As a teratogen information specialist at OTIS, I frequently hear the same scenario regarding pregnancy and asthma. A mom is so excited that she is being “safe” in her pregnancy because she has come off all of her asthma medications. She is almost completely out of breath, exhausted from wheezing all night, and extremely limited in the activities she can still do. Despite her own suffering, she is proud of her heroic acts in saving her developing fetus from potential harm. Unfortunately, like many other breathless moms, she has been misinformed about the effects of asthma and asthma medications in pregnancy… and the truth often leaves her feeling a lot less like a hero.
The Breadth of Breath
Everyone knows that breathing is crucial to life, but do we really understand why? Let’s re-visit the basics. Breathing delivers oxygen to our lungs, where the oxygen is transferred to our blood, brought to the heart and then pumped out to all the cells in our body. In fact, oxygen makes up 65% of our body mass!
Oxygen is crucial to a cell’s normal metabolism. Cells use oxygen as their primary source of energy. With oxygen, cells are able to carry out all of their marvelous acts like re-building old tissue, disposing of waste, and creating new cells. Without enough oxygen, our cells become weak and are more susceptible to viruses.
Cells that rely more heavily on oxygen to survive are the cells in our brain. While the brain only makes up 2% of our body weight, it uses up 20% of our oxygen. So, oxygen is also necessary for our mental processing, like memory, movement and thought. Brain cells are so sensitive to oxygen that they begin to die after a few minutes without it.
Asthma is caused by an inflammation in the air passageways, which prevents air from being able to enter the lungs. Thus, asthma is a serious condition that causes a person to take in less oxygen than they may need.
Breathing for Two
While not as fun as eating for two, it is important for pregnant women to remember that they are their babies’ only source of oxygen. If a mom’s asthma is not controlled, both she and her baby are getting less oxygen. Although babies do not take their first breath until they are born, in utero they receive all their oxygen from the placenta (the blood connection between mom and baby). Now that we know how crucial oxygen is to life, it’s probably clear why a fetus that develops from a single cell to a full-functioning human needs it. In fact, untreated asthma is considered to be riskier than asthma controlled with medications in pregnancy. Here is why:
- Mom’s risk: Untreated asthma during pregnancy increases the mother’s risk for pre-eclampsia (a group of symptoms including high blood pressure, ankle swelling and kidney problems), excessive vomiting, vaginal bleeding, and premature and complicated labor. In fact, the more severe the asthma is in pregnancy, the more likely a pregnant mom will be hospitalized during pregnancy.
- Baby’s risk: Untreated asthma during pregnancy increases the baby’s risk for slowed growth, preterm birth (before 37 weeks gestation), and even death.
Just Breathe…Through Your Inhaler
You are not alone. Asthma affects 8% of all pregnancies. Although one-third of women experience an improvement of asthma during pregnancy, about one-third of women get worse. Asthma can also become worse in the second or third trimesters as your belly pushes up against your diaphragm, making it harder to breathe. Thankfully, while severe asthma is associated with more severe risks, better-controlled asthma is associated with lower risks. Thus, most asthmatic pregnant women will need to take a medication to adequately control their condition.
Most asthma medications have not been shown to have harmful effects on the baby. The majority of women can control their asthma by taking an inhaled medication like albuterol or an inhaled corticosteroid. Inhaled medications act directly on the air passageways to decrease inflammation and open them up for breath. Because inhaled medications are not meant to be absorbed and distributed throughout the body like a pill you swallow is, very little of inhaled medications are absorbed into your blood and able to go to your developing baby. Thus, inhaled medications are usually considered to be of a low risk to the baby.
Information about specific medications (albuterol, prednisone/prenisolone, inhaled corticosteroids, formoterol, salmeterol and montelukast) can be found on the OTIS Fact Sheet page on our website: http://www.otispregnancy.org/otis-fact-sheets-s13037. You can always call OTIS for individual risk/benefit analysis and speak with a counselor (like me J) directly by calling toll-free 1-877-311-8972.
Be a real superhero this pregnancy by delivering one of the most essential elements, oxygen, to your growing and developing baby. Although it can feel taboo to take a medication during pregnancy, if you are feeling breathless, it is likely that your baby is also not getting enough oxygen. Remember, the benefits of treating asthma during pregnancy generally outweigh the potential risks of the medication. So, talk to your doctor, stay away from irritants (like smoke, dust, pollen etc.), and take control of that breath! And when you see your big and healthy baby take his or her first real breath, you can finally let your breath be taken away!
Nadia Mohamedi is a teratogen information specialist and also serves as a research assistant/interviewer for OTIS studies in San Diego, CA. She holds a BA in neurobiology and a minor in psychology from Harvard College. In addition to her work with OTIS, Nadia has worked for the Alcohol and Drug Abuse Treatment Program at McLean Hospital as well as served as a teacher’s assistant at a school for children with disabilities in Lima, Peru.
OTIS is a North American non-profit dedicated to providing accurate evidence-based information about exposures during pregnancy and lactation. Questions or concerns about medications and other exposures during pregnancy or breastfeeding can be directed to OTIS counselors at (866) 626-OTIS (6847) or online at OTISPregnancy.org.