The Effect of Pregnancy on the Course of Asthma

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Normal physiologic changes of pregnancy and their effects on asthma

There are many physiologic changes that occur during pregnancy. Some of these could have beneficial effects on the course of asthma and others could be deleterious (Box 1) [5]. The exact effects of these physiologic changes on the course of asthma during pregnancy are unknown.

Retrospective studies

It is important to recall that for many years, obstetricians and their patients stopped all treatment as soon as pregnancy began. Asthma was not regarded as a high-risk condition, so it is likely that more women had severe difficulty with their asthma because of lack of treatment. In the 1966 edition of Williams Obstetrics, the entire subject of asthma and pregnancy is discussed in just two paragraphs [22]. Relying on one retrospective study [23], it stated that pregnancy had no effect on

Course of asthma post partum

In general, after delivery, asthma returns to the severity that was present before pregnancy. If the course of asthma during pregnancy was unchanged, the disease remained the same after delivery in 72% of the women studied. When asthma changed during pregnancy, it returned to the prepregnancy state within 3 months in 74% of women (Fig. 3) [18]. Similarly, 56% of women who had severe asthma during pregnancy had fewer symptoms after delivery, whereas only 22% of mild asthmatics improved after

Course of asthma during subsequent pregnancies

Several studies found that the course of asthma in individual women is similar during subsequent pregnancies. Gammal and Warraki [28] reported consistency in deterioration in 29 of 33 patients and consistent improvement in 23 of 28 patients. Williams [30] found that 63% of his patients had similar courses; all of Jensen's [24] patients had consistent courses of asthma during subsequent pregnancies. Stenius-Aarniala and colleagues [32] followed 13 women through two pregnancies, but adjusted

Reluctance to treat

Asthma severity and control of asthma are important risk factors during pregnancy. Factors, such as reluctance to treat, result in poor control of asthma during pregnancy. Additionally, decreased compliance may occur because of a patient's concerns about the safety of medication for the fetus.

A study of treatment of acute asthma in emergency departments across the United States included 551 women (51 pregnant and 500 not pregnant) [37]. Both groups had similar durations of symptoms and peak

Summary

The course of asthma is changed by pregnancy in variable ways for unknown reasons. Although the prospective studies used different criteria to stratify the severity of the patients' asthma, their conclusions were remarkably similar. Overall, an equal number of women have asthma symptoms that improve, worsen, or are unchanged through pregnancy. Asthma symptoms can worsen during pregnancy because of identifiable factors, such as infection, gastroesophageal reflux disease, reduction of appropriate

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