How is asthma treated in pregnant women?

Updated: Oct 07, 2019
  • Author: John J Oppenheimer, MD; Chief Editor: Michael A Kaliner, MD  more...
  • Print
Answer

Answer

Asthma affects up to 8% of pregnant women, and these patients should be treated similarly to, and possibly even more aggressively than, other patients, given the detrimental effects of hypoxia on maternal and fetal outcomes. During pregnancy, airway hyperreactivity (AHR) generally is stable to improved 69% of the time and worse 31% of the time.

Theophylline may be associated with drug toxicity in the newborn because of poor clearance.

Beclomethasone is an older and, therefore, better-studied inhaled steroid for use during pregnancy. 

Systemic glucocorticoids may increase the risk of preeclampsia and decreased birth weight but should be used if asthma exacerbation is severe, because untreated asthma bears its own risks on the pregnancy.

Potentially, beta-agonists may interfere with uterine contractility; therapy during labor should be restricted to patients in whom the benefits clearly outweigh risks.

Leukotriene pathway medications generally should not be used because of a lack of safety information; montelukast use in pregnant women is not associated with risk of major birth defects; leukotrienes should only be used during pregnancy if there are no other alternatives 

Immunotherapy should not be started nor dosage escalated during pregnancy, given the rare, but significant, risk of anaphylaxis. If already begun, immunotherapy may be maintained without further dose escalation.


Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!