Navigating asthma in pregnancy: Immunologic changes, barriers, and disparities in management

Background: Asthma is the most prevalent chronic condition in pregnancy. It is associated with an increased risk of maternal and perinatal complications, including low birth weight, preeclampsia, and preterm delivery. In women with asthma, pregnancy-induced immunologic changes are dysregulated, including a high T helper type 17 (Th17) to regulatory T cell ratio, a shift from Th1 to Th2 immunity, and an increase in proinflammatory cytokines. Multiple barriers exist that prevent optimal asthma management during pregnancy. This review examines the multifaceted relationship between asthma and pregnancy and discusses the challenges and opportunities for allergists in the management of asthma during pregnancy. Methods: A relevant literature search was performed by using the PubMed data base. Selected peer-reviewed journal articles published from April 1999 to March 2025, were identified. The data extracted were categorized into the following themes: immunologic changes in pregnancy, barriers to asthma management during pregnancy, and socioeconomic disparities of expectant mothers with asthma. Results: The immunologic changes with asthma in pregnancy lead to worsened severity and thereby worsened control of asthma. Management of asthma during pregnancy is further challenging due to barriers such as the lack of patient education; poor self-management skills; concerns around medication safety; health-care provider competence and hesitancy; and health-care disparities. including race, gender, and socioeconomic status considerations. There is a pressing need for evidence-based information on the safety of asthma medications during pregnancy and lactation, the impact of health-care disparities on asthma during pregnancy, provider education on asthma management, and self-management skills. Conclusion: Allergists must manage the proinflammatory immunologic milieu as well as address barriers such as medication nonadherence, patient education, provider hesitancy and competency, and social determinants of health to improve maternal health and pregnancy outcomes. Whereas research exists on the impact of asthma on pregnancy outcomes, there is a need for further evidence of the safety of medications during pregnancy and lactation.