Pharmacotherapeutic management of asthma in pregnancy and the effect of sex hormones

ABSTRACT

Introduction

Asthma is a common medical condition that can frequently affect pregnancy, and thus optimal management of asthma in pregnancy is important for both mother and baby. This article reviews recent developments of asthma pharmacotherapy and provides emerging data on the safety of asthma controller medications and biological therapies in pregnancy. The authors highlight the clinical outcomes of asthma during pregnancy, and summarize emerging new data related to the influence of sex hormones and fetal sex on asthma severity.

Areas covered

This review of asthma pharmacotherapy during pregnancy examines the recent guidelines and reports the most pertinent publications on safety data and asthma management.

Expert opinion

Asthma management during pregnancy follows the same principles as that of non-pregnant asthma. The available data for most asthma medications are reassuring, however there is a lack of adequate safety data available because pregnant women are generally excluded from clinical trials. More clarity is needed in guidelines regarding the management of asthma in pregnancy, and high-quality randomized control trials are required to strengthen the evidence base and inform future guidelines. In particular, safety studies examining biological therapies in pregnant women with severe asthma are needed.

KEYWORDS:

• (4-10): medication adherence
• asthma
• corticosteroids
• gender
• management
• pregnancy
• sex hormones
• treatment

Article highlights

•Asthma is one of the most common medical conditions to affect pregnancy.

•Approximately one-third of women experience a worsening of asthma during pregnancy, one-third improve, and one-third remain unchanged.

•Pregnant asthmatics have a higher incidence of adverse perinatal outcomes; however effective asthma control can reduce these complications.

•Poor asthma control and exacerbations may be due to hormonal or mechanical changes, or due to reduction/non-adherence of asthma medications.

•The available data for most asthma medication are reassuring, however further studies for biological therapies pregnant women with severe asthma are needed.

This box summarizes key points contained in the article.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This manuscript was not funded.