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Asthma and pregnancy

08/06/2018
“Eating for two” is a common narrative amongst moms-to-be, even though physicians warn that eating twice as much food is a recipe for excessive weight gain and other pregnancy complications. Lesser known is the fact that expectant moms are actually “breathing for two” — our bodies go into overdrive during pregnancy to make sure the fetus receives enough oxygen. Keeping up with this demand can put a lot of stress on the respiratory systems of pregnant women, especially those who already have trouble breathing. 
 
Up to 70 percent of women experience shortness of breath during pregnancy, and usually it’s nothing to worry about. But nearly 8 percent of pregnant women have asthma – the most common respiratory illness to complicate pregnancy — which occurs when the airways become inflamed, making it hard to breathe. Treatment is easy, but it’s important to keep your doctor in the loop.

Sucharita Kher, MD is a physician at Tufts Medical Center in downtown Boston.Having asthma while pregnant

Not all women with preexisting asthma experience worsening of symptoms during pregnancy, but they are at higher risk for certain conditions and complications, according to Sucharita Kher, MD, Pulmonologist and Director of the Outpatient Pulmonary Clinic at Tufts Medical Center.

“It’s all about the rule of thirds,” she said. “About a third of women with asthma experience worsening of asthma control during pregnancy, a third remain unchanged and another third experience improved control of asthma.”

Women with asthma typically experience nothing more than congestion or a stuffy nose, but they are higher risk for serious conditions like preeclampsia, hemorrhage and gestational diabetes. They are also more likely to contract colds than pregnant women without asthma.  

“The frequency and severity of respiratory viral infections, particularly the common cold, are higher for women with asthma,” Dr. Kher said. “But influenza is especially concerning for all pregnant women, so we encourage everyone to get flu shots.” 

The key for these women is to have their asthma well controlled before becoming pregnant, because that boosts their chances of having a healthy pregnancy. This may mean taking medication, such as a steroidal inhaler.

“I have some patients who stop taking their asthma medication when they find out they’re pregnant because they don’t want to harm the fetus,” Dr. Kher said. “But these medications are almost always safe for both mom and baby.” 

Controlling asthma while pregnant

Whether you have preexisting or new onset asthma, there are a few lifestyle changes you can make to help control your symptoms. But first, go to your doctor and develop an asthma action plan. Dr. Kher recommends monthly appointments with your doctor, so they can assess your symptoms and ensure they are adequately controlled, treat flare ups and monitor lung function.

“If a patient with asthma is contemplating pregnancy, they should discuss it with their primary care physician or obstetrician ahead of time,” Dr. Kher said. “If their asthma is uncontrolled, they should be seen by a specialist in pulmonology.”

For many women, an effective way of controlling their asthma is by avoiding their “triggers” — these typically include the following:

  • Cigarette smoke 
  • Dust mites 
  • Mold
  • Perfume
  • Cockroaches
  • Pollen
  • Cleaning agents
  • Pet dander

Identifying these triggers and eliminating them from your home as much as possible will help you breathe easier. And if your trigger is your furry friend, thankfully there is an alternative to giving them away. 

“A lot of pets sleep on the bed with their owners, so that’s 7 or 8 hours a night breathing in those allergens,” said Dr. Kher. “Keeping your pet out of the bedroom at night is a small step women can take to really improve their symptoms.”