Bronchial asthma in pregnant women

The article was professionally consulted by Doctor Nguyen Van Dinh - Department of General Internal Medicine, Vinmec Times City International General Hospital.

Asthma is a common disease in pregnancy, the incidence can be over 8% of pregnant women. If asthma is not well controlled, it can seriously affect both mother and baby. Here are some frequently asked questions about asthma and pregnancy, refer to the information below for treatment and prevention.

Asthma is a respiratory disease, if it is well controlled, the patient can live with this condition like a normal person, can still get pregnant and give birth, but due to the risk of the disease, should be closely monitored during pregnancy to ensure the safety of mother and baby.

The majority of women with bronchial asthma and their fetuses do not suffer complications during pregnancy and labor when their asthma is well controlled, conversely, if the asthma is not controlled, breathing difficulties are frequent. lead to fetal hypoxia, causing complications for the fetus: fetal distress, premature delivery, fetal growth retardation. Hypertension and preeclampsia can be seen in the mother.
Regular treatment and regular follow-up help reduce complications for both mother and baby.

You should inform your doctor about your planned pregnancy in advance. Your doctor will advise when your medical condition allows for a safer pregnancy.
Before becoming pregnant, in addition to the preparation work like other normal women, women should be vaccinated against diseases: measles, mumps, Rubella, HBV before pregnancy, flu vaccination can be during pregnancy due to There is no evidence of harm to the fetus.
During pregnancy:
Many pregnant women, when their condition stabilizes or fear the drug's risk to the fetus, stop taking the drug on their own, this can trigger a severe asthma attack that threatens mother and baby . Therefore, do not arbitrarily stop the drug during pregnancy. Do not arbitrarily take other drugs without consulting a doctor because it can aggravate asthma or affect the fetus. Periodic examination by a specialist, the interval between follow-up visits depending on the disease status and gestational week, helps to evaluate: Pulmonary function : when combined with the home visit peak flowmeter. Peak flowmeter plays a very important role in monitoring and controlling the disease, depending on the condition of the disease, it can be measured twice a day, morning and night, 12 hours apart, but remember to reduce the peak flow, which signals the worsening of the disease even I feel completely healthy
Blood pressure measurement, blood and urine tests: assessment of complications of hypertension, preeclampsia.
Fetal development status : it is necessary to repeat the pregnancy ultrasound between 18-20 weeks of pregnancy to assess the development of the fetus, if the pregnant woman needs to use oral corticosteroids, the ultrasound should be repeated every 4 weeks. 20 weeks to ensure normal fetal development. In patients with recurrent episodes of bronchial asthma, additional fetal movements should be measured during ultrasonography.
Ensure a stimulant-free lifestyle (coffee, passive smoking, alcohol) and minimize allergens that can cause disease exacerbation (should be tested for specific allergens before treatment). get pregnant if you have allergic asthma)

Pregnancy does not mean that it will make asthma worse, it depends on each woman, asthma can be mild (usually improves gradually), does not have an asthma attack during pregnancy or is stable. As before (30% of pregnant women) however, the condition may be more severe in one third of pregnant women with bronchial asthma, which is common at 29-36 weeks of pregnancy. Serious illness is rare in the last week of pregnancy and during labor.
The severity of asthma symptoms in the first pregnancy is often the same as in subsequent pregnancies.

Depending on the condition of the disease, during pregnancy, the treatment drug will be adjusted and the appropriate dose adjusted to ensure stable disease control without affecting the fetus. Pregnant women should adhere to treatment to limit the occurrence of asthma attacks, which also helps to limit the use of drugs that can affect the baby.
Inhaled or inhaled bronchodilators:
Fast-acting bronchodilators that relieve symptoms (such as albuterol, terbutaline) are safe during pregnancy. Long-acting bronchodilators (salmeterol, formoterol) often combined with inhaled corticosteroids play a role in disease control and prevention of asthma attacks, although there is little evidence of safety, but they are still used because of their benefits. superiority is demonstrated and due to chemical similarity to the aforementioned short-acting class. Inhaled glucocorticoids: commonly used during pregnancy, such as budesonide and beclometasone.
Oral glucocorticoids: Treatment experience shows that glucocorticoids are quite safe for both mother and fetus, although some studies show a very small incidence of cleft palate when the mother is used orally under the 13th week of pregnancy. There are also studies showing an association with complications of preterm birth and low birth weight of the fetus, but this complication has not been ruled out in relation to asthma attacks during pregnancy. In fact, the risk above may be much smaller than the risk when severe asthma is left untreated because it can be fatal for both mother and baby. Some other medications used during pregnancy include: theophylline, anti-leukotrienes, antihistamines (diphenhydramine, ferofenadine, cetirizine, loratadine) and specific immunotherapy while in progress.
Biologic drugs such as: Omalizumab does not have much research evidence on its safety, but initiation of use during pregnancy is not recommended), other drugs such as IL-5 antagonists are not available at this time. research.

During pregnancy, asthma attacks most often appear at week 17-24 of the cycle, the reason is unknown but can also be related to the discontinuation of medication due to incorrect understanding of the disease.
When you have an asthma attack during pregnancy, home management is similar to that of when you are not pregnant (preferably with a short-acting inhaled bronchodilator such as albuterol), but hospitalization is required to monitor the status of both mother and baby and be treated promptly due to the high risk of complications.

Usually asthma symptoms return to their original state after the first 3 months of life.
Breastfeeding is recommended. Besides the usual nutritional, immunological and psychological benefits for mother and baby, breastfeeding can reduce the risk of wheezing episodes in the first 2 years of life. . Some drugs can pass through milk into the baby's body, so you need to consult your doctor about suitable drugs to treat during this period.
In short, bronchial asthma is not a contraindication of pregnancy, the mother and the fetus can be completely healthy if:
Plan to become pregnant and notify the doctor in advance to determine the time of pregnancy appropriate depending on stable disease status. Equip yourself with basic knowledge about the risks during pregnancy, measures to prevent asthma attacks, the process of raising children and proper nutrition. Adhering to treatment, antenatal check-ups and bronchial asthma periodically, absolutely do not give up drugs to avoid unnecessary danger to mother and fetus. When symptoms worsen at home, in addition to management of the relief, immediate hospitalization is required for close monitoring and appropriate care.

Although the pathogenesis is complicated related to internal factors and interactions with the environment, children will be at risk of bronchial asthma and other diseases (atopic dermatitis, urticaria, .. ) higher than other children, especially if both parents have allergic bronchial asthma.

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