Managing asthma during pregnancy

Counseling women on safe medication use during pregnancy is no easy task, most pharmacists would agree. But with the debut of new asthma guidelines, pharmacists can help educate women of childbearing age who are often caught between how to manage their asthma and avoiding harm to their baby.

"With these new guidelines, pharmacists can confidently educate women that it is safe to take asthma medications during pregnancy," said asthma expert Renée Ahrens Thomas, Pharm.D., a pharmacy professor at Shenandoah University in Winchester, Va. "This may come as a surprise to some women, but managing asthma is important for the health and safety of the baby. Anytime a mother cannot breathe, that's less oxygen that is getting to the fetus, which can lead to possible complications."

A multidisciplinary panel convened by the National Asthma Education & Prevention Program (NAEPP) recently developed a set of guidelines describing the latest thinking on asthma management during pregnancy. The panel's conclusion, which may counter current practices, is that it is safer for pregnant women with asthma to be treated with asthma medications than for them to have asthma symptoms and exacerbations.

Growing health threat The prevalence of asthma is rising at an alarming rate and is affecting more and more pregnant women each year. One study found that there was a twofold increase in asthma for women of childbearing age. The same study found that the chronic condition affects as many as 8.4% of pregnant women in the United States, making it one of the most common medical problems to complicate pregnancy.

Asthma does not always get worse during pregnancy. In fact, asthma may improve or remain unchanged; however, in about 30% of cases it worsens. It is unknown what triggers asthma to change during pregnancy, but studies show that asthma complicates pregnancy and increases the risk of perinatal mortality, preeclampsia, preterm birth, and low birth weight infants, including children born small for their gestational age.

According to Thomas, asthma can change fairly dramatically. "Pregnant women will notice a gradual improvement or a gradual worsening of symptoms. That's why they really should be monitored on a regular basis during pregnancy, and community pharmacists are in a great position to do that."

Lingering misperceptions To protect the mother and fetus and provide guidance to healthcare professionals about managing asthma during pregnancy, NAEPP, part of the National Heart, Lung & Blood Institute (NHLBI), issued recommendations more than a decade ago. But with several new asthma medications arriving on pharmacy shelves in the past few years, and the emergence of gestational safety data, the panel updated the guidelines, which are available at: http://www.nhlbi.nih.gov/health/prof/lung/asthma/astpreg.htm

The guidelines, "Managing Asthma During Pregnancy: Recommendations for Pharmacologic Treatment," help to address the common misperceptions that still exist about treating asthma during pregnancy. One of the greatest misunderstandings is that steroids will cause harm. In fact, studies show that inhaled corticosteroids are safe therapies to use during pregnancy. "The new guidelines emphasize that long-term studies of the birth registries show there are no links between deformities and inhaled corticosteroids," explained Thomas. "In fact, if you don't use them, there is a higher likelihood of having a premature birth or a low birth weight infant."

There is some evidence that oral corticosteroids may cause cleft palate and low birth weight. Short-term use of systemic corticosteroids is generally considered safe, said Hendeles, who is professor of pharmacy and pediatrics at the University of Florida in Gainesville.

"Cleft palate does not happen in humans unless the mother is given daily oral prednisone, which we don't do anymore because we have inhaled steroids," Hendeles noted. "Patients who are pregnant and asthmatic are usually undertreated because doctors are afraid of steroids, and these guidelines clearly demonstrate that lack of treatment is a greater risk to the baby than the inhaled steroids."