Asthma in Pregnancy

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30 Jul Asthma in Pregnancy

Posted at 04:55h in Uncategorized by admin

Asthma is a prevalent condition in Australia with 2.8 million people (10.8%) as of 2022 living with the condition. Women are at a higher risk than males and pregnancy can add to the difficulty of symptom management. Although much research is still required as to the “why”, immunological changes through T-helper 2 immune environment or mechanical changes such as uterus growth are potential influencers.

Statistics:

  • 40% of women with asthma have worse symptoms during pregnancy.
  • 3-fold increase for occurrence of exacerbations in moderate – severe asthma over mild.
  • Increased risk of respiratory virus infection.
  • Infants of an asthma population have a 1.27, 1.25 and 1.36 increased chance of requiring NICU, having respiratory distress syndrome and congenital malformations respectively.

 

Risk Population:

  • Current or ex-smoker
  • Non-Caucasian ethnicity
  • Diagnosis during adulthood
  • Lower maternal age
  • Starting ICS later in pregnancy

 

Hurdles to overcome:

  • Percetions on inhaler use:
    • Unpleasant taste and throat or mouth symptoms.
    • 1/5 women believe it could be harmful to their baby.
      • Usual dose of SABA and ICS have not been associated with increased risk of malformations, pre-term delivery or low birth weight and can be taken in conjunction.
  • Other conditions such as rhinitis, reflux and depression/ anxiety.
  • Behavioural traits including smoking, Inhaler technique, Diet and Reduced physical activity.

 

How a General Practitioner can help?

  • Ask about changes in your patient’s asthma with each regular visit. This is necessary as midwives and obstetricians potentially lack knowledge and confidence with specific asthma advice.
  • Encourage spacer use and check technique (<50% adequate use).
  • Increase education towards continuing inhaler use.
  • Asthma plan (85% of pregnant women do NOT have one).
  • Perform lung function testing as required – Remain safe and accurate, changes to FVC and FEV1 are due to asthma changes, not pregnancy.
  • Breastfeed as usual.

 

Challenges postpartum:

  • Change in mother’s symptoms for 1 year (hypothesised to be hormonal).
    • Symptoms become worse for more than 50% of asthmatics within 3 months.
  • ICS non-adherence increased, being at its worse during the 6 month stage.
  • Asthmatics are less inclined to begin breast feeding and continue this beyond 6 months.

 

References:

 

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