Pregnancy & Asthma

Women who are pregnant are generally advised not to take any medication to avoid exposing the fetus to potentially harmful chemicals. So it's not uncommon to find a pregnant woman struggling with a sinus infection because she wants to avoid antibiotics, or a headache because she's not taking aspirin. But asthma is a different story. Studies suggest that women with untreated asthma are more likely to have problems with their pregnancies and that women with asthma should be treated for it during pregnancy.

There has been concern that the use of inhaled steroids, which are used to treat persistent asthma, during pregnancy might lead to the birth of infants who are small for their gestational age and have a low birth weight. But a recent study of 474 women, published in the Journal of Allergy and Clinical Immunology, did not find such a link. Below, Michael Schatz, MD, chief of the allergy department at Kaiser Permanente Medical Center in San Diego, and incoming president of the American Academy of Allergy and Immunology, discusses how this information can help pregnant women with asthma feel more comfortable with their decision to treat their lung condition.

How can pregnancy affect breathing in all women?

Interestingly, about 70 percent of women notice shortness of breath during pregnancy. Although one might expect that as the baby grows, in most of those women, it actually starts early in pregnancy. The exact causes aren't known, but it's felt to be related to extra breathing induced by hormones, presumably to provide the extra oxygen that the baby needs. As a result, the woman is breathing deeper during pregnancy and, for many women, it seems to translate into a feeling of shortness of breath. That can, of course, sometimes be confusing in people with asthma. But while any woman can experience shortness of breath during pregnancy, a cough, wheezing or chest tightness is associated with asthma.

How can untreated asthma put the baby or mother at risk?

The data suggest that women with asthma may have increased risks of the baby dying, either of a stillbirth or an early death, preeclampsia of the mother, low birth weight of the baby, or prematurity. It appears that it's the more severe and uncontrolled asthma that poses the greatest risk. There is also a risk to the mother of increasing the severity of asthma symptoms or episodes, and even of asthma death.

What can women do about nasal symptoms from allergies?

There have been some studies that suggest that the course of the nasal symptoms during pregnancy, which many women have, is similar to the course of the asthma. It seems that, in women who have preexisting nasal symptoms due to allergy, they can either get better or worse, and there appears to be a real concordance between what the nose does and what the chest does in that regard. So part of the comprehensive treatment of the pregnant woman with asthma is doing the best she can with the nasal symptoms.

The inhaled steroids come in an intranasal form as well and, for nasal allergies, the intranasal steroids are really the most effective single medicine.

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