Controlling Asthma Attacks
Despite moms'-to-be and their doctors' best efforts, asthma attacks still can occur. Controlling these attacks with medication deemed not-harmful to the baby is critical. Uncontrolled asthma can reduce the amount of oxygen available to the developing baby, which in turn can affect fetal growth, development, and survival. In general, low-dosage topical (or inhaled) medications are preferred over oral ones because they are minimally absorbed into the bloodstream and have the least effect on the developing fetus.
Lisa Anderson, an asthmatic since birth, admits she was concerned about how her asthma medication would affect her unborn child, but she was assured by her doctor that she could use her inhaler safely as needed. "I didn't use my inhaler unless I really, really needed it," notes Anderson, who says the same held true for allergy medications that she took while pregnant. The benefits of taking medications to control asthma far outweigh the risks.
In the event of a severe asthma attack, quick-relief medicines, such as oral steroids, may be needed. While these medications have been deemed safe to use during pregnancy, they should be limited to situations when they're absolutely necessary because long-term use has been associated with preeclampsia. In addition, the ACAAI recommends that pregnant women get an annual flu shot during the second or third trimester. Allergy shots, if already started, can be continued at the same dose throughout pregnancy, but pregnancy is not a good time to start getting shots.
Asthma in the Delivery Room
Only about one in 10 women with asthma have symptoms during delivery. Generally, the same medications used during pregnancy are safe for labor and delivery. Asthmatic women should expect to continue long-term control medicines throughout labor, and should keep quick-relief medicines, such as inhalers, on hand as well. Just because a woman has asthma does not mean she must deliver by C-section, but if a C-section is warranted, intravenous steroids may be used during the procedure. Depending on the severity of the mother's asthma and the progression of labor, a fetal monitor may be used to make sure there are no signs of distress.
Anderson says her delivery went surprisingly well despite feeling as though she didn't have enough breath to push properly. "It was very hard to exhale and push for the ten counts because I couldn't take in enough air," says Anderson, who used an inhaler during labor and was also given oxygen. Thankfully her son was born without complications (and with a very healthy set of lungs!).
Breastfeeding and Asthma
Most asthma medicines are safe for nursing newborns and do not affect milk production. Exceptions to this include leukotriene modifiers, which are excreted in breast milk and should not be used by nursing moms. In general, the use of inhaled medication is preferred because less of it passes into breast milk. To obtain the lowest concentration of a medication in breast milk, the ACAAI recommends taking the medication 15 minutes after nursing or three to four hours before the next feeding.
Getting Complete Care
Pregnant women should continue to see their allergist/immunologist regularly during pregnancy so that any worsening of asthma can be countered by appropriate changes in the management program.
Communication between patient and doctor is critical with any pregnancy, but it becomes even more important when asthma is in the picture. The integration of asthma care with obstetric care can help to successfully control asthma throughout pregnancy and delivery, and ensure the outcome everyone wants: a healthy baby.