Diagnosis and Management of Asthma During Pregnancy

Asthma affects 8% to 13% of pregnant individuals and worsens in approximately 30% to 40% during pregnancy. Exacerbations during pregnancy are associated with adverse maternal and infant outcomes. Despite extensive evidence supporting the safety and efficacy of asthma medications during pregnancy, medication nonadherence is common for myriad reasons, even among previously adherent patients, and presents an important modifiable risk factor for asthma control. Asthma management during pregnancy is accompanied by other unique complexities regarding diagnosis, potential need for increased maternal and fetal monitoring, and delivery considerations. In this Grand Rounds Review, we discuss the clinical perspective in managing patients with asthma, including presentation, diagnosis, treatment and exposure mitigation, medication adherence, assessment of control, and how to address common concerns unique to pregnancy, delivery, and the postpartum period. Health care professionals are encouraged to take a holistic approach, considering the multiple factors that may influence asthma control and medication adherence, and using shared decision-making to address barriers to asthma control. Factors such as obstetric history, comorbidities, and structural factors, including housing, air pollution, and poverty, can impact management.