Asthma in pregnancy
|
Asthma Microchapters |
|
Diagnosis |
|---|
|
Other Diagnostic Studies |
|
Treatment |
|
Case Studies |
|
Asthma in pregnancy On the Web |
|
American Roentgen Ray Society Images of Asthma in pregnancy |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Varun Kumar, M.B.B.S. [2]; Lakshmi Gopalakrishnan, M.B.B.S. [3]
Overview
Asthma is one of the most common pulmonary conditions occurring during pregnancy[1] with a prevalence rate of 3.7% to 8.4% in United States during the period 1997-2001[2].
Pathophysiology
During pregnancy, due to high levels of progesterone, minute ventilatory rate is increased causing compensated respiratory alkalosis.[3] Hence the arterial blood gases may reveal a higher PO2 and lower PCO2 with mild alkalotic PH. Normal PCO2 during pregnancy is suggestive of impending respiratory failure.
Asthma is characterized by broncho-constriction or inflammation of airways with production of thick mucoid secretions. In a small prospective study involving 16 asthmatic pregnant women, hyper-reactivity was seen to be lower as evidenced by a reduction in minimum medication requirements.[4]
Natural History, Complications and Prognosis
Asthma during pregnancy may have negative impact on both mother and the child especially in severe or poorly controlled cases. Complications include:
- Complications during labor[5]
- Congenital anomalies
- Complications of corticosteroid use[6]
- Cesarean delivery[5]
- Hyperemesis
- Hypertensive conditions[7][5]
- Low birth weight infants[5][8]
- Neonatal hypoglycemia
- Neonatal mortality
- Neonatal seizures
- Preterm labor and premature delivery[5][8]
- Preeclampsia[9]
- Respiratory failure
- Uterine hemorrhage
Treatment [4]
- Monitor asthma control during all prenatal visits.
- Asthmatic symptoms worsen in about a third during pregnancy and improve in a third; hence, medications should be adjusted accordingly.
- Regular monitoring and maintenance of lung function to ensure adequate oxygen supply to the fetus.
- It is safer to treat asthma with medications than to have poorly-controlled asthma.
- Drug of choice in pregnancy:
- Albuterol is preferred to short-acting β2-agonist (SABA)
- Inhaled corticosteroid such as budesonide is preferred for long-term control of symptoms.
References
- ↑ Rey E, Boulet LP (2007). "Asthma in pregnancy". BMJ. 334 (7593): 582–5. doi:10.1136/bmj.39112.717674.BE. PMC 1828355. PMID 17363831.
- ↑ Kwon HL, Belanger K, Bracken MB (2003). "Asthma prevalence among pregnant and childbearing-aged women in the United States: estimates from national health surveys". Ann Epidemiol. 13 (5): 317–24. PMID 12821270.
- ↑ Wise RA, Polito AJ, Krishnan V (2006). "Respiratory physiologic changes in pregnancy". Immunol Allergy Clin North Am. 26 (1): 1–12. doi:10.1016/j.iac.2005.10.004. PMID 16443140.
- ↑ Juniper EF, Daniel EE, Roberts RS, Kline PA, Hargreave FE, Newhouse MT (1989). "Improvement in airway responsiveness and asthma severity during pregnancy. A prospective study". Am Rev Respir Dis. 140 (4): 924–31. PMID 2679270.
- ↑ 5.0 5.1 5.2 5.3 5.4 Liu S, Wen SW, Demissie K, Marcoux S, Kramer MS (2001). "Maternal asthma and pregnancy outcomes: a retrospective cohort study". Am J Obstet Gynecol. 184 (2): 90–6. doi:10.1067/mob.2001.108073. PMID 11174486.
- ↑ Perlow JH, Montgomery D, Morgan MA, Towers CV, Porto M (1992). "Severity of asthma and perinatal outcome". Am J Obstet Gynecol. 167 (4 Pt 1): 963–7. PMID 1415433.
- ↑ Lehrer S, Stone J, Lapinski R, Lockwood CJ, Schachter BS, Berkowitz R; et al. (1993). "Association between pregnancy-induced hypertension and asthma during pregnancy". Am J Obstet Gynecol. 168 (5): 1463–6. PMID 8498428.
- ↑ 8.0 8.1 Breton MC, Beauchesne MF, Lemière C, Rey E, Forget A, Blais L (2009). "Risk of perinatal mortality associated with asthma during pregnancy". Thorax. 64 (2): 101–6. doi:10.1136/thx.2008.102970. PMID 19008298.
- ↑ Triche EW, Saftlas AF, Belanger K, Leaderer BP, Bracken MB (2004). "Association of asthma diagnosis, severity, symptoms, and treatment with risk of preeclampsia". Obstet Gynecol. 104 (3): 585–93. doi:10.1097/01.AOG.0000136481.05983.91. PMID 15339773.