Asthma in Pregnancy

Asthma affects up to 10% of pregnancies and confers risk to both mother and child. Adverse maternal outcomes associated with asthma include preeclampsia, preterm labor, and increased risk of cesarean delivery. Maternal asthma also increases risks of low birth weight and small-for-gestational-age birth weight, as well as pediatric respiratory disease, including neonatal respiratory distress and early-onset asthma. Despite these risks, evidence suggests that both chronic asthma and acute asthma exacerbations remain undertreated in pregnancy. Recent landmark clinical trials in nonpregnant individuals have shown that, even for patients with mild disease, using as-needed inhaled corticosteroids combined with long-acting bronchodilators as rescue therapy dramatically reduces exacerbations. Inhaled corticosteroids are considered safe in pregnancy and are effective in reducing symptoms, preventing exacerbations, and mitigating some adverse pregnancy outcomes. Therefore, inhaled corticosteroids should be included as a mainstay in the treatment regimens of all pregnant women with asthma, preferably with an inhaled corticosteroid and rapid-onset bronchodilator combination inhaler for as-needed use and for daily maintenance use in those with more persistent asthma symptoms or risk factors for complications. Clinicians should actively discourage discontinuation or de-escalation of asthma therapies during pregnancy and educate women on the safety and importance of these medications for both themselves and their offspring. Asthma exacerbations during pregnancy confer additional risk, so they must be promptly recognized and treated with systemic corticosteroids and bronchodilators. This Clinical Expert Series article provides an overview of asthma in pregnancy, with a focus on its potential adverse health effects and the core principles of asthma evaluation and treatment in pregnancy.