THE DIAGNOSIS AND MANAGEMENT OF ASTHMA DURING PREGNANCY - 04/09/11

Doi : 10.1016/S0889-8561(05)70181-8

Allan T. Luskin, MD ^a, Myron A. Lipkowitz, MD, RPh ^b

^a Department of Medicine, University of Wisconsin, Madison; Respiratory Center, Dean Medical Center, Sun Prairie, Wisconsin (ATL)

^b Deceased; formerly from the Department of Family Practice, Kimball Medical Center, St. Barnabas Health Care System, Lakewood, New Jersey

Résumé

Asthma is one of the most common illnesses that complicate pregnancy. It has been conservatively estimated that 1% to 4% of pregnancies are affected by bronchial asthma, but this figure may be much higher, as 10% or more of the general population appear to have nonspecific airway hyperreactivity, a hallmark of asthma.^{23 Gluck J.C., Gluck P.A., Bahna S.L. The effect of asthma on pregnancy and labor Asthma and Allergy in Pregnancy and Early Infancy New York: Marcel Dekker (1993).
213

Cliquez ici pour aller à la section Références, 35 National Asthma Education Program Report of the Working Group on Asthma and Pregnancy: Management of asthma during pregnancy. NIH Publication #93-3279, September 1993

Cliquez ici pour aller à la section Références} If left untreated, asthma can lead to serious complications for both mother and fetus. Fortunately, when appropriately managed, mother and baby should have an outcome not significantly different from pregnancies unaffected by asthma.^{2 Bailey B., Addis A. Motherisk Update: Asthma during pregnancy Canadian Family Physician 1997 ; 43 : 1711-1718

Cliquez ici pour aller à la section Références, 11 Chazotte C. Asthma in pregnancy: A review Journal of the Association for Academic Minority Physicians 1994 ; 5 : 107-110

Cliquez ici pour aller à la section Références, 24 Greenberger P., Patterson R. The outcome of pregnancy complicated by severe asthma Allergy Proc 1988 ; 9 : 540-543

Cliquez ici pour aller à la section Références, 55 Schatz M., Zeiger R.S., Hoffman C.P. , et al. Perinatal outcomes in the pregnancies of asthmatic women: A prospective controlled analysis Am J Respir Crit Care Med 1995 ; 151 : 1170-1174

Cliquez ici pour aller à la section Références} Following the tragic experiences with thalidomide during the 1960s,^{56 Scialli A.R., Lione A. The reproductive effects of specific medications for asthma and allergy Asthma and Allergy in Pregnancy and Early Infancy New York: Marcel Dekker (1993).
140-141

Cliquez ici pour aller à la section Références} many women are reluctant to take, and some physicians to prescribe, medications during pregnancy. Although this reluctance to take medication can be very problematic, it may provide an opportunity to place emphasis on preventive measures, including smoking cessation and the avoidance of environmental triggers; however, medications will be necessary in many cases.

Because extensive controlled human safety data on the effects of exposure to most medications during pregnancy is lacking, it is generally recommended that the physician prescribe agents whose long track records have failed to demonstrate teratogenic or other adverse maternal or fetal effects. Prescribing any medication during pregnancy entails evaluating expected benefits and determining that these benefits outweigh the risks of adverse effects. When giving any treatment during pregnancy, one must obtain adequate informed consent, including an explanation of the consequences of failing to prescribe therapy that may alleviate the effects of potentially life-threatening asthma to mother, fetus, or both.^{20 Fern F.H., Brushwood D.B. Medical—Legal aspects of prescribing during pregnancy Asthma and Allergy in Pregnancy and Early Infancy New York: Marcel Dekker (1993).
187-209

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