How Do I Treat Asthma During Pregnancy?

With pregnancy comes big life changes. Suddenly, you’re thinking about what brand of diapers to buy, what sort of car seat is the safest, and whether or not your daily cup of coffee is going to have to stop. I see a lot of pregnant patients in my office, and the top concern that brings them to me is asthma—primarily, how to treat it, and if their standing asthma medications are still safe now that they’re expecting.

Asthma is a chronic lung disease that causes inflammation in the airway and can complicate normal breathing patterns—not ideal for a woman whose lung capacity is already minimized thanks to that baby taking up so much space! Asthma is a very common condition, with over 25 million people receiving a diagnosis in the United States alone… that doesn’t mean asthma isn’t serious, though, especially when you’re expecting. Studies have shown that asthma can complicate up to 7% of pregnancies. But before you become alarmed, let’s take a look at asthma, how it affects pregnancy, and the best ways to treat and manage this condition.

Asthma and Pregnancy

Pregnancy comes with some unpleasant symptoms: nausea, fatigue, trouble sleeping, and shortness of breath, to name just a few. Patients with pre-existing asthma can find that their symptoms worsen, improve, or remain unaffected during pregnancy. It’s unfortunately a roll of the dice situation that cannot be predicted by any doctor because everyone’s body reacts differently to the surge of hormones.

If you’re lucky and your asthma gets better, it’s usually a gradual improvement that happens throughout the pregnancy. If your asthma symptoms worsen, this typically occurs during the first trimester when your body is inundated with new hormones or the third trimester when your baby starts restricting your lung capacity and ability to breathe properly. Not only is pregnancy-related shortness of breath annoying, it can increase the risk of pregnancy complications. It’s important to manage your asthma properly since you’re essentially breathing for two! When you can’t breathe well, the oxygen levels in your blood decrease, which can harm your baby. Unmanaged or poorly managed asthma during pregnancy can cause:

• Poor or restricted fetal growth
• Pre-eclampsia (pregnancy-related high blood pressure, a dangerous condition)
• Premature birth

It’s estimated that about 30% of women with asthma report that their symptoms worsen during pregnancy, and one of the reasons for this is that some women stop taking their daily asthma medication (long-term steroids and fast-acting inhalers) out of fear that it will hurt their baby. The top question I receive from my pregnant patients is, “Are my asthma medications safe during pregnancy?” To explore this, let’s take a look at how medications are classified for use during pregnancy and which asthma medications are considered “safe” for use while pregnant and/or breastfeeding.

Medication Classification During Pregnancy

It’s perfectly reasonable to wonder if the medicine you were prescribed while not carrying a baby is still safe to take during pregnancy. Generally speaking, the benefits of taking asthma medications outweigh any potential risks to a developing baby. In most cases, it is safer to take asthma medication during pregnancy than to suffer from chronic asthma-related breathing problems, or worse, to risk a full-blown asthma attack. 

“That’s great,” you might be saying, “But I still want to know if my asthma medication is safe.”

Here’s the lowdown on asthma medications and pregnancy. 

The FDA puts medications into categories to determine their safety during pregnancy. The categories and their meanings are:

Category A

Adequate & well-controlled studies have failed to demonstrate a risk to the fetus in the first trimester, and there is no evidence of risk in the second or third trimesters. 

Category B

Animal reproduction studies have failed to demonstrate a risk to the fetus and there are no adequate & well-controlled studies in humans.

Category C

Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate & well-controlled studies in humans. However, the benefits may potentially warrant use of the drug in pregnant women despite the risks involved.

Category D

There is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience or studies in humans. However, the benefits may potentially warrant use of the drug in pregnant women despite the risks involved.

Category X

Studies in animals or humans have demonstrated fetal abnormalities and/or there is positive evidence of human fetal risk based on adverse reaction data from investigational or marketing experience. The risks involved in the use of these drugs in pregnant women clearly outweigh any potential benefits.

Pregnancy Safe Asthma Medication

It is vital to ensure your asthma is well-controlled for the duration of your pregnancy. You can sometimes manage asthma symptoms without the use of medication by avoiding typical triggers (see below), but in other cases medication is necessary. Asthma medications that are considered “safe” during pregnancy (meaning the benefits of using them outweigh the risks) include:

• Certain inhaled corticosteroids like budesonide
• Oral anti-leukotriene medications like Singulair®
• Fast-acting inhalers (bronchodilators)

During pregnancy, you should visit a physician who specializes in respiratory health (like a pulmonologist) regularly to make sure your asthma is well-controlled. This doctor can prescribe the safest medications at the most appropriate dosages. 

Some women wonder if they can receive allergy shots (a form of immunotherapy) during pregnancy. Again, each case is different, but generally speaking, allergy shots that you began taking before becoming pregnant are safe to take throughout the duration of your pregnancy. However, if you don’t already have an established history of allergy shots, you might want to wait. Allergy shots can sometimes cause an allergic reaction known as anaphylaxis, which can be fatal, so introducing them while you are pregnant isn’t the best practice.

Decrease Asthma Symptoms During Pregnancy Without Medication

If you simply aren’t comfortable taking any medication during pregnancy, there are some steps you can take to try and manage your asthma without medication. These include:

• Quitting smoking if you smoke and staying far away from those who do
• Avoiding asthma/allergy triggers like dust, animal dander, and seasonal pollens (limiting your time outside if necessary)
• Controlling GERD (reflux disease) by eliminating acidic and spicy foods in your diet
• Keeping regular prenatal appointments with your OBGYN and visits to your pulmonary specialist

Whether you decide to take medication or not, you should work closely with your doctor to develop the best plan of action for you. 

It’s completely natural to fret about the health of your baby when you’re pregnant, but there’s no need to panic: with proper treatment and care, like the kind we offer at The Lung Docs, you can have a happy and healthy 9 months of growing another human. If you’re concerned about your asthma symptoms, medications, and the effects they may have during pregnancy, give us a call or request an appointment online. We’re here to help you live, laugh, love, and breathe better again!