Asthma and pregnancy – good control is essential
First the good news: asthma and pregnancy are not necessarily mutually exclusive. For the vast majority of women, asthma is not a reason to forego pregnancy.
However, asthma should be closely controlled during pregnancy and the course of the disease should be well monitored. Pregnancy can have different effects on the development of asthma. About one third of pregnant women experience a worsening of symptoms. As a general rule, the more severe the asthma was before pregnancy, the more likely it is to worsen during pregnancy.1-3 Another third experience no change and one third even notice an improvement in symptoms.
There are several explanations for why asthma may worsen during pregnancy. As the baby grows in the womb, this leads to increased pressure on the internal organs. Together with the generally higher physical and psychological strain (worry, stress), this can increase shortness of breath already present due to asthma. Hormonal changes also have an impact on the airways. There is a correlation, for example, between decreasing progesterone and estrogen levels and an increase in bronchial sensitivity.4
However, shortness of breath in itself does not necessarily indicate asthma; it may be related to physiological changes and greater exertion in general and consequently not require medical treatment. This is something to be clarified with your doctor.
As it is not possible to predict what effects pregnancy will have on asthma, it is particularly important for both mom-to-be and the unborn baby during this time that asthma is well controlled. Since asthma attacks can be dangerous not only for the expectant mother but also for the child, they should be avoided at all costs.
To succeed in this, pregnant asthmatics should continue to take their usual medication and consult a doctor at the first sign of a worsening of their condition. It is generally recommended to talk to your primary care doctor and obtain medical advice before a planned pregnancy. Close cooperation between your gynecologist and pulmonary specialist is advisable here.
Asthma control during pregnancy – what changes?
During pregnancy, particular care should be taken to avoid allergy-triggering substances and situations, because pregnant women often react even more sensitively to known allergens or environmental stimuli. In most cases, every asthmatic knows from experience what these are; if not, an allergy test is advised.
Asthma medication control remains the same as before pregnancy for both emergency and long-term medications. You should not make any changes to your therapy without first consulting with your doctor.
Poorly controlled asthma increases the risk for mother and child
If asthma is poorly controlled or not controlled at all, there are significant risks to the mother and baby during pregnancy and also during delivery. These include high blood pressure, an increased risk of premature birth, low birth weight of the child, oxygen deficiency in the fetus, and a generally higher mortality risk for mother and child.
A severe asthma attack during pregnancy can pose an incalculable risk in terms of its consequences for mother and child. It is considered an emergency and should be monitored in hospital, if only to ensure a sufficient supply of oxygen to the unborn child. Appropriate medication and close monitoring by a pulmonologist is therefore particularly important during pregnancy to minimize the likelihood of an asthma attack.
Can asthma medications harm the unborn baby?
Many pregnant women fear that asthma medication will have negative effects on their unborn baby. But these fears have proved unfounded, as modern asthma medications are considered very safe. In addition, most asthma medications are inhaled. This means that the active ingredients reach directly where they are intended to work, in the bronchial tubes. From there, only small amounts of the active ingredients pass into the pregnant woman’s bloodstream and to the unborn child. Occasionally, cortisone tablets may be prescribed for severe asthma. Again, after weighing up the benefits and risks, taking tablets for a short period of time has been shown to do more good than harm. In any case, a severe asthma attack is more dangerous for the unborn child than correctly dosed medication. An asthma attack can lead to hypoxia and thus to permanent damage to the fetus.3
When you’re pregnant it’s especially important to adhere to the correct medication dosage. The goal is to be symptom-free so that emergency medications are needed as infrequently as possible or, preferably, not at all. Then the risk of complications for mother and child during pregnancy is not significantly greater than in healthy women. Optimal asthma management to ensure a correct medication regimen and regular home monitoring and check-ups by a specialist are very important during pregnancy. Like this, the medication can be adjusted as and when needed.
Breastfeeding and asthma
You can also continue with your normal medication when you are breastfeeding, as the individual active ingredients only pass into breast milk in harmless concentrations. Because the children of asthmatics have a threefold increased risk of also developing asthma, breastfeeding should be continued for as long as possible. It has been shown that children who have been breastfed for a long time are significantly less likely to develop asthma than those who have never been breastfed or have been breastfed for only a short time.5
FeNO value measurement for monitoring the course of the disease during pregnancy
How asthma develops during pregnancy can be tracked with the help of various parameters. For example, increased occurrence of symptoms that impose constraints on everyday life, or the need to reach for emergency medication more and more frequently.
Another indicator that shows how the disease is developing is the . This shows the degree of inflammation in the bronchial tubes by measuring the amount of nitric oxide in exhaled breath. Now you can simply measure and record the FeNO value regularly for follow-up monitoring from the comfort of your own home. With – the world's first home measuring device for – the FeNO value in exhaled air is determined in a matter of seconds. This gives pregnant asthmatics an objective indication of the degree of bronchial constriction. If the value rises or is already too high, this may indicate that your asthma is not properly under control and you need to consult a specialist.
Regularly measuring FeNO values enables doctors to monitor the effectiveness of prescribed medications and where necessary adjust the dosage, helping to mitigate the risk of complications.
In addition, a study1 conducted in Australia has shown that regular FeNO monitoring in pregnant asthmatics reduces the risk of their children subsequently developing early-onset asthma.
Regular FeNO measurement can also benefit the child
Regular FeNO monitoring can not only help pregnant asthmatics to monitor the progression of their asthma. A study6 conducted in Australia has also shown that it can significantly reduce the risk of their children subsequently developing early-onset asthma.
Children whose mothers received asthma therapy aligned with FeNO levels during pregnancy were significantly less likely to be diagnosed with asthma than children born to mothers whose asthma was aligned with symptoms (see Figure).
4 Graziottin A, Serafini A: Perimenstrual asthma: from pathophysiology to treatment strategies. Multidiscip Respir Med 2016; 11: 30 https://www.annallergy.org/article/S1081-1206(18)30023-1/fulltext
6 Morten M et al. J Managing Asthma in Pregnancy (MAP) trial: FENO levels and childhood asthma. Allergy Clin Immunol. 2018 Dec;142(6):1765-1772.
7 Powell H et al. Management of asthma in pregnancy guided by measurement of fraction of exhaled nitric oxide: a doubleblind, randomised controlled trial. Lancet. 2011 Sep 10;378(9795):983-90.