Physiology and clinical course of asthma in pregnancy
- Steven E Weinberger, MD
Steven E Weinberger, MD
- Adjunct Professor of Medicine
- University of Pennsylvania School of Medicine
- Executive Vice President and CEO Emeritus
- American College of Physicians
- Michael Schatz, MD, MS
Michael Schatz, MD, MS
- Clinical Professor, Department of Medicine
- University of California San Diego School of Medicine
- Section Editors
- Peter J Barnes, DM, DSc, FRCP, FRS
Peter J Barnes, DM, DSc, FRCP, FRS
- Editor-in-Chief — Pulmonary and Critical Care Medicine
- Section Editor — Asthma
- Professor of Medicine
- National Heart and Lung Institute, Imperial College, London
- Charles J Lockwood, MD, MHCM
Charles J Lockwood, MD, MHCM
- Section Editor — Obstetrics
- Senior Vice President, USF Health
- Dean, Morsani College of Medicine
- Professor, Obstetrics and Gynecology
- University of South Florida
Asthma is the most common pulmonary disease encountered during pregnancy, occurring in 3 to 8 percent of pregnant women [1-8]. Two questions about the interaction of asthma and pregnancy are raised by clinicians and patients alike:
●How does pregnancy affect asthma?
●How does asthma affect the outcomes of pregnancy?
The pathophysiology of asthma during pregnancy and the interrelationships of these two conditions will be reviewed here. The management of gestational asthma, the evaluation of dyspnea in pregnancy, and the changes in the respiratory system during pregnancy are discussed separately. (See "Management of asthma during pregnancy" and "Physiologic respiratory changes and dyspnea during pregnancy".)
RESPIRATORY PHYSIOLOGY DURING PREGNANCY
A review of maternal respiratory physiology during pregnancy is helpful in understanding the interrelationships between pregnancy and asthma. More detailed discussions of the normal physiologic changes in the cardiopulmonary system during pregnancy are presented separately. This review will emphasize those changes that directly impact or are influenced by co-existent asthma. (See "Physiologic respiratory changes and dyspnea during pregnancy" and "Maternal cardiovascular and hemodynamic adaptations to pregnancy" and "Physiologic respiratory changes and dyspnea during pregnancy", section on 'Respiratory changes'.)
- Murphy VE, Gibson PG, Smith R, Clifton VL. Asthma during pregnancy: mechanisms and treatment implications. Eur Respir J 2005; 25:731.
- Namazy JA, Schatz M. Pregnancy and asthma: recent developments. Curr Opin Pulm Med 2005; 11:56.
- Tan KS, Thomson NC. Asthma in pregnancy. Am J Med 2000; 109:727.
- Alexander S, Dodds L, Armson BA. Perinatal outcomes in women with asthma during pregnancy. Obstet Gynecol 1998; 92:435.
- Liccardi G, Cazzola M, Canonica GW, et al. General strategy for the management of bronchial asthma in pregnancy. Respir Med 2003; 97:778.
- Blaiss MS, Food and Drug Administration (U.S.), ACAAI-ACOG(American College of Allergy, Asthma, and Immunology and American College of Obstetricians and Gynecologists.). Management of rhinitis and asthma in pregnancy. Ann Allergy Asthma Immunol 2003; 90:16.
- Demoly P, Piette V, Daures JP. Asthma therapy during pregnancy. Expert Opin Pharmacother 2003; 4:1019.
- Kwon HL, Belanger K, Bracken MB. Asthma prevalence among pregnant and childbearing-aged women in the United States: estimates from national health surveys. Ann Epidemiol 2003; 13:317.
- Nelson-Piercy C. Asthma in pregnancy. Thorax 2001; 56:325.
- Sroczyński T. [Evaluation of respiratory tract function in healthy women in the last month of uncomplicated pregnancy]. Ann Acad Med Stetin 2002; 48:331.
- Grindheim G, Toska K, Estensen ME, Rosseland LA. Changes in pulmonary function during pregnancy: a longitudinal cohort study. BJOG 2012; 119:94.
- Stenius-Aarniala B, Piirilä P, Teramo K. Asthma and pregnancy: a prospective study of 198 pregnancies. Thorax 1988; 43:12.
- Weinberger SE, Weiss ST, Cohen WR, et al. Pregnancy and the lung. Am Rev Respir Dis 1980; 121:559.
- Milne JA, Mills RJ, Howie AD, Pack AI. Large airways function during normal pregnancy. Br J Obstet Gynaecol 1977; 84:448.
- Management of asthma during pregnancy: Report of the Working Group on Asthma and Pregnancy NIH Publication No. 93-3279. National Asthma Education Program; National Institutes of Health, Bethesda, MD, 1993.
- Juniper EF, Daniel EE, Roberts RS, et al. Improvement in airway responsiveness and asthma severity during pregnancy. A prospective study. Am Rev Respir Dis 1989; 140:924.
- Wise RA, Polito AJ, Krishnan V. Respiratory physiologic changes in pregnancy. Immunol Allergy Clin North Am 2006; 26:1.
- Cousins L. Fetal oxygenation, assessment of fetal well-being, and obstetric management of the pregnant patient with asthma. J Allergy Clin Immunol 1999; 103:S343.
- Gluck JC. The change of asthma course during pregnancy. Clin Rev Allergy Immunol 2004; 26:171.
- Schatz M, Dombrowski MP, Wise R, et al. Asthma morbidity during pregnancy can be predicted by severity classification. J Allergy Clin Immunol 2003; 112:283.
- Schatz M, Harden K, Forsythe A, et al. The course of asthma during pregnancy, post partum, and with successive pregnancies: a prospective analysis. J Allergy Clin Immunol 1988; 81:509.
- Gluck JC, Gluck P. The effects of pregnancy on asthma: a prospective study. Ann Allergy 1976; 37:164.
- Williams, DA. Asthma and pregnancy. Acta Allergol 1967; 22:311.
- Murphy VE, Gibson P, Talbot PI, Clifton VL. Severe asthma exacerbations during pregnancy. Obstet Gynecol 2005; 106:1046.
- Stenius-Aarniala BS, Hedman J, Teramo KA. Acute asthma during pregnancy. Thorax 1996; 51:411.
- Enriquez R, Wu P, Griffin MR, et al. Cessation of asthma medication in early pregnancy. Am J Obstet Gynecol 2006; 195:149.
- Sawicki E, Stewart K, Wong S, et al. Management of asthma by pregnant women attending an Australian maternity hospital. Aust N Z J Obstet Gynaecol 2012; 52:183.
- Lim AS, Stewart K, Abramson MJ, et al. Asthma during pregnancy: the experiences, concerns and views of pregnant women with asthma. J Asthma 2012; 49:474.
- Zetstra-van der Woude PA, Vroegop JS, Bos HJ, de Jong-van den Berg LT. A population analysis of prescriptions for asthma medications during pregnancy. J Allergy Clin Immunol 2013; 131:711.
- Gordon M, Niswander KR, Berendes H, Kantor AG. Fetal morbidity following potentially anoxigenic obstetric conditions. VII. Bronchial asthma. Am J Obstet Gynecol 1970; 106:421.
- Bahna SL, Bjerkedal T. The course and outcome of pregnancy in women with bronchial asthma. Acta Allergol 1972; 27:397.
- Perlow JH, Montgomery D, Morgan MA, et al. Severity of asthma and perinatal outcome. Am J Obstet Gynecol 1992; 167:963.
- Schatz M, Zeiger RS, Hoffman CP. Intrauterine growth is related to gestational pulmonary function in pregnant asthmatic women. Kaiser-Permanente Asthma and Pregnancy Study Group. Chest 1990; 98:389.
- Lehrer S, Stone J, Lapinski R, et al. Association between pregnancy-induced hypertension and asthma during pregnancy. Am J Obstet Gynecol 1993; 168:1463.
- Triche EW, Saftlas AF, Belanger K, et al. Association of asthma diagnosis, severity, symptoms, and treatment with risk of preeclampsia. Obstet Gynecol 2004; 104:585.
- Liu S, Wen SW, Demissie K, et al. Maternal asthma and pregnancy outcomes: a retrospective cohort study. Am J Obstet Gynecol 2001; 184:90.
- Breton MC, Beauchesne MF, Lemière C, et al. Risk of perinatal mortality associated with asthma during pregnancy. Thorax 2009; 64:101.
- Murphy VE, Namazy JA, Powell H, et al. A meta-analysis of adverse perinatal outcomes in women with asthma. BJOG 2011; 118:1314.
- Mihrshahi S, Belousova E, Marks GB, et al. Pregnancy and birth outcomes in families with asthma. J Asthma 2003; 40:181.
- Tata LJ, Lewis SA, McKeever TM, et al. A comprehensive analysis of adverse obstetric and pediatric complications in women with asthma. Am J Respir Crit Care Med 2007; 175:991.
- Mendola P, Laughon SK, Männistö TI, et al. Obstetric complications among US women with asthma. Am J Obstet Gynecol 2013; 208:127.e1.
- Källén B, Rydhstroem H, Aberg A. Asthma during pregnancy--a population based study. Eur J Epidemiol 2000; 16:167.
- Mendola P, Männistö TI, Leishear K, et al. Neonatal health of infants born to mothers with asthma. J Allergy Clin Immunol 2014; 133:85.
- Blais L, Kettani FZ, Forget A. Relationship between maternal asthma, its severity and control and abortion. Hum Reprod 2013; 28:908.
- Dombrowski MP, Schatz M, Wise R, et al. Asthma during pregnancy. Obstet Gynecol 2004; 103:5.
- Schatz M, Zeiger RS, Hoffman CP, et al. Perinatal outcomes in the pregnancies of asthmatic women: a prospective controlled analysis. Am J Respir Crit Care Med 1995; 151:1170.
- Minerbi-Codish I, Fraser D, Avnun L, et al. Influence of asthma in pregnancy on labor and the newborn. Respiration 1998; 65:130.
- Murphy VE, Wang G, Namazy JA, et al. The risk of congenital malformations, perinatal mortality and neonatal hospitalisation among pregnant women with asthma: a systematic review and meta-analysis. BJOG 2013; 120:812.
- Schatz M. Asthma and pregnancy. Lancet 1999; 353:1202.
- Schatz M, Dombrowski MP, Wise R, et al. Spirometry is related to perinatal outcomes in pregnant women with asthma. Am J Obstet Gynecol 2006; 194:120.
- Blais L, Kettani FZ, Forget A, et al. Asthma exacerbations during the first trimester of pregnancy and congenital malformations: revisiting the association in a large representative cohort. Thorax 2015; 70:647.
- Namazy JA, Murphy VE, Powell H, et al. Effects of asthma severity, exacerbations and oral corticosteroids on perinatal outcomes. Eur Respir J 2013; 41:1082.
- Landau R, Xie HG, Dishy V, et al. beta2-Adrenergic receptor genotype and preterm delivery. Am J Obstet Gynecol 2002; 187:1294.
- Bertrand JM, Riley SP, Popkin J, Coates AL. The long-term pulmonary sequelae of prematurity: the role of familial airway hyperreactivity and the respiratory distress syndrome. N Engl J Med 1985; 312:742.
- Siddiqui S, Goodman N, McKenna S, et al. Pre-eclampsia is associated with airway hyperresponsiveness. BJOG 2008; 115:520.
- RESPIRATORY PHYSIOLOGY DURING PREGNANCY
- Maternal pulmonary function
- Maternal airway hyperresponsiveness
- Maternal arterial blood gases
- Fetal oxygenation
- EFFECTS OF PREGNANCY ON ASTHMA
- General trends
- Acute exacerbations
- EFFECTS OF ASTHMA ON PREGNANCY
- Complications of pregnancy
- Possible causes of adverse outcomes
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS