Asthma in pregnancy: contemporary management

Area of Science:

• Obstetrics and Gynecology
• Pulmonology
• Immunology

Background:

• Asthma affects 8-13% of pregnancies, posing risks to both mother and fetus.
• Uncontrolled asthma, not the diagnosis itself, is the primary driver of adverse pregnancy outcomes.
• Associated risks include preterm birth, hypertensive disorders, and fetal growth impairment.

Purpose of the Study:

• To review biological pathways linking active asthma to adverse pregnancy outcomes.
• To integrate asthma heterogeneity principles with pregnancy-specific immunologic shifts.
• To synthesize updated guidance for proactive asthma management in pregnancy.

Main Methods:

• Review of biological pathways (airway inflammation, oxidative stress, placental dysfunction, hypoxemia).
• Integration of phenotype/endotype principles with pregnancy immunology (Th2 state).
• Synthesis of international asthma guidelines for pregnancy management.

Main Results:

• Uncontrolled asthma is linked to higher rates of preterm birth (aORs 1.3-1.6), hypertensive disorders (aORs 1.2-1.5), and fetal growth impairment (aORs 1.2-1.4).
• Modifiable factors like infections, pollution, obesity, and comorbidities influence asthma activity.
• Proactive monitoring and controller therapy escalation are key to maintaining asthma control.

Conclusions:

• Optimizing maternal-fetal outcomes requires achieving complete asthma symptom remission.
• Precision-guided care and biologic therapies are promising future research directions.
• Active management and maintaining asthma control are paramount throughout gestation.