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World J Pharmacol. Dec 9, 2014; 3(4): 56-71
Published online Dec 9, 2014. doi: 10.5497/wjp.v3.i4.56
Asthma in pregnancy
Hayley K Blackburn, Douglas R Allington, Kendra A Procacci, Michael P Rivey
Hayley K Blackburn, Douglas R Allington, Kendra A Procacci, Michael P Rivey, Department of Pharmacy Practice, University of Montana Skaggs School of Pharmacy, Missoula, MT 59812, United States
Hayley K Blackburn, Douglas R Allington, Michael P Rivey, Department of Pharmacy, Community Medical Center, Missoula, MT 59804, United States
Kendra A Procacci, Department of Pharmacy, Grant Creek Family Practice, Missoula, MT 59804, United States
Author contributions: Blackburn HK, Allington DR, Procacci KA and Rivey MP were all involved in the conception and writing of the manuscript.
Correspondence to: Hayley K Blackburn, PhD, Department of Pharmacy Practice, University of Montana Skaggs School of Pharmacy, 32 Campus Dr, Missoula, MT 59812, United States.
Telephone: +1-406-2434624 Fax: +1-706-6536645
Received: July 1, 2014
Revised: August 1, 2014
Accepted: September 16, 2014
Published online: December 9, 2014

Asthma affects approximately 8% of women during pregnancy. Pregnancy results in a variable course for asthma control, likely contributed to by physiological changes affecting the respiratory, immune, and hormonal systems. While asthma during pregnancy has been associated with an increased risk of maternal and fetal complications including malformations, available data also suggest that active asthma management and monitoring can decrease the risk of adverse outcomes. The diagnosis, disease classification, and goals for asthma management in the pregnant woman are the same as for nonpregnant patients. However, evidence shows that pregnant asthmatics are more likely to be undertreated, resulting in asthma exacerbations occurring in approximately one third and hospitalization in one tenth of patients. Pharmacotherapeutic management of asthma exacerbations in pregnant patients follows standard treatment guidelines. In contrast, the principles of asthma maintenance therapy are slightly modified in the pregnant patient. Patients and practitioners may avoid use of asthma medications due to concern for a risk of fetal complications and malformations. A variable amount of information is available regarding the risk of a given asthma medication to cause adverse fetal outcomes, and it is preferable to use an inhaled product. Nevertheless, based on available data, the majority of asthma medications are regarded as safe for use during pregnancy. And, any increased risk to either the mother or fetus from medication use appears to be small compared to that associated with poor asthma control.

Keywords: Asthma, Pregnancy, Fetal outcomes, Maternal outcomes, Management of asthma, Pharmacotherapy

Core tip: This comprehensive review of the impact of asthma during pregnancy provides information regarding proposed pathophysiological alterations and fetal and maternal outcomes associated with asthma during pregnancy. In addition, we outline the treatment of acute exacerbations and the maintenance management of asthma throughout pregnancy, including specific information on the various classes of medication used to treat asthma.