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Asthma in pregnancy

Tan, Kia Soong, and Thomson, Neil C. (2000) Asthma in pregnancy. American Journal of Medicine , 109 (9). pp. 727-733. ISSN 0002-9343 (doi:10.1016/S0002-9343(00)00615-X)

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Publisher's URL: http://dx.doi.org/10.1016/S0002-9343(00)00615-X

Abstract

Although about 1% of pregnant women have asthma, it is often underrecognized and suboptimally treated. The course of asthma during pregnancy varies; it improves, remains stable, or worsens in similar proportions of women. The risk of an asthma exacerbation is high immediately postpartum, but the severity of asthma usually returns to the preconception level after delivery and often follows a similar course during subsequent pregnancies. Changes in β2-adrenoceptor responsiveness and changes in airway inflammation induced by high levels of circulating progesterone have been proposed as possible explanations for the effects of pregnancy on asthma. Good control of asthma is essential for maternal and fetal well-being. Acute asthmatic attacks can result in dangerously low fetal oxygenation. Chronically poor control is associated with pregnancy-induced hypertension, preeclampsia, and uterine hemorrhage, as well as greater rates of cesarian section, preterm delivery, intrauterine growth retardation, low birth weight, and congenital malformation. Women with well-controlled asthma during pregnancy, however, have outcomes as good as those in their nonasthmatic counterparts. Inhaled therapies remain the cornerstone of treatment; most appear to be safe in pregnancy.

Asthma is a common and potentially serious medical problem in pregnant women (1). Retrospective data suggest a prevalence of approximately 1% in pregnancy 2 and 3, but these estimates may be conservative due to lack of reporting and underdiagnosis. The objectives of asthma management are similar to those in nonpregnant patients, namely, to maximize lung function, control asthma symptoms, prevent exacerbations, and minimize drug side effects. To manage patients optimally, health professionals need to appreciate the effects of asthma on pregnancy, the influence of pregnancy on asthma control, and the efficacy and safety of asthma treatment in pregnant women. This article explores evidence for these objectives and discusses practical issues involved in treating pregnant women with asthma.

To do so, we performed a Medline search of all English language reports of asthma and pregnancy from 1966 to 2000 using the keywords “asthma” and “pregnancy.” All relevant clinical studies were reviewed.

Item Type:Article
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Thomson, Prof Neil and Tan, Dr Kia Soong
Authors: Tan, Kia Soong, and Thomson, Neil C.
College/School:College of Medical Veterinary and Life Sciences > Institute of Infection Immunity and Inflammation
Journal Name:American Journal of Medicine
Publisher:Elsevier
ISSN:0002-9343

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