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Why it’s ‘extremely important’ pregnant women manage their asthma


Evelyn Lewin


12/01/2021 3:49:36 PM

Taking asthma medication while pregnant is linked to adverse outcomes, but stopping is even worse.

Pregnant woman using asthma puffer
Research shows that some women discontinue or reduce their asthma medication during pregnancy.

‘It’s our role to inform women that asthma control is extremely important not only for their health, but also for the wellbeing of their future child.
 
‘Those who stop medication during pregnancy [and find their] asthma is not controlled as well, do worse.’
 
That is Dr Alex Polyakov, a senior lecturer in the Department of Obstetrics and Gynaecology at the University of Melbourne and a consultant obstetrician, gynaecologist and fertility specialist at the Reproductive Biology Unit at the Royal Women’s Hospital in Melbourne.
 
He is talking to newsGP about recent research, published in PLOS ONE, which analysed more than 100,000 births along with associated maternal prescription data.
 
It found that prescriptions for asthma medication before or during pregnancy were associated with higher prevalence of adverse perinatal outcomes such as birth before 32 weeks gestation and birthweight below the 10th percentile.
 
Stillbirth was also more prevalent among women prescribed asthma medications when compared to the unexposed population.
 
But, the more noteworthy finding, Dr Polyakov says, is that adverse events were more likely to occur in women with asthma who ceased taking their medication during pregnancy.
 
He says that is the key message that needs to be stressed to pregnant women.
 
‘The conclusion that I would draw from this is that women who have asthma that is not well controlled do worse,’ he said. ‘It’s extremely important to make sure that pregnant women are properly managed in terms of their asthma control.’
 
While this may be well known among health professionals, Dr Polyakov says some women still harbour fears about taking medication while pregnant and may cease taking their medication without informing their doctor.
 
He believes most patients are ‘sensible’ and would discuss their desire to cease their medication with their doctor before stopping it.
 
‘At least that’s what we assume,’ he said.
 
‘But as healthcare providers we should always be mindful of the fact that some people don’t tell us when they stop their medication, especially when they’re pregnant, and there should be active enquiry into how their asthma is managed and whether it’s managed adequately during pregnancy.’
 
Dr Polyakov says he has patients who have voiced their hesitations about taking medication while pregnant, and that these worries may be heightened for asthma medication in particular.
 
‘There are some concerns about corticosteroids and various other medicines that are used in asthma management,’ he said.
 
‘[But if] someone abruptly stops their medication and their asthma spirals out of control, obviously there is a risk for [the pregnant woman] – but also for her children.’
 
Research published in the American Journal of Obstetrics and Gynecology in 2006 backs the notion that some women with asthma decrease their asthma use during pregnancy.
 
That research explored asthma medication use in more than 8000 pregnant women enrolled in the Tennessee Medicaid program and found that, during the first trimester, there was a:
 

  • 23% decline in inhaled corticosteroid prescriptions
  • 13% drop in short-acting beta-agonist prescriptions
  • 54% decline in rescue corticosteroid prescriptions.
 
The researchers noted these results were similar to those of a survey of women from a managed care organisation, which found 39% of women discontinued or reduced medication use for asthma during pregnancy, with 33% of them doing so without discussing it with their doctor.
 
Due to the increased risk associated with stopping asthma medication during pregnancy, Dr Polyakov says clinicians need to keep in mind that pregnancy alone should not lead to flare-ups of asthma, and that some women may actually have fewer symptoms during pregnancy.
 
‘Pregnancy itself doesn’t worsen asthma,’ he said.
 
‘It would [therefore] be worthwhile enquiring whether the women [with worsening symptoms] are taking their medications appropriately, and whether they think they’re harmful in some way.
 
‘Poor control of asthma in pregnancy should raise red flags about non-compliance and that concern should be aggressively addressed.’
 
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A.Prof Ralph Gustav Audehm   13/01/2021 7:20:00 AM

this was a retrospective trial with no data on the severity of asthma. We do not know if the adverse outcomes were related to more severe disease in those taking their meds or related to the med. It is hypothesis generating only.