Download PDF
Semin Respir Crit Care Med 2018; 39(01): 029-035
DOI: 10.1055/s-0037-1606216
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Management of Asthma during Pregnancy: Optimizing Outcomes and Minimizing Risk

Jennifer A. Namazy
1   Scripps Clinic, San Diego, California
,
Michael Schatz
2   Department of Allergy, Kaiser Permanente Medical Center, San Diego, California
› Author Affiliations
Further Information

Publication History

Publication Date:
10 February 2018 (online)

    Permissions and Reprints

Abstract

Pregnancy may be complicated by new onset or preexisting asthma. This article reviews diagnosis and management of asthma in the pregnant patient. Special attention is paid to the challenges in diagnosis and management of this condition during pregnancy. Asthma is one of the most common potentially serious medical problems to complicate pregnancy, and asthma may adversely affect both maternal quality of life and perinatal outcomes. Asthma may adversely affect both maternal quality of life and, perinatal outcomes. Pregnant asthmatics have been shown to be at an increased risk of adverse perinatal outcomes. Optimal management of asthma during pregnancy is thus important for both mother and baby. This article provides an update on the available literature regarding the safety of commonly used asthma medications during pregnancy.

Keywords

asthma - pregnancy - medications
 

  • References

  • 1 Schatz M, Dombrowski MP, Wise R. , et al. Asthma morbidity during pregnancy can be predicted by severity classification. J Allergy Clin Immunol 2003; 112 (02) 283-288
    CrossrefPubMedGoogle Scholar
  • 2 Belanger K, Hellenbrand ME, Holford TR, Bracken M. Effect of pregnancy on maternal asthma symptoms and medication use. Obstet Gynecol 2010; 115 (03) 559-567
    CrossrefPubMedGoogle Scholar
  • 3 Schatz M, Harden K, Forsythe A. , et al. The course of asthma during pregnancy, post partum, and with successive pregnancies: a prospective analysis. J Allergy Clin Immunol 1988; 81 (03) 509-517
    CrossrefPubMedGoogle Scholar
  • 4 Kim S, Kim J, Park SY. , et al. Effect of pregnancy in asthma on health care use and perinatal outcomes. J Allergy Clin Immunol 2015; 136 (05) 1215-1223.e1 , 6
    CrossrefPubMedGoogle Scholar
  • 5 Gluck J, Gluck P. The effect of pregnancy on the course of asthma. Immunol Allergy Clin North Am 2006; 26 (01) 63-80
    CrossrefPubMedGoogle Scholar
  • 6 Murphy VE, Gibson PG, Smith R, Clifton VL. Asthma during pregnancy: mechanisms and treatment implications. Eur Respir J 2005; 25 (04) 731-750
    CrossrefPubMedGoogle Scholar
  • 7 Hodyl NA, Stark MJ, Scheil W, Grzeskowiak LE, Clifton VL. Perinatal outcomes following maternal asthma and cigarette smoking during pregnancy. Eur Respir J 2014; 43 (03) 704-716
    CrossrefPubMedGoogle Scholar
  • 8 Murphy VE, Powell H, Wark PAB, Gibson PG. A prospective study of respiratory viral infection in pregnant women with and without asthma. Chest 2013; 144 (02) 420-427
    CrossrefPubMedGoogle Scholar
  • 9 Palmsten K, Schatz M, Chan PH. , et al. Validation of the pregnancy asthma control test. J Allergy Clin Immunol 2016; 4 (02) 310-315.e1
    CrossrefPubMedGoogle Scholar
  • 10 Eszes N, Toldi G, Bohács A. , et al. Relationship of circulating hyaluronic acid levels to disease control in asthma and asthmatic pregnancy. PLoS One 2014; 9 (04) e94678
    CrossrefPubMedGoogle Scholar
  • 11 Powell H, Murphy VE, Taylor DR. , et al. Management of asthma in pregnancy guided by measurement of fraction of exhaled nitric oxide: a double-blind, randomised controlled trial. Lancet 2011; 378 (9795): 983-990
    CrossrefPubMedGoogle Scholar
  • 12 Tinker SC, Broussard CS, Frey MT, Gilboa SM. Prevalence of prescription medication use among non-pregnant women of childbearing age and pregnant women in the United States: NHANES, 1999-2006. Matern Child Health J 2015; 19 (05) 1097-1106
    CrossrefPubMedGoogle Scholar
  • 13 Schatz M, Dombrowski MP, Wise R. , et al; Maternal-Fetal Medicine Units Network, The National Institute of Child Health and Development; National Heart, Lung and Blood Institute. The relationship of asthma medication use to perinatal outcomes. J Allergy Clin Immunol 2004; 113 (06) 1040-1045
    CrossrefPubMedGoogle Scholar
  • 14 Schatz M, Zeiger RS, Harden K, Hoffman CC, Chilingar L, Petitti D. The safety of asthma and allergy medications during pregnancy. J Allergy Clin Immunol 1997; 100 (03) 301-306
    CrossrefPubMedGoogle Scholar
  • 15 Norjavaara E, de Verdier MG. Normal pregnancy outcomes in a population-based study including 2,968 pregnant women exposed to budesonide. J Allergy Clin Immunol 2003; 111 (04) 736-742
    CrossrefPubMedGoogle Scholar
  • 16 Bracken MB, Triche EW, Belanger K, Saftlas A, Beckett WS, Leaderer BP. Asthma symptoms, severity, and drug therapy: a prospective study of effects on 2205 pregnancies. Obstet Gynecol 2003; 102 (04) 739-752
    PubMedGoogle Scholar
  • 17 Martel MJ, Rey E, Beauchesne MF. , et al. Use of inhaled corticosteroids during pregnancy and risk of pregnancy induced hypertension: nested case-control study. BMJ 2005; 330 (7485): 230
    CrossrefPubMedGoogle Scholar
  • 18 Källén B, Rydhstroem H, Aberg A. Congenital malformations after the use of inhaled budesonide in early pregnancy. Obstet Gynecol 1999; 93 (03) 392-395
    PubMedGoogle Scholar
  • 19 Bakhireva LN, Jones KL, Schatz M, Johnson D, Chambers CD. ; Organization Of Teratology Information Services Research Group. Asthma medication use in pregnancy and fetal growth. J Allergy Clin Immunol 2005; 116 (03) 503-509
    CrossrefPubMedGoogle Scholar
  • 20 Breton MC, Beauchesne MF, Lemière C, Rey É, Forget A, Blais L. Risk of perinatal mortality associated with inhaled corticosteroid use for the treatment of asthma during pregnancy. J Allergy Clin Immunol 2010; 126 (04) 772-777.e2
    CrossrefPubMedGoogle Scholar
  • 21 Blais L, Beauchesne MF, Lemière C, Elftouh N. High doses of inhaled corticosteroids during the first trimester of pregnancy and congenital malformations. J Allergy Clin Immunol 2009; 124 (06) 1229-1234.e4
    CrossrefPubMedGoogle Scholar
  • 22 Blais L, Forget A. Asthma exacerbations during the first trimester of pregnancy and the risk of congenital malformations among asthmatic women. J Allergy Clin Immunol 2008; 121 (06) 1379-1384 , 1384.e1
    CrossrefPubMedGoogle Scholar
  • 23 Garne E, Hansen AV, Morris J. , et al. Use of asthma medication during pregnancy and risk of specific congenital anomalies: A European case-malformed control study. J Allergy Clin Immunol 2015; 136 (06) 1496-1502.e1 , 7
    CrossrefPubMedGoogle Scholar
  • 24 Cossette B, Forget A, Beauchesne MF. , et al. Impact of maternal use of asthma-controller therapy on perinatal outcomes. Thorax 2013; 68 (08) 724-730
    CrossrefPubMedGoogle Scholar
  • 25 Murphy VE, Wang G, Namazy JA. , et al. The risk of congenital malformations, perinatal mortality and neonatal hospitalisation among pregnant women with asthma: a systematic review and meta-analysis. BJOG 2013; 120 (07) 812-822
    CrossrefPubMedGoogle Scholar
  • 26 Baribeau V, Beauchesne MF, Rey É, Forget A, Blais L. The use of asthma controller medications during pregnancy and the risk of gestational diabetes. J Allergy Clin Immunol 2016; 138 (06) 1732-1733.e6
    CrossrefPubMedGoogle Scholar
  • 27 Lin S, Munsie JP, Herdt-Losavio ML. , et al; National Birth Defects Prevention Study. Maternal asthma medication use and the risk of gastroschisis. Am J Epidemiol 2008; 168 (01) 73-79
    CrossrefPubMedGoogle Scholar
  • 28 Lin S, Herdt-Losavio M, Gensburg L, Marshall E, Druschel C. Maternal asthma, asthma medication use, and the risk of congenital heart defects. Birth Defects Res A Clin Mol Teratol 2009; 85 (02) 161-168
    CrossrefPubMedGoogle Scholar
  • 29 Wang G, Murphy VE, Namazy J. , et al. The risk of maternal and placental complications in pregnant women with asthma: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2014; 27 (09) 934-942
    CrossrefPubMedGoogle Scholar
  • 30 Van Zutphen AR, Bell EM, Browne ML, Lin S, Lin AE, Druschel CM. ; National Birth Defects Prevention Study. Maternal asthma medication use during pregnancy and risk of congenital heart defects. Birth Defects Res A Clin Mol Teratol 2015; 103 (11) 951-961
    CrossrefPubMedGoogle Scholar
  • 31 Cossette B, Beauchesne MF, Forget A. , et al. Relative perinatal safety of salmeterol vs formoterol and fluticasone vs budesonide use during pregnancy. Ann Allergy Asthma Immunol 2014; 112 (05) 459-464
    CrossrefPubMedGoogle Scholar
  • 32 Eltonsy S, Forget A, Beauchesne MF, Blais L. Risk of congenital malformations for asthmatic pregnant women using a long-acting β2-agonist and inhaled corticosteroid combination versus higher-dose inhaled corticosteroid monotherapy. J Allergy Clin Immunol 2015; 135 (01) 123-130
    CrossrefPubMedGoogle Scholar
  • 33 Busse WW. ; National Heart, Lung, and Blood Institute; National Asthma Education and Prevention Program Asthma and Pregnancy Working Group. NAEPP expert panel report. Managing asthma during pregnancy: recommendations for pharmacologic treatment-2004 update. J Allergy Clin Immunol 2005; 115 (01) 34-46
    CrossrefPubMedGoogle Scholar
  • 34 Sarkar M, Koren G, Kalra S. , et al. Montelukast use during pregnancy: a multicentre, prospective, comparative study of infant outcomes. Eur J Clin Pharmacol 2009; 65 (12) 1259-1264
    CrossrefPubMedGoogle Scholar
  • 35 Nelsen LM, Shields KE, Cunningham ML. , et al. Congenital malformations among infants born to women receiving montelukast, inhaled corticosteroids, and other asthma medications. J Allergy Clin Immunol 2012; 129 (01) 251-254.e1 , 6
    CrossrefPubMedGoogle Scholar
  • 36 Park-Wyllie L, Mazzotta P, Pastuszak A. , et al. Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiological studies. Teratology 2000; 62 (06) 385-392
    CrossrefPubMedGoogle Scholar
  • 37 Hviid A, Mølgaard-Nielsen D. Corticosteroid use during pregnancy and risk of orofacial clefts. CMAJ 2011; 183 (07) 796-804
    CrossrefPubMedGoogle Scholar
  • 38 Namazy J, Cabana M, Scheuerle A. , et al. The Xolair pregnancy registry (EXPECT): An observational study of Omalizumab during pregnancy in women with asthma. J Allergy Clin Immunol 2015; 135 (02) 407-412
    CrossrefPubMedGoogle Scholar
  • 39 Cox S, Posner SF, McPheeters M, Jamieson DJ, Kourtis AP, Meikle S. Hospitalizations with respiratory illness among pregnant women during influenza season. Obstet Gynecol 2006; 107 (06) 1315-1322
    CrossrefPubMedGoogle Scholar
  • 40 Forbes RL, Wark PAB, Murphy VE, Gibson PG. Pregnant women have attenuated innate interferon responses to 2009 pandemic influenza A virus subtype H1N1. J Infect Dis 2012; 206 (05) 646-653
    CrossrefPubMedGoogle Scholar