الله رسول على والسالم والصالة الله بسم

ASTHMA and PREGNANCY

Dr.Ramadan Elberbash

Dr.AML.M.Alhashimi

What's asthma?

Inflammation of the airways, with an abnormal accumulation of eosinophils, lymphocytes, mast cells, macrophages, dendritic cells, and myofibroblasts. Leads to a reduction in airway diameter caused by smooth muscle contraction, vascular congestion, bronchial wall edema and thick secretions.

Triggers that can cause an asthma attack vary from person to person. Common triggers include

breathing in cold air, cold/flu viruses, strenuous exercise, chemicals, cigarette smoke, and allergies to dust, animals, pollen, or mold. Avoiding these triggers can reduce the number of asthma attacks.

I have asthma and am planning on getting pregnant. Is there anything I need to know?

Asthma management during pregnancy should continue to include the medicines that best control an individual’s asthma symptoms.

It is not possible to predict how a woman’s asthma will act during pregnancy.

For about one third of women, symptoms will improve during pregnancy, another one third will have no change in asthma symptoms, and a final one third of women will have worsening of symptoms

Will my asthma symptoms get worse during my pregnancy?

The pattern of asthma during one pregnancy will often define the pattern of asthma during subsequent pregnancies.

Asthma attacks seem to be most likely during weeks 17 through 24 of pregnancy possibly because women often discontinue their asthma medications when they become pregnant.

In general asthma is less severe during the last 4 weeks of pregnancy (37-41weeks).

There is no association of worsening of asthma with labour and deliveryA.

The effects of pregnancy on asthma vary with each person and it is difficult to predict the course that asthma will follow in individual women who become pregnant for the first time.

Is it safe to take my asthma medications during my pregnancy?

Studies have shown that treated asthmatic women have fewer adverse infant and maternal outcomes than those without therapy. This means that when asthma is controlled, pregnant women with asthma have no more complications during pregnancy and givingbirth than non-asthmatic women.

These complications of Uncontrolled or poorly controlled asthma during pregnancy

o premature birth,o low birth weight,o maternal blood pressure changeso Preeclampsia o Need for C/So Maternal morbidity o Maternal mortality

Can asthma cause birth defects?

Some studies have suggested an increased risk for birth

defects while others have not. In these studies, it is difficult to determine whether the

adverse effects seen were due to the mother’s asthma, medicines needed to control the asthma, or other factors.

If a pregnant woman has trouble breathing she will take in less oxygen. This could lead to a reduced amount of oxygen getting to the baby. Reduced oxygen for the developing baby could cause problems in organ development.

If there is a risk from asthma itself, it is expected to be very low. The vast majority of women with asthma have babies without birth defects.

Can asthma lead to any other pregnancy problems?

Yes. Maternal asthma, especially poorly controlled asthma, is associated with higher rates of pregnancy complications, such as placental problems, high blood pressure, premature delivery, higher rates of cesarean section, and low birth weight.

It is important for women who are pregnant to speak with their health care provider about the best way to treat their asthma during pregnancy. The benefits of treating asthma during pregnancy generally outweigh the potential risks of the medication.

Can taking medicine for asthma during pregnancy cause birth defects?

Most asthma medicines have not been shown to have harmful effects on the developing baby.

Some studies have suggested an increased risk for cleft lip with or without cleft palate (split in the lip or roof of the mouth) when corticosteroid pills are taken during the first trimester. Based on the available information, if there is a real risk for cleft lip and/or palate, the absolute risk would be small (less than 1%).

If I have asthma, can I breastfeed my baby?

Most asthma medicines are compatible with breastfeeding.

Breastfeeding should be encouraged as it may reduce the risk of childhood asthma, especially in children with a family history of atopy

Can I still take antihistamines, decongestants and allergy shots?

It is Ok to continue with these medications if you are already taking them but normally they are not started during pregnancy.

Can I still get the Influenza Vaccine when I am pregnant?

Yes, it can be given after the first three months of pregnancy.

It is recommended for anyone who has identified viral infections as an asthma trigger.*

If you have an egg allergy talk to your doctor about this before taking the flu shot.

DRUG TREATMENT OF ASTHMA IN PREGNANCY

The drug treatment of asthma in pregnancy is similar to the treatment of asthma in non pregnant women

Management of ACUTE asthma in pregnant women Oxygen supplementation

(SaO2>95%)( po2>70) I.V fluid hydration Inhaled sulbutamol(every 20 Min

up to 3 times in first hour) Ipratropium bromide (atrovent) in

sever cases Systemic corticosteroids either

intravensouly or orally I.V Mg sulphate may be beneficial.

Intrapartum considerations related to asthma

Exacerbations of asthma are uncommon during labour and birth Except in the most severe cases

asthma should not preclude a vaginal birth Occasionally, women with very severe asthma

may be advised to have an elective delivery (induction of labour or caesarean section) at a time when their asthma is well controlled2

Plan after 37+6 weeks unless there are medical complications requiring earlier intervention

oSymptoms of asthma during labour are generally controlled with standard asthma therapy o Inhaled β-agonists do not impair uterine contractions or delay the onset of labouro There is no evidence that oxytocin causes bronchoconstriction2 oErgometrine has been reported to cause bronchospasm, especially if general anaesthesia is being used, but this does not appear to be an issue if Syntometrine is used for prophylaxis of postpartum bleeding oRegional anaesthesia is preferred over general anaesthesia (reduced risk of chest infection)

Postpartum considerations related to asthma

Postpartum haemorrhage

Prostaglandin E1 (misoprostol) may be used for the management of postpartum haemorrhage

Use intramyometrial PGF2 alpha (dinoprost) with

caution as this may trigger bronchospasm

summery Women with asthma should be counselled

regarding the importance and safety of continuing their asthma medications during pregnancy to ensure good asthma control.

Women should be advised that poorly controlled asthma may lead to adverse pregnancy outcomes (or ‘is associated with increased problems for both mother and baby’)

Monitor pregnant women with moderate/severe asthma closely because poorly controlled asthma is associated with poorer pregnancy outcomes.

Acute severe asthma in pregnancy is an emergency and should be treated vigorously in hospital.

Give drug therapy for acute asthma as for the non-pregnant patient including systemic steroids and magnesium sulphate

Use inhaled steroids as normal during pregnancy.

. Use oral and intravenous theophyllines as normal during pregnancy.

Use steroid tablets as normal when indicated during pregnancy for severe asthma.

oSteroid tablets should never be withheld because of pregnancy.

o If anaesthesia is required, regional blockade is preferable to general anaesthesia in women with asthma.

o Use prostaglandin F2α with extreme caution in women with asthma because of the risk of inducing bronchoconstriction.

o Use asthma medications as normal during lactation in line with manufacturer’s recommendations.

Remember: if you can’t breathe, neither can your baby!

Thank you