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Asthma and pregnancy

Key points about asthma and pregnancy

Changes to your body during pregnancy may affect your asthma – it may become better or it may worsen, it may even reappear after not having been an issue since childhood.
Do not stop your asthma medication unless advised by your doctor.
Know the asthma warning signs to watch for.
Avoid situations that trigger asthma attacks.
Get the flu, whooping cough and COVID-19 vaccinations to protect yourself and your unborn child.
Create an asthma management action plan with your doctor or nurse.

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Every woman reacts to pregnancy differently. In pregnant women with asthma, asthma control improves in about 1 in every 3 women, worsens in about 1 in every 3 women and remains the same in about 1 in every 3 women.

Worsening of asthma symptoms can happen at any stage of pregnancy, but it seems to be most common between 17 and 36 weeks, mainly in the 6th month of pregnancy.

Asthma can also begin again during pregnancy in women who have not experienced asthma symptoms since childhood.

Warning signs to watch out for
Signs that your asthma may be getting worse include: a cough that is worse at night or in the early morning, or when you exercise wheezing breathlessness tightness in your chest. If you have these symptoms, speak to your doctor or asthma specialist, who will advise you on the best treatment.
Signs of a severe asthma attack include: severe difficulty with breathing, walking or talking lips or skin turning blue exhausted and tired due to the effort of breathing wheezing stops suddenly. If you experience any of the signs of a severe asthma attack, dial 111 and ask for an ambulance.

Warning signs to watch out for

Signs that your asthma may be getting worse include:

a cough that is worse at night or in the early morning, or when you exercise
wheezing
breathlessness
tightness in your chest.

If you have these symptoms, speak to your doctor or asthma specialist, who will advise you on the best treatment.

Signs of a severe asthma attack include:

severe difficulty with breathing, walking or talking
lips or skin turning blue
exhausted and tired due to the effort of breathing
wheezing stops suddenly.

If you experience any of the signs of a severe asthma attack, dial 111 and ask for an ambulance.

When asthma is well controlled during pregnancy, you will generally have a normal pregnancy with little or no increased risk of harm to you or your developing baby.

If your asthma is not controlled during pregnancy, it can cause possible harm to you and your baby. If you're having trouble breathing, your baby might not get enough oxygen.

Risks to your health:

High blood pressure during pregnancy.
Vaginal bleeding.
Pre-eclampsia, a condition that causes high blood pressure that can affect the placenta, kidneys, liver and brain.
Complicated labour.

Risks to your baby's health:

Slow growth of your baby.
Low birth weight (when born, the baby appears small).
Preterm birth (early birth before 37th week of pregnancy).
Death of baby immediately before or after birth.

Image credit: Canva

Any medication you take during pregnancy can affect your baby, but most asthma treatments are safe to use when you are pregnant. Medical experts advise that it is far safer to manage your asthma with medicine than it is to leave asthma untreated during pregnancy. Keep taking your asthma medication as normal unless instructed to do otherwise by your doctor.

Preventer inhalers

Preventer inhalers help to control your asthma.
Preventer inhalers contain a corticosteroid which does not relieve your symptoms immediately but builds up over time to reduce swelling in the airways and stop your asthma symptoms developing.
Use your prescribed regular preventer inhaler throughout pregnancy, even when you are well, to reduce the chance of severe asthma attacks.
Examples of preventer inhalers are:

Reliever inhalers

Relievers work quickly to reduce your symptoms straight away.
You should use your reliever inhaler whenever you get asthma symptoms or if you are having an asthma attack.
Your reliever inhaler works by relaxing the muscles around the airways, allowing them to widen and making it easier for you to breathe.
Everyone with asthma should have a reliever inhaler and you should always carry your reliever inhaler with you.
Examples of reliever medications are:
- Respigen®
- Salamol®
- Ventolin®
- Bricanyl®.

Steroid tablets

Steroid tablets contain larger amounts of medication than a preventer inhaler.
They are prescribed by your doctor for a short time if your asthma gets worse.
Steroid tablets work to reduce the inflammation in your airways and are safe to take during pregnancy.
An example of steroid tablets is prednisone.

There are many things you can do to help reduce the severity and frequency (how often) of your asthma symptoms, such as:

Have an asthma management action plan(external link)(external link)
Exercise regularly.
Avoid smoking and exposure to secondhand smoke.
Avoid allergens that normally trigger your asthma. Note that if you are avoiding foods to protect your unborn child’s risk of asthma, there is no evidence that avoiding specific foods while you are pregnant/hapu prevents later development of asthma and allergy in children/tamariki.
Control conditions affecting the nose such as sinusitis, allergic rhinitis or hayfever.
Control gastro-oesophageal reflux disease (GORD) symptoms.
Get vaccinated for COVID-19, pertussis (whooping cough) and flu.

Read more in our self-care section below.

Most women do not get severe asthma symptoms during labour and delivery. Some women may be advised to have continuous monitoring of their baby during labour and delivery. If you are taking asthma medication, continue doing so during labour and delivery. During labour and delivery you have the same choice of pain medication as any woman.

There are many things you can do to help reduce how severe and how often you experience asthma symptoms. The following are some useful tips.

Have an asthma management action plan

Like all people with asthma, pregnant women should have an asthma management action plan(external link). This is a written plan that you develop with your doctor to help control your asthma.

Your action plan describes the medicines you need to take and when to take them. It also explains how to adjust your treatment to meet your needs, such as if your asthma is getting worse or during asthma attacks.

Exercise regularly

You can continue to exercise normally during your pregnancy. If you find that exercise makes your asthma worse, try using your reliever before exercise.

Talk to your doctor about how you should manage your symptoms.

Avoid smoking

Do not smoke during your pregnancy and avoid secondhand smoke. This can make your asthma worse. Also, smoking during pregnancy increases the chance of sudden unexplained death of an infant (SUDI) and of chest infections, asthma and middle-ear disease in babies.

Avoid allergic triggers

As much as possible try to avoid or control the things that make your asthma worse (called triggers), such as animal fur, pollen, mould and dust.

Control conditions affecting your nose

Conditions such as sinusitis or hay fever can make asthma worse. The common symptoms are sneezing, a blocked or runny nose, an itchy nose, mouth or inner ear, and headaches.

Talk to your doctor about how to best manage these symptoms if they are troublesome.

Control gastro-oesophageal reflux disease (GORD) symptoms

GORD causes acid reflux and heartburn, which can make asthma symptoms worse. If you develop GORD, talk to your doctor about how to best manage your symptoms.

Some suggestions to help reduce GORD symptoms include to:

raise the head of your bed with extra pillows
eat smaller meals
wait at least 3 hours after eating before lying down
avoid foods that seem to start heartburn.

Get the flu vaccine

Having the flu (influenza) can make your asthma worse. The flu vaccine gives you extra protection against the flu. It is safe in pregnancy and is recommended for all pregnant women. Get the flu vaccine as soon as it is available, whether you are in your first, second or third trimester at the time.