Contemporary management and treatment strategies for asthma during pregnancy

ABSTRACT

Introduction: Asthma is one of the most common conditions that afflict pregnant women. Because uncontrolled asthma in pregnancy affects both maternal and offspring outcomes, careful attention to maintaining control of asthma symptoms throughout pregnancy is of critical importance.

Areas Covered: Using a search of PUBMED/MEDLINE for ‘asthma and pregnancy,’ this article will review the current literature regarding epidemiology and course of asthma in pregnancy, the effects of uncontrolled asthma on both the mother and offspring, and provide an overview of the management, both non-pharmacologic and pharmacologic, of asthma in pregnancy.

Expert Opinion: There is a lack of adequate safety information for most medications taken during pregnancy. Future research might allow better methods to predict which women will experience worsening during pregnancy. For now, surveillance systems like pregnancy registries or observational cohort studies can provide safety information for medications used during pregnancy.

KEYWORDS:

• Pregnancy
• asthma
• treatment
• inhaled corticosteroids
• biologics
• management

Article highlights

• Asthma is one of the most common conditions that afflict pregnant women.

• The prevalence of asthma is also increasing in child bearing aged women.

• Because uncontrolled asthma in pregnancy affects both maternal and offspring outcomes, careful attention to maintaining control of asthma symptoms throughout pregnancy is of critical importance.

• During the course of pregnancy, 1/3 of asthmatics experience worsening of their symptoms, 1/3 experience improvement of symptoms, and 1/3 remain unchanged.

• Suboptimal control of asthma or more severe asthma during pregnancy may be associated with increased maternal or fetal risk.

• Physician reluctance to use medications during pregnancy and patient non-compliance remain important barriers to asthma control during pregnancy.

• There is a need for higher quality evidence human data regarding the safety of asthma medication during pregnancy that adequately accounts for the potential effect of uncontrolled asthma.

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 paper was not funded.