Bronchial asthma during pregnancy effects on the fetus. Bronchial asthma and pregnancy. Should we be afraid? Choosing the timing and method of delivery

Asthma and pregnancy are conditions that complicate each other. But what should those who suffer from bronchial asthma do? After all, this disease requires constant medication.

During pregnancy, a woman should think about preserving and maintaining not only her own health, but also about the unborn child, especially in the first few months, when the formation of the basic systems of his body occurs. Therefore, pregnant women should avoid any drug treatment.

In this case, the best solution would be constant medical monitoring of both the condition of the woman herself and the dose of therapeutic agents used by her. This will be the key to the birth of a healthy and strong baby.

Controlled asthmatic attack

A controlled course of the disease is one in which attacks of suffocation during night sleep occur less than twice every 30 days. Each attack is characterized by a decrease in the lumen in the bronchi, supplemented by edema, which causes bronchial obstruction, but inhalation and exhalation do not require much effort. But it is best if the attacks are practically absent, appearing only once a month, while they are short-lived and occur during the day.

• There is no need to use painkillers and inhalers with beta2 agonists to stop a suffocation attack. A woman can take a full breath and exhale volumetrically without inhalation.

• There is no fatigue, lethargy or restriction on physical activity within the next 24 hours after the attack.

• External respiration indicators are within normal limits, inhalation and exhalation are not difficult. But these functional features can only be determined in a hospital. Forced exhalation, its volume in the first seconds, and forced vital capacity of the lungs are established. Based on the ratios of these data, the degree of asthmatic threat to the woman and her fetus is determined.

• Exhalation should be within the minimum limits of daily fluctuations in peak volume flow. This parameter is determined twice a day, after waking up and before going to bed. For these purposes, an individual peak flow meter is used.

• The adverse effect of treatment is minimized, which is significant for pregnant women, especially if bronchial asthma is acquired and manifests itself only during pregnancy.

The danger of uncontrolled seizures

During an attack, the pregnant woman's body experiences severe oxygen starvation, which inevitably leads to fetal hypoxia. Mother and child have the same blood flow system, so the embryo suffers along with the pregnant woman. If suffocating attacks bother the patient frequently and last for a long time, then hypoxia can cause irreversible brain damage in the unborn baby.

If the disease is left to chance, it will lead to intrauterine growth retardation, and this, in turn, causes premature birth, which results in a low-weight baby.

In particularly advanced cases, pregnancy may freeze.

Asthma and pregnancy are two practically incompatible conditions, and with inadequate medical control, bronchial obstruction becomes the cause of preeclampsia. A woman in the second trimester experiences swelling, increased blood pressure, and increased levels of protein in the urine. Proteinuria leads to kidney damage, and in addition, preeclampsia causes brain damage, retinal destruction, and liver dysfunction. A pregnant woman or fetus may experience convulsions, which is eclampsia.

Controlling asthma without medication

The situation forces a pregnant woman to refuse treatment with medications, but this does not mean that there are no means to help control asthmatic attacks in other ways. To cope with asthma, you must first identify and eliminate the causes of attacks. Any chronic disease, including congenital bronchial asthma, inherited genetically, can be stopped.

During pregnancy, special triggers appear that provoke exacerbation of bronchial asthma. But this list reflects only the advantageous factors, without taking into account the individual characteristics of the course of the disease:

• Allergens that are in the air of a living room enter the body in large quantities when a woman takes a full breath. The smell of household chemicals and paints, cigarette smoke, pollen.

• Allergens that enter the body of a pregnant woman with food: citrus fruits, chocolate products and natural honey. And in addition, food preservatives, for example, nitrates and sulfites. Any synthetic substances that are added to food with a long shelf life.

• Drug allergens, for example, painkillers and antipyretics such as Aspirin, provoke bronchial spasm and cause an allergic reaction. An illustrative example is asthmatic allergies to beta blockers used to relieve heart failure.

Nonspecific causes of seizures

• excessive physical activity;
• constant changes in external temperature;
• high humidity;
• pronounced or prolonged stress, with changes in mental state and emotional imbalance;
• professional activities related to chemical or construction industries;
• aggravating diseases of infectious etiology, can be viral and bacterial.

If provoking factors occur in the environment of a pregnant woman, then it is necessary to take appropriate measures and eliminate the irritants.

Treatment

If the disease is mild and characterized by rare attacks, then the treatment regimen includes beta2-agnosts, such as Terbutaline and Albuterol, but they are used only to relieve suffocation, that is, according to the situation.

When attacks become more frequent, and they are mild and persistent, they say they have moderate asthma. In this case, the therapeutic regimen is supplemented with Nedocromil, Tailed and Intal. Studies have shown that these drugs are practically harmless to both the mother and the fetus. Naturally, with their reasonable use.

In some situations, doctors are unable to stop allergic attacks in pregnant women; this is the so-called hormone-dependent asthma.

It is characterized by a course of moderate severity and, which is much less common, by a severe form of obstruction. It is hormone-dependent because it requires treatment with corticosteroids, for example, drugs based on beclomethasone. It is best taken as a means of first choice precisely if the woman’s situation requires abstinence from other potent substances.

Hormone-dependent asthma responds well to treatment with Theophylline. However, this drug is prescribed only as a last resort, when its effectiveness objectively outweighs the risks of possible complications.

As a side effect, the instructions for Theophylline indicate the likelihood of developing intrauterine cardiac disorders in the child. Therefore, the medicine is prescribed when corticosteroids are extremely ineffective and in inhalation form. It copes well with increasing hypoxia of the mother and fetus if you resort to taking pills the very next day after an attack of suffocation. You need to drink the minimum effective dose.

Prevention

There are several easy-to-implement, but quite effective measures that help prevent another asthmatic attack:

• You should avoid consuming those foods and medications that caused allergies before pregnancy. Even if previously this only manifested itself in redness or a rash, in the current situation it can cause a sudden asthmatic attack.

• It is necessary to install an air conditioner in the room, in which a humidity regulator must be installed. Mold and dust mites only form colonies if the humidity in the room is greater than 50%.

• It is necessary to regularly carry out wet cleaning in the room where the pregnant woman spends the most time. Ideally, this room should be cleaned once a day. But the pregnant woman herself should not participate in this event, so as not to inhale house dust.

• Be sure to avoid contact with people who smoke and tobacco smoke. Try not to inhale the smells of paints and varnishes, exhaust gases, fuel and other toxic fumes, which not only provoke an asthmatic attack, but can also complicate inhalation and exhalation.

Uncontrolled bronchial asthma

Many women who complain of asthma attacks know that during pregnancy, treatment with pharmaceutical drugs is prescribed only in cases of complete hopelessness, when physiotherapeutic methods and homeopathic remedies are not able to help. Only if the entire complex of preventive measures fails, as well as taking into account the safety parameters for the mother and her child, can a medicine be prescribed, the viability of which in this case is justified by the life support criteria for both.

The use of drugs is extremely undesirable in the first three months of pregnancy, because it is during this period that they can have the most adverse effect on intrauterine development.

But if there is absolutely no way to do without treatment, then they prefer monotherapy, when drug regimens are based around one main drug. Sometimes this remedy is taken only on its own, without supplementation in the form of other medications. A pregnant woman is prescribed the minimum effective dose, and the drug is taken for a short period of time.

They prefer inhalers with local action, which inject the main substance by aerosol method. If you use it while inhaling, it immediately enters the respiratory system and stops an asthmatic attack much faster and more effectively. Systemic medications, such as tablets and injections, are prescribed extremely rarely, only for severe asthma.

The characteristics of the drug are determined by the doctor and depend on the severity of the clinical picture of the underlying disease. Experts distinguish three main degrees of severity of the disease: mild, moderate and severe. And the lung can be divided into episodic attacks, that is, intermittent, and constant ones - persistent.

How to recognize an episodic intermittent seizure:

• suffocation usually occurs at night, but manifests itself no more than a couple of times over the course of a month;
• daytime attacks occur less frequently than once every 7 days;
• the acute period is short-term – it takes from 2-3 hours to 2-3 days, but there is no insomnia or impairment of physical abilities, inhalation and exhalation are not difficult;
• in the interval between exacerbations, external respiration is stable.

How to recognize a persistent persistent attack:

• attacks of night suffocation occur much more often than 2 times a month;
• a daytime attack occurs more often than once every 7 days, but no more than one attack in one day, inhalation is calm, exhalation is difficult;
• in the acute period, the pregnant woman complains of sleep disturbances and constant physical fatigue.

How to recognize a moderate attack:

• attacks at night occur more often than once every 7 days;
• every day a woman has one attack while she is awake; inhalation can be done with diligence, but exhalation is very difficult;
• in the acute period, performance is impaired, the ability to exercise is lost, and insomnia appears;
• continuous treatment with beta2-agnists with a short period of action is prescribed.

How to recognize a severe attack:

• every night a pregnant woman experiences attacks of suffocation, most often several times, inhalation is possible, but exhalation is extremely difficult;
• during wakefulness, constant attacks also recur;
• a woman experiences constant problems with physical activity.

Peculiarities

Anesthesia for bronchial asthma is contraindicated, so anesthesia is used only in extreme cases. This means that women suffering from asthma are in most cases forced to give birth themselves, since obstetrics in the form of a caesarean section have to be excluded. In case of bronchial asthma, it is advisable to carry out any manipulations only under local anesthesia; such anesthesia is short-lived: all serious operations and treatment are postponed to the postpartum period.

It is not possible to reliably predict what the clinical picture of asthma will be in each specific case of pregnancy. Usually the course becomes more severe, especially in those women who are carrying girls. This may be due to various hormonal changes.

Most often, the condition worsens during the second and third trimester. If a tendency to weight gain was observed during the first pregnancy, then the second one will be associated with the same health problems.

Bronchial asthma (BA) is a chronic relapsing disease with primary damage to the bronchi.

The main symptom is attacks of suffocation and/or status asthmaticus due to spasm of bronchial smooth muscles, hypersecretion, discrimination and swelling of the respiratory tract mucosa.

ICD-10 CODE
J45 Asthma.
J45.0 Asthma with a predominance of an allergic component.
J45.1 Non-allergic asthma.
J45.8 Mixed asthma.
J45.9 Asthma, unspecified.
O99.5 Respiratory diseases complicating pregnancy, childbirth and the postpartum period.

EPIDEMIOLOGY

The incidence of asthma has increased significantly in the last three decades. According to WHO experts, bronchial asthma is one of the most common chronic diseases: this disease is detected in 8–10% of the adult population. In Russia, more than 8 million people suffer from bronchial asthma. Women suffer from bronchial asthma twice as often as men. As a rule, bronchial asthma manifests itself in childhood, which leads to an increase in the number of patients of childbearing age.

PREVENTION OF BRONCHIAL ASTHMA IN PREGNANCY

The basis of prevention is limiting exposure to allergens that provoke the disease (triggers). Triggers are identified using allergy tests.

Measures aimed at reducing exposure to household allergens:
· use of impermeable coverings for mattresses, blankets and pillows;
· replacing floor carpets with linoleum or wooden floors;
· replacing fabric upholstery with leather;
· replacing curtains with blinds;
Maintaining low humidity in the room;
· preventing animals from entering residential premises;
· quit smoking.

There are currently no asthma prevention measures that can be recommended during the prenatal period. However, prescribing a hypoallergenic diet during lactation to women at risk significantly reduces the likelihood of developing atopic disease in a child. Exposure to tobacco smoke, both in the prenatal and postnatal periods, provokes the development of diseases accompanied by bronchial obstruction.

Screening

Careful history taking, auscultation and study of peak expiratory flow using a peak flow meter can identify patients who need additional examination (assessment of allergic status and pulmonary function test).

CLASSIFICATION OF BRONCHIAL ASTHMA

Bronchial asthma is classified based on the etiology and severity of the disease, as well as the temporal characteristics of bronchial obstruction. In practical terms, the most convenient classification of the disease is by severity. This classification is used in the management of patients during pregnancy. Based on the noted clinical signs and respiratory function indicators, four degrees of severity of the patient’s condition before treatment were identified.

· Bronchial asthma of intermittent (episodic) course: symptoms occur no more than once a week, night symptoms no more than twice a month, exacerbations are short (from several hours to several days), pulmonary function indicators outside of exacerbation are within normal limits.

· Mild persistent bronchial asthma: symptoms of suffocation occur more than once a week, but less than once a day, exacerbations can disrupt physical activity and sleep, daily fluctuations in forced expiratory volume in 1 s or peak expiratory flow are 20–30%.

· Bronchial asthma of moderate severity: symptoms of the disease appear daily, exacerbations interfere with physical activity and sleep, nighttime symptoms occur more than once a week, forced expiratory volume or peak expiratory flow is from 60 to 80% of the proper values, daily fluctuations in forced expiratory volume or peak exhalation rate ³30%.

· Severe bronchial asthma: symptoms of the disease appear daily, exacerbations and nighttime symptoms are frequent, physical activity is limited, forced expiratory volume or peak expiratory flow is £60% of the expected value, daily fluctuations in peak expiratory flow are ³30%.

If the patient is already undergoing treatment, the severity of the disease must be determined based on the identified clinical signs and the number of medications taken daily. If symptoms of mild persistent bronchial asthma persist despite appropriate therapy, the disease is defined as moderate persistent bronchial asthma. If, during treatment, the patient develops symptoms of persistent bronchial asthma of moderate severity, a diagnosis of “Bronchial asthma, severe persistent course” is made.

ETIOLOGY (CAUSES) OF BRONCHIAL ASTHMA IN PREGNANT WOMEN

There is strong evidence that asthma is a hereditary disease. Children of patients with asthma suffer from this disease more often than children of healthy parents. The following risk factors for the development of asthma are identified:

· atopy;
· hyperreactivity of the respiratory tract, which has a hereditary component and is closely related to the level of IgE in the blood plasma, inflammation of the respiratory tract;
· allergens (house mites, animal hair, molds and yeasts, plant pollen);
· occupational sensitizing factors (more than 300 substances are known that are related to occupational bronchial asthma);
· smoking;
· air pollution (sulfur dioxide, ozone, nitrogen oxides);
· ORZ.

PATHOGENESIS OF GESTATION COMPLICATIONS

The development of complications of pregnancy and perinatal pathology is associated with the severity of bronchial asthma in the mother, the presence of exacerbations of this disease during pregnancy and the quality of therapy. In women who had exacerbations of bronchial asthma during pregnancy, the likelihood of perinatal pathology occurring is three times higher than in patients with a stable course of the disease. The immediate causes of complicated pregnancy in patients with bronchial asthma include:

changes in respiratory function (hypoxia);
· immune disorders;
· disturbances of hemostatic homeostasis;
· metabolic disorders.

Changes in respiratory function are the main cause of hypoxia. They are directly related to the severity of bronchial asthma and the quality of treatment provided during pregnancy. Immune disorders contribute to the development of autoimmune processes (APS) and a decrease in antiviral antimicrobial protection. The listed features are the main causes of common intrauterine infections in pregnant women with bronchial asthma.

During pregnancy, autoimmune processes, in particular APS, can cause damage to the vascular bed of the placenta by immune complexes. The result is placental insufficiency and fetal growth retardation. Hypoxia and damage to the vascular wall cause a disorder of hemostatic homeostasis (the development of chronic disseminated intravascular coagulation syndrome) and disruption of microcirculation in the placenta. Another important reason for the formation of placental insufficiency in women with bronchial asthma is metabolic disorders. Studies have shown that in patients with bronchial asthma, lipid peroxidation is increased, the antioxidant activity of the blood is reduced and the activity of intracellular enzymes is reduced.

CLINICAL PICTURE (SYMPTOMS) OF BRONCHIAL ASTHMA IN PREGNANT WOMEN

The main clinical signs of bronchial asthma:
attacks of suffocation (difficulty in exhaling);
unproductive paroxysmal cough;
· noisy wheezing;
· shortness of breath.

COMPLICATIONS OF GESTATION

With bronchial asthma, in most cases, pregnancy is not contraindicated. However, if the course of the disease is uncontrolled, frequent attacks of suffocation, causing hypoxia, can lead to the development of complications in the mother and fetus. Thus, in pregnant women with asthma, the development of premature birth is noted in 14.2%, the threat of miscarriage - in 26%, FGR - in 27%, fetal malnutrition - in 28%, hypoxia and asphyxia of the fetus at birth - in 33%, gestosis - in 48%. Surgical delivery for this disease is performed in 28% of cases.

DIAGNOSIS OF BRONCHIAL ASTHMA IN PREGNANCY

ANAMNESIS

When collecting anamnesis, the presence of allergic diseases in the patient and her relatives is established. During the study, the features of the appearance of the first symptoms are clarified (the time of year of their appearance, connection with physical activity, exposure to allergens), as well as the seasonality of the disease, the presence of occupational hazards and living conditions (presence of pets). It is necessary to clarify the frequency and severity of symptoms, as well as the effect of anti-asthma treatment.

PHYSICAL INVESTIGATION

The results of the physical examination depend on the stage of the disease. During the period of remission, the study may not show any abnormalities. During the period of exacerbation, the following clinical manifestations occur: rapid breathing, increased heart rate, participation of auxiliary muscles in the act of breathing. On auscultation, harsh breathing and dry wheezing are noted. When percussing, a boxy sound may be heard.

LABORATORY RESEARCH

For timely diagnosis of gestational complications, determination of the level of AFP and b-hCG at the 17th and 20th week of pregnancy is indicated. A study of fetoplacental complex hormones (estriol, PL, progesterone, cortisol) in the blood is carried out at the 24th and 32nd weeks of pregnancy.

INSTRUMENTAL RESEARCH

· Clinical blood test to detect eosinophilia.
· Detection of increased IgE levels in blood plasma.
· Examination of sputum to detect Kurschmann spirals, Charcot-Leyden crystals and eosinophilic cells.
· Study of respiratory function to detect a decrease in maximum expiratory flow, forced expiratory volume and a decrease in peak expiratory flow.
· ECG to establish sinus tachycardia and overload of the right heart.

DIFFERENTIAL DIAGNOSTICS

Differential diagnosis is carried out taking into account the anamnesis data, the results of an allergological and clinical examination. Differential diagnosis of respiratory function (presence of reversible bronchial obstruction) with COPD, HF, cystic fibrosis, allergic and fibrosing alveolitis, occupational diseases of the respiratory system.

INDICATIONS FOR CONSULTATION WITH OTHER SPECIALISTS

· Severe course of the disease with pronounced signs of intoxication.
· Development of complications in the form of bronchitis, sinusitis, pneumonia, otitis media, etc.

EXAMPLE OF FORMULATION OF DIAGNOSIS

Pregnancy 33 weeks. Persistent bronchial asthma of moderate severity, unstable remission. Threat of premature birth.

TREATMENT OF BRONCHIAL ASTHMA DURING PREGNANCY

PREVENTION AND PREDICTION OF GESTATION COMPLICATIONS

Prevention of gestational complications in pregnant women with bronchial asthma consists of complete treatment of the disease. If necessary, carry out basic therapy using inhaled glucocorticosteroids according to
recommendations of the Global Initiative for Asthma (GINA) group. Treatment of chronic lesions is mandatory
infections: colpitis, periodontal diseases, etc.

FEATURES OF TREATMENT OF GESTATIONAL COMPLICATIONS

Treatment of gestational complications by trimester

In the first trimester, treatment of bronchial asthma in the event of a threat of miscarriage does not have any characteristic features. Therapy is carried out according to generally accepted rules. In the second and third trimester, treatment of obstetric and perinatal complications should include correction of the underlying pulmonary disease and optimization of redox processes. To reduce the intensity of lipid peroxidation, stabilize the structural and functional properties of cell membranes, normalize and improve fetal trophism, the following drugs are used:

· phospholipids + multivitamins 5 ml intravenously for 5 days, then 2 tablets 3 times a day for three weeks;
· vitamin E;
· Actovegin© (400 mg intravenously for 5 days, then 1 tablet 2-3 times a day for two weeks).

To prevent the development of infectious complications, immunocorrection is carried out:
Immunotherapy with interferon-a2 (500 thousand rectally twice a day for 10 days, then twice a day
every other day for 10 days);
Anticoagulant therapy:
- sodium heparin (to normalize hemostasis and bind circulating immune complexes);
- antiplatelet agents (to increase the synthesis of prostacyclin by the vascular wall, which reduces intravascular platelet aggregation): dipyridamole 50 mg 3 times a day, aminophylline 250 mg 2 times a day for two weeks.

If an increased level of IgE is detected in the blood plasma, markers of autoimmune processes (lupus
anticoagulant, anti-hCG) with signs of intrauterine fetal suffering and lack of sufficient effect from
Conservative therapy requires therapeutic plasmapheresis. Carry out 4–5 procedures 1–2 times a week with
removing up to 30% of the volume of circulating plasma. Indications for inpatient treatment - the presence of gestosis,
threat of miscarriage, signs of PN, grade 2–3 FGR, fetal hypoxia, severe exacerbation of asthma.

Treatment of complications during childbirth and the postpartum period

During childbirth, therapy aimed at improving the functions of the fetoplacental complex is continued. Therapy includes the administration of drugs that improve placental blood flow - xanthinol nicotinate (10 ml with 400 ml of isotonic sodium chloride solution), as well as taking piracetam for the prevention and treatment of intrauterine fetal hypoxia (2 g in 200 ml of 5% glucose solution intravenously). To prevent asthma attacks that provoke the development of fetal hypoxia, therapy for bronchial asthma using inhaled glucocorticoids is continued during childbirth. Patients taking systemic glucocorticosteroids, as well as with unstable bronchial asthma, require parenteral administration of prednisolone in a dose of 30–60 mg (or dexamethasone in an adequate dose) at the beginning of the first stage of labor, and if labor lasts more than 6 hours, the glucocorticosteroid injection is repeated at the end of the second stage childbirth

ASSESSMENT OF TREATMENT EFFECTIVENESS

The effectiveness of the therapy is assessed based on the results of determination of hormones of the fetoplacental complex in the blood, ultrasound of fetal hemodynamics and CTG data.

CHOICE OF DATE AND METHOD OF DELIVERY

Delivery of pregnant women with a mild course of the disease with adequate pain relief and corrective drug therapy does not present any difficulties and does not cause a deterioration in the patients’ condition. In most patients, labor ends spontaneously. The most common complications of childbirth are:

· rapid course of labor;
· antenatal rupture of agents;
· abnormalities of labor.

Due to the possible bronchospastic effect of methylergometrine, when preventing bleeding in the second stage of labor, preference should be given to intravenous administration of oxytocin. In pregnant women with severe asthma, uncontrolled asthma of moderate severity, status asthmaticus during this pregnancy, or exacerbation of the disease at the end of the third trimester, delivery is associated with the risk of developing severe exacerbation of the disease, acute respiratory failure, and intrauterine fetal hypoxia. Considering the high risk of infection and complications associated with surgical trauma, planned vaginal delivery is considered the method of choice for severe illness with signs of respiratory failure. During vaginal delivery, before induction of labor, puncture and catheterization of the epidural space in the thoracic region at the ThVIII–ThIX level is performed with the introduction of a 0.125% solution of bupivacaine, which gives a pronounced bronchodilator effect. Then labor is induced by amniotomy. The behavior of the woman in labor during this period is active. After the onset of regular labor, labor anesthesia is carried out using epidural anesthesia at the level LI–LII. The introduction of a long-acting anesthetic in low concentration does not limit the mobility of the woman in labor, does not weaken efforts in the second stage of labor, has a pronounced bronchodilator effect (increasing the forced vital capacity of the lungs, forced expiratory volume, peak expiratory flow) and allows for the creation of a kind of hemodynamic protection. As a result, spontaneous delivery is possible without the exception of pushing in patients with obstructive breathing disorders. To shorten the second stage of labor, an episiotomy is performed.

In the absence of sufficient experience or technical capabilities to perform epidural anesthesia at the thoracic level, delivery should be performed by CS. The method of choice for pain relief during a cesarean section is epidural anesthesia. Indications for surgical delivery in pregnant women with bronchial asthma are signs of cardiopulmonary failure in patients after relief of a severe long-term exacerbation or status asthmaticus and the presence of a history of spontaneous pneumothorax. A caesarean section can be performed for obstetric indications (for example, the presence of an incompetent scar on the uterus after a previous CS, a narrow pelvis, etc.).

INFORMATION FOR THE PATIENT

Treatment of bronchial asthma during pregnancy is mandatory. There are drugs for the treatment of bronchial asthma that are approved for use during pregnancy. If the patient's condition is stable and there are no exacerbations of the disease, pregnancy and childbirth proceed without complications. It is necessary to take classes at the Asthma School or independently familiarize yourself with the materials of the educational program for patients.

It was considered a serious obstacle to pregnancy. Often with such a diagnosis, if the attacks were frequent, women were prohibited from becoming pregnant and giving birth. But today, the attitude towards this diagnosis has been significantly revised, and doctors around the world no longer consider the presence of bronchial asthma to be a reason for prohibiting pregnancy or even the natural birth of a baby. But it is absolutely obvious that during such a gestation there are some peculiarities and nuances, and doctors need a specific attitude towards the woman and the fetus she is carrying, which needs to be known in advance.

What is bronchial asthma?

Today, bronchial asthma is considered one of the most common pathologies of the bronchopulmonary system during pregnancy. This is especially true for the atopic (allergic) type of asthma, which is associated with an increase in the total number of women with allergies.

Please note

According to allergists and pulmonologists, the number of cases of asthma ranges from 3-4 to 8-9% of all allergy sufferers, and their number is constantly increasing by approximately 2-3% per decade.

If we talk about the nature of the pathology, it is a chronically ongoing inflammatory process in the area of ​​the bronchial mucosa with the simultaneous formation of their narrowing, a temporary spasm of smooth muscle elements, which reduces the lumen of the airways and makes breathing difficult.

Attacks are associated with increased reactivity (excitability) of the walls of the bronchi, their abnormal reactions in response to various types of influences. You should not think that bronchial asthma is always an allergic pathology; this condition of the respiratory tract is possible after suffering a brain injury, severe infectious diseases, due to pronounced endocrine disorders and other influences . In most cases, the development of asthma is provoked by the influence of allergens, and in some cases a milder form of pathology (c) is initially formed, and then transitions to damage to the bronchopulmonary system and asthmatic attacks with the formation of shortness of breath, wheezing and suffocation.

Asthma options: allergies and more

By their nature, there are two types of bronchial asthma - infectious-allergic and allergic, without the participation of an infectious factor. If we talk about the first option, such bronchial asthma can form after suffering serious infectious lesions of the respiratory system - these are, severe, or. Various pathogens, most often of microbial or fungal origin, act as provocateurs and allergenic components.

The infectious-allergic form is one of the most common among all variants of the course; episodes of its development account for up to 2/3 of all variants of asthmatic attacks in women.

If we talk about atopic (purely allergic, without germs) bronchial asthma, then various substances of both organic (plant, animal, artificial synthesis) origin and inorganic (environmental substances) can act as allergens. The most common provocateurs are wind-pollinated pollen, household or professional dust, street dust, components of wool, feathers, animal down, and birds. Food components can also provoke attacks - these are citrus fruits, bright berries with a high allergenic potential, as well as some types of medications (salicylates, synthetic vitamins).

A special place is given to occupational and chemical allergens, which enter the air and the respiratory system in the form of suspensions, dust, and aerosols. These can be various compounds of perfumes, household chemicals, varnishes and paints, aerosols, etc.

For atopic asthma and its development, a woman’s hereditary predisposition to any allergy is extremely important.

How do seizures manifest?

Regardless of the form in which the patient has bronchial asthma, there are three stages in its development, which can sequentially replace each other. This is pre-asthma, then typical asthmatic attacks (with whistling or suffocation), gradually turning into the formation of status asthmaticus. All three of these options are quite likely during pregnancy:

• If we talk about pre-asthmatic state , it is characterized by attacks of obstructive, asthmatic bronchitis or frequent pneumonia with the presence of bronchospasm. However, episodes of severe suffocation typical of bronchial asthma have not yet been observed.
• On early stage of asthma typical attacks with suffocation occur from time to time, and against the background of an infectious-allergic form of the condition, they can manifest themselves during an exacerbation of any chronic bronchopulmonary diseases (bronchitis, pneumonia). Asthmatic attacks are usually easily recognized, they usually begin at night, they can last within a few minutes, although they can last for an hour or more.

  Please note

  Attacks of suffocation may be preceded by certain precursors - a burning sensation with a strong sore throat, runny nose or sneezing, a feeling of pressure, sharp tightness in the chest.

  The attack itself usually starts as a persistent cough without sputum, after which sharply difficult exhalation appears, almost complete nasal congestion and a feeling of constriction in the chest. To make breathing easier, the woman sits down and strains the auxiliary muscles in the chest, neck, and shoulder girdle, which helps to exhale forcefully. Typically noisy and hoarse breathing with whistling sounds that can be heard from a distance. Initially, breathing becomes more frequent, but then due to hypoxia of the respiratory center, it slows down to 10-15 breaths per minute. The patient's skin becomes covered with perspiration, the face may become red or bluish, and at the end of the attack, when coughing, a lump of viscous sputum, similar to shards of glass, may separate.

• emergence status asthmaticus – an extremely dangerous condition that threatens the lives of both. With it, the attack of suffocation that occurs does not stop for a long time for several hours, or even days in a row, and respiratory disorders are expressed to the maximum extent. Moreover, all the medications that the patient usually takes do not have any effect.

Bronchial asthma: the impact of attacks on the fetus

During pregnancy, hormonal changes naturally occur in the body of the expectant mother, as well as specific deviations in the functioning of the immune system, so that the fetus, which is half composed of the father’s genes, is not rejected. Therefore, at this time, the course of bronchial asthma can either worsen or improve. Naturally, the presence of attacks will negatively affect the condition of the pregnant woman herself, as well as the course of pregnancy.

Often, bronchial asthma is present before pregnancy, although it is quite possible for it to develop already during gestation, especially against the background of previously existing allergic manifestations, including hay fever. There is also a hereditary predisposition, a tendency to asthma in the pregnant woman’s relatives, including the presence of asthmatics.

Attacks of suffocation can begin in the first weeks, or occur in the second half of the gestational age. The presence of asthma in the early stages, similar to the manifestations of early asthma, may spontaneously disappear in the second half. Making preliminary predictions in such cases will be most favorable for the woman and her child.

Course of attacks by trimester

If asthma was present before pregnancy, then during gestation its course can be unpredictable, although doctors identify certain patterns.

In approximately 20% of pregnant women, the condition remains at the same level as it was before pregnancy, approximately 10% of mothers note relief of attacks and significant improvement, and in the remaining 70% the disease is much more severe than before.

In the latter case, both moderate and severe attacks predominate, which occur daily, or even several times a day. From time to time, attacks can drag on, the effect of treatment is quite weak. Often the first signs of deterioration are noted already in the first weeks of the first trimester, but by the second half of gestation it becomes easier. If during the previous pregnancy there were dynamics in a positive or negative direction, subsequent gestations usually repeat the scenario.

Asthmatic attacks during childbirth are rare, especially if women are treated with bronchodilators or hormonal drugs during this period for preventive purposes. After giving birth, about a quarter of women with mild asthma experience improvement. Another 50% do not notice any changes in their condition, and for the remaining 25%, the condition becomes worse, and they are forced to constantly take hormonal medications, the doses of which are constantly increasing.

The effect of bronchial asthma on women and fetuses

Against the background of existing bronchial asthma, women more often than healthy women suffer from early toxicosis of pregnancy; they have a higher risk and disorders in labor.. Often there can be a rapid or rapid birth, which is why the percentage of birth injuries for both the mother and the baby is high. They also often give birth to low birth weight or premature babies.

Against the background of severe attacks, the percentage of and, as well as, is high. Serious complications for the fetus and its death are possible only in extremely serious conditions and inadequate treatment. But the presence of a mother’s illness can negatively affect the child in the future. About 5% of babies may suffer from asthma, which develops in the first three years of life; in subsequent years the chances reach 60%. Newborns are prone to frequent pathologies of the respiratory tract.

If a woman suffers from bronchial asthma and the pregnancy is full term, childbirth is carried out naturally, since possible attacks of suffocation can be easily stopped. If attacks are frequent or status asthmaticus threatens, the effectiveness of treatment is low, and indications for early delivery may arise after 36-37 weeks.

The problem of asthma therapy during gestation

For a long time, experts believed that the basis of the disease was a spasm of smooth muscle elements in the bronchi, which leads to attacks of suffocation. Therefore, the basis of treatment was drugs with a bronchodilator effect. Only in the 90s of the last century it was determined that the basis of asthma is chronic inflammation of an immune nature, and the bronchi remain inflamed no matter the course and severity of the pathology, even when there are no exacerbations. The discovery of this fact led to a change in the fundamental approaches to the treatment of asthma and its prevention . Today, the basic medications for asthmatics are anti-inflammatory drugs in inhalers.

If we talk about pregnancy and its combination with bronchial asthma, then the problems are associated with the fact that during gestation it can be poorly controlled with medications. Against the background of attacks, the biggest risk for the fetus is the presence of hypoxia - a lack of oxygen in the maternal blood. Asthma makes this problem several times more acute. When an attack of suffocation occurs, it is felt not only by the mother herself, but also by the fetus, which is completely dependent on her and suffers sharply from a lack of oxygen. It is frequent attacks of hypoxia that lead to disturbances in the development of the fetus, and during critical periods of development they can even lead to disturbances in the formation of tissues and organs.

To give birth to a relatively healthy baby, complete and adequate treatment is necessary, which fully corresponds to the severity of bronchial asthma. This will prevent attacks from becoming more frequent and hypoxia from worsening.

During pregnancy, treatment should be mandatory, and the prognosis for those women whose asthma is completely under control regarding the health of their children is very favorable.

Planning and preparing for pregnancy

It is important to approach pregnancy with bronchial asthma with all responsibility, in advance against the background of all necessary treatment and prevention measures. It is important to have a preliminary visit to a pulmonologist or allergist with the selection of basic treatment, as well as training in self-monitoring of the condition and inhalation administration of drugs. If the attacks are of an allergic nature, it is necessary to carry out tests and tests in order to fully determine the spectrum of dangerous allergens and eliminate contact with them. Immediately after conception, a woman needs close medical supervision and is prohibited from taking any medications without his permission. If there are concomitant pathologies, treatment is also carried out taking into account the condition and presence of asthma.

Measures to prevent attacks and exacerbations

It is strictly forbidden to smoke during pregnancy and even to come into contact with tobacco smoke.. Its components lead to irritation of the bronchi and the formation of their inflammation, increasing the reactivity of the immune system. It is important to convey this information to the future father; if he smokes, the risk of having an asthmatic child increases 4 times.

It is equally important to exclude possible contacts with allergens, which most often provoke asthma attacks, especially in the warm season. There are also options for year-round allergic asthma, which requires the creation of a special hypoallergenic lifestyle that reduces the load on a woman’s body and leads to an alleviation of the disease and a reduction in the risk of complications. This allows you to reduce (but not completely eliminate) medications during gestation.

How is bronchial asthma treated in pregnant women?

Often, women during pregnancy try to stop taking medications, but this is not the case with asthma; its treatment is simply necessary. The harm that severe attacks that are not controlled, as well as episodes of hypoxia, can cause to the fetus is much more dangerous for the fetus than the possible side effects that are likely when taking medications. If you refuse treatment for asthma, this can threaten the woman with asthmatic status, then both can die.

Today, in treatment, the use of topical inhaled drugs is preferred, which act locally and have maximum activity in the bronchi area while creating the lowest possible concentrations of drugs in the blood plasma. In treatment, it is recommended to use inhalers without freon; they are usually marked “ECO” or “N”, and there is a phrase “free of freon” on the packaging. If this is a metered dose aerosol inhaler, it is worth using it in combination with a spacer - this is an additional chamber into which the aerosol enters from the cylinder before the patient inhales. Due to the spacer, the effect of inhalation is increased, problems with using the inhaler are eliminated and the risk of side effects that are possible due to the aerosol getting on the mucous membranes of the pharynx and mouth is reduced.

Basic therapy: what and why?

In order to control a woman’s condition during pregnancy, it is necessary to use basic therapy that suppresses the process of inflammation in the bronchi. Without it, fighting only the symptoms of the disease will lead to the progression of the pathology. The volume of basic treatment is selected by the doctor, taking into account the severity of asthma and the condition of the expectant mother. These medications must be taken constantly, every day, regardless of how you feel or whether there are attacks. Through such treatment, the number of attacks and their severity can be significantly reduced, as well as the need for additional medications, which helps in the normal development of the child. Basic therapy is carried out throughout pregnancy and throughout childbirth. Then it is carried out after the birth of the baby.

In case of mild pathology, hormones are used (Tyled or Intal drugs), and if asthma occurs for the first time during pregnancy, they start with Intal, but if adequate control over it is not achieved, then they are replaced with hormonal inhaled drugs. During pregnancy, Budesonide or Beclomethasone from this group are used, but if asthma was present before gestation, it was controlled by some other hormonal drug, you can continue therapy with it. The medications are selected only by the doctor, based on the condition data and peak flowmetry indicators (measurement of peak expiratory flow).

To monitor the condition of the house, today they use portable devices - peak flow meters, which measure breathing parameters. Doctors rely on their data when drawing up a treatment plan. Readings are taken twice a day, in the morning and in the evening, before taking medications. The data is recorded in a graph and then shown to the doctor so that he can assess the dynamics of the condition. If there are “morning dips” or low readings, it is important to adjust therapy; this is a sign of a possible exacerbation of asthma.

Asthma is a disease characterized by a relapsing course. The disease appears with equal frequency in men and women. Its main symptoms are attacks of lack of air due to spasm of the smooth muscles of the bronchi and the secretion of viscous and copious mucus.

As a rule, the pathology first appears in childhood or adolescence. If asthma occurs during pregnancy, pregnancy management requires increased medical supervision and adequate treatment.

Asthma in pregnant women - how dangerous is it?

If the expectant mother ignores the symptoms of the disease and does not seek medical help, the disease negatively affects both her health and the well-being of the fetus. Bronchial asthma is most dangerous in the early stages of gestation. Then the course becomes less aggressive and the symptoms decrease.

Is it possible to get pregnant with asthma? Despite its severe course, the disease is compatible with bearing a child. With proper therapy and constant doctor monitoring, dangerous complications can be avoided. If a woman is registered, receives medications and is regularly examined by a doctor, the risk of complications during pregnancy and childbirth is minimal.

However, sometimes the following deviations appear:

1. Increased frequency of attacks.
2. The attachment of viruses or bacteria with the development of the inflammatory process.
3. Worsening of attacks.
4. Threat of spontaneous abortion.
5. Severe toxicosis.
6. Premature delivery.

In the video, the pulmonologist talks in detail about the disease during pregnancy:

The effect of the disease on the fetus

Pregnancy changes the functioning of the respiratory organs. The level of carbon dioxide rises, and the woman’s breathing quickens. Ventilation of the lungs increases, causing the expectant mother to experience shortness of breath.

At a later stage, the location of the diaphragm changes: the growing uterus lifts it. Because of this, the pregnant woman has an increased feeling of lack of air. The condition worsens with the development of bronchial asthma. With each attack, placental hypoxia is caused. This entails intrauterine oxygen starvation in the baby with the appearance of various disorders.

The main deviations in the baby:

• lack of weight;
• intrauterine growth retardation;
• formation of pathologies in the cardiovascular, central nervous system, muscle tissue;
• with severe oxygen starvation, asphyxia (suffocation) of the baby may develop.

If the disease takes a severe form, there is a high risk of giving birth to a baby with heart defects. In addition, the baby will inherit a predisposition to respiratory diseases.

How does childbirth occur with asthma?

If the gestation of the child was controlled throughout the pregnancy, spontaneous childbirth is quite possible. 2 weeks before the expected date, the patient is hospitalized and prepared for the event. When a pregnant woman receives large doses of Prednisolone, she is given Hydrocortisone injections during the expulsion of the fetus from the uterus.

The doctor strictly monitors all indicators of the expectant mother and baby. During childbirth, the woman is given a medicine to prevent an asthma attack. It will not harm the fetus and has a beneficial effect on the patient’s well-being.

When bronchial asthma becomes severe with frequent attacks, a planned caesarean section is performed at 38 weeks. By this time, the child is fully formed, viable and considered full-term. During the operation, it is better to use a regional block than inhalation anesthesia.

The most common complications during childbirth caused by bronchial asthma:

• premature rupture of amniotic fluid;
• rapid birth, which has a negative impact on the baby’s health;
• discoordination of labor.

It happens that the patient gives birth on her own, but an asthma attack begins, accompanied by cardiopulmonary failure. Then intensive care and emergency caesarean section are performed.

How to deal with asthma during pregnancy - proven methods

If you received medications for the disease, but became pregnant, the course of therapy and medications are replaced with a more gentle option. Doctors do not allow the use of some medications during pregnancy, while the doses of others should be adjusted.

Throughout pregnancy, the doctor monitors the condition of the baby, performing ultrasound examinations. If an exacerbation begins, oxygen therapy is carried out, which prevents oxygen starvation of the baby. The doctor monitors the patient’s condition, paying close attention to changes in the uterine and placental vessels.

The main principle of treatment is the prevention of asthma attacks and the selection of harmless therapy for mother and baby. The tasks of the attending physician are to restore external respiration, eliminate asthma attacks, relieve side effects from medications and control the disease.

Bronchodilators are prescribed to treat mild asthma. They allow you to relieve spasm of smooth muscles in the bronchi.

During pregnancy, long-acting drugs (Salmeterol, Formoterol) are used. They are available in the form of aerosol cans. They are used daily and prevent the development of nighttime asthma attacks.

Other basic drugs are glucocorticosteroids (Budesonide, Beclomethasone, Flutinasone). They are released in the form of an inhaler. The doctor calculates the dosage, taking into account the severity of the disease.

If you have been prescribed hormonal medications, do not be afraid to use them daily. The medications will not harm the baby and will prevent the development of complications.

When the expectant mother suffers from late gestosis, methylxanthines (Eufillin) are used as a bronchodilator. They relax the muscles of the bronchi, stimulate the respiratory center, and improve alveolar ventilation.

Expectorants (Mukaltin) are used to remove excess mucus from the respiratory tract. They stimulate the work of the bronchial glands and increase the activity of the ciliated epithelium.

In the later stages, the doctor prescribes maintenance therapy. It is aimed at restoring intracellular processes.

Treatment includes the following medications:

• Tocopherol - reduces tone, relaxes the muscles of the uterus;
• multivitamins - replenish insufficient vitamin content in the body;
• anticoagulants - normalize blood clotting.

What drugs should pregnant women not take for treatment?

During the period of bearing a child, you should not use medications without medical advice, and even more so if you have bronchial asthma. You must follow all instructions exactly.

There are medications that are contraindicated for asthmatic women. They can have a harmful effect on the fetal health of the baby and the condition of the mother.

List of prohibited drugs:

Drug name	Negative influence	During what period are they contraindicated?
Adrenalin	Causes oxygen starvation of the fetus, provokes the development of vascular tone in the uterus	Throughout pregnancy
Short-acting bronchodilators – Fenoterol, Salbutamol	Complicates and delays childbirth	In late gestation
Theophylline	Enters the fetal circulation through the placenta, causing rapid heartbeat in the baby	In the 3rd trimester
Some glucocorticoids – Dexamethasone, Betamethasone, Triamcinolone	Negatively affects the fetal muscular system	Throughout pregnancy
II generation antihistamines – Loratadine, Dimetindene, Ebastine	The resulting side effects negatively affect the health of the woman and child.	During the entire gestational period
Selective β2-blockers (Ginipral, Anaprilin)	Causes bronchospasm, significantly worsening the patient's condition	Contraindicated in bronchial asthma, regardless of pregnancy duration
Antispasmodics (No-shpa, Papaverine)	Provokes the development of bronchospasm and anaphylactic shock	It is undesirable to use for asthma, regardless of gestational age.

Traditional medicine

Non-traditional treatment methods are widely used by patients with bronchial asthma. Such remedies cope well with attacks of suffocation and do not harm the body.

Use folk recipes only as a complement to conservative therapy. Do not use them without first consulting with your doctor or if you have identified an individual allergic reaction to the components of the product.

How to fight asthma with traditional medicine recipes:

1. Oatmeal broth. Prepare and wash 0.5 kg of oats well. Put 2 liters of milk on gas, add 0.5 ml of water. Bring to a boil, pour in the cereal. Cook for another 2 hours to obtain 2 liters of broth. Take the product hot on an empty stomach. Add 1 tsp to 1 glass of drink. honey and butter.
2. Oatmeal broth with goat milk. Pour 2 liters of water into the pan. Bring to a boil, then stir in 2 cups oats. Boil the product over low heat for about 50–60 minutes. Then pour in 0.5 liters of goat milk and boil for another half hour. Before taking the decoction, you can add 1 teaspoon of honey. Drink ½ glass 30 minutes before meals.
3. Inhalation with propolis and beeswax. Take 20 g of propolis and 100 g of beeswax. Heat the mixture in a water bath. When she warms up, cover her head with a towel. After this, inhale the product through your mouth for about 15 minutes. Repeat these procedures in the morning and evening.
4. Propolis oil. Mix 10 g of propolis with 200 g of sunflower oil. Heat the product in a water bath. Strain it and take 1 tsp. morning and evening.
5. Ginger juice. Extract the juice from the root of the plant, adding a little salt. The drink is used to combat attacks and as a preventive measure. To relieve choking, take 30 g. To prevent difficulty breathing, drink 1 tbsp daily. l. juice For taste, add 1 tsp. honey, washed down with water.

Disease prevention

Doctors advise asthmatic women to control the disease even when planning pregnancy. At this time, the doctor selects the correct and safe treatment and eliminates the effects of irritating factors. Such measures reduce the risk of seizures.

The pregnant woman herself can also take care of her health. Smoking must be stopped. If loved ones living with the expectant mother smoke, you should avoid inhaling smoke.

To improve your health and reduce the threat of relapse, try to follow simple rules:

1. Review your diet, exclude foods that cause allergies from the menu.
2. Wear clothes and use bedding made from natural materials.
3. Take a shower every day.
4. Do not contact animals.
5. Use hygiene products that have a hypoallergenic composition.
6. Use special humidifier devices that maintain the necessary humidity and clean the air of dust and allergens.
7. Take long walks in the fresh air.
8. If you work with chemicals or toxic fumes, move to a safe work area.
9. Beware of large crowds of people, especially in the autumn and spring seasons.
10. Avoid allergens in your daily life. Wet clean rooms regularly, avoiding inhalation of household chemicals.

At the stage of planning your baby, try to get vaccinated against dangerous microorganisms - Haemophilus influenzae, pneumococcus, hepatitis virus, measles, rubella and the causative agents of tetanus, diphtheria. Vaccination is carried out 3 months before planning a child under the supervision of the attending doctor.

Conclusion

Bronchial asthma and pregnancy are not mutually exclusive. Often the disease occurs or worsens when an “interesting situation” occurs. Don't ignore symptoms: asthma can negatively affect the health of mother and child.

Do not be afraid that the disease will cause any complications for the baby. With proper medical monitoring and adequate therapy, the prognosis is favorable.