Question 1. Does the course of asthma change during pregnancy?

From Chapter 8 of the Philippine Consensus Report on Asthma 2004 by the Philippine College of Chest Physicians.
This guideline starts below.

Does the course of asthma change during pregnancy?

Answer

Asthma may remain unchanged, become worse, or improve during pregnancy.

Summary of Evidence

Approximately 4% of pregnancies are complicated by bronchial asthma. The true prevalence may be even higher; at least 10% of the population appears to have nonspecific airway hyperreactivity, a hallmark of asthma. The course of asthma during pregnancy is variable; it may remain unchanged, become worse or improve during pregnancy. In a prospective study by Steinus-Aarniala et al, 42% of pregnant asthmatics required more medications, 40% were managed with the same medications before pregnancy and 18% actually needed less medications.

As a rule, women with more severe asthma prior to pregnancy are likely to deteriorate during pregnancy. The factors most likely contributing to worsening asthma during pregnancy include upper respiratory tract infections and patient non-compliance with medical regimen. The peak of exacerbations appears between the 24th-36th weeks age of gestation (AOG). Asthma generally remains quiescent during labor and delivery in about 90% of pregnant women. Whatever the course of asthma may be during pregnancy, changes generally revert to pre-pregnancy level of severity within three months postpartum.