Asthma and pregnancy

If a woman with asthma is planning to become pregnant, explain the importance of maintaining good control of asthma throughout pregnancy. Exacerbations and poor asthma control increase the risk of pre-eclampsia and preterm delivery and low birth weight, but with good control of asthma, the risk of these complications is similar to the normal population.

Women may be concerned about using drug therapy during pregnancy; explain that the advantages of maintaining good asthma control significantly outweigh any risks associated with drug therapy. Asthma slightly increases the risk of congenital abnormalities, but this risk is not influenced by drug therapy. Inhaled corticosteroids, beta agonists and montelukast are not associated with fetal abnormalities. Consider changing preventer therapy to budesonide monotherapy (the only preventer therapy classed Category A for pregnancy by the Therapeutic Goods Administration) before conception. However, this is not essential, and should not be tried in a woman who is already pregnant—stepping down therapy increases the risk of an exacerbation.

Asthma often changes during pregnancy—around one-third of women experience an improvement in control, while at least one-third experience worsening of control. Measure baseline spirometry before conception.

Manage asthma during pregnancy as for asthma in other adults, but with more regular review (eg every 4 to 6 weeks). Treat asthma exacerbations in pregnant women the same as exacerbations in nonpregnant women—oral corticosteroids should not be avoided. See Acute asthma for details about the management of asthma exacerbations.

Strongly advise women with asthma who are pregnant not to smoke, and to avoid exposure to tobacco smoke.

Recommend vaccination according to the Australian Immunisation Handbook.