their asthma treatment when they become pregnant. Most asthma therapy is safe during pregnancy, and a significant asthma attack may be more harmful for the fetus than asthma drug therapy. Gastro-esophageal reflux during pregnancy my aggravate asthma, and may require treatment.
| Asthma drug | Safety |
| Short acting beta-agonists (eg. Ventolin, Bricanyl) | Safe |
| Long acting beta-agonist (eg. Oxeze, Serevent) | Safe (newer drugs, therefore less data) |
| Epinephrine | Avoid for asthma in pregnancy |
| Inhaled steroids (eg. budesonide, fluticasone) | Safe |
| Singulair (montelukast) | Safe |
| Prednisone (or other oral/IV steroids) | Small possible/theoretical risk, but commonly used in asthma during pregnancy if required. |
An acute asthmatic attack in pregnancy requires prompt and aggressive treatment, with attention to oxygen supplementation. No change is necessary to the usual management approach (inhaled bronchodilators, systemic corticosteroids). Systemic epinephrine should not be used.
Suggested links:
NAEPP Working Group Report on Asthma and Pregnancy
ACOG Practice Bulletin, Asthma in Pregnancy, 2008