Asthma & Pregnancy

When you become pregnant, you may notice many physical and emotional changes. Joy and wonder are often mixed with concerns about your health and the health of your unborn child.

Studies show that having asthma does not increase your chances of having a baby with birth defects, particularly if you keep your asthma under good control during pregnancy. Further studies show that asthma can be controlled during pregnancy with little or no risk to you or your baby.

If you have asthma, you may be concerned about this also. It is helpful to know that studies show having asthma does not increase your chances of having a baby with birth defects or of having multiple births. Further studies show that asthma can be controlled during pregnancy with little or no risk to you or your baby.

Your Health Care Provider

Many women with asthma do very well during pregnancy. Your doctor will consider the benefits of medication versus the risks to both you and your unborn baby. Together, you will determine the best ways to manage your asthma. Your doctor will review your asthma history and may have you do a breathing test (spirometry).

Since uncontrolled asthma can threaten your well-being and that of your baby, you and your doctor share a common goal throughout your pregnancy. The goal is to keep you healthy and breathing normally. Keeping your asthma under control during pregnancy is one of the most important things you can do for your baby’s health.
 

Symptoms and Management

Good asthma management is always important but never more so than during your pregnancy. Asthma management includes:

• Learning more about your asthma and pregnancy
• Identifying and controlling asthma triggers during pregnancy
• Taking appropriate medications during pregnancy
• Monitoring your asthma closely
• Developing and following an asthma action plan

Watching for asthma symptoms and monitoring peak flow can help you and your health care provider keep track of your asthma during your pregnancy. It is important to identify and treat asthma symptoms before they become worse.

Asthma symptoms can range from mild to severe. It is important to identify and treat your asthma when the symptoms are still mild. This can help decrease the amount of inflammation and reduce the risk of a more serious asthma attack. Common asthma symptoms include:

• Coughing
• Shortness of breath
• Tightness in the chest
• Wheezing

Shortness of breath, unrelated to asthma, often occurs during pregnancy, so it is important to tell your provider if you experience this symptom. The peak flow meter can help you distinguish the normal shortness of breath associated with pregnancy from shortness of breath as an asthma symptom. A peak flow meter measures the peak expiratory flow — how much air you blow out after a maximum inhalation. Sometimes peak flows can decrease hours, or even a day or two, before other asthma symptoms start. Ask your doctor about using a peak flow meter to help monitor your asthma.

Triggers

It is important to know what things make your asthma worse and how to avoid or manage them when pregnant.
Things that can make asthma worse include: irritants, allergies, exercise, infections, sinusitis, weather, emotions, gastroesophageal reflux disease and hormone changes.
 

Irritants

Avoid smoking and exposure to secondhand smoke. Both can make asthma worse. Smoke exposure can also pose major risks for your unborn baby. Learn more about the risks of secondhand smoke. 
 

Allergies

Avoid things to which you are allergic (allergens). Pollen, mold, animal dander, house dust mites and cockroaches are common allergens. If you are on allergy shots when you get pregnant, you can continue your shots a long as you stay at a steady dose during pregnancy. Learn more about allergies and asthma.
 

Exercise

Continuing to exercise while pregnant is desirable. If exercise makes your asthma worse, talk with your doctor. Using inhaled medication before you exercise can often prevent asthma symptoms while you exercise. Read more about exercise-induced asthma.
 

Infections

A cold, the flu, COVID-19, and other respiratory infections can make asthma worse. Good hand-washing is the most effective way to avoid the spread of common viruses. The yearly flu vaccine is recommended for people with asthma. It may be given during the second or third trimester of pregnancy. COVID-19 vaccination is also recommended for pregnant women who are not up-to-date on their COVID-19 vaccine series.
 

Sinusitis

Sinusitis can make asthma worse, especially at night. Treating the inflammation in the nose and sinuses can decrease postnasal drip, reduce cough and throat irritation, and indirectly decrease inflammation in the lungs. This can decrease asthma symptoms and improve asthma control.

Sinus care often includes:
 

• Nasal wash. A saltwater or nasal saline wash helps remove mucus and bacteria from the nose and sinuses. When done routinely, this can also decrease postnasal drip and congestion. The nasal wash should be done 10 or 15 minutes before using a steroid nasal spray. If using nasal washes in the evening, they should be done 1-2 hours before lying down.
• Steroid or antihistamine nasal sprays. These sprays help to decrease irritation and inflammation in the nasal and sinus passages. Mucus production and swelling should decrease as a result.

Learn more about sinusitis.
 

Emotions

Emotions do not cause asthma, but if a person has asthma, emotions can sometimes make asthma worse. Simple reactions such as laughing or crying can sometimes cause asthma symptoms. Strong emotions such as anger, fear and feelings of stress can also heighten asthma symptoms. It is important to express emotions, and good asthma management can minimize the effect of emotions on asthma. If you are pregnant and experiencing chronic distress or emotional problems, it may be especially important to talk with your doctor because of their additional effect on your asthma and lifestyle.
 

Weather

Asthma symptoms may occur with changes in the weather. However, there is not one type of climate that is good or bad for all people with asthma. Work with your doctor on keeping your asthma under control wherever you live.
 

Gastrointestinal or Gastroesophageal Reflux Disease (GERD)

In some people, the muscle between the esophagus and stomach may not work well. This allows some back flow of stomach acid into the esophagus, which may cause heartburn. This acid is also thought to possibly cause a reflex response that results in asthma symptoms. This is more common during pregnancy and is treatable. Learn more about gastroesophageal reflux disease.
 

Hormone Changes

There are a variety of hormonal changes during pregnancy. For pregnant women with asthma, approximately one-third worsen, one-third improve, and one-third stay the same during pregnancy.  Regardless of which third a woman falls into, most note that asthma severity usually returns to baseline following pregnancy.
 

Creating an Asthma Action Plan

It is important to treat asthma symptoms and low peak flow numbers to ensure you and your baby receive enough oxygen. An asthma action plan is a written plan, customized by your healthcare provider to help you manage asthma episodes. Your action plan is based on changes in asthma symptoms and peak flow numbers. It will give you information about when and how to use long-term control medicine and quick-relief medicine. If you know what to watch for and what steps to take, you will be able to make timely and appropriate decisions about managing your asthma during your pregnancy.

Severe Asthma Attacks During Pregnancy

A small number of pregnant women with asthma may have an asthma attack severe enough to be hospitalized. A severe asthma attack is a true medical emergency, and you should seek medical assistance right away. You and your baby can be closely monitored during your hospital stay. Your treatment may include oxygen, frequent inhaled medications and IV steroids.
 

Asthma Management During Labor and Delivery

It is important to continue long-term control medicines through the labor and delivery process. Have quick-relief medicines available also. Bring your own medicine to the hospital, so the health care provider will know the current medication and dosage that has been prescribed by your doctor. Plan ahead to ensure that you have your most current medication information available.

Talk with your health care provider before your delivery date about pain relief options during labor and birth. Epidurals are commonly used to reduce pain during labor and can also be used if a cesarean birth becomes necessary. Regional anesthesia (either an epidural or spinal) is most commonly used for cesareans; general anesthesia is rarely used and only during emergencies. Electronic fetal heart monitoring is done during labor and birth to keep track of the heart rate of your baby and the strength and duration of the contractions of your uterus. Your baby’s heart rate is a good way to tell whether your baby is doing well or may have some problems.

If a cesarean birth is required, you may need IV steroids. This is considered if you are steroid-dependent or have been on steroid tablets in the past 4-6 weeks.

It is important to plan ahead and discuss these decisions and potential problems with your health care providers. This will help decrease fears and problems that may arise once labor begins.

Breastfeeding When You Have Asthma

Research shows that breastfeeding for the first 6-12 months of life may help prevent or delay the development of certain allergies. The decision to breastfeed should be based on you and your baby's special needs.
In general, when breastfeeding, the use of most asthma medicines does not affect your baby or interfere with your milk production. It is important to discuss your use of any medicines with the health care provider caring for your baby. The medicines listed earlier for use during pregnancy are generally used while breastfeeding without problems. Remember, your bloodstream absorbs less medicine with inhaled medicine; therefore, less medicine passes into your breast milk. Medication exposure to the infant can be decreased by nursing prior to taking your asthma medication.

The following list of medicines offers some additional information that can be discussed with your doctor:

• Leukotriene Modifiers: The leukotriene modifiers are excreted in breast milk. Because of the potential for adverse effects, these medicines should not be taken while you are breastfeeding.
• Oral Steroids: Oral steroids pass through breast milk in trace amounts. Even at high dosages, they have not been associated with problems.
• Theophylline: This medicine passes through breast milk in trace amounts. This has been associated with irritability and insomnia in some infants.