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Asthma and pregnancy.

Asthma is the most common chronic condition in pregnancy and can cause tremendous morbidity to both the fetus and the mother. Severe and/or poorly controlled maternal asthma has been associated with premature birth, congenital anomalies, fetal growth restriction and low birth weight.

Asthma is characterized by inflammation of the airways, with an abnormal accumulation of cells, macrophages, and myofibroblasts. This leads to a reduction in airway diameter caused by smooth muscle contraction, vascular congestion, bronchial wall edema and thick secretions

According to Dr. Winstone Nyandiko, MD, senior lecturer at Moi University School of Medicine, Eldoret, Kenya, "Asthma is the most common condition affecting the lungs during pregnancy. Many women worry about how the changes of pregnancy will affect their asthma and if asthma treatments will harm the baby. With appropriate asthma therapy, most women can breathe easily, have a normal pregnancy, and deliver a healthy baby."

The severity of asthma during pregnancy varies from one woman to another. It is difficult to predict the course that asthma will follow in a woman's first pregnancy. During pregnancy, asthma worsens in about one-third of women, improves in one-third, and remains stable in one-third. Dr. Nyandiko explains that, "Asthma is less severe during the last month of pregnancy. Labor and delivery do not usually worsen asthma. Among women whose asthma improves, the improvement typically progresses gradually throughout pregnancy." He further says that the severity of asthma symptoms during the first pregnancy is often similar in subsequent pregnancies.

Nyandiko continues, "Pregnancy has a significant effect on the respiratory physiology of a woman. While the respiratory rate and vital capacity [do] not change in pregnancy, there is an increase in tidal volume, minute ventilation (40%), and minute oxygen uptake (20%) with resultant decrease in functional residual capacity and residual volume of air as a consequence of the elevated diaphragm ... Symptoms of asthma during pregnancy are the same as those of asthma at any other time. However, each woman with asthma responds differently to pregnancy ... You may have milder symptoms or more severe symptoms, or your symptoms may be pretty much what they are when you aren't pregnant."

Asthma triggers are the same during pregnancy as at any other time. During pregnancy sensitivity to triggers may be increased, decreased, or stay about the same. These differences are attributed to changes in hormones during pregnancy.

Nyandiko recommends that pregnant women who are asthmatic should, "Avoid exposure to specific allergens, especially pet dander, house dust, and nonspecific irritants, such as tobacco smoke, strong perfume, and pollutants. Cover mattresses and pillows with special casings to reduce exposure to dust mites." He also suggests that pregnant women with asthma should be seen by their doctor every two to four weeks until 28 weeks of pregnancy. Between 28 and 36 weeks, they should be seen every two weeks, and between 36 weeks and delivery be seen once per week.

Pregnant women can monitor their lung function at home by using a simple device that measures the peak expiratory flow rate (PEFR) by measuring this rate twice per day: once upon awakening and again 12 hours later. Decreasing flow rates usually signal a worsening of asthma and a need for more intensive therapy. Lung function tests performed in a clinician's office are also useful for distinguishing the shortness of breath associated with a worsening of asthma from the normal shortness of breath that many women experience during pregnancy.

Dr. Nyandiko says it is good to have knowledge, "Learning about asthma enables people to better manage their symptoms, prevent attacks, and react when attacks do occur. Asthma education teaches strategies to recognize the signs and symptoms of asthma, avoid factors that trigger attacks, and use asthma-controlling drugs correctly." This information helps patients and their doctors create an individualized treatment plan for sudden attacks.

Most medications used to treat asthma during pregnancy are similar to the medications used to treat asthma at other times during a person's life. The type and dose of asthma medications will depend upon many factors. In general, inhaled drugs are recommended because there are limited body-wide effects in the mother and the baby. It is difficult to prove that asthma-controlling drugs are completely safe during pregnancy. However, pregnant women have used asthma medications for many years, suggesting that most of them probably carry little or no risk for the mother or baby.

Nydandiko believes, "Asthma attacks can reduce the oxygen supply to the baby. Therefore, it is important to take asthma medications on a regular basis to prevent asthma symptoms. In most cases, under-treated asthma poses a far greater risk to both the mother and the baby than the use of asthma-controlling drugs."

Abel Mwema is a nursing student at Moi University, School of Medicine, Kenya. He is also a freelance writer specializing in health and is the assistant editor of Enhsamu Digest, a university magazine for environmental health students. He also develops proposals and manuscripts with other authors.
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Author:Mwema, Abel
Publication:Pediatrics for Parents
Article Type:Report
Geographic Code:1USA
Date:Jan 1, 2010
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