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Controlling Asthma During Pregnancy

Posted Aug 24 2008 1:49pm
ANNOUNCER: More than 17 million adult Americans have asthma. Surveys show many are under treated, or untreated. When those who fail to control their asthma are women who are pregnant, two lives are put in harms' way.

MICHAEL SCHATZ, MD: It's certainly important that asthma be controlled during pregnancy for a number of reasons. Certainly the mother's discomfort is not the least among them. Not only is it important for the mother to feel good, but if you talk to any perinatologist, they will tell you that the best way to have a healthy baby is to have a healthy mother.

ANNOUNCER: Women with poorly treated asthma who are pregnant are at increased risk of suffering from uterine hemorrhage and vaginal bleeding. But the most frequent complication for the mother is a condition that can lead to premature delivery, or the need to induce delivery, sometimes before the fetus is viable.

RUSSELL SETTIPANE, MD: Asthma in general can increase the risk of complications such as high blood pressure in a condition known as preeclampsia, which is a very high blood pressure that is associated with tremendous swelling.

MICHAEL SCHATZ, MD: The usual incidence, for example, of preeclampsia is about 7 percent. And it appears that asthmatic patients may have about a doubling of that risk.

ANNOUNCER: A woman's asthma can impact her unborn baby in many ways.

RUSSELL SETTIPANE, MD: Well, the most important reason why asthmatic women should really control their asthma in pregnancy is to make sure their baby gets adequate oxygen throughout their pregnancy. And the mother knows that she's not just breathing for herself, but she's breathing for her baby. And if she's having difficulty with her breathing -- shortness of breath and wheezing and coughing -- although she may be getting by or adjusting to it, the baby may not be faring as well.

ALLAN STILLERMAN, MD: The risks to the infant are either being born pre-term, or being born at a lower weight because of intrauterine -- intrauterine growth retardation or increased perinatal mortality which is death before, during or after delivery.

ANNOUNCER: Deaths of a baby due to a mother's asthma are rare. But a large study of medical records showed that babies born to women with asthma are 36 percent more likely to be born premature, are 32 percent more likely to have a low birth weight and are 37 percent more likely to have a birth defect.

Asthma carries a broad range of symptoms, with varying severity. The worse it is for the mom, the worse for the baby.

EMILY DIMANGO, MD: The severity of asthma during pregnancy plays a considerable role in the outcome for baby and mother.

ANNOUNCER: For a person with asthma, sometimes flare-ups are infrequent, requiring treatment with what are called "rescue" medicines. When symptoms are more chronic, doctors say a person with asthma needs regular treatment with "controller" medicines.

ALLAN SCHATZ, MD: The first goal of asthma -- of dealing with asthma during pregnancy -- is to make sure it's adequately controlled. Women need to understand what that should mean to them is that ideally they're not having symptoms more than once or twice a week. It's not bothering their sleep at night any more than once or twice a month. They're not needing a rescue inhaler every day. And ideally, they're not having episodes that take them to the emergency room, really at all.

ANNOUNCER: Those are the same guidelines doctors use in determining whether any patient needs to control her asthma. So the message to pregnant women is, don't stop or avoid taking asthma medicine with pregnancy.

ALLAN STILLERMAN, MD: The management of the pregnant asthmatic patient should be no different and equally as aggressive to the management of a non-pregnant female.

ANNOUNCER: What about the risks of medication to the unborn child?

MICHAEL SCHATZ, MD: Virtually all of the commonly used asthma medicines, at least the ones that have been around for a while are not associated with an inordinate risk. And if we balance that against the fairly definite risk of uncontrolled asthma either to the mother or the baby or both -- it definitely appears that the risk of not treating the asthma is much greater than the risk of treating. The risk of uncontrolled asthma is greater than the risk of the asthma medications.

EMILY DIMANGO, MD: Any woman who is considering becoming pregnant should see their doctor about getting their asthma under good control. Because it's healthiest for the mother and healthiest for the baby if mom goes into the pregnancy with well controlled asthma.

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