Asthma and pregnancy: focus on disease control to reduce the risk of maternal and fetal complications

During pregnancy, women with asthma monitoring should involve the lung and the obstetrician to maintain a constant oxygen to the fetus while it avoids the side effects of treatment, said Dr. Marc Humbert, the pulmonology department of the hospital Antoine Béclère in Clamart (Hauts-de-Seine).

Pregnancy, asthma and GERD

This specialist has used the press conference to present the program of the Days Parisian allergy to take stock of the problems of asthma during pregnancy.

During pregnancy, one third of asthmatics experiencing an improvement in asthma, another third remain stable, while the other third has severe deterioration, said the specialist.

Exacerbations of asthma occur more frequently during the third trimester of pregnancy, particularly in connection with a current gastroesophageal reflux disease (GERD) during this period, due to the extra pressure exerted on the fetus stomach. In addition, asthma and some of its treatments also promote GERD, said Dr. Marc Humbert.

Which treatment to choose?

Another factor often being the cause of exacerbations: a "washout" wild ", such as" I stopped my treatment because I'm pregnant. "

In case of severe exacerbations, or in the case of difficult to control asthma "should not hesitate to use corticosteroids short course", preferring the old molecules for which there is a decline in new generation products, insisted the pulmonologist.

Given that the use of corticosteroids during pregnancy can "make a little scared", always "accompany prescription explanation of the usefulness of the drug," he advised.

Concerning the processing of background, the choice of drugs should focus on "the molecules for which there is a decline and risk of teratogenicity or excluded exceptional, yet active enough to control the asthmatic disease." In this context in particular must be excluded antileucotrienes, especially during the first trimester of pregnancy.

However, it is rare that the visit to the pulmonologist before pregnancy. If this is the case and if necessary, Prof. Marc Humbert recommends proceeding preventively in well balanced asthma, a "switch to the molecules for which one has the most back."

But more often the consultation takes place while the "critical period" in the first quarter has already passed or in progress. For asthmatics "already pregnant and well balanced," the change in treatment is justified, however, that if they take a potentially teratogenic molecule, he said.

The main goal is to maintain stable asthma throughout pregnancy, taking background therapy should be accompanied by measures of therapeutic education of the patient and the eviction of triggers (allergens, tobacco ...) concluded the pulmonologist.