Sunday October 21, 2012
Asthma in pregnancy
By Dr NORZILA MOHAMED ZAINUDIN
Around 8% of women in their childbearing years have asthma. How will this affect the child?
PREGNANCY is usually a time that is filled with excitement in a woman’s life. However, if you have a condition like asthma, you might be concerned about how it can affect the health of your unborn child.
Asthma is the most common serious medical condition that can potentially complicate pregnancy. During an asthma attack, the foetus may not receive enough oxygen. After the birth of your child, you might have worries as to whether your asthma medications will affect your breast milk.
However, all this does not mean you should avoid getting pregnant at all costs if you’re asthmatic. With a thorough medical management plan and avoidance of known triggers, you will be able to reduce your risks and increase your chances of having a safe pregnancy.
Therefore, you need to be aware of the precautions that should be taken to manage your condition effectively to prevent serious complications and protect your baby.
It’s important to be aware that the advent of pregnancy can alter your asthma condition. Approximately one-third of women with asthma report improvement during pregnancy, while another one-third become worse, while the other third remain the same.
Studies have suggested that those with severe asthma are more likely to worsen, while those with mild asthma are more likely to improve or stay the same.
Symptoms tend to become apparent during weeks 24-36 of pregnancy. Within three months after you have delivered your baby, any changes in the severity of asthma will normally return to what you were experiencing before pregnancy.
Asthma medications and pregnancy
You may think that you need to stop taking your asthma medications once you become pregnant, worrying that it might harm your foetus.
Don’t do this, because the risks of uncontrolled asthma are much worse than the risks of taking asthma medications during pregnancy. Instead, consult your doctor so that an individualised treatment plan can be created, and appropriate medication changes can be made, if necessary.
If possible, asthma care should be combined with obstetric care, and doctors from both sides should work as a team.
In general, inhaled medications are preferred due to their localised effect, with only small quantities entering the bloodstream. Numerous studies have indicated no increased risk of pre-eclampsia, premature birth, low birth weight or congenital malformations in women who used inhaled medications.
Apart from this, older medications that have been tested during pregnancy are also preferred.
During the first trimester, medication use will be limited as much as possible, as the foetus is forming.
Your doctor will plan your treatment by taking into account a careful balance between medication use and symptom control.
Asthma medications and breastfeeding
Medications that can be used during pregnancy are generally safe for consumption when breastfeeding as well. Oral steroids sometimes penetrate into breast milk, but only in small amounts, and not in harmful quantities.
Take note that asthma medications will not affect your ability to produce breast milk.
A recent study conducted in the UK that was published in the American Journal of Respiratory and Critical Care Medicine found evidence of improvement in lung function in children who were breastfed as babies by mothers who had asthma. The study suggests that overall, breastfeeding is beneficial for lung development, as well as strengthens the immune system and overall health of the baby.
Asthma that is not controlled well poses serious risks to both mother and child. The mother might develop pre-eclampsia or hypertension during pregnancy, which can also harm the baby. A severe asthma attack can also lead to maternal hypoxemia, which is a dangerously low amount of oxygen in the arterial blood.
Uncontrolled asthma raises the chances of your baby being born premature, to be underweight at birth, and to need longer hospitalisation after birth. At worst, uncontrolled asthma can lead to a miscarriage because of the lack of oxygen to the foetus.
Severe asthma attacks should not be ignored. If at any time, you experience severe chest tightness and difficulty in breathing, go to the nearest hospital emergency department immediately. Once you’re there, you will be given oxygen and “rescue” medications that are safe for you and your unborn child.
Frequent monitoring is important for pregnant women with asthma, so that any problems can be identified and given the required attention. To make sure your growing foetus is receiving an adequate supply of oxygen throughout your pregnancy, go for monthly check-ups with your doctor to monitor your symptoms and lung function closely.
After 28 weeks of pregnancy, you should monitor foetal movements every day on your own. You can do this by observing foetal activity or number of kicks, and writing them in a notebook. Communicate these observations to your physician.
During your third trimester, you may need to undergo some tests to evaluate foetal well-being, such as electronic heart rate monitoring and ultrasonic determinations.
It is best to avoid known triggers for asthma attacks. Doing so can improve your symptoms, and reduce the amount of medication you need to take. Here are some guidelines:
·After you get pregnant, you may find that your asthma symptoms or sensitivity to some triggers changes. Therefore, together with your healthcare provider, review the action plan for asthma you’ve been using before you were pregnant, and make changes if needed.
·Don’t smoke, as it dangerously reduces oxygen supply to the foetus. It can also greatly increase your likelihood of experiencing a severe asthma attack at some time during the pregnancy.
·Stay away from people who smoke, as second-hand smoke is also harmful.
·Avoid having allergy-causing pets, or at least, restrict them to a part of the house away from your bedroom.
·Identify things you are allergic to, and make it a point to avoid them. Talk to your doctor about medicines like antihistamines that you can take to treat your allergies.
·Cover pillows, mattresses and box springs in special dust mite-proof casings.
·If you are prone to having gastroesophageal reflux disease (GERD) such as heartburn, take steps to manage it, because it can worsen asthma. Try breaking up your three main meals into four or five smaller meals throughout the day. Also, avoid lying down right after eating.
·Exercise should be carried out carefully, and under the supervision of a doctor.
·Keep your distance from people with colds or flu to prevent yourself from being infected. Colds and flu can exacerbate asthma symptoms.
On the whole, the asthma medications you take are not a major problem for the health of your baby. However, it’s highly important that you take them regularly, according to how your doctor prescribed them.
The best way to keep asthmatic symptoms under control is through regular monitoring, avoidance of known triggers, having a basic knowledge of medical management during pregnancy, and an individualised medication plan.
Managing your asthma well will help ensure a pregnancy and delivery that is as healthy and normal as a woman without asthma.
> Dr Norzila Mohamed Zainudin is a consultant paediatrician and paediatric respiratory physician. This article is courtesy of Positive Parenting Programme by Malaysian Paediatric Association and is supported by an educational grant from GlaxoSmithKline. The opinions expressed in the article are the view of the author. For more information, please visit www.mypositiveparenting.org.