Asthma and pregnancy

Here’s how you can lower your risk of asthma symptoms and asthma attacks:

• Keep taking your asthma medicines as prescribed. They’re safe to take when you’re pregnant. In fact, your baby is more at risk if you stop taking your medicines and have symptoms and asthma attacks.
• Have an asthma review. Your GP can check your asthma medicines, your inhaler technique and update your written asthma action plan. Book further appointments if you notice symptoms during your pregnancy. 
• Tell your midwife you have asthma. Make sure asthma’s in your notes and included in your birth plan. Looking after your asthma needs to be part of your overall antenatal care plan.
• Stop smoking. Smoking while you’re pregnant means your baby’s more likely to have breathing problems, including asthma. It also puts you more at risk of both miscarriage and premature labour. And avoid breathing in secondhand smoke too. There’s lots of support to help you give up.
• Have the flu jab. Pregnant women, and people with asthma, are more at risk of complications from flu, like chest infections or pneumonia. The flu jab is safe in pregnancy. It will also help protect your baby from flu in their first few months.

Because every pregnancy is unique, and everyone’s asthma is different, it’s hard to predict what will happen with your asthma when you’re pregnant.

Some pregnant women find their asthma improves. Some don't notice any changes in their symptoms at all. And some women – especially those with severe asthma – may find their symptoms get worse.

If you do notice changes in your asthma during pregnancy, these may not carry on once your baby is born. In most cases asthma goes back to how it was before you were pregnant.

If you have difficult or severe asthma ask your GP or asthma nurse if you need an asthma specialist to support you during your pregnancy. It’s important to keep an eye on your symptoms, and make sure the medicines you’re taking are working well.

Some women notice asthma symptoms for the first time during pregnancy
If this happens to you it probably means you had mild asthma without realising it. And pregnancy hormones in pregnancy have triggered your symptoms.

The sooner you get help the quicker you can cut the risks to you and your baby. So talk to your GP, asthma nurse, midwife, or pharmacist if you notice any of the following:

• You’re coughing or wheezing more especially at night.
• Your chest feels tight
• You’re taking your reliever inhaler more often. If you’re taking your reliever inhaler three or more times a week, you may be at risk of an asthma attack and should get an urgent GP appointment.
• Your nose feels stuffy This is a common pregnancy symptom. But it could also affect your asthma. If your nose is stuffy you’re more likely to breathe through your mouth instead. This means the air doesn’t get warmed up before it hits your airways. And allergens can’t be filtered out as well.
• You feel more breathless. Getting a bit breathless more than usual is another common pregnancy symptom. But don’t ignore it. It’s also a sign your asthma is getting worse.
• Your hay fever gets worse. Hay fever or pollen allergy can make your asthma symptoms worse so it’s important to treat it. Ask your GP or pharmacist about which hay fever treatments are safe for you to use during your pregnancy. It’s likely that you’ll be recommended eye drops or nasal sprays first. You can also try other ways to relieve hay fever symptoms.
• You have acid reflux – this is common in pregnancy and can make your asthma worse.

The medicines used to treat asthma are safe in pregnancy. They won't harm your baby. This includes reliever inhalers; preventer inhalers; long-acting and combined relievers; theophylline; and steroid (prednisolone) tablets.

“There are more risks to both you and your baby if you don't take your medicines and your asthma gets worse,” says Dr Andy Whittamore. “This is because when asthma isn’t controlled there may not be enough oxygen getting to your baby.”

If you’re already taking a leukotriene receptor antagonist (LTRA), such as Montelukast, it’s safe to continue taking it during pregnancy.

If you’ve been taking steroid tablets in the weeks leading up to your due date, make sure you tell your midwife and the hospital staff.  They should keep a closer eye on your asthma.

And if you’re still taking steroid tablets when you go into labour, your birth team will need to make sure you continue to take these medicines during labour. It’s really important these medicines are not stopped suddenly.

If you’re worried about taking your medicines when you’re pregnant talk to your GP, asthma nurse or midwife. You can also talk about medicines and any potential side effects during your asthma review.

Talk to your GP, asthma nurse or midwife during the weeks and months before your due date and make sure your asthma is included in your birth plan.  

You need to know that everyone supporting you with the birth knows you have asthma and knows what to do if you have symptoms.

What if I have an asthma attack during labour?
Asthma attacks during labour are very rare – it’s thought this is because the steroids your body produces naturally to help with labour also help reduce inflammation in your airways.

If you do have asthma symptoms during labour, it's safe to use your reliever inhaler as normal. It won't harm your baby in any way.

Make sure you tell your midwife and the hospital staff about any allergies you have. For example, some people with asthma have a latex allergy and staff should use latex-free gloves.

Pain relief during labour for women with asthma
There are a number of different ways to relieve pain during labour and they are all safe for women with asthma:

• Gas and air (Entonox)
• Pain relief injections (usually Pethidine)
• Epidurals  

If you have severe asthma, your GP, midwife and obstetrician will talk to you about which pain relief is suitable for you. You can add this to your birth plan.

Vaginal birth
Most women with asthma can aim for a vaginal birth. But if you’re anxious about whether your asthma will affect you giving birth vaginally, talk to your midwife or consultant.

If, after discussion and support, you still feel you’d prefer a planned caesarean, it’s your right to ask for one.

Home birth or midwife-led unit
As long as your asthma has been well managed during your pregnancy it’ll be safe for you to have your baby at home or in a midwife-led unit.

But if you’ve needed to increase your asthma medicines during pregnancy, or have needed hospital treatment for your asthma, you’ll probably be advised that it’s safer to give birth in hospital.

If labour needs to be induced or accelerated
If your labour has to be induced (started medically) make sure you remind your doctor or midwife that you have asthma so they can use the safest medicines for you.

You also need to do this if you birth needs moving along (accelerating). Ask your midwife to include details about your asthma in the birth plan and notes.

Having a C-section (caesarean)
Having asthma doesn’t mean you need to have a C-section. But if you do have one the anaesthetist will aim to use a spinal block or epidural rather than a general anaesthetic.

It’s considered a safer option for women with asthma. And it’s safe to use your reliever inhaler during the operation if you need to.

If you need to have a c-section under general anaesthetic, be reassured that the anaesthetist will choose the best anaesthetic medicines for you and your asthma.

And if you do develop asthma symptoms under general anaesthetic, they can give you your inhaler through a special adaptor.

Only very small amounts of asthma medicines pass into breast milk and these are no risk to your baby.

Breastfeeding has lots of health benefits for both you and your baby. There’s some evidence that suggests breastfed babies may be less likely to develop asthma,

But if you decide to bottle-feed, for whatever reason, it doesn't mean your baby will necessarily go on to develop asthma. And if they do it may not be because you didn’t breastfeed. There are lots of different reasons why asthma can be more likely for some babies.