References

ACOG practice bulletin: clinical management guidelines for obstetrician-gynecologists number 90, February 2008: asthma in pregnancy. Obstet Gynecol. 2008; 111:(2 Pt 1)457-64 https://doi.org/10.1097/AOG.0b013e3181665ff4

American College of Allergy, Asthma and Immunology. When pregnancy is complicated by asthma and allergies. 2010. http://acaai.org/allergies/who-has-allergies/pregnancy-allergies (accessed 16 February 2015)

Angier E, Willington J, Scadding G, Holmes S, Walker S Management of allergic and non-allergic rhinitis: a primary care summary of the BSACI guideline. Prim Care Respir J. 2010; 19:(3)217-22

Bain E, Pierides KL, Clifton VL, Hodyl NA, Stark MJ, Crowther CA, Middleton P Interventions for managing asthma in pregnancy. Cochrane Database Syst Rev. 2014; 10 https://doi.org/10.1002/14651858.CD010660.pub2

Bakhireva LN, Schatz M, Jones KL, Chambers CD Asthma control during pregnancy and the risk of preterm delivery or impaired fetal growth. Ann Allergy Asthma Immunol. 2008; 101:(2)137-43

Blias L, Forget A Asthma exacerbations during the first trimester of pregnancy and the risk of congenital malformations among asthmatic women. J Allergy Clin Immunol. 2008; 121:(6)1379-84

Blais L, Kettani FZ, Forget A Associations of maternal severity and control with pregnancy complications. J Asthma. 2014; 51:(4)391-8 https://doi.org/10.3109/02770903.2013.879880

Briggs GG, Freeman RK, Yaffe SJ, 9th ed. Philadelphia: Lippincott Williams and Wilkins; 2011

British Thoracic Society/Scottish Intercollegiate Guidelines Network. British Guideline on the Management of Asthma. 2013. http://sign.ac.uk/guidelines/ (accessed 2 February 2015)

Brozek JL, Bousquet J, Baena-Cagnani CE, Bonini S, Canonica GW Allergic rhinitis and its impact on asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol. 2010; 126:(3)466-76

Clark JM, Hulme E, Devendrakumar V Effect of maternal asthma on birthweight and neonatal outcome in a British inner-city population. Paediatr Perinat Epidemiol. 2007; 21:(2)154-62

Firoozi F, Lemiere C, Ducharme FM Effect of maternal moderate to severe asthma on perinatal outcomes. Respir Med. 2010; 104:(9)1278-87

Friedman NJ, Zeiger RS The role of breast-feeding in the development of allergies and asthma. J Allergy Clin Immunol. 2005; 115:(6)1238-48

Gilboa SM, Ailes EC, Rai RP, Anderson JA, Honein MA Antihistamines and birth defects: a systematic review of the literature. Expert Opin Drug Saf. 2014; 13:(11)1-32

Gregersen TL, Ulrik CS Safety of bronchodilators and corticosteroids for asthma during pregnancy: what we know and what we need to do better. J Asthma Allergy. 2013; 6:117-25 https://doi.org/10.2147/JAA.S52592

Hanania NA, Alpan O, Hamilos DL Omalizumab in severe allergic asthma inadequately controlled with standard therapy: a randomized trial. Ann Intern Med. 2011; 154:(9)573-82 https://doi.org/10.7326/0003-4819-154-9-201105030-00002

Incaudo GA, Takach P The diagnosis and treatment of allergic rhinitis during pregnancy and lactation. Immunol Allergy Clin North Am. 2006; 26:(1)137-54

Jackson DJ, Sykes A, Mallia P, Johnston SL Asthma exacerbations: origin, effect, and prevention. J Allergy Clin Immunol. 2011; 128:(6)1165-74

Kennedy S Providing specialist care for pregnant women with asthma. Nursing Stand. 2009; 23:(20)43-8

Lim AS, Stewart K, Abramson MJ, Walker SP, Smith CL, George J Multidisciplinary approach to management of maternal asthma (MAMMA): A randomized controlled trial. Chest. 2014; 13:(5)1046-54 https://doi.org/10.1378/chest.13-2276

Maselli DJ, Adams SG, Peters JI, Levine SM Management of asthma during pregnancy. Ther Adv Respir Dis. 2013; 7:(2)87-100 https://doi.org/10.1177/1753465812464287

McCallister JW, Benninger CG, Frey HA, Phillips GS, Mastronarde JG Pregnancy related treatment disparities of acute asthma exacerbations in the emergency department. Respir Med. 2011; 105:(10)1434-40

Monteiro de Aguiar M, Rizzo JA, Ferreira de Melo E, Silva Lima MEPL, Sarinho ESC Validation of the asthma control test in pregnant asthmatic women. Respir Med. 2014; 108:(11)1589-93 https://doi.org/10.1016/j.rmed.2014.09.009

Murdock MP Asthma in pregnancy. J Perinat Neonatal Nurs. 2002; 15:(4)27-36

Murphy VE, Clifton VL, Talbot PL Severe asthma exacerbation during pregnancy. Obstet Gynecol. 2005; 106:(5 Pt1)1046-54

Murphy VE, Gibson PG Asthma in pregnancy. Clin Chest Med. 2011; 32:(1)93-110 https://doi.org/10.1016/j.ccm.2010.10.001

Namazy JA, Schatz M Diagnosing rhinitis during pregnancy. Curr Allergy Asthma Rep. 2014; 14:(9) https://doi.org/10.1007/s11882-014-0458-0

National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma: Full Report 2007. 2007. http://www.nhlbi.nih.gov/files/docs/guidelines/asthgdln.pdf (accessed 2 February 2015)

Osur SL The Management of asthma and rhinitis during pregnancy. J Womens Health (Larchmt). 2005; 14:(3)263-76

Rance K, O'Laughlen MC Managing asthma during pregnancy. J Am Assoc Nurse Pract. 2013; 25:(10)513-21 https://doi.org/10.1002/2327-6924.12052

Rocklin RE Asthma, asthma medications and their effects on maternal foetal outcomes during pregnancy. Reprod Toxicol. 2011; 32:(2)189-97

Schatz M, Drombrowski MP Clinical practice. Asthma in pregnancy. N Engl J Med. 2009; 360:(18)186-209 https://doi.org/10.1056/NEJMcp0809942

Tamasi L, Horváth I, Bohács A, Müller V, Losonczy G, Schatz M Asthma in pregnancy – Immunological changes and clinical management. Respir Med. 2011; 105:(2)159-64 https://doi.org/10.1016/j.rmed.2010.11.006

Vatti RR, Teuber SS Asthma and Pregnancy. Clin Rev Allergy Immunol. 2012; 43:(1–2)45-56 https://doi.org/10.1007/s12016-011-8277-8

World Health Organization. Asthma fact sheet. 2014. http://www.who.int/mediacentre/factsheets/fs307/en/ (accessed 2 February 2015)

Midwifery management of asthma and allergies during pregnancy, birth, and the postpartum

02 April 2015
14 min read
Volume 23 · Issue 4

Abstract

Asthma and allergic rhinitis are two of the most common health problems worldwide and can present serious complication during pregnancy. While these diseases may improve, remain unchanged, or become exacerbated during pregnancy, they are frequently under-diagnosed and under-treated. The inflammatory processes involved in asthma and allergic rhinitis are superimposed on the normal respiratory changes of pregnancy, making early intervention crucial. Recognition of factors that can aggravate asthma, implementation and adherence to treatment guidelines, and diligent follow-up are important in midwifery management. Patient education is particularly important for prevention of asthma exacerbations. With careful control of asthma and allergic rhinitis, if present, excellent obstetrical outcomes can be expected.

Asthma, often complicated by allergies, is a common health problem that can cause complications in pregnancy (World Health Organization (WHO), 2014). The UK has an asthma prevalence during pregnancy of around 8% (Clark et al, 2007), although more recent epidemiological data is unavailable. With the prevalence and morbidity associated with asthma increasing, midwives are likely to care for women with varying degrees of asthma control. It is therefore imperative that there be prompt recognition and intervention to promote optimal perinatal outcomes. Asthma, often accompanied by allergic rhinitis (Angier et al, 2010), can be well-controlled and devastating consequences avoided with careful attention.

Asthma is a ‘chronic inflammatory disorder of the airways in which many cells and cellular elements play a role: in particular, mast cells, eosinophils, T-lymphocytes, macrophages, neutrophils, and epithelial cells’ (Murdock, 2002: 28). It is characterised by exposure to a precipitating factor (or trigger), which narrows the airways and obstructs airflow (National Asthma Education and Prevention Program (NAEPP), 2007). The obstruction is usually reversible, either spontaneously or with treatment. Asthma triggers, including allergens or irritants, can lead to several responses in the initial acute stage where there is a susceptible individual who is exposed for a long enough period of time. These responses are classified as early (immediate), late phase, dual phase, and recurrent asthmatic reaction.

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month