Acute asthma in pregnancy
Section snippets
Maternal and fetal physiologic considerations during pregnancy
Respiratory and cardiovascular changes that occur during pregnancy have been well documented. Minute ventilation is increased by 50% in late pregnancy secondary to progesterone effect. This hyperventilation usually results from the increased tidal volume with minimal changes in respiratory rate. Arterial blood gases often reveal a compensated respiratory alkalosis (pH, 7.40–7.45; Pco2, 28–32 mm Hg) and a mild increase in Po2 (106–110 mm Hg). The increase in pH secondary to respiratory alkalosis
Effect of asthma on pregnancy
Studies on the effects of asthma on maternal and fetal outcomes are nonconclusive. Some studies found no significant difference in birth outcomes among asthmatic and nonasthmatic women [5], [9]. Other studies demonstrated that asthmatic mothers had more adverse outcomes, including intrauterine growth retardation [2], [10], [11], [12], preterm labor and delivery [2], [11], [12], [13], [14], and preeclampsia [11], [12], [15]. Other adverse outcomes included increased incidence of transient
Asthma management during pregnancy
The principles of asthma management for pregnant women are not different from those for nonpregnant women [33]. The goals of asthma management during pregnancy include the optimal control of asthma symptoms, attainment of normal pulmonary function, prevention and reversal of asthma exacerbation, and prevention of maternal and fetal complications. The four key components of management needed to achieve these goals are the following:
- 1.
Objective assessment and monitoring of maternal lung function
Efficacy and safety of asthma medications during pregnancy
There is limited information on the long-term efficacy and safety of currently approved asthma medications in pregnant women, largely because traditional, double-blind, placebo-controlled research is unethical in pregnant women. Most such information comes from retrospective case studies and anecdotal and epidemiologic reports that do not control for variables and isolate a particular drug's effect on a developing fetus. The main challenge in management is to reinforce the critical need for
Management of acute asthma during pregnancy
Approximately 18% of pregnant asthmatics have at least one ED visit, and as many as 62% of pregnant women with acute severe asthma require hospitalization [39]. As previously mentioned, poorly controlled severe asthma may result in a variety of maternal and fetal complications, including increased risks for preeclampsia, intrauterine growth retardation, preterm infants, and perinatal mortality [59]. When optimally managed with appropriate medications and monitoring, pregnant asthmatics manifest
Life-threatening asthma during pregnancy
Hospitalized patients with acute asthma must be evaluated carefully and appropriately transferred to the ICU, especially at the onset of maternal fatigue or with evidence of fetal distress or respiratory failure as evidenced by worsening Pco2. As mentioned earlier, acute asthma can result in dangerously low fetal oxygenation, and the basic management of acute life-threatening asthma exacerbation during pregnancy has the immediate goals of preventing and correcting hypoxemia (Pao2<60) with
Management of asthma during labor and delivery
Acute asthma exacerbations during labor and delivery are uncommon. They can cause substantial maternal and fetal distress. Asthma guidelines recommend that all regularly scheduled asthma medications be continued during labor and delivery [33]. Patients experiencing an acute asthma exacerbation should be treated promptly as outlined earlier. Intensive fetal and maternal monitoring is recommended. In patients who were treated with systemic corticosteroids 4 week before the onset of labor, stress
Obstetric management of pregnant patients with asthma
Lumbar epidural analgesia reduces oxygen consumption and minute ventilation and is considered an excellent choice during labor. Because morphine and meperidine may cause histamine release, their use should be avoided. The use of fentanyl as a narcotic analgesic is preferred.
If preterm labor occurs during pregnancy, tocolytic therapy may be considered. Because most patients with asthma are already receiving inhaled β2-agonists, administration of systemic β2-agonists as tocolytic agents may cause
Summary
Asthma commonly occurs in pregnant women. Although most women who have asthma during pregnancy have controlled disease, some women may experience exacerbation of their disease, necessitating immediate intervention. Treating physicians must overcome the common belief that pregnant women should not take any medications during pregnancy, and they should keep asthma in pregnant women under control so to minimize the risk for maternal and fetal hypoxia. Almost all medications used by nonpregnant
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Cited by (27)
Status Asthmaticus Gravidus: Emergency and Critical Care Management of Acute Severe Asthma During Pregnancy
2023, Immunology and Allergy Clinics of North AmericaCitation Excerpt :In addition, nearly half of pregnant women experience exacerbations.6 Acute asthma exacerbations remain a common reason why pregnant patients seek emergency care.9–11 Reasons for these asthma exacerbations include undertreated disease (including medication noncompliance), exposure to triggers (viruses and allergens), and physiological changes due to pregnancy.6,12
The Pregnant Patient With Asthma: Assessment and Management
2016, Journal for Nurse PractitionersCitation Excerpt :PEFR can be valuable in helping to monitor asthma symptoms outside the practitioner’s office. Both PEFR and spirometry are indicated in the management of the asthmatic patient, because symptomatology alone is often not accurate in evaluating the severity of airflow obstruction.18 Women with asthma who become pregnant often stop asthma medications or take less of their asthma medications, particularly inhaled corticosteroids (ICS),19 which may be related to patients’ negative attitudes regarding ICS.20
Effect of maternal moderate to severe asthma on perinatal outcomes
2010, Respiratory MedicineCitation Excerpt :The effects of chronic oxygen deprivation on the fetus are described by several clinicians and were also confirmed by observation of pregnancies at high altitude and in females with congenital heart diseases.12 Maternal asthma can induce hypoxia combined with respiratory alkalosis that decreases the placental blood flow.8,9 Lack of oxygen to the fetus and the long-term effect of hypoxemia could affect fetal growth.10–12
High doses of inhaled corticosteroids during the first trimester of pregnancy and congenital malformations
2009, Journal of Allergy and Clinical ImmunologyCitation Excerpt :Another argument in favor of uncontrolled asthma is that women who did not use ICSs but had uncontrolled asthma during the first trimester we found to be more at risk of having a baby with a congenital malformation than women who used low to moderate doses of ICSs. A last argument in favor of an effect of uncontrolled or severe asthma is that uncontrolled asthma and exacerbations might provoke maternal and fetal hypoxia combined with respiratory alkalosis, which in turn can decrease the placental blood flow,1,40-42 and these phenomena have been associated with congenital malformations in mice and rats.43 The results of this study should be interpreted in light of the following weaknesses.
Asthma exacerbations during the first trimester of pregnancy and the risk of congenital malformations among asthmatic women
2008, Journal of Allergy and Clinical ImmunologyCitation Excerpt :Uncontrolled asthma and exacerbations are potentially dangerous to the fetus because they can provoke maternal hypoxia combined with respiratory alkalosis, which in turn can decrease the placental blood flow.14,37,38 Decreased fetal blood oxygen could result in abnormal growth and development of the fetus.14,37-39 Indeed, there is increasing evidence that the oxygen supply to the fetus in the first trimester is tightly controlled and that hypoxia causes an abnormal development of the fetus.40