Asthma is a common medical condition. About eight percent of pregnant women have been diagnosed with asthma.
The good news is that if you have mild to moderate asthma, you’re less likely to have a problem in pregnancy. In fact, your asthma is likely to get less problematic in pregnancy. Though the same is not true if you already had severe asthma. The most likely time for your asthma to act up is between 24 and 36 weeks of gestation.
While well controlled asthma is not generally a problem in pregnancy, there are risks to the pregnancy when asthma is not well controlled. This makes sense because being short of breath has numerous increased risks to the pregnancy and therefore your newborn.
Some of these risks include:
- Preterm labor
- Low birth weight
While each of these can occur without asthma, they are more likely to occur in women who have had their pregnancies complicated with untreated asthma. This means that it's imperative keep asthma controlled, which means working with your doctor or midwife to stay safe. This may or may not mean using medications in pregnancy.
Medications in pregnancy
Pregnant women have often been told to limit medication use in pregnancy. The fear is that medications will harm the growing baby. Most of the risks of medication use occurs in the first trimester as the baby’s organs are forming. The same is true for asthma medications. Two things to consider, the first is, if you can’t breathe, neither of you will survive long, and the second is, even with all of the medication use taken into consideration, fewer than one percent of all birth defects is due to medication use.
You and your asthma doctor should work in conjunction with your doctor or midwife covering your prenatal care to find the right medications for you. In general, inhaled medications are preferred because their target is very localized, meaning your baby is exposed to less medication. Your practitioners will probably also want to stick to medications that are well-known and have been in use for a while. This is because we have more information about how they work in pregnancy and their risks in general.
The two main types of medications used in asthma treatment are rescue medications, used in emergency situations, and asthma control medications used to prevent asthma attacks. Rescue treatments are almost always inhaled medications like albuterol. The control medications can be inhaled cromoyln and corticosteroids. Other medications may be required if your asthma doesn’t respond.
Asthma in labor
It is very uncommon for an asthma attack to happen in labor, which is good news. Though if you do have an asthma attack, normal treatments can be used and side effects from the asthma attack on the labor or baby are very rare. This can still be disconcerting and if you’re concerned about it, be sure to talk to your practitioner.
Asthma medications and breastfeeding
Breastfeeding is considered very safe, even when you are taking medications to control or treat asthma attacks. The medications used in the control of asthma result is the baby getting 10 to 1000 times less than if the woman were pregnant. There is some medication that may be passed along in breast milk, but it is less than 3 percent of a therapeutic dose, meaning it is considered very safe. In fact, breastfeeding is one way to help prevent asthma in your child and even if a breastfed child has asthma, the problems from it are less than in non-breastfed children.
Prevention of asthma in children
The benefits of breastfeeding in the prevention of asthma in the baby are most likely seen when there is exclusive breastfeeding for the first six months of life. This matches the recommendations from the American Academy of Pediatrics (AAP) and the World Health Organization (WHO).
There are also some studies that indicate that the mode of delivery, vaginal or cesarean birth, may alter the risk of your child developing asthma. Cesarean delivery is a potential risk factor for developing asthma. In absence of medical necessity, a vaginal birth is often the safest mode of delivery and the mode that is least likely to increase the risk for your baby to develop asthma. There is also some evidence that if you require a cesarean, breastfeeding can help even the playing field in asthma risk.
Asthma in pregnancy is something that you should absolutely talk to your practitioner about. A game plan should include a discussion of medications to be used in pregnancy that are safest for your baby as well as potential issues that may arise if you do not have good control of your asthma. You should also talk to your practitioner about having a vaginal birth and planning to breastfeed to protect your baby from asthma in the future. Your medications are best used when required and as prescribed.