Abstract
One in 10 pregnant women worldwide has asthma and of these, 10% will have a severe
exacerbation requiring oral corticosteroids (OCSs) in pregnancy. This review of recent
publications in the field will describe the effects of exacerbation on maternal and
neonatal health, the use of asthma medications during pregnancy, and will suggest
novel management approaches for asthma in pregnancy. Pregnancy results in unpredictable
changes in the disease; therefore, regular monitoring of symptoms is recommended.
Uncontrolled asthma is frequently described in cohorts of pregnant women with asthma,
and some recent studies show associations with adverse perinatal outcomes, as previously
demonstrated with exacerbations. Guidelines for the management of asthma recommend
the continued use of inhaled corticosteroids (ICSs) in pregnancy, with budesonide
having a particularly good safety profile. Recent data suggest small effects of asthma
and/or asthma medication use on congenital malformations; however, there is less data
available on the safety of ICS/long-acting β agonist combinations, which are increasingly
used for maintenance treatment. Novel management strategies are needed to address
the complex needs of pregnant women with asthma. These include medication nonadherence
and the presence of numerous comorbidities which can affect asthma, such as rhinitis,
cigarette smoking, obesity, and mental health issues. Inflammation-based management
has been shown to be effective in reducing exacerbations in pregnancy and may also
improve perinatal outcomes. The involvement of a multidisciplinary team and the assessment
of comorbidities have potential to improve the health of mothers and their offspring.
Keywords
asthma - exacerbation - pregnancy - perinatal - inhaled corticosteroid - exhaled nitric
oxide - management
