Asthma in pregnancy

Regarding asthma in pregnancy, which one of the following statements is TRUE?

a) Asthma attacks in brittle asthmatics are more common during labour than at any

other stage of the pregnancy

b) Theophyllines are contraindicated for treating asthmatics in pregnancy

c) Oral steroid therapy should be avoided in gravid patients with acute severe asthma

d) Intravenous magnesium sulphate should not be administered to an asthmatic in

labour

e) Uncontrolled asthma is associated with pre-eclampsia

Answer: e

Explanation

One third of asthmatic patients will experience an improvement in their symptoms

during pregnancy, one third will suffer a worsening and one third notice no change. In

those that deteriorate, the peak severity is between weeks 24 and 36 after which symptoms

improve with attacks being very unusual in labour because of endogenous steroid

production. No adverse outcomes have been demonstrated with the use of inhaled β2

agonists, inhaled steroids, theophyllines or magnesium during pregnancy. Oral steroids

do not have convincing evidence of harm and the British Thoracic Society concludes that

the detriment to mother and foetus by not adequately treating acute severe asthma

outweighs the potential, unproven risk of systemic steroids in pregnancy. Uncontrolled

asthma during pregnancy is associated with hyperemesis, hypertension, pre-eclampsia,

premature delivery and low birthweight babies. Emphasis is therefore on maintaining

good control with the patient’s pre-pregnancy medications, regular clinical review and

rapid treatment of acute severe asthma with drug therapy as for the non-pregnant patient.

Reference

British Thoracic Society/Scottish Intercollediate Guidlelines Network. 101 British

Guideline on the Management of Asthma: a National Clinical Guideline. NHS QIS, May

2008, revised June 2009. Online at www.sign.ac.uk/pdf/sign101.pdf (Accessed

30 October 2009)