Congratulations! Pretty soon you will be a new mother. While you are pregnant, it is doubly important that your asthma be well-managed. Uncontrolled asthma can be a threat to maternal well-being and to fetal growth and survival.

Studies indicate that maternal asthma that is well-managed during pregnancy does not increase the risk of maternal or infant complications. However, there is a direct relationship between uncontrolled asthma and lower birth weight. Therefore, keeping your asthma in check is the best bet for you and your baby.

Uncontrolled asthma affects your fetus because it causes a decrease in the oxygen content in the mother's blood. The baby is receiving its oxygen from that blood which can lead to impaired fetal growth and survival, since a fetus requires a constant supply of oxygen for normal growth and development.

Medications are a large part of controlling asthma. Most inhaled asthma medications are appropriate for patients to use while pregnant. The risks of uncontrolled asthma appear to be greater than the risks of necessary asthma medications.

The following recommendations have been issued by the Advisory Committee of the American Academy of Allergy, Asthma & Immunology with regards to treating asthmatic women during pregnancy. A full report of these guidelines will be issued shortly by the National Asthma Education and Prevention Program, part of the National Heart, Lung and Blood Institute.

Asthma affects about 7% of pregnant women, and research has suggested that some of these women are at increased risk for pre-eclampsia, premature birth, low-birth weight, and/or perinatal mortality. These risks are felt to be significantly decreased if a pregnant woman's asthma is well controlled.

The new guidelines discuss the need to intensely monitor women with asthma once a month during pregnancy.

Allergen avoidance procedures, especially with regards to dust mite, animal danders and molds need to be strictly enforced. Environmental irritants, especially cigarette smoke and air pollution, need to be avoided. Patients need to be well educated on the importance of asthma control.

Caution must also be taken when decreasing medications during pregnancy, as asthmatic flareups are more likely to cause complications than well-controlled asthma. Decreasing medications should probably be postponed until after the pregnancy is completed.

The following recommendations focus on the drug treatment of asthma. Researchers reviewed a total of 6,113 articles in the medical literature published between 1990 and May 2003, analyzing 44 in depth.

The new recommendations are as follows:

• For mild, intermittent asthma, pregnant women should be prescribed short-acting inhaled beta2-agonist, preferably albuterol. Previously, the recommended drug was terbutaline.

• For mild, persistent asthma, pregnant women should be prescribed low-dose inhaled corticosteroids (ICS), preferably budesonide. Previously, cromolyn was the initial preferred treatment. Now, cromolyn is an alternative recommended treatment, as are leukotriene receptor antagonists and/or theophylline.

  If a patient is doing well on a ICS other than budesonide, the committee members advised against switching to budesonide. Budesonide, however, is the ICS of choice in pregnancy, or for women of childbearing age who may become pregnant.

• For moderate, persistent asthma, there are two equal recommendations: either a lowdose inhaled cortiscosteroid plus a long-acting inhaled beta2-agonist such as salmeterol, or a medium-dose of an inhaled corticosteroid. Previous recommendations of cromolyn and an oral beta2-agonist are no longer recommended.

• For severe, persistent asthma, pregnant women should be prescribed a high dose inhaled corticosteroid, preferably budesonide, and oral Prednisone as a last resort at a maximum of 60 mg/day. The risks of not treating severe asthma need to be weighed against the indication that oral corticosteroid use during the first trimester was associated with an increased risk in cleft palate and with preterm birth and low birth weight. As noted previously, uncontrolled asthma is itself a risk for perinatal morbidity and mortality.

• The researchers made no recommendations regarding omalizumab (Xolair), an asthma medication approved last June by the U.S. Food and Drug Administration, as there is no published data yet regarding its use among pregnant women.

Allergy shots do not have an adverse effect on pregnancy, so they can be continued. We will monitor your allergy extract dose to lessen the risk of an allergic reaction to the shots. These reactions are rare, but you will want to take all precautions. You should not begin allergy shots for the first time while pregnant.

How asthma effects pregnancy is different for many people. This is why it is important to communicate with us immediately to properly manage your particular situation. Additionally, most women with asthma are able to perform Lamaze breathing techniques without difficulty.

Breast feeding is a good way to increase your child's immunity. The transfer of drugs into breast milk has not been precisely evaluated; however, there appears to be no evidence that asthma medications adversely affect nursing infants. Also, if you have allergy symptoms while nursing, most nasal steroid sprays, antihistamines and decongestants can be used.

Please contact us if you have additional concerns about your allergies and asthma with regards to your pregnancy or breast feeding.

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Michigan Allergy, Sinus & Asthma Specialists

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