Asthma & Pregnancy

What is asthma in pregnancy?

Asthma is a chronic (long-lasting) disease that causes your airways to tighten and narrow, making breathing harder. Shortness of breath is a common pregnancy symptom, even among people without asthma. The struggle to take easy breaths may feel even more intense if you’re living with asthma, which involves additional symptoms, like wheezing, coughing episodes and chest tightness. In addition to feeling concerned about your own health, you may worry that the fetus isn’t getting enough oxygen.

If you have asthma and become pregnant, it’s important to continue treatments to prevent asthma attacks, or flare-ups. Unmanaged asthma can pose major health risks to both you and the fetus.

On the other hand, if you follow your treatment plan and take all medicines as prescribed, there’s no reason you can’t have a healthy pregnancy and a healthy baby.

Does pregnancy make asthma worse?

It can, but it depends on your unique case. Recent research suggests that about 40% of people have worsening asthma during pregnancy. Most people whose symptoms get worse have severe (not mild or moderate) asthma before they’re pregnant. The other 60% either don’t notice changes or their asthma symptoms actually improve.

Researchers have also found that:

• Asthma that worsens typically does so between weeks 29 and 36 of pregnancy.
• Asthma that improves usually does so gradually over a pregnancy.
• Asthma symptoms don’t typically get worse during labor and delivery.
• Asthma symptoms that change during pregnancy usually return to normal within the first three months after the baby’s born.
• People who experience changes in asthma symptoms in a past pregnancy experience similar changes in future pregnancies.

Does asthma affect the fetus during pregnancy?

Asthma can pose health risks to the fetus if it’s unmanaged. That last part is essential. Managing any medical condition during pregnancy is vital to your, and the fetus’s, health. Unmanaged asthma can decrease the amount of oxygen available in your blood for a developing fetus. It can increase your risk of pregnancy complications.

Most pregnant people with asthma who experience complications do so because they’re unsure how to manage their asthma during pregnancy. For example, they may worry that their asthma medicine may harm the fetus, so they stop taking it. But not managing your asthma poses significantly more risks to the fetus than any treatment.

On the other hand, taking the right steps to manage your asthma (such as taking all medicines as prescribed) increases your chances of having a normal pregnancy and delivering a healthy baby.

How common is asthma in pregnancy?

About 3% to 8% of all pregnant people in the United States have asthma. It’s the most common lung disease healthcare providers treat during pregnancy.

What are the symptoms of asthma during pregnancy?

Asthma symptoms during pregnancy are the same as asthma symptoms in general. You may have persistent symptoms that you have to keep at bay. Or, you may have occasional asthma attacks, where you go from being fine to having trouble breathing.

Symptoms include:

• Shortness of breath.
• Coughing (especially at night).
• Chest tightness, pain or pressure.
• Wheezing (the shrill or coarse rattling sound you hear when your airway is partially blocked).

What’s different in pregnancy is symptom severity. Symptoms may get better or worse during pregnancy. Or, they may not change at all.

What causes asthma during pregnancy?

Pregnancy doesn’t cause asthma. But pregnancy-related changes in your body can cause you to experience the condition differently. Changes that affect your breathing include:

• Increase in uterus size. Your uterus expands to house a growing fetus. As it does, it repositions your diaphragm (the muscle that helps you pull air into your lungs and release it). Your diaphragm may not be able to move as freely to allow you to take full breaths.
• Increases in pregnancy hormones. Spikes in pregnancy hormones can dry out your sinuses, causing them to become inflamed. It may make your nose feel “stuffy,” making breathing harder. In particular, spikes in progesterone stimulate faster breathing.
• Increases in your heart rate. Your heart has to work harder to supply blood to you and the fetus. The extra work can feel tiring and leave you short of breath.

If you haven’t been diagnosed with asthma and you suddenly have trouble breathing, you may be experiencing shortness of breath because of these changes. This isn’t the same as asthma, which is a chronic condition that involves other symptoms, too. Or, you may have had mild, undiagnosed asthma that’s become noticeable because pregnancy-related changes have worsened it.

See a provider to be sure.

Does asthma cause complications during pregnancy or labor?

Unmanaged asthma can increase your risk of certain pregnancy complications. Also, people diagnosed with severe asthma are more likely to experience complications than people with mild or moderate asthma. Complications include:

• Preeclampsia: A serious blood pressure condition that can stress your organs and pose serious risks to the fetus.
• Premature birth: When a baby is born before 37 weeks of pregnancy. Babies born too early may have health problems related to developmental issues.
• Small gestational age or low birth weight. Babies that are smaller than normal may have underdeveloped systems that can cause health problems.

Whether your asthma is mild, moderate or severe, having a treatment plan to prevent and manage attacks reduces your risk of issues affecting you or the fetus.

What factors may increase my risk of an asthma-related pregnancy complication?

Certain factors may increase your risk of asthma worsening during pregnancy, including:

• Smoking.
• Not taking your asthma medications or following your treatment plan as prescribed.
• Having overweight (BMI between 25 and 29) or obesity (a BMI of 30 or higher).

How do healthcare providers diagnose asthma during pregnancy?

Most pregnant people with asthma are diagnosed before pregnancy. The diagnostic process is similar whether you’re pregnant or not. Your healthcare provider will only perform tests that are safe for you and the fetus.

Diagnosis may include:

• Medical history, including a description of your symptoms and when they tend to arise or worsen.
• Physical exam.
• Spirometry, a test that measures airflow throughout your lungs.

You may also need blood tests and imaging procedures to rule out conditions other than asthma that impact your breathing.

How can I treat my asthma during pregnancy?

You should continue to follow your asthma management plan during pregnancy. This includes taking asthma medicines as prescribed. Your healthcare provider will ensure the medicines are safe for you and the fetus.

Managing your asthma means that you:

• Have minimal (or no) symptoms during the day.
• Sleep all night without asthma symptoms.
• Can perform everyday activities.
• Rarely need to use your reliever inhaler (also called a rescue inhaler).
• Have normal or near normal lung function.

Develop a treatment plan with your provider

Many healthcare providers recommend a preconception appointment before you start trying to get pregnant. Many people use this appointment to make a game plan for how they’ll want to treat their medical conditions — like asthma — during pregnancy. You can ask what changes (if any) you’ll need once you become pregnant.

Once you’re pregnant, you can discuss a plan to monitor your health to ensure you’re managing your asthma.

Monitor your condition

Monitoring your condition includes keeping tabs on your health and the fetus’s health. Your healthcare provider will:

• Check your lungs and breathing. You may need regular tests to check your breathing. You may need spirometry to check how your lungs are working. You get this test in a doctor’s office or hospital. You may need to check your airflow at home daily with a peak flow meter.
• Check the fetus’s organ function and growth. You’ll need tests to check on fetal development. Regular pregnancy ultrasounds check how the fetus is growing. If you have moderate to severe asthma or poorly managed asthma, you may need an ultrasound or a nonstress test after week 32 of pregnancy to check the fetal heart rate.

Avoid triggers

You should be mindful of your “triggers,” or substances that can cause an asthma attack, and avoid them as much as possible. Common triggers include:

• Tobacco smoke.
• Pest droppings (cockroaches and mice).
• Strong chemical smells (like cleaning products).
• Powerful aromas (like perfume or cologne).
• House dust mites.
• Getting sick (colds, the flu).
• Pet dander.
• Stress.
• Pollen.
• Mold.

Take asthma medications according to your treatment plan.

Safe and effective asthma medications come in multiple forms, including inhalers and oral medications (pills and liquids). When prescribing asthma medications during pregnancy, your provider will consider multiple factors, including:

• Which medicines have the longest track record of being safely used during pregnancy.
• Which medicines are most effective at controlling your asthma (based on its severity).
• Which medicines are safest and most effective in each trimester.

Most people can continue taking their usual asthma medications during pregnancy and labor, and while breastfeeding (chestfeeding).

How can I reduce my risk of asthma-related complications during pregnancy?

The best way to reduce your risk is to follow your treatment plan, which includes avoiding triggers and taking medications regularly. Many people stop taking their asthma medications during pregnancy because they worry about how it may affect the fetus.

Poor asthma management poses a greater risk to the fetus than most common treatment side effects. Also, your healthcare provider will monitor your medications to ensure you’re receiving the safest treatment possible.

What is the outlook for people with asthma in pregnancy?

People with asthma have a slightly increased risk of pregnancy complications compared to people without asthma. The risk is much higher if you don’t manage your asthma. This is why following your treatment plan throughout pregnancy is so important. Don’t stop taking medications unless your healthcare provider tells you to.

What questions should I ask my healthcare provider?

• Which doctors (allergist, immunologist, etc.) will be involved in helping me manage my asthma?
• Will we need to adjust my medications?
• How often will I need appointments to monitor my asthma?
• How will I monitor my asthma at home?
• What symptoms should prompt me to schedule an appointment? Go to the ER?

What is the one-three rule for asthma in pregnancy?

Previous research suggested that changes in asthma symptoms during pregnancy could be understood in thirds:

• One-third of people have symptoms improve.
• One-third have symptoms that worsen.
• One-third have no change in symptoms.

More recent research suggests that the number of people with worsening symptoms is closer to 40%.

Is it safe to take albuterol while pregnant?

Albuterol is considered one of the safest asthma medications during pregnancy. It’s been around for a long time, which means many pregnant people who’ve used it to control their asthma have delivered healthy babies.

Still, the safest medication to take is the one that’s best at controlling your asthma so it doesn’t put you at risk of pregnancy complications. Your healthcare provider can recommend the best option based on your case.

Can I take allergy shots when I’m pregnant?

Healthcare providers don’t start giving allergy shots during pregnancy. If you’re already receiving shots, your healthcare provider may continue them.

Can I get the flu shot during pregnancy?

You can and should get the flu shot. The flu shot is recommended in all trimesters of pregnancy. It can protect you from getting sick—a common trigger for asthma attacks.

A note from Cleveland Clinic

When it comes to having a successful pregnancy, taking care of yourself is key. This applies whether or not you have a chronic condition like asthma. Talk with a pregnancy provider about how asthma may affect your pregnancy, including what adjustments you may need to make to your medications or routine. Once you develop a plan, stick to it. Taking steps to manage your asthma increases your chances of delivering a healthy baby.