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Counsel on Increased Risk with Pregnancy
- Studies show that as pregnancy progresses, about 30% of women with mild asthma will develop moderate to severe asthma while about 23% of women with moderate to severe asthma will improve to mild asthma as pregnancy progresses.
- Uncontrolled asthma during pregnancy is associated with maternal health risks, intrauterine growth restriction and preterm birth.
- Poor compliance with prescribed asthma medications during pregnancy jeopardizes asthma control.
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Management
- Optimize asthma control prior to conception; multidisciplinary care may be advantageous. Develop an asthma management plan that can be shared with the obstetrician when pregnancy occurs.
- Predictors of how asthma will behave in pregnancy:
- Severity of baseline asthma
- Frequency of exacerbations
- Level of control prior to pregnancy
- Other risk factors for exacerbations:
- Inadequate prenatal care
- Medication noncompliance
- Suboptimal prescribing
- Lack of inhaled corticosteroids when indicated
- Obesity
- Most asthma medications are safe to use during pregnancy (such as inhaled short acting beta agonists and inhaled corticosteroids). Information on medications' reproductive risks is available through Reprotox.
- Active management strategies that focus on identifying patient-specific risk factors,patient and provider education, and targeted treatment interventions can improve asthma care for women during pregnancy.
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Contraception Counseling
- Consider methods that suppress ovulation, as menses may exacerbate reactive airway disease.
- All contraceptive methods are safer for women than pregnancy.