Pregnancy in Women With Asthma

May 4th 2018
Jeannette Y Wick, RPh, MBA, FASCP

Obstetricians and general practitioners most often field questions from women who have asthma, as this condition is more common than most other chronic conditions in young people.

Chronic disease is a concern in women of childbearing age who wish to conceive. Obstetricians and general practitioners most often field questions from women who have asthma, as this condition is more common than most other chronic conditions in young people. Numerous researchers have investigated concerns and tried to clarify expectations about asthma's course in pregnant women. Researchers' estimates of how many women decompensate during pregnancy have been variable.

The journalAllergy, Asthma & Clinical Immunologyhas published a new study that takes another look at pregnancy in women diagnosed with asthma. Until now, clinicians have generally believed that about 1/3 of women who have asthma will have a worsening disease course during pregnancy. This study suggests that estimate is significantly higher than the reality.

These researchers looked at data belonging to more than 1,300 women, and found that 92 of them had conceived. They examined medical records and found that 16 women worsened, 31 remained unchanged, and 25 improved. Based on this data, they indicate that slightly less than 19% of women experienced worsening asthma during pregnancy.

These researchers also documented a relationship between asthma severity and worsening asthma during pregnancy. Women who had the most severe asthma were most likely to experience worsening, even if they were adherent to their medications. In addition, individuals who experienced rhinitis as a co-occurring symptom were also at increased risk for worsening. Studies have associated asthma exacerbations with increased risk of preterm delivery, low birth weight, preeclampsia and Cesarean delivery.

More than 1/3 of women appear to discontinue their asthma medications during pregnancy. Many of these women do so without consulting healthcare providers. In addition, approximately half of pregnant women with asthma are nonadherent to controller medications.

Medication discontinuation, and medication nonadherence can, and do contribute to worsening asthma. Healthcare providers need to be vigilant for patients diagnosed with asthma who become pregnant, and provide counseling and encouragement to ensure they remain medication adherence.

Reference

Grosso A, Locatelli F, Gini E, et al. The course of asthma during pregnancy in a recent, multicase-control study on respiratory health. Allergy Asthma Clin Immunol. 2018 Apr 17;14:16.

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