Undertreatment a problem in pregnant asthmatics. (Management Tips).

SARASOTA, FLA. -- The biggest problem with asthma in pregnancy is undertreatment, Dr. Felice Baron said at a pennatal symposium sponsored by Symposia Medicus.

Patients, and often their physicians, tend to fear that asthma medications could be harmful to the fetus, so they discontinue them and go through pregnancy with poorly controlled asthma, said Dr. Baron, director of the Perinatal Center at Sarasota Memorial Hospital.

"Chronic hypoxia is going to hurt the baby far more than anything that any pharmaceutical company is going to create," she said.

In fact, poorly controlled and! or severe asthma are associated with increased risk for intrauterine growth restriction, low birth weight, preeclampsia, preterm labor, and neonatal morbidity due to hypoxia.

Approximately 4% of pregnancies are complicated by asthma, and status asthmaticus complicates 0.2% of pregnancies. A third of asthmatic pregnant patients' asthma will improve during pregnancy, one-third will worsen, and one-third will stay the same. While it is difficult to predict the impact of pregnancy on asthma, generally, the more severe and poorly controlled the asthma is before pregnancy, the worse it will be during pregnancy.

Most patients with mild asthma will do well during pregnancy Outcomes in those with mild, well-controlled asthma are not very different from those in nonasthmatic patients.

Mild intermittent patients--those with fewer than two exacerbations weekly--can continue to use rescue medications, such as an albuterol inhaler, to treat the exacerbations. Those with mild persistent asthma (more than two attacks weekly) will probably require a steroid inhalant. Don't take patients off this, or they will likely develop moderate asthma, Dr. Baron warned.