Pregnant women should continue their medications if their asthma is well controlled.
More research is needed about safety of newer drugs, such as biologics, for pregnant patients.
While attending a conference in Canada, Sarah A. Bendien, MD, a respiratory physician at Haga Teaching Hospital in The Hague, Netherlands, realized the way asthma and pregnancy care were organized in her home country was not ideal.
“Asthma care in the Netherlands is divided between different health care providers, including respiratory physicians, general practitioners and pharmacists,” Bendien told Healio. “For pregnant women, midwives and obstetricians are also involved.”
This inspired her to open a specialized asthma-pregnancy outpatient clinic with providers from multiple specialties working together at her teaching hospital.
“This clinic has been running for about 10 years, and we are seeing more and more patients,” Bendien said. “In our hospital, we have organized a monthly multidisciplinary team meeting with respiratory physicians, obstetricians, respiratory nurses and pharmacists. During this meeting, we discuss all our pregnant patients at least once in order to provide consistent advice.”
Need for multidisciplinary consensus
Bendien has also spent time researching the best way to care for pregnant women with asthma, and in her most recent publication in Journal of Allergy and Clinical Immunology: In Practice, she and colleagues outlined multidisciplinary guidelines with information about preconception counseling and medication safety during pregnancy and breastfeeding for providers in the Netherlands.
“We felt it was important and would probably improve outcomes to have a multidisciplinary consensus on the management of asthma in pregnancy,” Bendien said.
This set of research expands on a 2019 statement from the European Respiratory/Thoracic Society of Australia and New Zealand Task Force about managing pregnancy in women with airway diseases. Bendien’s team wrote the guidelines based on Appraisal of Guidelines for Research and Evaluation (AGREE) and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) standards and made sure to include patient input.
Focus on keeping asthma well controlled
The first set of recommendations stress the importance of preconception counseling for women with asthma. Providers should discuss pregnancy planning with all of their female patients with asthma who are of reproductive age and offer preconception counseling.
“We need to pay more attention to preconception health so a woman can start her pregnancy in the best possible health,” Bendien said.
Uncontrolled asthma or moderate and/or severe asthma are considered major risk factors for complications during pregnancy that should be identified and treated as early as possible, the researchers wrote.
“During pregnancy, there is a complex interaction between hormonal, physiological and immunological changes, which can affect disease control among patients with atopic diseases,” Bendien said. “Because of concerns about teratogenic effects, many women tend to taper or discontinue maintenance medication before or during pregnancy.”
But overall, the researchers said that it is safe for women to continue taking their asthma medication during pregnancy and breastfeeding, as doing so leads to fewer complications than uncontrolled asthma.
Medication safety
However, the researchers noted in the guidelines that there are special considerations to take with certain types of medications may that carry risks for adverse outcomes or lack safety data.
Providers should be cautious when prescribing recurrent courses or maintenance oral corticosteroids, which may carry the risk for developing secondary adrenal insufficiency in both the mother and child.
Some medications do not have safety data during pregnancy, such as the long-acting B-agonist vilanterol, the long-acting muscarinic antagonist tiotropium and biologics other than omalizumab (Xolair; Genentech, Novartis). Providers should also be cautious about decreasing maintenance inhalation medication in pregnant patients and should focus on keeping asthma well controlled and preventing exacerbations.
Women should be encouraged to continue using their medication during breastfeeding as well; transmission of inhaled medications and biologics into breast milk is low, according to the researchers.
‘There is still much to be done’
Although information was available to researchers when creating this guidance on many common asthma medications, Bendien said more research needs to be done on newer medications such as biologics, which are becoming more frequently prescribed among women of reproductive age.
She also said there is a need for better and more widespread education about asthma and pregnancy.
“The most rewarding part is the teamwork — the multidisciplinary collaboration between health care providers to achieve the best possible care for these patients,” Bendien said. “Information from atopic disease patients involved in the guideline development about their needs and experiences when pregnant, or having the desire to conceive, has helped us a great deal to provide more patient-centered advice, but there is still much to be done.”
Reference:
For more information:
Sarah A. van Nederveen-Bendien, MD, can be reached at [email protected]
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