About 7% of pregnant women have a history of asthma. Most often, exacerbation occurs in the second or third trimester. According to statistics, in 33% of patients the disease proceeds without sharp changes, in 28% there is an improvement, and in 35% there is an aggravation and complication. Therefore, many couples planning a pregnancy are wondering how to combine pregnancy and asthma, whether the disease will affect the development of the fetus. Could it serve as an obstacle to natural childbirth and what other consequences could there be? The answers to these questions are presented in the article below.
What ailment
The chronic inflammatory process that occurs in the bronchi is called asthma. The disease can be triggered by various pathogens, as the bronchi are very sensitive to them. In some cases, asthma is inherited. It manifests itself as a dry cough, bouts of breathing difficulties, which can be very strong. Despite the awesome diagnosis, asthma and pregnancy are quite compatible.
This disease is not always permanent, it can either arise, disappear, or appear only in a certain period of time. For example, many patients report that seizures appear more often at night than during the day or in the morning. Since respiratory organs are affected, allergens that are in the air most often act as provoking factors. It also includes viral infections, poor ecology (exhaust gases, tobacco smoke), food additives (in particular, the fragrances contained in them), household cleaners and detergents (namely perfumes). Doctors on this list include stress, anxiety, mental disorders, overwork.
Most of all, a woman may be worried about how to cope with asthma attacks during pregnancy. Doctors say that the disease can manifest itself at the most unexpected moment. Therefore, factors provoking the development of asthma or the onset of another attack should be avoided. It is highly undesirable to interrupt treatment and medication. An experienced specialist can offer an alternative treatment regimen during pregnancy. This will avoid side effects and survive attacks.
Symptoms and stages
It is necessary to know about the first signs of asthma during pregnancy, if only because it will allow you to take timely measures to combat the attack and prevent their further occurrence. Doctors warn that asthma develops as a result of untreated pneumonia and bronchitis. In this case, asthma attacks may be completely absent or have an episodic nature. At this stage, few doctors will be able to immediately diagnose asthma. Short-term exacerbations of the disease that occur approximately once a week, in medical terminology, refer to the intermittent (initial) stage. The number of seizures that form at night does not exceed more than two episodes per week.
The second stage of the disease is mild persistent, in which symptoms occur once a day, more than once a week, the number of night attacks at least two per month. When exacerbation of asthma occurs during pregnancy, the disease negatively affects sleep and physical activity, they talk about the third stage. At this stage, a woman may experience more than once a week attacks at night, the remaining symptoms are repeated daily.
The last stage is the fourth, in which a pregnant woman develops a night cough without sputum, noisy, wheezing, feeling as if her throat is scratched, tightness in the chest area. During coughing, the face may acquire a bluish tint, sweat may appear. If sputum is excreted, then most likely it is plentiful and fluid. The described symptoms should alert and prompt a woman to be examined by a doctor. An asthma attack during pregnancy, which does not stop for several hours or even days, is a clear signal for urgent medical attention. It is almost impossible to cope with such symptoms of the disease on your own, and the usual medications can be ineffective.
Features of the disease during gestation
The special condition of a woman associated with bearing a baby leaves a certain imprint. This is due to the treatment methods and the consequences that may affect the development of the fetus. If a woman was diagnosed with bronchial asthma during pregnancy, then the doctor should warn that late toxicosis and complications in childbirth are possible. As for the child, the problems with the supply of oxygen also negatively affect his height and weight gain. In pregnant women who suffer from frequent attacks and do not take any measures to eliminate them, the pressure rises, which further threatens the development of hypertension. Left unattended, the disease is also fraught with the fact that it can lead to the occurrence of a disease such as preeclampsia. It affects the brain, liver, placenta, kidneys.
A specialist who leads a pregnant woman for all nine months should monitor the effectiveness of her medications. If the usual drugs (for example, cromones) have ceased to act, then the treatment regimen should be changed. As a rule, they resort to inhalers containing hormonal components. At the initial appointment of this kind of medicine, the choice usually lies with Pulmicort (budesonide). This drug has been tested in practice, about 2000 pregnant women took it during pregnancy and had a positive effect. Experts also note that newborns had a good mark immediately after birth and they did not have signs of hypoxia, developmental delays. In short, the children were no different from those whose mothers were healthy.
Diagnostics
In order to establish a diagnosis and choose the right treatment for asthma during pregnancy, the doctor prescribes a number of studies:
- Clinical blood test.
- Microscopic examination of sputum.
- Assessment of the condition of the lungs, which determines the most important indicator - the volume of forced expiration and the vital capacity of both lungs (spirometry).
Any other studies, such as tests for allergens and x-rays, are unacceptable during pregnancy. Therefore, when diagnosing a disease, it is necessary to pass an examination with a doctor in advance and, at the planning stage, pass all kinds of tests. You may also need to use a pneumotachometer, which allows you to evaluate lung function.
Exacerbation periods
The main reason for the development of an attack is a decrease in tone in the bronchi, namely, smooth muscles. Edema, which occurs as a result of the inflammatory process, leads to a thickening of the walls of the vessels. In turn, the submucous glands and goblet cells produce a viscous tight secret, which exacerbates the picture of the disease. Pregnancy and asthma during an exacerbation can provoke a delay in the supply of oxygen through the placenta.
The doctor who observes the woman during the period of bearing the baby should constantly monitor the breathing and work of the bronchi. It is known that even in the absence of symptoms, bronchial asthma can manifest itself as the development of an inflammatory process that occurs in the bronchi. You can cope with the disease, adhering to the treatment regimen chosen by the doctor and taking the necessary medications. As a rule, these are inhalers, which should always be at hand.
Experienced mothers study reviews of pregnancy and asthma, as these two conditions of the body can affect the developing fetus. Most of the reviews are positive, and this is due to the fact that the woman is responsible for the doctor's recommendations. Even during periods of remission of the disease, the situation cannot be left to chance. With moderate persistent asthma, experts recommend the use of drugs, as a result of which a long-term positive effect is preserved. The drug that contains ephedrine is excluded from the list, since it provokes fetal hypoxia and narrowing of the uterine vessels.
Treatment methods
Wanting not to harm the baby by taking medications, some women flatly refuse the previously prescribed treatment. This is one of the biggest mistakes. Modern treatment regimens for asthma during pregnancy make it possible to use those medications that are safe in relation to the baby’s health and can alleviate the condition of the mother during periods of exacerbation of the disease.
If the patient has confirmed pregnancy, and bronchial asthma does not bother, it is necessary to make timely adjustments to the previously selected therapy. The treatment regimen for a disease caused by an allergic reaction (for example, rhinitis) consists in the selection of antihistamines. However, experts do not recommend taking drugs that contain iodine as a treatment. Experts say that they can adversely affect the functioning of the thyroid gland in the fetus.
The treatment regimen should be selected depending on the severity of the disease, since each category of drugs is intended for a specific stage of its development. Ideally, therapy should minimize the need for medication. If a woman planned pregnancy in advance, then with a competent approach to treatment throughout the term, the number of seizures will be minimal.
Inhalers
Doctors warn that in no case should you choose your own inhalers during pregnancy. Asthma is a specific disease that can be confused with similar ailments. For example, it can be: cystic fibrosis, upper respiratory tract infections, lung diseases, pulmonary vasculitis, hypopnea or apnea syndrome, fungal infections of the lungs and others. In medical practice, there are cases when the above diseases are diagnosed together with bronchial asthma. This complicates the treatment process and the selection of treatment regimens during pregnancy.
Inhalation allows you to deliver the necessary components directly to the bronchi, while an insignificant content of active substances gets into the blood, which minimizes side effects that can negatively affect the development of the fetus. Experts recommend that you do not interrupt the treatment regimen and do not change the dosage of the drugs prescribed before pregnancy. Otherwise, it can lead to stress in the body and an increase in the number of day and night attacks.
The composition of inhalers may include glucocorticosteroids, cromolyn sodium, theophylline. The main rule: Freon should not be included in the number of components. One of the safest is considered to be Symbicort Turbuhaler, it is approved for use during pregnancy. Asthma and other lung diseases are the main indications for its purpose. You can take it on an ongoing basis or to stop sudden attacks, you can not abruptly cancel the drug. It is contraindicated in the initial stage and with occasional treatment. The duration of the course is selected under the supervision of a doctor.
Approved Medicines
In medical practice, there are two categories of asthma drugs during pregnancy:
- Bronchodilators - are intended for emergency care, relieve an attack, but can not be used on an ongoing basis.
- Medicines that relieve the allergic reaction and the inflammatory process are not intended for emergency care. They are taken for a long time, perhaps even several months or years.
When prescribing medications, doctors try to choose those that have minimal side effects and are allowed during pregnancy. If you look at the letter classification, those that belong to group “B” are Cromoglin and “Nedocromil” cromons, “Budesonide” corticosteroids in the inhaler, “Montelukast” and “Zafirlukast” leukotriene receptor blockers. The remaining popular beta-agonists of fast and long-acting, theophyllines belong to group “C” (that is, they were not tested in humans, the study was conducted only in animals).
It is important to understand that this information is for informational purposes only. A woman should be responsible for her pregnancy with bronchial asthma. Reviews of those who have already become a happy parent, having such a diagnosis in their medical history, are recommended by antagonists of leukotrienes. Despite the availability in terms of acquisition, only a doctor can prescribe them. It is not recommended to change drugs on their own during pregnancy, even if there is information about their harmlessness.
Preventive measures
Any disease is easier to prevent than to cure. This also applies to asthma during pregnancy at any stage of its development. The easiest option is to avoid allergens, after which a woman has asthma attacks, coughing, shortness of breath. It is advisable to keep order and cleanliness in the house, since dust can also become a provocateur of asthma. A favorable home environment, the absence of stress and excitement also belong to preventive measures.
If a pregnant woman has a tendency to seasonal allergies (for example, in the spring during the flowering period of trees and flowers), experts do not recommend planning the start of pregnancy at this time. The optimal period for conception can be chosen together with the attending physician, who, adequately assessing the state of health of a woman, will be able to offer the most successful period for the beginning of active actions.
The same applies to situations where the patient often has respiratory illnesses. It is important to take timely measures to prevent nasal congestion, the formation of edema. This can be achieved by taking vitamins and dietary supplements that stimulate the immune system. This will avoid a negative effect on the fetus of asthma during pregnancy.
If during the diagnosis of the fetal health state oxygen deficiency is established, a specialist can recommend or prescribe oxygen therapy. It is also important to maintain physical activity and spend more time outdoors. It is desirable that there are as few allergens as possible, especially plants and trees, which can provoke an allergic attack.
The opinion of experts
The negative effect on the fetus of bronchial asthma during pregnancy can be minimized by adhering to the recommendations of specialists. They unanimously argue that harming the baby can be done only in one way - by refusing any previously prescribed treatment. Children born as a result of mother taking during pregnancy drugs that are prescribed to reduce asthma attacks do not differ (due to health) from other children. We can safely say that bronchial asthma and pregnancy are completely compatible and manageable for all nine months.
Doctors recommend having a special portable device at hand - a peak flow meter, which allows you to evaluate lung function without visiting a doctor’s office.
The device has a special multi-colored scale, which when exhaled into a special tube shows the performance of the lungs. In addition to assessing the state of bronchial function and understanding the overall picture of the disease at the moment, the data obtained are necessary for analysis. During the next visit to the doctor, it is desirable to have the results of home measurements. Thus, the specialist will be able to diagnose changes in the pregnant body in time.
It is possible to assess the well-being of the fetus not only during ultrasound diagnostics or a routine examination by a gynecologist, but also by measuring the number of movements during the day. As a rule, such a diagnosis is carried out after the 28th week of pregnancy. It is also advisable to pay attention to how the fetus reacts during the next attack. A woman should be wary if the number of movements becomes noticeably less. There is a possibility that at this moment the child receives insufficient oxygen, which can lead to hypoxia. The most frightening moment when the number of asthma attacks becomes noticeably greater, and the baby's mobility is less. Do not wait for a doctor's visit, in this case there is a risk of fetal death. Timely hospitalization allows you to quickly normalize the condition of the mother and child.