Asthma in pregnancy

Although about 1% of pregnant women have asthma, it is often underrecognize d and suboptimally treated. The course of asthma during pregnancy varies; i t improves, remains stable, or worsens in similar proportions of women. The risk of an asthma exacerbation is high immediately postpartum, but the sev erity of asthma usually returns to the preconception level after delivery a nd often follows a similar course during subsequent pregnancies. Changes in beta (2)-adrenoceptor responsiveness and changes in airway inflammation in duced by high levels of circulating progesterone have been proposed as poss ible explanations for the effects of pregnancy on asthma. Good control of a sthma is essential for maternal and fetal well-being. Acute asthmatic attac ks can result in dangerously low fetal oxygenation. Chronically poor contro l is associated with pregnancy-induced hypertension, preeclampsia, and uter ine hemorrhage, as well as greater rates of cesarian section, preterm deliv ery, intrauterine growth retardation, low birth weight, and congenital malf ormation. Women with well-controlled asthma during pregnancy, however, have outcomes as good as those in their nonasthmatic counterparts. Inhaled ther apies remain the cornerstone of treatment; most appear to be safe in pregna ncy. Am J Med. 2000;109:727-733. (C) 2000 by Excerpta Medica, Inc.