Asthma control in pregnancy

Overview

Asthma control in pregnancy means managing your asthma so that you have few symptoms and can breathe well, while keeping you and your baby safe. Asthma is a long-term condition where the airways in your lungs become narrow and swollen, making it hard to breathe.

Yes, asthma is one of the most common long-term conditions that can affect pregnancy. It affects about 8 to 10 out of every 100 pregnant women.

It affects women who already have asthma before pregnancy, or rarely, women may develop asthma symptoms for the first time during pregnancy.

Symptoms

Common symptoms

• Wheezing (a whistling sound when breathing)
• Coughing, especially at night or early morning
• Chest tightness
• Shortness of breath

Symptoms in children

• While this topic focuses on pregnancy, children with asthma can have similar symptoms including coughing that worsens with activity or at night, wheezing, and rapid breathing. If you are a mother with asthma, your child may have a higher risk of developing asthma.

Symptoms in older adults

• In older adults, asthma symptoms are similar but may be mistaken for other conditions like heart problems or COPD. It is important to have any breathing concerns checked by a healthcare provider.

Causes

Main causes

• Asthma is caused by inflammation in the airways. During pregnancy, hormonal changes, increased blood volume, and physical changes can affect your airway function.
• Common triggers include allergens (like pollen, dust mites, pet dander), cold air, exercise, infections (like colds or flu), and stress.

Risk factors

• Personal or family history of asthma
• History of eczema or allergies
• Exposure to tobacco smoke or air pollution
• Being overweight or obese

When to see a doctor

See a doctor urgently if:

• If your asthma symptoms are getting worse despite using your prescribed medications
• If you find yourself using your reliever inhaler more often than usual
• If you have a cough or wheeze that does not go away

Book a routine appointment if:

• At your regular pregnancy check-ups, discuss your asthma control
• If you are planning a pregnancy, have a pre-conception check-up
• Anytime you have concerns about your breathing or medications

Diagnosis

If you already have asthma, your healthcare provider will assess your control. If you have new symptoms, diagnosis is based on your history, symptoms, and breathing tests.

Tests that may be done

• Peak flow meter: a simple device that measures how fast you can blow out air
• Spirometry: a test that measures how much air you can breathe in and out and how fast
• Sometimes, a trial of asthma medication to see if symptoms improve

What to expect at your appointment

Your doctor will ask about your symptoms, triggers, and medications. You may be asked to use a peak flow meter at home to track your breathing. They will work with you to create a management plan that is safe for pregnancy.

Treatment

The goal of treatment is to keep your asthma well-controlled, so you have minimal symptoms and can maintain normal activity. Good control also ensures your baby gets enough oxygen.

Self-care at home

• Avoid your known asthma triggers as much as possible
• Use your inhalers exactly as prescribed, even when you feel well
• Monitor your symptoms and peak flow readings regularly
• Take your preventer medication daily as directed

Medical treatments

Treatment usually involves two types of inhalers: a preventer (controller) inhaler used daily to reduce airway inflammation, and a reliever (rescue) inhaler used only when symptoms occur. Both are generally considered safe in pregnancy. Your doctor may adjust the dose or type based on your control. Do not stop or change your medication without speaking to your healthcare provider.

When is surgery considered?

This information is not relevant for asthma control in pregnancy.

Living with this condition

With good asthma control, you can carry on with your normal daily activities. Use your preventer inhaler every day, avoid triggers, and keep a peak flow diary if advised by your doctor.

Lifestyle tips

• Stop smoking and avoid second-hand smoke
• Manage stress with relaxation techniques like deep breathing or gentle yoga
• Get enough rest and sleep
• Stay up to date with your prenatal appointments

Diet and exercise

Eat a balanced diet rich in fruits, vegetables, and whole grains. Mild to moderate exercise, such as walking or swimming, is safe and beneficial for most pregnant women with asthma. Always warm up before exercise and have your reliever inhaler handy.

Mental health and emotional wellbeing

It is common to feel anxious about managing asthma during pregnancy, especially about medications and the baby's health. Talk to your healthcare provider about your concerns. Remember that good control is best for both of you.

Prevention

Asthma itself cannot be prevented, but you can take steps to prevent flare-ups and maintain good control during pregnancy.

Vaccines

It is recommended that pregnant women with asthma get the annual flu vaccine and the whooping cough (pertussis) vaccine, to reduce the risk of infections that can worsen asthma.

Screening programmes

Regular asthma check-ups and peak flow monitoring help catch any worsening early. Your healthcare provider may also monitor your baby's growth and well-being through ultrasound scans if needed.

Complications

If left untreated

• Poorly controlled asthma can lead to reduced oxygen supply to the baby, increasing the risk of preterm birth, low birth weight, and preeclampsia
• Severe asthma attacks may require emergency treatment and hospitalization

Long-term outlook

The outlook for women with well-controlled asthma in pregnancy is excellent. Most women have a normal pregnancy and a healthy baby. With proper management, you can keep both you and your baby safe.

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