Pregnancy is an exciting time in a woman's life. Changes in your body may be matched by changes in your emotions. You don't know what to expect from day to day. You may feel tired, uncomfortable, or cranky one day and energetic, healthy, and happy the next. The last thing you need is an asthma attack.



Asthma is one of the most common medical conditions in the US and other developed countries. If you have asthma, you know what it means to have an exacerbation (attack). You may wheeze, cough, or have difficulty breathing. Remember that the fetus (developing baby) in your uterus (womb) depends on the air you breathe for its oxygen. When you have an asthma attack, the fetus may not get enough oxygen. This can put the fetus in great danger.

Symptoms of asthma during pregnancy are the same as those of asthma at any other time. However, each woman with asthma responds differently to pregnancy. You may have milder symptoms or more severe symptoms, or your symptoms may be pretty much what they are when you aren't pregnant.

In general, asthma triggers are the same during pregnancy as at any other time. Like the situation with asthma symptoms, during pregnancy sensitivity to triggers may be increased, decreased, or stay about the same. These differences are attributed to changes in hormones during pregnancy.

Common triggers of asthma attacks include respiratory infections such as a cold, flu, bronchitis, and sinusitis: Both bacterial and viral infections can trigger an asthma attack, cigarette smoke (firsthand or secondhand), gastroesophageal reflux disease (GERD), or regurgitation of stomach contents up the esophagus or "food pipe" , smoke from cooking or wood fires, emotional upset, food allergies, allergic rhinitis (hay fever or seasonal allergies).

Changes in weather, especially cold, dry air, exercise, strong smells, sprays, perfumes, allergic reactions to certain chemicals, allergic reaction to cosmetics, soaps, shampoos, Allergic reaction to irritants, such as dust/dust mites, molds, feathers, pet dander, etc. also trigger asthma attack.

If you took medication for your asthma before you became pregnant, especially if your asthma was well controlled, you may be tempted to stop taking your medication out of fear that it might harm the fetus. That would be a mistake without the advice of your health care provider. The risk to the fetus from most asthma medications is tiny compared to the risk from a severe asthma attack.

Moreover, women with asthma that is uncontrolled are more likely to have complications during pregnancy. Their babies are more likely to be born preterm (premature), to be small or underweight at birth, and to require longer hospitalization after birth. The more severe the asthma, the greater the risk to the fetus. In rare cases, the fetus can even die from oxygen deprivation.

How pregnancy may affect your asthma is unpredictable. About one third of women with asthma experience improvement while they are pregnant, about one third get worse, and the other third stay about the same. The milder your asthma was before pregnancy, and the better it is controlled during pregnancy, the better your chances of having few or no asthma symptoms during pregnancy.

If asthma control deteriorates during pregnancy, the symptoms tend to be at their worst during weeks 24-36 (months 6-8). Most women experience the same level of asthmatic symptoms in all their pregnancies. It is rare to have an asthma attack during delivery (10%). In most cases, symptoms return to "normal" within 3 months after delivery.

The important thing to remember is that your asthma can be controlled during pregnancy. If your asthma is controlled, you have just as much chance of a healthy, normal pregnancy and delivery as a woman who does not have asthma.

The best way to treat asthma is to avoid having an attack in the first place. Avoid exposure to your asthma triggers. This might improve your symptoms and reduce the amount of medication you have to take.

If you smoke, quit. Smoking can harm you and your fetus. Avoid being around others who are smoking; secondhand smoke can trigger an asthma attack. Secondhand smoke also can cause asthma and other health problems in your children.

If you have symptoms of gastroesophageal reflux (for example, heartburn), avoid eating large meals or lying down after eating. Stay away from people who have a cold, the flu, or other infection. Avoid things you are allergic to. Remove contaminants and irritants from your home. Also, avoid your known personal triggers (cat dander, exercise, whatever sets you off).

Asthma medications usually are taken in the same stepwise sequence you would take them in before pregnancy. During pregnancy, inhaled corticosteroids are the mainstay for long-term control. Long-term medications are sometimes combined into single preparations, such as an inhaled steroid and a long-acting beta-agonist.

Rescue medications are taken only when symptoms appear. Inhaled short-acting beta-agonists are usually the first choice for fast relief of symptoms.

If possible, avoid regular use of epinephrine and other related medication (alpha-adrenergics) as they may pose a higher risk to the fetus. Epinephrine may be given as an injection to treat a severe asthma attack or a life-threatening allergic response. If this situation occurs, treating your reaction effectively and quickly is important to decrease the risk of oxygen deprivation to the fetus.

Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs): These medications are used to relieve headaches, muscle pain, inflammation, and fever. They are not recommended during late-term pregnancy.

If medications are needed to control GERD (heartburn), avoid regular use of antacids that contain bicarbonate and magnesium.