Abstract
Asthma is one of the most common conditions that afflict pregnant women. Because uncontrolled asthma in pregnancy affects both maternal and offspring outcomes, careful attention to maintaining control of asthma symptoms throughout pregnancy is of paramount importance. This chapter will review the epidemiology and course of asthma in pregnancy and the effects of uncontrolled asthma to both the mother and offspring and provide an overview of the management, both non-pharmacologic and pharmacologic, of asthma in pregnancy. While the management of asthma in pregnancy relies on guidelines for the general population, special considerations regarding the safety of medications are required. Data available for established medications and newer therapies are presented.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Mazurek JM, Syamlal G. Prevalence of asthma, asthma attacks, and emergency department visits for asthma among working adults – National Health Interview Survey, 2011–2016. MMWR Morb Mortal Wkly Rep. 2018;67(13):377–86.
Kwon HL, Belanger K, Bracken MB. Asthma prevalence among pregnant and childbearing-aged women in the United States: estimates from national health surveys. Ann Epidemiol. 2003;13(5):317–24.
Hansen C, et al. Medication exposure in pregnancy risk evaluation program: the prevalence of asthma medication use during pregnancy. Matern Child Health J. 2013;17(9):1611–21.
Kemppainen M, et al. Maternal asthma is associated with increased risk of perinatal mortality. PLoS One. 2018;13(5):e0197593.
Lee CH, et al. Healthcare utilisation by pregnant patients with asthma in South Korea: a cohort study using nationwide claims data. BMJ Open. 2015;5(11):e008416.
Cleary BJ, et al. Medication use in early pregnancy-prevalence and determinants of use in a prospective cohort of women. Pharmacoepidemiol Drug Saf. 2010;19(4):408–17.
Sawicki E, et al. Management of asthma by pregnant women attending an Australian maternity hospital. Aust N Z J Obstet Gynaecol. 2012a;52(2):183–8.
Rejno G, et al. Asthma during pregnancy in a population-based study–pregnancy complications and adverse perinatal outcomes. PLoS One. 2014;9(8):e104755.
Schatz M, et al. The relationship of asthma medication use to perinatal outcomes. J Allergy Clin Immunol. 2004a;113(6):1040–5.
Blais L, et al. Long-acting beta(2)-agonists and risk of hypertensive disorders of pregnancy: a cohort study. J Allergy Clin Immunol Pract. 2018;6(2):555.
Gluck JC, Gluck P. The effects of pregnancy on asthma: a prospective study. Ann Allergy. 1976;37(3):164–8.
Belanger K, et al. Effect of pregnancy on maternal asthma symptoms and medication use. Obstet Gynecol. 2010;115(3):559–67.
Schatz M, et al. The relationship of asthma-specific quality of life during pregnancy to subsequent asthma and perinatal morbidity. J Asthma. 2010;47(1):46–50.
Schatz M, et al. Asthma morbidity during pregnancy can be predicted by severity classification. J Allergy Clin Immunol. 2003;112(2):283–8.
Stenius-Aarniala B, Piirila P, Teramo K. Asthma and pregnancy: a prospective study of 198 pregnancies. Thorax. 1988;43(1):12–8.
White RJ, et al. A prospective study of asthma during pregnancy and the puerperium. Respir Med. 1989;83(2):103–6.
Beecroft N, Cochrane GM, Milburn HJ. Effect of sex of fetus on asthma during pregnancy: blind prospective study. BMJ. 1998;317(7162):856–7.
Henderson CE, et al. Predicting asthma severity from allergic sensitivity to cockroaches in pregnant inner city women. J Reprod Med. 2000;45(4):341–4.
Kircher S, Schatz M, Long L. Variables affecting asthma course during pregnancy. Ann Allergy Asthma Immunol. 2002;89(5):463–6.
Mirzakhani H, et al. Asthma control status in pregnancy, body mass index, and maternal vitamin D levels. J Allergy Clin Immunol. 2017;140(5):1453–1456 e7.
Bobrowski RA. Pulmonary physiology in pregnancy. Clin Obstet Gynecol. 2010;53(2):285–300.
Hegewald MJ, Crapo RO. Respiratory physiology in pregnancy. Clin Chest Med. 2011;32(1):1–13.
LoMauro A, Aliverti A. Respiratory physiology of pregnancy: physiology masterclass. Breathe (Sheff). 2015;11(4):297–301.
Wise RA, Polito AJ, Krishnan V. Respiratory physiologic changes in pregnancy. Immunol Allergy Clin N Am. 2006;26(1):1–12.
Cooper BG. An update on contraindications for lung function testing. Thorax. 2011;66(8):714–23.
Choi HS, et al. Dyspnea and palpitation during pregnancy. Korean J Intern Med. 2001;16(4):247–9.
Milne JA. Respiratory response to pregnancy. Postgrad Med J. 1979;55(643):318–24.
Wang G, et al. The risk of maternal and placental complications in pregnant women with asthma: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2014;27(9):934–42.
Mendola P, et al. Obstetric complications among US women with asthma. Am J Obstet Gynecol. 2013;208(2):127.e1–8.
Murphy VE, et al. A prospective study of respiratory viral infection in pregnant women with and without asthma. Chest. 2013a;144(2):420–7.
Murphy VE, et al. A meta-analysis of adverse perinatal outcomes in women with asthma. BJOG. 2011;118(11):1314–23.
Chen J, et al. In utero beta-2-adrenergic agonists exposure and risk of epilepsy: a Danish nationwide population-based cohort study. Pharmacoepidemiol Drug Saf. 2018;27(11):1200–8.
Eltonsy S, Forget A, Blais L. Beta2-agonists use during pregnancy and the risk of congenital malformations. Birth Defects Res A Clin Mol Teratol. 2011;91(11):937–47.
Litonjua AA, et al. Parental history and the risk for childhood asthma. Does mother confer more risk than father? Am J Respir Crit Care Med. 1998;158(1):176–81.
Liu X, et al. Maternal asthma severity and control during pregnancy and risk of offspring asthma. J Allergy Clin Immunol. 2018;141(3):886–92.e3.
Dombrowski MP, Schatz M, ACOG Committee on Practice Bulletins-Obstetrics. ACOG practice bulletin: clinical management guidelines for obstetrician-gynecologists number 90, February 2008: asthma in pregnancy. Obstet Gynecol. 2008;111(2 Pt 1):457–64.
Schatz M, Dombrowski MP. Clinical practice. Asthma in pregnancy. N Engl J Med. 2009;360(18):1862–9.
Powell H, et al. Management of asthma in pregnancy guided by measurement of fraction of exhaled nitric oxide: a double-blind, randomised controlled trial. Lancet. 2011;378(9795):983–90.
Morten M, et al. Managing Asthma in Pregnancy (MAP) trial: FENO levels and childhood asthma. J Allergy Clin Immunol. 2018;142(6):1765–72.e4.
Koo SM, et al. Effect of pregnancy on quantitative medication use and relation to exacerbations in asthma. Biomed Res Int. 2017;2017:8276190.
Lim AS, et al. Asthma during pregnancy: the experiences, concerns and views of pregnant women with asthma. J Asthma. 2012;49(5):474–9.
Murphy VE, et al. Severe asthma exacerbations during pregnancy. Obstet Gynecol. 2005;106(5 Pt 1):1046–54.
Schatz M, Leibman C. Inhaled corticosteroid use and outcomes in pregnancy. Ann Allergy Asthma Immunol. 2005;95(3):234–8.
Lim AS, et al. Management of asthma in pregnant women by general practitioners: a cross sectional survey. BMC Fam Pract. 2011;12:121.
Lim AS, et al. Multidisciplinary approach to Management of Maternal Asthma (MAMMA): a randomized controlled trial. Chest. 2014;145(5):1046–54.
Ali Z, Nilas L, Ulrik CS. Excessive gestational weight gain in first trimester is a risk factor for exacerbation of asthma during pregnancy: a prospective study of 1283 pregnancies. J Allergy Clin Immunol. 2018;141(2):761–7.
Murphy VE, et al. Influence of maternal body mass index and macrophage activation on asthma exacerbations in pregnancy. J Allergy Clin Immunol Pract. 2017;5(4):981–987 e1.
Buczko GB, et al. Effects of cigarette smoking and short-term smoking cessation on airway responsiveness to inhaled methacholine. Am Rev Respir Dis. 1984;129(1):12–4.
Mullen JB, et al. Nonspecific airway reactivity in cigarette smokers. Relationship to airway pathology and baseline lung function. Am Rev Respir Dis. 1986;133(1):120–5.
Murphy VE, Clifton VL, Gibson PG. The effect of cigarette smoking on asthma control during exacerbations in pregnant women. Thorax. 2010;65(8):739–44.
Sorri M, Hartikainen A, Karja I. Rhinitis during pregnancy. Rhinology. 1980;18(2):83–6.
Munn M, Groome L, Atterbury J. Pneumonia as a complication of pregnancy. J Matern Fetal Med. 1999;8:151–4.
Namazy JA, et al. Antibiotics for respiratory infections during pregnancy: prevalence and risk factors. J Allergy Clin Immunol Pract. 2016;4(6):1256–1257 e2.
Schatz M, et al. The safety of asthma and allergy medications during pregnancy. J Allergy Clin Immunol. 1997;100(3):301–6.
Norjavaara E, de Verdier MG. Normal pregnancy outcomes in a population-based study including 2,968 pregnant women exposed to budesonide. J Allergy Clin Immunol. 2003;111(4):736–42.
Bracken MB, et al. Asthma symptoms, severity, and drug therapy: a prospective study of effects on 2205 pregnancies. Obstet Gynecol. 2003;102(4):739–52.
Martel MJ, et al. Use of inhaled corticosteroids during pregnancy and risk of pregnancy induced hypertension: nested case-control study. BMJ. 2005;330(7485):230.
Kallen B, Rydhstroem H, Aberg A. Congenital malformations after the use of inhaled budesonide in early pregnancy. Obstet Gynecol. 1999;93(3):392–5.
Bakhireva LN, et al. Asthma medication use in pregnancy and fetal growth. J Allergy Clin Immunol. 2005;116(3):503–9.
Breton MC, et al. Risk of perinatal mortality associated with inhaled corticosteroid use for the treatment of asthma during pregnancy. J Allergy Clin Immunol. 2010;126(4):772–777 e2.
Blais L, et al. Use of inhaled corticosteroids during the first trimester of pregnancy and the risk of congenital malformations among women with asthma. Thorax. 2007;62(4):320–8.
Hyiid A, Molgaard-Nielesen D. Corticosteroid use during pregnancy and the risk of orofacial clefts. CMAJ. 2011;183:796–804.
Kallen B, Otterblad Olausson P. Use of anti-asthmatic drugs during pregnancy. 3. Congenital malformations in the infants. Eur J Clin Pharmacol. 2007;63(4):383–8.
Hyiid A, Mølgaard-Nielsen D. Corticosteroid use during pregnancy and the risk of orofacial clefts. CMAJ. 2011;183:796–804.
Blais L, et al. High doses of inhaled corticosteroids during the first trimester of pregnancy and congenital malformations. J Allergy Clin Immunol. 2009;124(6):1229–1234 e4.
Blais L, Forget A. Asthma exacerbations during the first trimester of pregnancy and the risk of congenital malformations among asthmatic women. J Allergy Clin Immunol. 2008;121(6):1379–84, 1384.e1.
Cossette B, et al. Impact of maternal use of asthma-controller therapy on perinatal outcomes. Thorax. 2013;68(8):724–30.
Murphy VE, et al. The risk of congenital malformations, perinatal mortality and neonatal hospitalisation among pregnant women with asthma: a systematic review and meta-analysis. BJOG. 2013b;120(7):812–22.
Wang G, et al. The risk of maternal and placental complications in pregnant women with asthma: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2013;27(9):934–42.
de Aguiar MM, et al. Inhaled beclomethasone in pregnant asthmatic women – a systematic review. Allergol Immunopathol (Madr). 2013;42(5):493–9.
Cossette B, et al. Relative perinatal safety of salmeterol vs formoterol and fluticasone vs budesonide use during pregnancy. Ann Allergy Asthma Immunol. 2014;112(5):459–64.
Charlton RA, et al. Safety of fluticasone propionate prescribed for asthma during pregnancy: a UK population-based cohort study. J Allergy Clin Immunol Pract. 2015;3(5):772–9.e3.
Lin S, et al. Maternal asthma medication use and the risk of gastroschisis. Am J Epidemiol. 2008;168:73–9.
Lin S, Herdt-Losavio M, Gensburg L, et al. Maternal asthma medication use and the risk of congenital heart defects. Birth Defects Res (Part A). 2009a;85:161–8.
Lin S, et al. Maternal asthma, asthma medication use, and the risk of congenital heart defects. Birth Defects Res A Clin Mol Teratol. 2009b;85(2):161–8.
Lin S, et al. Maternal asthma medication use and the risk of selected birth defects. Pediatrics. 2012;129:e317–24.
Busse ww. NAEPP expert panel report. Managing asthma during pregnancy: recommendations for pharmacologic treatment-2004 update. J Allergy Clin Immunol. 2005;115(1):34–46.
Schaible AM, et al. High capacity for leukotriene biosynthesis in peripheral blood during pregnancy. Prostaglandins Leukot Essent Fatty Acids. 2013;89(4):245–55.
Sarkar M, et al. Montelukast use during pregnancy; a multicentre, prospective, comparative study of infant outcomes. Eur J Clin Pharmacol. 2009;65(12):1259–64.
Nelsen LM, et al. Congenital malformationsamong infants born to women receiving montelukast, inhlaed corticosteroids, and other asthma medications. J Allergy Clin Immunol. 2012;129(1):251–254.e6.
Dombrowski MP, et al. Randomized trial of inhaled beclomethasone dipropionate versus theophylline for moderate asthma during pregnancy. Am J Obstet Gynecol. 2004;190(3):737–44.
Park-Wyllie L, Mazzotta P, Pastuszak A, et al. Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiologic studies. Teratology. 2000;62:385–92.
Skuladottir H, et al. Corticosteroid use and risk of orofacial clefts. Birth Defects Res A Clin Mol Teratol. 2014;100(6):499–506.
Namazy J, et al. Effects of asthma severity,exacerbations and oral corticosteroids on perinatal outcomes. Eur Respir J. 2012;41(5):1082–90.
Namazy J, et al. The Xolair pregnancy registry (EXPECT): the safety of omalizumab use during pregnancy. J Allergy Clin Immunol. 2015;135(2):407–12.
Bandoli G, et al. A review of systemic corticosteroid use in pregnancy and the risk of select pregnancy and birth outcomes. Rheum Dis Clin N Am. 2017;43(3):489–502.
Namazy J, et al. Use of inhaled steroids by pregnant asthmatic women does not reduce intrauterine growth. J Allergy Clin Immunol. 2004;113(3):427–32.
Rahimi R, Nikfar S, Abdollahi M. Meta-analysis finds use of inhaled corticosteroids during pregnancy safe: a systematic meta-analysis review. Hum Exp Toxicol. 2006;25(8):447–52.
Wilson J. Use of sodium cromoglycate during pregnancy: results on 296 asthmatic women. Acta Therap. 1982;8(Suppl):45–51.
Tata LJ, et al. A comprehensive analysis of adverse obstetric and pediatric complications in women with asthma. Am J Respir Crit Care Med. 2007;175(10):991–7.
Bakhireva LN, et al. Safety of leukotriene receptor antagonists in pregnancy. J Allergy Clin Immunol. 2007;119(3):618–25.
Cavero-Carbonell C, et al. Fetal exposure to Montelukast and congenital anomalies: a population based study in Denmark. Birth Defects Res. 2017;109(6):452–9.
Briggs GG, et al. Drugs in pregnancy and lactation : a reference guide to fetal and neonatal risk. 11th ed. Philadelphia, PA: Wolters Kluwer; 2017. xiii, 1646 pp.
Munsie JW, et al. Maternal bronchodilator use and the risk of orofacial clefts. Hum Reprod. 2011;26(11):3147–54.
Garne E, et al. Use of asthma medication during pregnancy and risk of specific congenital anomalies: a European case-malformed control study. J Allergy Clin Immunol. 2015;136(6):1496–1502 e7.
Heinonen OP, Slone D, Shapiro S. Birth defects and drugs in pregnancy. Littleton: Publishing Sciences Group; 1977. xi, 516 p.
Wilton LV, et al. The outcomes of pregnancy in women exposed to newly marketed drugs in general practice in England. Br J Obstet Gynaecol. 1998;105(8):882–9.
Eltonsy S, et al. Risk of congenital malformations for asthmatic pregnant women using a long-acting beta(2)-agonist and inhaled corticosteroid combination versus higher-dose inhaled corticosteroid monotherapy. J Allergy Clin Immunol. 2015;135(1):123–30.
Stenius-Aarniala B, Riikonen S, Teramo K. Slow-release theophylline in pregnant asthmatics. Chest. 1995;107(3):642–7.
Park JM, Schmer V, Myers TL. Cardiovascular anomalies associated with prenatal exposure to theophylline. South Med J. 1990;83(12):1487–8.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Namazy, J.A., Schatz, M., Litonjua, A.A. (2020). Severe Asthma in Pregnancy: Special Considerations. In: Khurana, S., Holguin, F. (eds) Difficult To Treat Asthma. Respiratory Medicine. Humana, Cham. https://doi.org/10.1007/978-3-030-20812-7_13
Download citation
DOI: https://doi.org/10.1007/978-3-030-20812-7_13
Published:
Publisher Name: Humana, Cham
Print ISBN: 978-3-030-20811-0
Online ISBN: 978-3-030-20812-7
eBook Packages: MedicineMedicine (R0)