The Realities of Asthma and Pregnancy

Chronic disease is a concern in women of childbearing age who wish to conceive. Obstetricians and general practitioners most often field questions from women who have asthma, as this condition is more common than most other chronic conditions in young people. Numerous researchers have investigated concerns, and tried to clarify expectations about asthma's course in pregnant women. Researchers' estimates of how many women decompensate during pregnancy have been variable.

The journal Allergy, Asthma & Clinical Immunology has published a new study that takes another look at pregnancy in women diagnosed with asthma. Until now, clinicians have generally believed that about 1/3 of women who have asthma will have a worsening disease course during pregnancy. This study suggests that estimate is significantly higher than the reality.

These researchers looked at data belonging to more than 1,300 women, and found that 92 of them had conceived. They examined medical records, and found that 16 women worsened, 31 remained unchanged, and 25 improved. Based on this data, they indicate that slightly less than 19% of women experienced worsening asthma during pregnancy.

These researchers also documented a relationship between asthma severity and worsening asthma during pregnancy. Women who had the most severe asthma were most likely to experience worsening even if they were adherent to their medications. In addition, individuals who experienced rhinitis as a co-occurring symptom were also at increased risk for worsening.

Studies have associated asthma exacerbations with increased risk of preterm delivery, low birth weight, preeclampsia, and Cesarean delivery.

Of importance in the pharmacy is the fact that more than 1/3 of women appear to discontinue their asthma medications during pregnancy. Many of these women do so without consulting healthcare providers. In addition, approximately half of pregnant women with asthma are nonadherent to controller medications.

Certainly these two facts—medication discontinuation, and medication nonadherence—can, and do contribute to worsening asthma. Pharmacists need to be vigilant for patients diagnosed with asthma who become pregnant, and provide counseling, and encouragement to ensure they maintain medication adherence.

Reference

Grosso A, Locatelli F, Gini E, et al. The course of asthma during pregnancy in a recent, multicase-control study on respiratory health. Allergy Asthma Clin Immunol. 2018 Apr 17;14:16.