Overview
Asthma is a chronic inflammatory airway disease characterized by reversible bronchoconstriction, airway hyperresponsiveness, and inflammation. In pregnancy, uncontrolled asthma can lead to adverse maternal and fetal outcomes.Diagnosis
Management
Special Populations
Pregnancy:
* Approximately 8-13% of pregnant patients report a penicillin allergy, but true allergy is rare, with 95% of unverified allergies being delabeled upon evaluation 1. Penicillin and beta-lactam avoidance in these patients can lead to suboptimal therapy 1.
* Regular physical exercise during pregnancy is associated with numerous benefits, including prevention of gestational diabetes, excessive weight gain, hypertensive disorders, and prenatal depression 2. Exercise is not associated with increased maternal or perinatal adverse outcomes 2.
* Biologicals are increasingly used for severe atopic diseases like asthma, but data on their safety and pharmacokinetics in pregnancy are scarce 3. Preconception counseling and healthcare provider education are crucial due to the long half-life of biologicals 3.
* Music therapy interventions during pregnancy may offer benefits such as relaxation, decreased anxiety and pain, improved sleep quality, and better control of maternal blood pressure 4.
* Health literacy interventions in pregnancy have the potential to improve knowledge, but results for health behaviors, fetal outcomes, and health service utilization are inconsistent 5.
* Maternal antibiotic exposure during pregnancy may increase the risk of childhood asthma/wheeze (OR 1.29) and eczema/atopic dermatitis (OR 1.62) 6.Key Recommendations
Penicillin allergy evaluation is safe and recommended for pregnant patients with unverified penicillin allergies 1. (Evidence: Moderate)
Regular physical exercise during pregnancy is safe and can help prevent pregnancy-related disorders; exercise type and intensity should be adapted to the individual's fitness level and medical history 2. (Evidence: Moderate)
Due to limited data on biologicals in pregnancy for atopic diseases, a multidisciplinary approach, multicenter registries, and appropriate trial designs are needed for management and follow-up 3. (Evidence: Weak)
Maternal antibiotic use during pregnancy may be associated with an increased risk of childhood asthma/wheeze 6. (Evidence: Moderate)References
1 Reddeman L, Lim JWJ, Murphy KE, Fahmy D, Walsh C, Harris K. Safety, effectiveness, and acceptability of antenatal penicillin allergy evaluation: a systematic review. American journal of obstetrics and gynecology 2026. link
2 Ribeiro MM, Andrade A, Nunes I. Physical exercise in pregnancy: benefits, risks and prescription. Journal of perinatal medicine 2022. link
3 Pfaller B, José Yepes-Nuñez J, Agache I, Akdis CA, Alsalamah M, Bavbek S et al.. Biologicals in atopic disease in pregnancy: An EAACI position paper. Allergy 2021. link
4 Shimada BMO, Santos MDSOMD, Cabral MA, Silva VO, Vagetti GC. Interventions among Pregnant Women in the Field of Music Therapy: A Systematic Review. Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia 2021. link
5 Zibellini J, Muscat DM, Kizirian N, Gordon A. Effect of health literacy interventions on pregnancy outcomes: A systematic review. Women and birth : journal of the Australian College of Midwives 2021. link
6 Zhong Y, Zhang Y, Wang Y, Huang R. Maternal antibiotic exposure during pregnancy and the risk of allergic diseases in childhood: A meta-analysis. Pediatric allergy and immunology : official publication of the European Society of Pediatric Allergy and Immunology 2021. link