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GPs reminded of need for tight asthma control in pregnancy

Review highlights risk of adverse maternal and foetal outcomes when asthma poorly controlled

Ingrid Torjesen

Friday, 06 September 2013

Good asthma management during pregnancy is vital because poor asthma control can have adverse effects on maternal and foetal outcomes, warns a review published today in The Obstetrician & Gynaecologist (TOG).

Asthma affects around 10% of pregnant women, making it the most common chronic condition in pregnancy.

The severity of asthma during pregnancy remains unchanged, worsens or improves in equal proportions. For women with severe asthma, control is more likely to deteriorate (around 60% of cases) compared to women with mild asthma (around 10% of cases). But the review concludes that all pregnant women with asthma need to be closely reviewed throughout pregnancy, irrespective of disease severity.

National guidelines recommend the management and treatment for asthma in pregnant women should be generally the same as for non-pregnant women, with the intensity of antenatal maternal and foetal surveillance to be based on the severity of their condition.

However, the review notes that poor asthma control can lead to adverse effects on maternal and foetal outcomes. Previous studies have suggested that poor asthma control is associated with hypertension in pregnancy, a higher frequency of caesarean section and low birth weight.

Many mothers and some healthcare providers are concerned about the potential adverse effects that asthma drugs can have on both the mother and their babies during pregnancy, but the review concludes that it is still safer for women to use asthma therapy in pregnancy to avoid uncontrolled asthma.

Furthermore, the review says, asthma does not usually affect labour or delivery, with less than a fifth of women experiencing an exacerbation during labour. Additionally, in the postpartum period there is no increased risk of asthma exacerbations and within a few months after delivery a woman’s asthma severity typically reverts to its pre-pregnancy level.
 
Professor Chris Brightling, professor of respiratory medicine and honorary consultant physician at the University Hospitals of Leicester and a co-author of the review said:
 
“Asthma is a widespread condition and poor management during pregnancy can lead to adverse maternal and foetal outcomes.
 
“Good asthma management to maintain tight control is vital and standard therapy may be safely used in pregnancy to achieve this along with close surveillance from midwives, obstetricians and for women with severe asthma a respiratory physician.”
 
Jason Waugh, TOG Editor-in-chief added: “Any women who have concerns about their asthma management and management during pregnancy should contact their GP or midwife for further advice.”

Reference:
Goldie MH, Brightling CE. Asthma in pregnancy. The Obstetrician & Gynaecologist 2013; DOI: 10.1111/tog.12048.

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