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7. Asthma and Cystic Fibrosis in Pregnancy

Steroids role Cystic Fibrosis CF and breastfeeding Asthma

By Joe Kabyemela, MD

A prospective mother with asthma, which is a chronic condition characterized by breathlessness and attacks of wheezing, will inevitably worry about the effect of the condition on the pregnancy and vice versa. This is particularly so in the first pregnancy.

The questions and answers here are bound to clarify the situation for most asthma sufferers. The bottom line remains good control of the condition, which in turn hinges on taking medication and other prevention and treatment measures.

There are usually no additional or special measures required during pregnancy and exceptions to this general rule are few.

Labour is a time that may conceivably require special measures, both in ensuring certain ideal conditions and avoiding administration of certain types of medication commonly given to other delivering mothers. All these are clearly explained here.

Cystic fibrosis is another chronic condition, characterized by a tendency to chronic lung infections; pregnancy may pose special problems, which may be formidable and difficult to deal with. As it is a genetic disease, passed from parents to children, anxiety about this aspect is inevitable.

Not every young woman with cystic fibrosis can safely carry a pregnancy. Questions surrounding all these problems are answered in this chapter.

Asthma and pregnancy

If an asthmatic is planning to become pregnant, what is she advised to do?

Neither asthma nor the attack-preventing medication in common use has any direct adverse effect on the pregnancy or the baby. The advice is to optimise treatment to ensure good control of asthma before trying to conceive.

What are the drugs used to prevent asthma attacks?

Commonly used is an inhalant steroid called beclomethasone, usually prescribed under the trade name Becotide®. This is certainly safe for use in pregnancy and there is only minimal absorption from the airway.

Other steroids used similarly include Budesonide and Fluticasone, prescribed under the popular trade names Pulmicort® and Flixotide®. These steroids are also known to be safe.

Are there any other preventative drugs for asthma attacks?

Sodium cromoglycate, popularly known as Intal®, is used to prevent attacks. It is safe to use in pregnancy.

Also used for preventing attacks is Ipratropium (Atrovent®). It has no known adverse effect on the pregnancy or the fetus.

Drugs such as Salmeterol (Serevent®) have been in use only in the last few years and even though there has been no report or any indication of any ill-effect on pregnancy, the data is considered to be insufficient to advise on their safety.

What about leukotriene receptor antagonists?

Asthma sufferers may be prescribed one of this group of drugs. They are normally used as prophylaxis i.e. to prevent attacks. Examples are Zafirlukast (Accolate®) and Montelukast (Singulair®). Their safety in pregnancy cannot be absolutely guaranteed and therefore the standard advise is to avoid. Those who are using them prior to conception are usually taken off them  once they conceive.

What happens to asthma itself during pregnancy?

It does not get worse and, in some cases, the attacks may lessen or be less severe. However, this is by no means standard and the active advice is to optimise prevention of attacks and treatment.

For anybody who has been on regular medication to prevent attacks, stopping this during pregnancy without medical advice is usually a mistake.

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