Challenges in the successful management of asthma during conception, pregnancy and delivery

Abstract

Asthma and infertility are the most common disorders among women of reproductive age. Time to pregnancy is prolonged in women with asthma, and importantly, age seems to be a more important risk factor regarding fertility in women with asthma compared to women without asthma. Some data have shown a higher frequency of miscarriages in women with asthma, although the data are conflicting on this issue as studies have observed no association between asthma and pregnancy loss. Furthermore, studies have shown no negative effect of asthma on the total number of offspring. Pregnancy may, thus, have a significant impact on women with asthma, as well as on their offspring.The age of the women has an important impact on ability to conceive, but also for the pregnancy itself, with higher risk of uncontrolled asthma as well as asthma exacerbations with increasing age. Well-controlled asthma decreases the risk of maternal and fetal complications, while poorly controlled and undertreated asthma is associated with a range of risks for both mother and fetus. Asthma treatment should follow the general guidelines for asthma therapy, irrespective of pregnancy status, including treatment with inhaled corticosteroids, β2-agonists and muscarinic antagonists. Targeted treatment with biologics for severe asthma seems to be without important adverse effects. The use of systemic corticosteroids may be associated with adverse events during the first trimester; however, an exacerbation with the associated risk of hypoxaemia is worse for the fetus. Best possible asthma control may be achieved using repeated measurements of fractional exhaled nitric oxide (FENO), as the use of FENO compared with symptoms registration only has been shown to reduce exacerbation rate.In conclusion, women with asthma should be encouraged to conceive at an early age, might experience miscarriages, but the number of offspring are the same as in women without asthma. Well treated asthma is important for the well-being of both the mother and the unborn fetus.

Fertility Challenges in Asthmatic Women: Examining the Complexities of Pregnancy Loss, Infertility, and Assisted Reproductive Technologies

“…Collaboration between asthma specialists and fertility experts can help optimize asthma management while minimizing potential risks to fertility. Future research should focus on elucidating the mechanisms underlying the relationship between asthma and infertility and establishing guidelines for managing asthmatic women undergoing fertility treatments [ 35 ].…”

Asthma and pregnancy

“…The obstetric population often needs better asthma self-management skills and knowledge, regardless of disease severity 18 . Parents should be aware that poor asthma control in pregnancy increases the risk of maternal complications and poor neonatal outcomes 13 , 22 .…”

“…There are no published studies specifically addressing intrapartum management in women with respiratory disease and whether there are any clinical benefits of cesarean section versus vaginal birth 35 . Although there is a higher planned cesarean rate among moderate-severe asthmatics compared with mild asthma patients, labor induction is rarely indicated due to asthma 22 , 39 .…”

“…Pre-delivery evaluation and multidisciplinary planning are the cornerstones in managing women with respiratory disease 35 , decreasing severe respiratory complications 41 , probably to close collaboration between obstetricians and respiratory physicians regarding pregnant asthmatic women 22 .…”

Asthma care during pregnancy in South Asia

“…Bronchial asthma is among the commonest chronic diseases affecting ladies of reproductive age group. [5][6] The reported prevalence is upto 14%, varies from region to region and countries of regions. 5 The percentage of prevalence of asthma is reported to be higher in women than man during adulthood.…”