Pregnant and asthmatic?
New guidelines say it’s OK to use your inhaler
Sunday, January 23, 2005
Pregnancy can be tough. Pregnancy with asthma can be even tougher. How do you control your illness while avoiding drugs that might harm your baby?
New government guidelines suggest that it is better for women to keep their asthma in check with medications during pregnancy rather than risk an asthma attack.
“The evidence is reassuring and suggests that it is safer to take medications than to have asthma exacerbations,” says Dr. Barbara Alving, acting director of the National Heart, Lung and Blood Institute, a federal agency that oversees the National Asthma Education and Prevention Program which released the new guidelines.
If left unchecked, asthma can be dangerous for both the mother and baby. Asthma increases the risk of miscarriage, premature birth, low birth weight even with full-term babies and preeclampsia, a condition in which the mother’s blood pressure shoots up.
With the new guidelines in place, doctors hope to reassure women that the medications are safe for their babies.
“What we see all the time is women who stop taking their asthma medicine as soon as they find out they are pregnant. Yet, most asthma medications are perfectly safe for the baby,” says Dr. Maura Quinlan, an obstetrician and gynecologist at University of Chicago Hospitals. “[These women] are well intentioned, but it is much better for the baby that they breathe.”
Even women with mild asthma should be closely monitored by their doctors, the guidelines recommend. A majority of women with asthma see the disease change over the course of a pregnancy, experts say.
About 30 percent of women with mild asthma see it get worse as their pregnancy progresses, a recent study found. Conversely, about 23 percent of pregnant women with moderate or severe asthma see an improvement.
Women with asthma account for 4 to 8 percent of all pregnancies and the disease is considered to be the most common serious complication of pregnancy.
“We cannot predict who will worsen during pregnancy, so the new guidelines recommend that pregnant patients with persistent asthma have their asthma checked at least monthly,” says Dr. Mitchell Dombrowski, chief of obstetrics and gynecology at St. John Hospital in Detroit and a member of the panel.
Although it is important for women with asthma to see their doctors as early as possible in their pregnancies, the new guidelines recommend:
n Albuterol, a quick-acting inhaled drug, be on hand at all times during the pregnancy.
n Inhaled corticosteroids are the preferred drug for those with persistent asthma—usually defined as having symptoms at least two days a week or two nights a month.
Oral corticosteroids may be required to treat severe asthma. Even though there is some conflicting data on the safety of these drugs during pregnancy, severe asthma poses a definite risk to both mother and fetus.