Asthma and pregnancy: how to manage the disease when you are pregnant?

Pregnancy should not change the management of asthma, pregnant women with asthma should continue to follow their treatment with the same rigor as before. However, it is important that they report their pregnancy to their general practitioner and their pulmonologist, and their asthma to their gynecologist-obstetrician, so that these healthcare professionals can adapt their treatment if necessary and ensure the safety of the drugs prescribed.

Symptoms of asthma during pregnancy

Asthma symptoms can change during pregnancy, particularly because of the hormonal changes it causes. However, not all women will experience a similar evolution:

• A third of pregnant women will see their asthma symptoms improve,
• A third will see them stabilize
• A remaining third will see them get worse.

Managing asthma during pregnancy

If you are asthmatic and pregnant, you must imperatively follow the personalized action plan that you have established with your doctor; this written document should help you monitor your disease and adjust your drug treatment to your symptoms. If your asthma changes during pregnancy, it may be advisable to readjust this plan and review some of your habits so that they are better suited to your new situation.

In any case, managing your asthma during pregnancy means that you must be particularly attentive to the slightest aggravation of your symptoms , such as a drop in your respiratory function. It is also advisable to evaluate it regularly, either by measuring your breath yourself using a peak flow meter , or by consulting your pulmonologist so that he can perform respiratory function tests.

It is essential that you keep your inhaler with you: in the event of an asthma attack , fast-acting bronchodilators ( Ventoline® type sprays ) immediately relieve the symptoms by rapidly opening the bronchial tubes and are harmless to the foetus. By making your breathing easier, these drugs allow it, on the contrary, to receive enough oxygen.

Under no circumstances should you interrupt your background treatment on the pretext that you are pregnant: if you have any concerns about the harmfulness of certain medicines for your baby, talk to your doctor. Generally, doctors turn to the oldest drugs, for which there is enough hindsight and which have proven their safety. They also prefer inhaled forms, because of their lower passage through the bloodstream. Finally, be aware that the risk associated with asthma is greater than that associated with medication for the fetus.

According to the Reference Center on Teratogenic Agents (CRAT)*, the following treatments can therefore be used in the event of asthma during pregnancy:

• corticosteroids ,
• Beta-2 mimetics ,
• Cholinergic bronchodilators ,
• Sodium cromoglicate .

Preventing Asthma Attacks When You're Pregnant

Pregnant and asthmatic, you must avoid an asthma attack at all costs , which could expose your fetus to hypoxia.

The strategy to adopt to prevent an asthma attack during pregnancy is the same as before. You must continue to protect yourself from triggers or irritants to which you are sensitive, in particular tobacco smoke and pollution which are in any case harmful to the health of your fetus, and ensure that your background treatment is well balanced.

It is, moreover, strongly recommended that pregnant women get vaccinated against the flu , a respiratory infection of viral origin which promotes the onset of asthma attacks. The influenza vaccine is safe for the fetus, it can be given at any time during pregnancy.

Medicines during and after childbirth

During childbirth, a pregnant woman's asthma is closely monitored by the obstetrician and the anesthesiologist. The first symptoms suggestive of an asthma attack must be treated immediately.

Asthma during breastfeeding

Childbirth and subsequent hormonal changes can again modify asthma; it will therefore be necessary to review the personalized action plan and adapt the treatment after the birth of your baby. Women with asthma who wish to breastfeed can safely continue their treatment while breastfeeding, as the drugs do not pass into breast milk. For the same reasons as during their pregnancy, the CRAT nevertheless recommends favoring inhaled forms**. In any case, it is best to talk about your desire to breastfeed with your doctor and your pediatrician, so that they can ensure that your treatment is compatible and safe for your newborn.