Asthma in Pregnancy

By Lara A. Friel, MD, PhD, University of Texas Health--Medical School at Houston

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The effect of pregnancy on asthma varies; deterioration is slightly more common than improvement, but most pregnant women do not have severe attacks.

The effect of asthma on pregnancy also varies, but severe, poorly controlled asthma increases risk of

Prematurity
Preeclampsia
Growth restriction
Maternal morbidity and mortality

Also, cesarean delivery is required more often.

Treatment

Inhaled bronchodilators and corticosteroids
For an acute exacerbation, addition of IV methylprednisolone, followed by oral prednisone

Pregnancy does not usually change treatment of asthma (see also the National Heart, Lung, and Blood Institute practice guideline Managing asthma during pregnancy). Women are taught strategies to help manage asthma, including how to minimize exposure to triggers and how to serially measure pulmonary function (usually with a handheld peak flow meter).

Inhaled bronchodilators and corticosteroids are first-line maintenance therapy for asthma in pregnant women. Budesonide is the preferred inhaled corticosteroid. Based on available data, inhaled budesonide does not appear to increase the risk of congenital malformations in humans. Theophylline is no longer recommended routinely during pregnancy.

For an acute exacerbation, in addition to bronchodilators, methylprednisolone 60 mg IV q 6 h for 24 to 48 h may be used, followed by oral prednisone in a tapering dose.

Last full review/revision March 2017 by Lara A. Friel, MD, PhD