Managing Asthma During Pregnancy and the Postpartum Period

Abstract

Asthma is one of the most common chronic diseases in pregnancy and is associated with adverse perinatal outcomes. Asthma symptoms worsen in approximately 40% of women, and exacerbations requiring medical intervention occur in at least 20% of women. Factors associated with exacerbation and worsening asthma include multiparity, obesity, black race, exacerbations prior to pregnancy and poor asthma control. Exacerbations are associated with further increased risks for poor perinatal outcomes including low birth weight, preterm birth and small for gestational age, as well as an increase in the development of asthma in early childhood. Common medications used for asthma, including short acting beta agonists and inhaled corticosteroids are considered safe to use in pregnancy. While guidelines generally suggest traditional step therapy for the management of asthma in pregnancy, there are alternative models of care and management approaches which may be effective in pregnancy, but require more research. These include single inhaler maintenance and reliever (SMART) therapy, treatment adjustment with fractional exhaled nitric oxide (FeNO), treatable traits personalised medicine approaches and telemedicine. Little is known about changes to asthma in the postpartum period, however, low adherence to medication, and potential effects of postpartum depression on asthma exacerbation risk warrant further research.