Asthma, pregnancy and breastfeeding
Your asthma severity can change during pregnancy, so it’s a good idea to enlist the help of your doctor to ensure you have good control and protect the health of your fetus as well as your own. At least one in 3 women will experience a worsening of their asthma control during pregnancy.
You may need to change your asthma treatment during pregnancy to keep good control and avoid flare-ups.
Here are the answers to some simple questions about managing your asthma during pregnancy.
Can I take my asthma medicines while I am pregnant?
According to the National Asthma Council, it is safe to continue taking your asthma medications while you are pregnant. Stopping your medications could put your baby at risk. Nearly a third of women in an Australian study who had a severe flare-up during pregnancy had not been taking their prescribed preventer before the flare-up.
Most asthma medicines have been shown to be extremely safe for both you and your developing baby, and will ensure that your asthma symptoms are not left untreated for the duration of your pregnancy. Untreated symptoms may be harmful for the baby and for you. If you have any concerns about your asthma medicines in pregnancy talk to your doctor.
Your asthma management plan should be reviewed regularly throughout pregnancy.
Uncontrolled asthma is far more of a danger to your pregnancy than any of your prescribed asthma medicines.
Do not stop taking either your preventer or reliever asthma medicines without consulting your doctor first.
Around one-third of pregnant women with asthma actually experience an improvement in their asthma symptoms, possibly due to increased levels of cortisone in the body during pregnancy.
Always check with your doctor before starting or stopping taking any types of drugs or medicines during pregnancy.
Do I need a new Asthma Action Plan when I’m pregnant?
It’s a good idea to have more regular reviews of your asthma action plan when you are pregnant. You may need to step up your medications to maintain control of asthma. Acting quickly when you have a mild flare-up will help to prevent severe asthma attacks developing.
Do I need any special immunisations for pregnancy?
Pregnant women are more at risk of complications from flu, so they should have a flu vaccination each time they are pregnant. It can be given at any stage of the pregnancy.
Pertussis (whooping cough) vaccine is recommended for you at 28-32 weeks. This will give your baby maternal antibodies via the placenta and help protect it during the first 3 months of its life.
Will having asthma make my pregnancy worse?
Many women experience breathlessness during pregnancy which is due to hormonal changes, not asthma.
In addition to this, many women also experience breathlessness during the last trimester of their pregnancy due to the enlarging uterus restricting movement of their diaphragm. This is normal for many pregnant women, even those who do not have asthma.
Pregnant women with severe asthma are more at risk of developing high blood pressure or pre-eclampsia during pregnancy.
Should I quit smoking?
Planning a pregnancy is a great opportunity for you or your partner to give up smoking. This will help keep your asthma under control and bring a myriad of other health benefits. Quitting smoking and avoiding second-hand cigarette smoke will reduce the risk of your baby having problems, such as being born too early, and the risk of SIDS (sudden infant death syndrome).
How should I monitor my asthma during pregnancy?
It is extremely important to monitor your asthma closely throughout your pregnancy. Follow your asthma management plan closely, and consult your doctor if you have any concerns about your health or that of your developing baby.
For some women, peak flow monitoring throughout your pregnancy will help you manage changes in your lung function, and allow you to adapt your medicines and management plans accordingly. Late in pregnancy your peak flow may decrease due to the enlarged uterus taking up space for the lungs to expand into.
Effective management of your asthma during pregnancy is essential: unstable asthma has been associated with premature births and low-birthweight babies.
Having allergic rhinitis during pregnancy is linked to having worse asthma control, so if you are having symptoms of hay fever, such as runny nose and nasal congestion, see your doctor.
How will my asthma affect my labour?
Taking asthma medicines during pregnancy does not delay or lengthen delivery time. Having well-controlled asthma reduces the risk of premature delivery. Talk to your doctor before your labour about how your asthma may affect the delivery, and ask them to advise other medical staff of your special needs.
Pain relieving drugs are available for use by women with asthma during labour and your options for pain management can be discussed with your doctor.
What if I have an asthma attack during labour?
Asthma attacks during childbirth happen rarely. If you have symptoms, it’s safe to use your reliever inhaler as you normally would. Talk to your doctor and midwife about any concerns you have about labour.
Will my asthma affect the health of my baby?
As mentioned, if your asthma is uncontrolled and unstable, there is an increased risk of your baby being of low birthweight.
There is no evidence that medicines for asthma, including inhaled corticosteroids, increase the risk of birth defects.
Is it safe to take asthma medicines while breastfeeding?
Yes – generally you should continue taking your asthma medicines while breastfeeding. The risks of poor asthma control outweigh any risks of the medicines. There are a small number of asthma medicines that are not recommended for breastfeeding women – your doctor will advise you if this is the case.
While some asthma medicines do enter breast milk, the extremely small concentrations do not harm the baby in any way. The baby’s exposure to the medicines through breast milk is much less than that during pregnancy.
With high doses of systemic corticosteroids, your doctor will be able to advise you how to time your dose to reduce the baby’s exposure to corticosteroids in breast milk.
See your doctor or healthcare professional if you have any concerns regarding breastfeeding your baby.
Will my child have asthma too?
The cause of asthma remains unknown, although there is an increased risk of a child developing asthma if he or she has a parent who has asthma. The World Health Organization says roughly half of asthma is due to genetics and half to environmental factors.
Babies born pre-term have a much higher risk of childhood asthma themselves. Even more reason to keep your asthma well controlled during pregnancy.
Protecting your child from cigarette smoke, during pregnancy and afterwards, is recommended to reduce the risk of your child developing asthma. Doctors also recommend breastfeeding as a means of reducing the likelihood of your child developing asthma and allergy.
Will my asthma return to ‘normal’ after the baby is born?
In most cases a woman’s asthma will return to pre-pregnancy levels once the baby is born.
Last Reviewed: 22/10/2020
1. National Asthma Council. Australian Asthma Handbook. Asthma in pregnant women. https://www.asthmahandbook.org.au/populations/pregnant-women (accessed Oct 2020)
2. National Asthma Council. Australian Asthma Handbook. Managing asthma actively during pregnancy. https://www.asthmahandbook.org.au/populations/pregnant-women/pregnancy/asthma-care
3. Wiley K, Regan A, McIntyre P. Immunisation and pregnancy - who, what, when and why? Australian Prescriber 2017; 40: 122-24. https://www.nps.org.au/australian-prescriber/articles/immunisation-and-pregnancy-who-what-when-and-why
4. Harvard Health Publishing. Shortness of breath in pregnancy. June, 2020. https://www.health.harvard.edu/decision_guide/shortness-of-breath-in-pregnancy
5. Lim A, Hussainy SY, Abramson MJ. Asthma drugs in pregnancy and lactation. Australian Prescriber 2013; 36: 150-53.
6. Blais L, Beauchesne MF, Rey E, et al. Use of inhaled corticosteroids during the first trimester of pregnancy and the risk of congenital malformations among women with asthma. Thorax. 2007; 62: 320-328. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2092465/
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