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Review
. 2021 Sep;14(3):135-144.
doi: 10.1177/1753495X20965072. Epub 2020 Nov 1.

Asthma in pregnancy: An update

Simon Couillard  1   2 , Clare Connolly  1 , Catherine Borg  1 , Ian Pavord  1
Affiliations
Review

Asthma in pregnancy: An update

Simon Couillard et al. Obstet Med. 2021 Sep.

Abstract

Aim: To update obstetric care providers about asthma management.

Summary: Asthma is the most frequent comorbid chronic illness in pregnancy. Convincing evidence shows that uncontrolled asthma magnifies the risk of maternal, fetal and neonate complications. Unfortunately, one in four women take no inhaler during pregnancy, and it is likely that decreased adherence, rather than changes in pathology, explains uncontrolled maternal asthma. Patient surveys reveal a need for information and reassurance. Although some molecules are preferred in pregnancy, there is currently no basis to withhold any asthma medication - old or new. Biomarkers such as blood eosinophils and fractional exhaled nitric oxide are an effective way to assess the risk of asthma attacks and the likelihood of responding to inhaled steroids. Furthermore, practice-changing trials in mild asthma show that switching reliever-only regimens to as-needed 'controller-and-reliever' therapy is effective. We suggest that applying these changes can alleviate women's concerns and improve outcomes.

Keywords: Asthma; FeNO; biomarkers; blood eosinophils; fetal outcomes; maternal outcomes; pregnancy.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Incidence and severity of physiological dyspnoea during pregnancy. □: dyspnoea climbing more than one flight of stairs. ▪: dyspnoea while walking at an even pace on level ground, ■: dyspnoea on slightest exertion or at rest. Figure reproduced and legend adapted from Milne. NP: not pregnant.
Figure 2.
Figure 2.
Type 2 driven inflammation is recognised as both a risk factor and a treatable trait. Figure and legend modified from Mason et al.
Figure 3.
Figure 3.
Incidence of adverse obstetric and perinatal outcomes in women with asthma who did and did not have asthma exacerbations during pregnancy. All outcomes listed were reported as significantly different after adjusted logistic regression analysis with generalized estimating equation for repeated measures or adjusted multivariable Poisson regression. Data from Abdullah et al. *Diagnosed before age 5.
See this image and copyright information in PMC

References

    1. 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: 317–324. - PubMed
    1. Kurinczuk JJ, Parsons DE, Dawes V, et al.. The relationship between asthma and smoking during pregnancy. Women Health 1999; 29: 31–47. - PubMed
    1. Abdullah K, Zhu J, Gershon A, et al.. Effect of asthma exacerbation during pregnancy in women with asthma: a population-based cohort study. Eur Respir J. Epub ahead of print February 2020. DOI: 10.1183/13993003.01335-2019. - PubMed
    1. Magriples U, Copel JA. Obstetric management of the high-risk patient. In: Burrow G, Duffy T, Copel J. (eds) Medical complications during pregnancy. Philadelphia: Elsevier, 2004, p.592.
    1. Gaiser R, et al.. Physiologic changes of pregnancy. In: Chestnut D, Wong C, Tsen L. (eds) Chestnut’s obstetric anesthesia: principles and practice. Philadelphia: Elsevier, p.1382.

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