Abstract
Asthma can be expected in at least 7% of women of childbearing age and has been reported to complicate 1% of pregnancies (1). The last decade has heralded a series of sometimes conflicting studies that have debated the inter-relationships between asthma, pregnancy, and fetal outcome. The literature on the effect asthma has on the fetus suggests an increased risk of perinatal mortality and low-birth-weight or preterm infants. Maternal hypertension and death can also complicate the pregnancy of an asthmatic woman. The severity of the asthma itself often seems to change during pregnancy, with the bulk of the data suggesting that asthma most frequently worsens. Furthermore, subsequent pregnancies tend to mimic the previous pattern of disease. Close medical supervision accompanied by aggressive management appear to favorably affect both fetal and maternal outcome. This chapter will review the differential diagnosis and interrelationships of asthma in pregnancy.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
References
Gordon M, Niswander KR, Berendes H, and Kantor AG. Fetal morbidity following potentially anoxigenic obstetric conditions. VII. Bronchial asthma. Am. J. Obstet. Gynecol. 1970; 106:421.
Gluck JC and Gluck PA. The effects of pregnancy on asthma: a prospective study. Ann. Allergy 1976; 37:164–168.
Stenius-Aarniala B, Piirila P, and Teramo K. Asthma and pregnancy: prospective study of 198 pregnancies. Thorax 1988; 43:12–18.
Schatz M, Harden K, Forsythe A, Chilingar L, Hoffman C, Sperling W, and Zeiger RS. The course of asthma during pregnancy, postpartum, and with successive pregnancies: a prospective analysis. J. Allergy Clin. Immunol. 1988; 81:509–517.
Juniper EF, Daniel EE, Roberts RS, Kline PA, Hargreave FE, and Newhouse MT. Improvement in airway responsiveness and asthma severity during pregnancy. Am. Rev. Resp. Dis. 1989; 140:924–931.
White RJ, Coutts II, Gibbs CJ, and MacIntyre C. A Prospective study of asthma during pregnancy and puerperium. Resp. Med. 1989; 83:103.
Greenberger PA and Patterson R. Management of asthma during pregnancy. N. Eng. J. Med. 1985; 312:897–902.
Williams DA. Asthma and pregnancy. Allergy 1967; 22:311.
Juniper EF and Newhouse MT. Effect of pregnancy on asthma: a critical appraisal of the literature, in Asthma and Allergy in Pregnancy and Early Infancy (Schatz M and Zeiger RS, eds.), Marcel Dekker, New York, 1993; pp. 223–249.
Pritchard JA, MacDonald PC, and Gand MF (eds.) Williams Obstetrics, Appleton-Century-Croft, Norwalk, CT, 1985; p. 119.
Foster PS, Goldie RG, and Paterson JW. Effect of steroid on beta-adrenoceptor-mediated relaxation of pig bronchus. Br. J. Pharmacol. 1983; 78:441.
Motulsky JH and Insel PA. Adrenergic receptors in man: Direct identification, physiologic regulation, and clinical alterations. N. Eng. J. Med. 1982; 307:18.
Pecora LJ, Putman LR, and Baum CL. Effect of intravenous estrogens on pulmonary diffusing capacity. Am. J. Med. Sci. 1963; 246:48.
Layne DS, Meyer CJ, Vaishwana PS, and Pineus G. The secretion and metabolism of cortisol and aldosterone in normal and in steroid-treated women. J. Clin. Endocrinol. Metab. 1962; 22:107.
Nolten WE, Rueckert PA, Lindheimer MD, Oparil S, and Ehrlich EN. A simple method for determining the free cortisol index in plasma: Measurement in human pregnancy J. Lab. Clin. Med. 1979; 93:146.
Lewis PJ, Boyland P, Friedman LA, Hensby CN, and Downing I. Prostacyclin in pregnancy. Brit. Med. J. 1980; 280:1581.
Bianco S, Robuschi M, Ceserani RE, and Gandolf C. Effect of prostacyclin on aspecifically and specifically induced bronchoconstriction in asthmatic patients Eur. J. Resp. Dis. 1980; 61(Suppl.):81.
Whalen JB, Clancey CJ, Farley DB, and van Order DE. Plasma prostaglandins in pregnancy. Obstet. Gynecol. 1978; 51:52.
Willson JR and Carrington ER. Obstetrics and Gynecology. CV Mosby, St. Louis, MO, 1979; p. 138.
Schatz M and Hoffman C. Interrelationships between asthma and pregnancy: clinical and mechanistic considerations. Clin. Rev. Allergy 1987; 5:301–315.
Schatz M, Wasserman S, O’Connor RD, Harden K, Forsythe A, Chilingar L, Hoffman C, Sperling W, and Zeiger RS. Distinguishing clinical and biochemical characteristics associated with improvement or deterioration of asthma during pregnancy. J. Allergy Clin. Immunol. 1985; 75:133(Abstract).
Maddox DE, Kephart GM, Coulan CB, Butterfield JH, Benirschke K, and Gleich GJ. Localization of a molecule immunochemically similar to eosinophil major basic protein in human placenta. J. Exp. Med. 1984; 160:29.
Gee JBL, Packer BS, Miller JE, and Robin EB. Pulmonary mechanics during pregnancy. J. Clin. Invest. 1967; 46:945.
Rubin A, Russo N, and Goucher D. The effect of pregnancy upon pulmonary function in normal women. Am. J. Obstet. Gynecol. 1956; 72:963.
Milne JA, Mills RJ, Howie AD, and Pack AI. Large airways function during normal pregnancy. Br. J. Obstet. Gynecol. 1977; 84:448.
Garrard GS, Littler WA, and Redman CWG. Closing volume during normal pregnancy. Thorax 1978; 33:488.
Russell IF and Chambers WA. Closing volume in normal pregnancy. Br. J. Anaesth. 1981; 53:1043.
Hiddlestone HJ. Bronchial asthma and pregnancy. N. Z. Med. J. 1964; 63:521–523.
Frederiksen MC, Ruo TI, Chow MJ, and Atkinson AJ. Theophylline pharmocokinetics in pregnancy. Clin. Pharmacol. Ther. 1986; 40:321.
Brown WA. Psychological Care During Pregnancy and the Postpartum Period. Raven, New York, 1979; pp. 23–33.
Falkoff R. Maternal immunologic changes during pregnancy: a critical appraisal. Clin. Rev. Allergy 1987; 5:287–300.
Sorri M, Bortikanen-Sorri AL, and Karja J. Rhinitis during pregnancy. Rhinology 1980; 18:83.
Slavin RG. Relationship of nasal disease and sinusitis to bronchial asthma. Ann. Allergy 1982; 49:76.
Vermes I, Kajtar I, and Szabo E. Changes of maternal and fetal pituitary-adrenocortical functions during human labor. Horm. Res. 1979; 11:213.
Demey-Ponsart E, Foidart JM, Sulon J, and Sodoyez JC. Serum CBG, free and total cortisol and circadian patterns of adrenal function in normal pregnancy. J. Steroid Biochem. 1982; 16:165.
Stiles GL, Caron MC, and Lefkowitz RJ. Beta-adrenergic receptors: biochemical mechanisms of physiological regulation. Physiol. Rev. 1984; 64:661.
Hubl W, Buchner M, Bellee H, et al. Study of plasma aldosterone in normal pregnancy, in preeclamptic women and in cord plasma of newborns. Endokrinologie 1979; 73:162.
Weir RJ, Doig A, Fraser R, Morton JJ, Parhoosing J, Robertson JIS, and Wilson A. Studies of the renin-angiotensin-aldosterone systems, cortisol, DOC, and ADH in normal and hypertensive pregnancy, in Hypertension in Pregnancy (Lindheimer MD, Katz AI, and Zuspen FP, eds.), John Wiley, NY, 1976; pp. 251–261.
Louise S, Kraznowski JJ, Bukontz SC, and Lockey RF. Effect of ergometrine on airway smooth muscle contractile responses. Clin. All. 1985; 15:173.
Crawford J. Bronchospasm following ergometrine. Anesthesia 1980; 35:397.
Fishburne JI, Jr, Brenner WE, Braaksma JT, and Hendricks CH. Bronchospasm complicating intravenous prostaglandin F2α for therapeutic abortion. Obstet. Gynecol. 1972; 39:892.
Kreisman H, Van de Wiel W, and Mitchell CA. Respiratory function in prostaglandin-induced labor. Am. Rev. Resp. Dis. 1975; 11:564.
Fraser IS and Brach JH. Comparison of extra-and intra-amniotic prostaglandins for therapeutic abortion. Obstet. Gynecol. 1974; 43:97.
Vermes I, Kajtar I, and Szabo E. Changes of maternal and fetal pituitary-adrenocortical functions during human labor. Hortn. Res. 1979; 11:213.
Mortola JF. Hormonal changes during normal pregnancy and their consequences, in Asthma and Allergy in Pregnancy and Early Infancy (Schatz M and Zeiger RS, eds.) Marcel Dekker, New York, 1993, p. 4.
Irestedt L, Lagercrantz H, Hjemdahl P, Hagnevik K, and Beitrage P. Fetal and maternal plasma catecholamine levels at elective cesarean section under general or epidural anesthesia versus vaginal delivery. Am. J. Obstet. Gynecol. 1982; 142:1004.
Chanez P, Mann C, Bousquet J, Chabrier PE, Godard P, Braquet P, and Michel FB. Atrial natriuretic factor (ANF) is a potent bronchodilator in asthma. J. Allergy Clin. Immunol. 1990; 86:321–324.
Merkouris RW, Miller FC, Catanzarite V, Rigg LA, Quirk Jr. JG, and Vesley DL. Increase in the plasma levels of the N-terminal and C-terminal portions of the prohormone of atrial natriuretic factor during normal pregnancy. Am. J. Obstet. Gynecol. 1990; 162:859–864.
Bahna SL and Bjerkedal T. The course and outcome of pregnancy in women with bronchial asthma. Allergy 1972; 27:397.
Schaefer G and Silverman F. Pregnancy complicated by asthma. Am. J. Obstet. Gynecol. 1961; 82:182.
Lao TT and Huengsburg M. Labor and delivery in mothers with asthma. Eur. J. Obstet. Gynecol. Reprod. Biol. 1990; 35:183.
Dombrowski MR, Bottoms SF, Boike GM, and Wald J. Incidence of preeclampsia among asthmatic patients lowers with theophylline. Am. J. Obstet. Gynecol. 1986; 155:265.
Schatz M, Patterson R, Zeitz S, O’Rourkes S, and Melam H. Corticosteroid therapy for the pregnant asthmatic patient. JAMA 1975; 233:804.
Fitzsimons R, Greenberger PA, and Patterson R. Outcome of pregnancy in women requiring corticosteroids for severe asthma. J. Allergy Clin. Immunol. 1986; 78:349.
Greenberger PA and Patterson R. Beclomethasone dipropionate for severe asthma during pregnancy. Ann. Int. Med. 1983; 98:478.
Schatz M, Zeiger R, Hoffman C, and Harden K. The outcome of pregnancy in actively managed asthmatic women. J. Allergy Clin. Immunol. 1992; 89:342 (Abstract).
Schatz M, Zeiger R, Hoffman C, Saunders BS, Harden KM, and Forsythe AB. Increased transient tachypnea of the newborn in infants of asthmatic mothers. Am. J. Dis. Child. 1991; 145:156–158.
Motoyama EK, Acheson F, Rivard G, and Cook CD. Adverse effect of maternal hyperventilation on the fetus. Lancet 1966; 1:286.
Wulf KH, Kunzel W, and Lehmann V. Clinical aspects of placental gas exchange, in Respiratory Gas Exchange and Blood Flow in the Placenta (Longo LD and Bartels H, eds.), Public Health Service (DHEW publication no. 73-361) Bethesda, MD, 1972; p. 505.
Moore LG, Rounds SS, Jahnigen D, Grover RF, and Reeves JT. Infant birth weight is related to maternal arterial oxygenation at high altitude. J. Appl. Physiol. 1982; 52:695.
Whittmore R, Hobbins JC, and Engle MA. Pregnancy and its outcome in women with and without surgical treatment of congenital heart disease. Am. J. Cardiol. 1982; 50:641.
Larsson K. Studies of sympatho-adrenal reactivity and adrenoreceptor function in bronchial asthma. Eur. J. Resp. Dis. 1985; 66(Suppl.):1–52.
Kaliner M, Shelhamer JH, Davis PB, Smith LJ, and Venter JC. Autonomic nervous system abnormalities and allergy. Ann. Intern. Med. 1982; 96:349–357.
Bertrand JM, Riley SP, Papkin J, and Coates AL. The long-term pulmonary sequelae of prematurity: the role of familial airway hyperreactivity and the respiratory distress syndrome. N. Eng. J. Med. 1985; 312:742.
Chan KN, Noble-Jamieson CM, Elliman A, Bryan EM, Aber VR, and Silverman M. Airway responsiveness in low birthweight children and their mothers. Arch. Dis. Child. 1988; 63:905–910.
Schatz M, Zeiger R, Hoffman C, and the Kaiser-Permanente Asthma and Pregnancy Study Group. Intrauterine growth is related to gestational pulmonary function in pregnant asthmatic women. Chest 1990; 98:389–392.
Center for Disease Control. Asthma-United States 1980–1987. MMWR 1990; 39:493.
Center for Disease Control. Low birthweight-United States 1975–1987. MMWR 1990; 39:148.
Sexton M and Hebel JR. A clinical trial of change in maternal smoking and its effect on birthweight. JAMA 1984; 251:911–915.
Cnaltingius S, Haglund B, and Meiri K. Cigarette smoking as risk factor for late fetal and early neonatal death. Brit. Med. J. 1988; 247;258–261.
Brar HS and Rutherford SE. Classification of intrauterine growth retardation. Semin. Perinatol. 1988; 12:2–10.
Rosenfeld CR, Barton MD, and Meschia F. Effects of epinephrine on distribution of blood flow in the pregnant ewe. Am. J. Obstet. Gynecol. 1971; 124:156.
Eng M, Berges PV, Ueland K, Bonica JJ, and Parer JT. The effect of methoximine and ephedrine in normotensive pregnant primates. Anesthesiology 1971; 35:354.
Bowton DL, Alford PT, McLees BD, Prough DS, and Stump DA. The effect of aminophylline on cerebral blood flow in patients with chronic obstructive lung disease. Chest 1987; 91:874–877.
Visser AA, Giesteira MVK, and Prinslow ST. The effectiveness of salbutamol as a suppressant of established labor. S. Afr. Med. J. 1979; 56:481.
Lipshitz J. Uterine and cardiovascular effects of aminophylline. Am. J. Obstet. Gynecol. 1978; 131:716.
Volpe JJ. Effects of methylxanthines on lipid synthesis in developing neural systems. Semin. Perinatol. 1981; 5:395.
Labovitz E and Spector S. Placental theophylline transfer in pregnant asthmatics. JAMA 1982; 247:286.
Reinisch JN, Simon NG, Karow WG, and Gandelman R. Prenatal exposure to prednisone in humans and animals retards intrauterine growth. Science 1978; 202:436.
Walsh SD and Clark FR. Pregnancy in patients on long-term corticosteroid therapy. Scot. Med. J. 1967; 12:302–306.
Greenberger, PA and Patterson, R. The outcome of pregnancy complicated by severe asthma. Allergy Proc. 1988; 9:539.
Author information
Authors and Affiliations
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 1994 Springer Science+Business Media New York
About this chapter
Cite this chapter
Incaudo, G.A., Schatz, M. (1994). The Interrelations Between Asthma, Pregnancy, and Lactation. In: Gershwin, M.E., Halpern, G.M. (eds) Bronchial Asthma. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-4612-0297-4_6
Download citation
DOI: https://doi.org/10.1007/978-1-4612-0297-4_6
Publisher Name: Humana Press, Totowa, NJ
Print ISBN: 978-1-4612-6697-6
Online ISBN: 978-1-4612-0297-4
eBook Packages: Springer Book Archive