Asthma in Pregnancy
Asthma is one of the most common chronic disease in pregnant women, according to the National Institutes for Health (NIH). For many women, asthma in pregnancy presents special challenges.
How does mild to moderate asthma impact pregnancy?
- One-third of pregnant women experience improved symptoms.
- One-third have worse symptoms.
- One-third experience no change at all.
Pregnant women with severe asthma are more likely to see worsened symptoms.
Asthma is a serious health condition. But this does not mean you can’t enjoy a healthy pregnancy and delivery – and have a healthy baby. The key is to remember that good asthma control is necessary because you are breathing for two – or more! The symptoms of asthma during pregnancy are treatable and, in most cases, preventable.
During pregnancy, work together with your healthcare team to manage your asthma care:
- your obstetrician (OB-GYN);
- your primary care physician;
- your allergist or pulmonologist;
- asthma educator or respiratory therapist;
- other healthcare provider
What does pregnancy asthma feel like?
During pregnancy, asthma symptoms can feel the same or different. Everyone’s experience will vary. Common symptoms include:
- chest tightness;
- shortness of breath.
Some breathing changes during pregnancy are normal. Hormones such as progesterone in early pregnancy can make you feel breathless. Then, as pregnancy progresses, there is less room inside your body to take a full, deep breath. Normal activities such as climbing stairs may leave you short of breath. But normal activities should not make you cough or wheeze. They should not make you have reduced breathing levels.
If your breathing improves after you use a quick-relief inhaler, then your symptoms are likely asthma. You should report this immediately to your healthcare team.
Remember you are breathing for two (or more)
Healthy breathing is vital to a healthy pregnancy and healthy baby. Your unborn baby depends on you for oxygen. Asthma symptoms during pregnancy could mean you and your baby may not be getting enough oxygen.
Are you wheezing during pregnancy?
Wheezing is a common asthma symptom. It is a whistling sound that comes from the chest area. Not every person with asthma wheezes, however.
If you are wheezing, you may not be getting all the air that your body needs. This can affect your baby’s oxygen levels. The only way to supply oxygen to the body is to breathe it deep into your airways. This way the oxygen reaches your vital organs – and your baby.
Remember, your baby’s lungs don’t start to bring in oxygen until after birth. For now, the baby’s oxygen comes from your lungs, to the placenta and your unborn baby.
What asthma complications can occur during pregnancy?
If you ignore your asthma symptoms, you’re at increased risk for serious complications. This can endanger the health of both the mother and unborn baby.
Asthma symptoms and asthma attacks during pregnancy
It is important to control asthma during pregnancy. Good asthma control protects both you and your baby.
Poorly controlled asthma is dangerous for both mom and unborn baby. It can cause:
- slowed growth
- preterm birth
- low birthweight
- low oxygen levels at birth
- loss of life (for mother and/or baby)
Asthma complications during pregnancy can be prevented with good asthma control. The best way to keep asthma under good control is to follow your written Asthma Action Plan. You can develop an Asthma Action Plan for pregnancy with your healthcare provider.
Use your Asthma Action Plan to track your asthma and treat symptoms. Your plan will list the medications you need for quick relief. It will also include the medications you need to control your asthma daily.
New resource from the
American Academy of Allergy, Asthma & Immunology (AAAAI)
Breathe 4 Baby Asthma and Pregnancy Toolkit
The Breathe 4 Baby Toolkit helps patients and providers determine if asthma is well-controlled and develop a plan in case symptoms emerge.
Changes in your asthma can happen during pregnancy. You may need to make adjustments to your Asthma Action Plan. Your medication may need to be changed to keep your asthma under control. You may need to schedule monthly appointments with an asthma specialist during pregnancy for these reasons.
Contact your healthcare team and/or get immediate help if you…
experience symptoms that do not respond to quick-relief medication;
notice reduced fetal movements.
Go to the emergency department or call 9-1-1 for immediate help if you have:
difficulty breathing and your asthma medicines do not help;
These are all signs your asthma is in the danger zone and need immediate help.
If all is well with you and your unborn baby, and you’re discharged from the hospital or ER, what’s next? Be sure to follow up with your asthma specialist to see if you need your asthma medication adjusted. You may want to schedule monthly appointments with an asthma specialist during pregnancy.
Preeclampsia and asthma
One complication of pregnancy is preeclampsia. A recent study found that pregnant women with moderate to severe asthma were at higher risk for preeclampsia than those without asthma.
Preeclampsia is a condition that involves the following symptoms:
high blood pressure
kidney problems (with high levels of protein in urine)
Preeclampsia typically develops after the 20th week of pregnancy. Left untreated, it can cause problems with the growth and health of your unborn baby. It can also lead to serious – even fatal – complications.
Preeclampsia may cause seizures and other complications including:
premature or complicated labor.
Talk with your healthcare team right away if you experience any of these symptoms.
What is the treatment of asthma in pregnancy?
The National Asthma Education and Prevention Program (NAEPP) has guidelines for asthma treatment. NAEPP guidelines say pregnant women should continue taking their asthma medications as directed. It is important to keep asthma under control and avoid asthma attacks during pregnancy. Uncontrolled asthma can cause both mother and baby to get less oxygen than they need.
Research has shown most asthma medications are safe for use during pregnancy. They do not harm the unborn baby. Asthma medications deemed to be safe include:
- Quick-relief albuterol inhaler or levalbuterol inhaler
- Inhaled corticosteroids including budesonide, fluticasone, mometasone and beclomethasone
- Leukotriene modifier pills including montelukast and zafirlukast
Budesonide has undergone the most studies demonstrating its safety and effectiveness for asthma and pregnancy.
Your doctor may prescribe a long-acting beta-agonist (LABA) for uncontrolled asthma during pregnancy. Oral corticosteroid pills, however, are not recommended unless needed to treat an asthma attack.
Work together with your healthcare team to develop a personalized asthma treatment plan. Your doctor will review the safety profiles of asthma treatments with you. The goal of the treatment plan is to keep control of your asthma throughout pregnancy. You can adjust the plan if there is a change in severity or frequency of symptoms. Always take your asthma medicine as directed by your doctors.
Do not start or stop taking any medications on your own without your doctor’s approval. Talk with your healthcare team first.
Medication safety is always a concern during pregnancy. No mother wants to harm their unborn child. Do not hesitate to speak with your doctor if you have any concerns with a medication. Remember – uncontrolled asthma is a higher risk to mother and unborn baby than the risk from taking asthma medications.
There are other things you can do to keep your asthma under control during pregnancy:
- avoid your asthma triggers;
- keep away from people who may have a respiratory virus;
- get your flu shot, COVID -19, pneumonia and whooping cough vaccine and other vaccinations.
All of these steps can further reduce risk of an asthma flare.
Resources from MotherToBaby and the American Academy of Allergy, Asthma & Immunology (AAAAI)
Asthma Medication Fact Sheets
The Breathe 4 Baby Toolkit includes Q&As for each asthma medication and their effect on pregnancy, lactation, birth defects and fertility.
Are there safe asthma inhalers during pregnancy?
Yes, asthma inhalers are considered safe to use during pregnancy. Quick-relief albuterol inhalers and daily inhaled corticosteroids are often prescribed to expectant mothers. When inhaled, these asthma medicines go into the airways in small particles and in small doses. Only a small amount enters the bloodstream.
Some inhalers need a slow, steady inhale, while others require a fast, deep inhale. Inhalers also may need priming before use. Our helpful videos will teach you how to prime and inhale your medicines correctly.
Can you use albuterol during pregnancy?
Yes, your albuterol inhaler is safe to use during pregnancy. Albuterol is a quick-relief medication used to treat sudden asthma symptoms. The medicine relaxes the muscles that tighten around the airways
Studies have found that albuterol use during pregnancy does not cause or increase the risk of birth defects in children.
Asthma control is essential during pregnancy. If you are using your quick-relief albuterol inhaler more than two times a week, your asthma may not be well controlled. Talk with your doctor about adding a controller medication to your treatment plan. Controller medicines reduce the swelling inside the airways and prevent asthma symptoms.
Can you use a steroid inhaler during pregnancy?
Yes, you can use an inhaled corticosteroid when pregnant. These medications reduce swelling inside your airways. This allows air to flow in and out easily. When taken as directed, they can reduce asthma attacks. They can also reduce the need to use a quick-relief albuterol inhaler.
Inhaled corticosteroids are recommended for asthma control over oral corticosteroids in pill form. Inhaled corticosteroid medicine goes directly into the lungs where it is needed most. Also, inhaled corticosteroids cause fewer side effects than oral corticosteroids and show no increased risk for birth defects, preterm delivery or low birthweight in children.
Oral corticosteroids should be avoided during pregnancy unless prescribed to treat an asthma attack. As a pill, this medicine must travel through the bloodstream before it can reach the lungs. This can cause side effects for the mother and baby. Side effects include weight gain, high blood sugar, eye problems, difficulty sleeping, changes in mood, or depression in the mother. For the baby, side effects may cause preterm birth, low birthweight or increased risk of cleft lip with or without cleft palate.
What other asthma medications are safe during pregnancy?
Pregnant women with allergic asthma can continue to take their allergy medications. These may include antihistamines and corticosteroid nasal sprays to treat allergic rhinitis. Caution is urged when using decongestants. A common decongestant is pseudoephedrine, which has been linked to birth defects.
It is not recommended to start allergy shots during pregnancy. Is it safe to continue allergen immunotherapy (allergy shots or tablets) during pregnancy? Yes, it is safe, but you and your doctor must take precautions to treat a severe allergic reaction. Epinephrine and other anaphylaxis treatments should be readily available for allergen immunotherapy. In addition, your doctor will likely stop increasing the allergen extract dose during pregnancy. This will reduce the risk of an allergic reaction.
Biologics for asthma are not well-studied in pregnant women. Currently there is not enough evidence for doctors to recommend biologics during pregnancy. However, studies have shown women who were on biologics when they became pregnant experienced no adverse outcomes. Talk with your doctor if you were on a biologic medication before pregnancy.
Long-acting muscarinic antagonists (LAMA) are also not well-studied in pregnant women. Their safety profile for pregnancy is uncertain. They are only recommended if the expected benefits of the medication outweigh the risks.
Two medications that should be avoided during pregnancy, according to the American College of Allergy, Asthma & Immunology (ACAAI):
Sulfonamides (sulfa drugs) are safe early in pregnancy, but their use in the last trimester might cause jaundice in your infant.
Tetracyclines at any stage of pregnancy may cause skeletal and dental deformities.
Remember: no medication is without risk. Discuss all your medications with your healthcare team.
Is asthma worse during pregnancy?
Asthma can get worse during pregnancy, stay the same, or get better. For some women, well-controlled asthma can change and become uncontrolled asthma. For others, moderate asthma may become severe. Changes in hormones and stress along with pressure on the diaphragm can make asthma worse.
Work with your healthcare team to make sure your Asthma Action Plan during pregnancy is up to date. After giving birth, many women go back to their pre-pregnancy asthma severity levels.
What is pregnancy-induced asthma?
Pregnancy does not cause or induce asthma. Some women may find their asthma gets worse during pregnancy. Others with undiagnosed asthma may start to experience worsened symptoms in pregnancy.
If you start to experience symptoms of asthma, tell your healthcare team. Your doctor can conduct a thorough diagnosis and may conduct a lung function test.
What about developing asthma after pregnancy?
There is no research that suggests a woman can develop asthma as a result of pregnancy. Some women may develop adult-onset asthma, but that is not related to pregnancy.
Are there home remedies for asthma during pregnancy?
Herbal and dietary supplements are not well studied in pregnant women. Discuss any supplements, including vitamins, you take with your healthcare team. They can help you understand the risks and benefits. Do not stop or start any new supplement without the guidance of your healthcare team. Always follow doctor-recommended asthma treatments.
What about home remedies for wheezing during pregnancy?
There are no proven home remedies to address wheezing. People with asthma wheeze because of inflammation in the airways. Medications are best suited to treat this inflammation.
Some home remedies may interfere with medications or even trigger asthma attacks. Ask your doctor how you can best manage wheezing, and always follow your treatment plan.
What about severe asthma and pregnancy?
If you have severe asthma, it is important to keep it well controlled. Uncontrolled asthma can cause health risks to both mother and baby.
Everyone with asthma should have an Asthma Action Plan to help them manage their asthma. If symptoms or severity change, work with your doctor to update the plan as often as needed. Follow the Asthma Action Plan and continue to use your prescribed medications as directed.
Good asthma control is essential for you and your baby’s health. It can reduce the risk of severe asthma attacks.
What about allergic asthma during pregnancy?
Allergic asthma is caused by allergy triggers. It’s important to identify and avoid asthma triggers, whether you’re pregnant or not. Common allergy triggers include pollen, mold, dust mites and pet dander.
Allergic asthma can be well-controlled during pregnancy. Women should continue taking their asthma and allergy medications as prescribed. Work with your healthcare team to find the treatment plan that’s best for you.
If you are undergoing allergy shots or tablets during pregnancy, it is safe to continue as long as you do not experience allergic reactions. Your doctor will likely maintain the same dosage through pregnancy. An increase could lead to an adverse reaction.
Questions and Answers (Q&A) about asthma and pregnancy
Here are answers to some common questions about asthma and pregnancy. If there is a question you would like to see answered here, email Gary Fitzgerald, Senior Editor.
Does pregnancy affect asthma?
During pregnancy, mild or moderate asthma may improve, get worse, or stay the same. Studies show:
⅓ of women who are pregnant will have worse asthma symptoms.
⅓ of women who are pregnant will have improved asthma symptoms.
⅓ of women who are pregnant will have no change in asthma symptoms.
Pregnant women with severe asthma are more likely to see their asthma symptoms get worse during pregnancy.
Once the baby is born, the mom’s asthma tends to go back to pre-pregnancy levels soon afterwards. Some women have reported their asthma improves post-pregnancy.
What about asthma during labor and delivery?
Most women with good asthma control will not experience symptoms during labor and delivery. It’s actually common for women with asthma to see improved symptoms during childbirth. This includes if the birth is by cesarean delivery (C-section).
Women with poorly controlled asthma are likely to experience symptoms during labor and delivery. This makes labor more difficult and dangerous for mother and baby.
Bring your quick-relief albuterol inhaler and other inhaled medications to the delivery room. If breathing problems arise, you may be given supplemental oxygen or medication via intravenous fluids. Belly breathing exercises may also be helpful during this time.
Meantime, the medical staff will monitor contractions, your breathing, and your heart rate. Staff will also check the baby’s heart rate and other vital signs during labor and delivery.
Before going to the hospital for delivery, find out how the staff will prevent and treat asthma attacks. This is especially important if you need general anesthesia or if you are planning for a C-section.
Is there a risk of asthma exacerbation during labor?
Yes, there is a risk of an asthma flare during labor and delivery. If it happens, treatment is available in hospital settings. Many women report their asthma actually improves during labor and delivery. Complications are rare.
Talk with your healthcare providers how they will manage asthma in the delivery room. Find out what treatment options are available as part of your delivery plan.
Does asthma affect the baby during pregnancy?
Poor asthma control during pregnancy can impact the baby’s oxygen levels. It could lead to the baby not getting enough air. In rare cases, this can lead to loss of life. Poor asthma control can also cause the baby to be born premature, have a low birth weight and experience slowed growth in childhood.
Work with your healthcare team to ensure you have good asthma control during pregnancy. If the mom is getting enough air, then the baby should be getting enough air.
What is gestational asthma?
There is no such thing as gestational asthma. (There is such a thing as gestational diabetes, but that is different disease.) Women cannot develop asthma as a result of pregnancy.
However, pregnancy can cause asthma to worsen. And women who have undiagnosed asthma may experience more obvious symptoms while pregnant.
Advice on asthma during pregnancy 2nd trimester
Research shows that asthma symptoms often peak in the late second or early third trimester. As the baby grows, it may become harder for the mother to breathe. This could be the result of asthma or it could be a normal pregnancy. It’s important to discuss any breathing problems – and the possible impact on your unborn baby – with your healthcare team. You may need to adjust your asthma treatment.
Advice on asthma during pregnancy 3rd trimester
When expectant moms are in the third trimester, they may feel more pressure on the diaphragm. They may also feel more excitement or stress. Hormones will continue to change, which can trigger asthma symptoms. As the baby takes up more room, it may be harder for the mom to get a deep breath. Again, it’s important to discuss any breathing problems with your healthcare team. Reevaluate your treatment plan if needed.
Can smoking while pregnant cause asthma?
Smoking while pregnant can cause asthma symptoms to flare up in women who are already diagnosed with asthma. What is the impact of smoking on the unborn baby? Smoking while pregnant is a known risk factor for development of asthma in children.
Simply put, smoking and asthma do not mix. Pregnant women with asthma should not smoke cigarettes, marijuana, hookah or e-cigarettes. Smoking during pregnancy can make breathing more difficult. It can damage the baby’s developing lungs. Smoking during pregnancy can cause your baby to be born too small or too early.
There is no safe level of firsthand, secondhand or thirdhand tobacco smoke. Pregnant women who smoke should work with their healthcare team to develop a plan to quit.
Can asthma cause birth defects?
For pregnant women with well controlled asthma, the risk of birth defects in their child is low. Uncontrolled asthma, however, can lead to a lower amount of oxygen getting to the baby. In addition to a potentially fatal outcome, reduced oxygen levels put the baby at risk for preterm birth, low birthweight and slowed growth. Reduced oxygen levels early in pregnancy could cause problems in organ development.
Most asthma medications do not cause birth defects or other pregnancy complications. The primary exception is oral corticosteroids. These medications are not recommended asthma treatments for pregnant women unless prescribed to treat an asthma attack. Use of oral corticosteroids during pregnancy are associated with an increased risk of cleft lip with or without cleft palate. They can also lead to preterm birth and low birthweight.
When should you go to the ER for asthma when pregnant?
Do your symptoms suggest you are in the yellow (caution) zone on your Asthma Action Plan? Use your quick-relief inhaler and immediately follow up with your physician. If your quick-relief inhaler does not help, then it’s best to call 911 or go to the emergency department.
Do your symptoms suggest you are in the red (danger) zone? This could be a breathing emergency. You should call 911 or go to the emergency department right away.
Signs of a breathing emergency that would require immediate medical attention include:
difficulty breathing, coughing and wheezing not helped by quick-relief medication
trouble talking in full sentences
fingertips or lips turning blue (or ashen gray in people of color)
intense headache or vomiting
skin sucked in around the chest, ribs and collarbone
When you’re experiencing asthma symptoms, be sure to monitor your unborn baby as well. If you feel there are reduced movements, this could be a sign of an emergency. Call 911 or go the emergency department.
See Related Pages
- Asthma Attack
- Asthma Symptoms & Triggers
- Asthma Medication and Treatment
- Asthma Diagnosis and Testing
- Lifestyle Changes to Manage Asthma
- Asthma Management and Control
- Asthma Patient Assistance
- Asthma Action Plan
- What is Severe Asthma?
- Asthma and Exercise
- Asthma in Babies and Children
- Asthma and Pregnancy
- Vaping and Smoking with Asthma
- Asthma Dictionary
- Asthma Statistics
- Asthma Webinars
- Ask the Allergist About Asthma
Jacqueline Eghrari-Sabet, MD, FACAAI, is board-certified in allergy, immunology and pediatrics. She is the Medical Director of Telehealth for Allergy & Asthma Network. Dr. Eghrari-Sabet is the founder of Family Allergy & Asthma Care and the FAAR Institute in the Washington, DC area, where she has been in private practice since 1994. Dr. Eghrari-Sabet is Assistant Clinical Professor at George Washington University School of Medicine and Health Sciences where she mentors the next generation of doctors. She is also President of White Coat Resources, a health education consulting service.
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