FAQs

Keeping a check on your asthma symptoms during pregnancy is important because symptoms can change when you become pregnant.

About 3 or 4 in every 10 women find that their asthma may worsen during pregnancy. Up to 1 in 2 pregnant women with asthma have an asthma attack which requires them to seek medical help – this is most likely a visit to the doctor, but can also include going to the emergency department, being admitted to hospital or needing to take corticosteroid tablets.

During pregnancy it is normal to become more aware of your breathing whether or not you have asthma. You might feel like breathing takes more effort, or you are breathing faster. These changes happen because of the hormonal changes of pregnancy and the physical changes due to expanding womb.

If you are pregnant and have asthma, and you feel short of breath, it is best to have your asthma reviewed by your doctor to check the cause of your symptoms.

If breathing becomes distressing or difficult – go to your nearest Emergency Department.

Most asthma medicines, including relievers (short acting beta agonists or bronchodilators) and preventers (inhaled corticosteroids, or ICS) are safe to use during pregnancy and are not harmful to your baby. This includes during breastfeeding. Medical guidelines around the world recommend that asthma treatment should be similar for pregnant and non-pregnant women.

Your doctor may consider some asthma medicines to be safer than others, so your medicines may change if you are pregnant. For treatment of severe asthma, you may be given steroid tablets (e.g. prednisone) to make sure that your asthma does not affect you or your baby’s oxygen levels. Other severe asthma treatments such as monoclonal antibodies for severe asthma (e.g. Nucala, Xolair) are not likely to cross the placenta in levels that can cause harm to the unborn baby.  Your doctor / respiratory specialist will advise which are the safest medications to use.

If your doctor discontinues your preventer medication, we recommend asking why and/or seeking a second opinion. All the scientific evidence points to the importance of continuing your preventer medication during pregnancy.

It is best for you and your baby if you keep your asthma under good control, using asthma medications approved by your health care provider. Use a spacer (with compatible inhalers) to allow more of your medication to reach your airways.

Asthma medications have not been shown to cause a loss in milk supply.

This includes corticosteroid tablets (such as prednisone or prednisolone). Amounts of prednisone / prednisolone that are transferred to breastmilk are very low. No harmful effects have been reported in breastfed infants with the mother’s use of any corticosteroid during breastfeeding.

A drop in milk supply can happen with an illness or asthma attack itself, particularly if the cause of the asthma attack is a viral infection, and the person becomes dehydrated.

If your milk supply is dropping you can get help from your doctor, midwife or lactation consultant or contact the Australia Breastfeeding Association (ABA) – Phone (free call): 1800 686 268.  More information can be found on the ABA website here.

The Royal Women’s Hospital, Victoria, Australia has useful factsheets about medicines during pregnancy and breastfeeding:

·       Medicines in pregnancy

·       Medicines in breastfeeding

In NSW, Australia, the service MotherSafe provides detailed guidance on medication safety in pregnancy and is available to both patients and doctors. Ph:  9382 6539 or 1800 647848.

An asthma flare-up or attack means your asthma is not under control.

An asthma flare-up means you have some or all of the following:

• An increase in asthma symptoms
• A worsening of asthma symptoms and lung function compared to what you would usually have day to day.
• Your reliever puffer isn’t helping you, or symptoms come back within 3 hours of using it.
• You’re wheezing a lot, have a very tight chest, or you’re coughing a lot over one or more days.
• Your breathing is waking you up at night more than one night in a row.
• When an asthma flare-up occurs very suddenly or is life threatening, people often call it an asthma attack and emergency help may be needed.

During pregnancy it is particularly important to seek help early if you think your asthma is not under control.

Recommended steps to follow:

1.      Refer to instructions on your written Asthma Action plan

2.      Use Asthma Australia’s ASTHMA FIRST AID guide to check symptoms and steps to follow

3.      Seek medical attention – this means visiting your doctor OR seek emergency help depending on severity.

Asthma Australia also has First Aid guides for other relievers, here.

• Brush up on your inhaler skills! Studies have shown that only 2 in 10 pregnant women with asthma are using their inhalers correctly. It is very important to use the correct technique to ensure your medication is reaching the place it needs to be – your airways. The National Asthma Council of Australia and Asthma Australia websites have videos on how to use different types of inhalers correctly.
• Take your medication as prescribed by your doctor so that you can have the best control of your asthma. If you have trouble remembering to use your preventer for example, you could set a regular phone alarm, or use a smart-phone app to help with medication reminders.
• Have regular asthma reviews (every 4-6 weeks during pregnancy is recommended) with your doctor / healthcare provider to check your symptoms and medications. Make sure your written Asthma Action Plan is up-to-date.
• Unfortunately pregnant women are more prone to viral infections like the common cold. Viral infections can lead to asthma flare-ups or attacks which can then lead to pregnancy complications for the mother and baby. By making sure you are up-to-date with vaccinations (including the flu and COVID-19 vaccines), and avoiding being with sick people where practical, you can reduce your risk of having a flare-up or asthma attack. Wearing a mask, and practising good hand hygiene can also help stop you from getting sick.
• Do your best to keep up a healthy lifestyle – with healthy eating, suitable exercise, avoiding asthma triggers, quitting smoking and avoiding alcohol. Find plenty of tips here. Read our Focus on Hayfever here.

This is unlikely. When asthma is under control asthma attacks are rare during labour and birth. If symptoms of asthma do occur during labour, they can usually be controlled with normal asthma medicines, which will not affect labour onset or your contractions.

It is important to let your midwife or obstetrician know that you have asthma and record this in your birth plan. The best way to ensure your asthma is monitored during pregnancy and labour is to discuss with your healthcare providers as early as possible, and keep a copy of your written Asthma Action Plan with your birth plan. If you have your baby in hospital this will help ensure that hospital healthcare staff are aware of, and can help you manage your asthma during your stay if needed.

• Even if you feel your asthma is well controlled: Visit your doctor for regular asthma reviews, every 4-6 weeks during pregnancy (recommended).
• If your symptoms are slightly worse than usual: Visit your doctor soon – when you are pregnant it is important to get help early, rather than try to self-manage at home.
• For a mild/moderate attack: If your breathing returns to normal after following instructions on your written Asthma Action Plan, visit your doctor as a priority, to review your asthma and update your written Asthma Action Plan.

If you don’t have a written Asthma Action plan, make an appointment to see your doctor to obtain one.

• If you have had a severe or life-threatening attack: Visit your doctor within 3 days after release from hospital / emergency department or sooner, or as advised by your hospital healthcare staff, to review your asthma and update your written Asthma Action Plan.

1. Can you please check that I am using my asthma inhalers and/or nasal spray correctly?
2. Can I have a written Asthma Action Plan? (or can you check that my written Asthma Action Plan is up to date?)
3. Can I have a list of my current medications, to take with my Asthma action plan, to my first / next antenatal appointment?
4. How can I tell if my asthma is under good control?
5. What should I do if my asthma gets worse?
6. What should I do if I have a severe asthma attack while I am pregnant?

We recommend making 4-6 weekly appointments with your doctor for an asthma review, during your pregnancy.

Download a printable copy here

An Asthma Action Plan is a set of clear instructions on how to manage your asthma, written by your doctor with your involvement. The goal of an Asthma Action Plan is to prevent and control your asthma symptoms. Everyone with asthma including pregnant women should have an Asthma Action Plan.

Visit Asthma Australia’s guide on Asthma Action Plans to learn more, here.

Although asthma can run in families, development of asthma is not just about your genes!

Making sure you have well controlled asthma is one of the best ways to lower the risk of your child having asthma. Research shows that this is likely because uncontrolled asthma in the mother during pregnancy (having asthma attacks) could trigger a brief but important decrease in oxygen to the baby. This could affect the baby’s lung development, leading to a greater chance of asthma developing during childhood.

As well as having good asthma control, breastfeeding is another important protective factor against childhood asthma. One reason for this may be that breastfeeding for at least 4 to 6 months strengthens a child’s immune system, and helps prevent lung infections which are a major cause of wheeze in children under 2 years of age.

It is very important not to expose babies and children to tobacco smoke before or after birth. Smoking during pregnancy increases the chances of a child having breathing problems such as wheezing during infancy. Secondhand smoke has also been shown to increase the development of asthma and other long-term respiratory illnesses.

Infants with a family history of allergic conditions have a greater risk for developing asthma, atopic dermatitis (eczema), allergic rhinitis (hayfever) or food allergy.

For children at high risk of developing asthma or allergies, reducing contact with substances that are known triggers of allergy or asthma symptoms early in life may delay or prevent allergy or asthma symptoms. The best evidence for this relates to dust mites. Steps you can take to reduce dust mite exposure in your child, as outlined by the American Academy for Allergy, Asthma & Immunology (AAAAI) include:

• Using “Anti-allergy” / “allergen-impermeable” covers on pillows and mattresses
• Washing bedding every week in hot water
• Keeping indoor humidity < 50% where possible.
• Avoiding carpets and upholstered furniture in your child’s bedroom if possible

Interestingly, some research suggests that that early exposure to animals (particularly cats and dogs) may protect children from developing allergic conditions. Research also shows that children raised on farms develop fewer allergies and asthma.

Infants with a family history of allergic conditions are also at risk for developing food allergies, especially if they already have symptoms of asthma, atopic dermatitis or allergic rhinitis. Current recommendations are that there is no benefit in avoiding highly allergenic foods (such as peanuts, eggs, cow’s milk) during pregnancy and/or breastfeeding, as a way of preventing allergies in your child.

Most pregnant women who become infected with COVID-19 will either have no symptoms or mild illness. However pregnant women are a vulnerable group and should take all precautions to reduce the risk of becoming infected with COVID-19 as they are at a higher risk of complications during pregnancy such as pre-eclampsia or preterm birth. Vaccination against COVID-19 (including booster doses) in pregnancy is strongly recommended.

Being pregnant and having COVID-19 puts you at a higher risk of complications such as admission to hospital and/or intensive care and needing mechanical ventilation (a breathing tube). Your baby has an increased risk of being born too early, being admitted to neonatal intensive care or the special care nursery after birth, or stillbirth. There is no current evidence of an increased risk of miscarriage or birth defects, and transmission of COVID-19 to newborn babies is uncommon. Pregnant women at higher risk for severe illness from COVID-19 include women who are not vaccinated, are obese, or have another pre-pregnancy illness such as diabetes or high blood pressure.

For people with asthma a recent large UK study showed that people with well controlled asthma are less likely to experience severe COVID-19 than people with poorly controlled asthma. 

Most pregnant women (more than 2 out of 3) have no symptoms, but when these do occur the most common ones are like those of the general population – cough, fever, sore throat, muscle pain, breathlessness, and loss of sense of taste. It is recommended that all people with asthma who get COVID-19 should seek medical advice early.

Yes. Vaccination for all pregnant women is recommended as there is now very good evidence to show that COVID-19 vaccination is safe and effective during pregnancy. In Australia, the mRNA vaccines for COVID-19 are recommended for all people trying to conceive (either spontaneously, or through IVF), or are pregnant or breastfeeding. The Pfizer and Moderna mRNA vaccines are currently preferred, as these have the most safety information available.

As well as protecting mothers, the vaccines give protection to newborn babies by transfer of antibodies through the placenta and through breastmilk.

Yes. Breastfeeding women can get an approved COVID-19 vaccine and don’t need to stop breastfeeding before or after. If you have any concerns, speak with your doctor.

Having asthma can mean that other respiratory viruses such as influenza (the flu) or ‘common cold’ viruses can cause problems such as reduced asthma control.

The flu can make pregnant women quite unwell, and there is a higher risk of health complications for both mum and baby. As for COVID-19, it is recommended that pregnant women take all precautions to reduce the risk of becoming infected, including getting vaccinated. Influenza and whooping cough (pertussis) vaccinations are highly recommended during pregnancy. Whooping cough in babies can be a serious illness.

Yes – continued breastfeeding is strongly recommended. Use proper hygiene precautions including handwashing before touching your infant, using a facemask and routine cleaning of surfaces that you touch.  

Breastfeeding has health benefits for your baby – breastmilk has antibodies and other protective factors.  There is now information from research studies that shows that breastfeeding reduces the risk of COVID-19 in children, as well as other types of infections.

If you become too unwell to breastfeed another choice is to express breastmilk regularly for your baby. Make sure to use good hygiene measures including thorough handwashing and breast pump/bottle cleaning procedures. You may have a reduced milk supply if you become very unwell – if this happens, seek support from your healthcare professional, a lactation consultant or the Australian Breastfeeding Association.

• Visit the Lactation Consultants of Australia and New Zealand website to find a Lactation Consultant.
• Visit the Australian Breastfeeding Association website (Breastfeeding Helpline Ph: 1800 686 268).

Hayfever/rhinitis

Hayfever or ‘rhinitis’ symptoms can affect more than 1 in 3 women during pregnancy. Sometimes this is due to ‘pregnancy rhinitis’ where you may have a blocked and/or runny nose which does not involve an allergy. This usually clears up after birth. This type of rhinitis can be difficult to treat as usual hayfever treatments are either not effective or can make the problem worse. Nasal saline washing and nasal breathing devices may help – speak to your doctor about the best options for you.

For pre-existing hayfever, many treatments are considered safe to use in pregnancy including nasal corticosteroid sprays such as Avamys, Flixonase (fluticasone), Nasonex (mometasone), Rhinocort (budesonide), nasal saline and oral antihistamines such as Claratyne (loratadine), Zyrtec (cetirizine) but always check with your health care provider if you are unsure. Don’t use decongestants (nasal or oral).

Heartburn (Reflux / GORD/ GERD)

Heartburn or GORD affects many women with asthma and is also common in pregnancy because hormones such as progesterone can cause the lower oesophageal muscles to relax. This is often worse after meals and when lying down. If lifestyle adjustments do not give relief, medication can be used under the guidance of your healthcare provider. Download Mothersafe’s guide to heartburn for further information and advice on treatments.

Gestational diabetes

Having asthma can increase the risk of being diagnosed with gestational diabetes, particularly with pre-existing obesity or excess weight gain during pregnancy. However, good asthma management and control, as well as having a healthy lifestyle during pregnancy reduces this risk. Your doctor will check your risk factors and perform a test such as a glucose test in early pregnancy, and plan regular monitoring during pregnancy if needed.

High blood pressure and pre-eclampsia

Having asthma can increase the risk of gestational hypertension and pre-eclampsia, both of which involve high-blood pressure after 20-weeks gestation. Your doctor will check your risk factors and perform regular monitoring for any signs of pre-eclampsia. Regular review of your asthma during your pregnancy is important as asthma flare-ups/attacks can increase the risk of developing pre-eclampsia.

If you are already on medication for hypertension, this should be reviewed by your doctor to ensure safety during pregnancy.

It is important to work out whether your discomfort is due to the changes in your body because of pregnancy, or whether they are symptoms of asthma. If you are not sure – talk to you doctor.

If discomfort is due to pregnancy changes in your body, you could using multiple pillows in different positions around your stomach, legs and neck to help move your baby away from your diaphragm. This can allow you to breathe more easily. In the second trimester, lying on your left-side is recommended to help keep blood flow to your baby – so it can be helpful to start getting used to this position early in pregnancy.

Air that is too hot or too cold may make breathing more uncomfortable, so consider fans or air-conditioning. Some people find that using a humidifier at night can help with breathing discomfort.

If you are still having difficulty sleeping, and your asthma is under control, your doctor may recommend some sleep medications that are safe to use during pregnancy.

• Maternal and child health nurse / Community health centre
• Your doctor
• Australian Breastfeeding Association (ABA)   ABA Breastfeeding Helpline Ph: 1800 686 268 
• Lactation Consultants of Australia and New Zealand (LCANZ)

For women in crisis or at risk of suicide, there are 24-hour crisis counselling services available over the telephone or online. In Australia, this includes:

• Lifeline: 13 11 14
• Suicide Call Back Service: 1300 659 467
• 13YARN: Specifically for Aboriginal and Torres Strait Island people: 13YARN or 13 92 76

There are many health professionals who can support you if you are feeling overwhelmed, including your local doctor or early childhood nurse, midwife or obstetrician. They can connect you with the right mental health services through your local health district if needed, including outpatient, inpatient and telehealth services.

There are also lots of helpful online support options for women experiencing anxiety and depression during and after birth:

• PANDA – you can call the PANDA helpline to connect with trained counsellors for support and information on 1300 726 306 or visit their website here for useful information on anxiety and depression for women and their families.
• Gidget Foundation Australia has programs to support women experiencing anxiety and depression before and after birth, including online support groups and telehealth.
• The Australian Government’s Head to Health website has online programs, apps and websites that may be useful, such as:-
  – MindMum app (a free phone app with information, strategies and activities),
  – Mum2BMoodBooster (a free online treatment program)

Don’t be afraid to ask questions or share concerns when you visit your doctor, obstetrician or midwife or pharmacist. If you don’t feel comfortable speaking to your allocated public health provider, ask if there is someone else you can speak to. It is important that you feel comfortable with the care you are receiving during your pregnancy, and it is ok to change your health professional if you are not satisfied with the information and/or care you are receiving.

You can also call 1800ASTHMA /1800 278 462 to speak to an Asthma Educators from Asthma Australia for free asthma information and support.