Allergic diseases are among the most common diseases in society, and due to this frequency, allergic diseases can occur frequently during pregnancy.
Asthma may occur for the first time during pregnancy, and pregnancy may worsen pre-existing asthma. Asthma that is not properly and regularly treated can cause serious problems for the mother and the baby.
The course of complaints caused by allergic asthma after pregnancy varies. While asthma complaints in Allergic Asthmatics show a decrease in one-third of the patients, as in other allergic complaints, asthma is controlled in these patients and intense asthma complaints may continue after pregnancy. It may remain the same in one-third, and may manifest itself as worsening asthma complaints in one-third.
Worsening and an increase in attacks are more common in patients whose asthma was not controlled before pregnancy. In cases of recurrent pregnancy, asthma often progresses in the same pregnancy as it did in the previous pregnancy.
Effects of asthma on pregnancy
Asthma during pregnancy. Its effect on pregnancy is also controversial, but many studies have shown that pregnancy-related hypertension, nausea and vomiting, an increase in the frequency of vaginal bleeding, an increase in maternal deaths, premature birth, low birth weight babies, growth retardation, chronic hypoxia (oxygen deficiency), and death in the womb increase. .
These are more common in cases of uncontrolled asthma. Premature birth occurs in 19% of pregnant women who require treatment due to acute asthma.
Uncontrolled asthma can lead to death and disability of mother and baby.
Asthma control How can it be understood that it is not under control?
In patients whose asthma was not under control before pregnancy, asthma complaints may increase further during pregnancy. He/she may need more medications specifically recommended for asthma. We can understand whether asthma is under control by doing an asthma control test. The 5 questions we ask in the asthma control test and the scores given according to the answers to these questions are not different. is evaluated. Each question is evaluated out of 5 points. If the total score is 25, it is under full control, if it is 24-20, it is partially controlled, and if it is ≤19, it is not under control.
Low FEV1 values in respiratory function tests indicate that asthma is not under control.
Allergic. Considering the complications caused by asthma not being under control, it is clear that adequate drug treatment should be administered to control asthma.
Are asthma medications safe for pregnant women?
Can the drugs used in the treatment of asthma be used safely during pregnancy? The question comes to our mind. Side effects that may occur due to medications used in asthma can be easily ignored compared to the damages that asthma will cause if it cannot be controlled.
It has been observed that patients with severe asthma complaints at the beginning of pregnancy have severe asthma throughout the pregnancy. The pregnancy process of pregnant women whose asthma is under control is also close to normal. The pregnancy process is completed without many problems for the fetus and the pregnant woman. Therefore, asthma control should be continuous, especially from the beginning of the pregnancy process.
Asthma medications to be used for allergic asthma control can be used without fear under the supervision of allergists and gynecologists.
During pregnancy. How should asthma treatment be?
The basic principle in treatment is to use the minimum number and dose of medication that keeps asthma under control. Asthma medications should not be avoided when necessary.
In the treatment of a pregnant patient with asthma, it is necessary to keep the pregnant woman's asthma under control as much as possible and to apply treatment in a way that will cause the least harm to the fetus. Therefore, the treatment of a pregnant patient with asthma must be balanced.
So how are asthma medications used?
Patients with asthma use many medications to control allergic asthma before pregnancy. is necessary. When asthmatic patients become pregnant, they need to be careful about the use of some medications they have used before. There are points.
Pregnant patients with asthma are also treated in the same way as in the asthma guide.
Patients evaluated by allergists should use asthma medications as above. As a result of the studies conducted for asthma drugs, a safety scale has been specified for their use in pregnant women.
It is necessary to be extremely careful as the drugs used in pregnant patients may have harmful effects on the fetus. In this regard, the FDA (Food and Drug Administration - the highest body that regulates drugs and foods in the USA) has divided drugs into five separate groups in terms of their effects on the baby during pregnancy: No harmful effects on the fetus were detected in the studies. There are very few drugs that belong to this group. Vitamins used during pregnancy are in this group.
B Category:
Studies conducted on animals have not detected any harmful or negative effects on animal fetuses, but there are no studies conducted on humans.
Or:
Negative effects have been detected in studies conducted on animals, but these negative effects have not been confirmed in studies conducted on humans. Penicillin group antibiotics are included in this group.
Category C:
Studies conducted in animals and/or humans are insufficient.
Or: Negative effects have been detected in animal experiments, but there is no data on humans. Most of the drugs used during pregnancy are in this group.
Category D:
Drugs in this group have negative effects on the human fetus. Drugs in this group are drugs that can be used when the profit/loss ratio is in favor of profit. The best example of this group is the drugs that expectant mothers with epilepsy should use.
Category X:
Drugs in this group have also had negative effects on the human fetus. However, when used during pregnancy, the drugs in this group have a benefit/harm ratio that is always in favor of harm. Therefore, it should never be used during pregnancy (drugs such as DES and Thalidomide).
This classification is inadequate in many respects and serves no purpose other than confusing. Because the classification does not take into account the period of pregnancy in which it is used and It also includes guidance on treatment along with the risk to the baby.
When looking at where asthma medications are located within the scale specified by the FDA, most of them are in the B and C categories.
In light of the information collected about asthma medications used during pregnancy. The medications we can use during pregnancy should be arranged in a way that will cause the least harm to the pregnant woman and the fetus.
Should allergy vaccinations be continued during pregnancy?
Another treatment during pregnancy is for patients with allergic asthma. These are allergy vaccines administered for ( immunotherapy ). Allergy vaccines administered before pregnancy have not been shown to cause any harm to the fetus or pregnant woman in maintenance doses. Allergy vaccinations started before pregnancy can be administered safely under the supervision of allergy specialists, if there has been no allergic reaction before and maintenance treatment has been started.
It is not appropriate to start allergy vaccinations or take high doses during pregnancy.
How is allergic rhinitis (rhinitis) treated during pregnancy?
The incidence of allergic asthma is very high, such as 60%-80%. Since high rates of allergic rhinitis occur, treatment of allergic rhinitis along with allergic asthma is necessary during pregnancy.
Treatment of allergic rhinitis during pregnancy is extremely important. The treatments we use to treat allergic rhinitis may also be necessary during pregnancy. Precautions, medication, allergy vaccines and education required for the treatment of allergic rhinitis are equally important for pregnant women.
Taking precautions against allergens that cause allergic complaints during pregnancy will help her allergic rhinitis be more controlled and use less medication. It is necessary because it will lead to Precautions taken for allergic rhinitis are also very important in controlling allergic asthma.
The treatment of asthmatic pregnant patients with allergic rhinitis complaints during pregnancy should be carried out together as before. In patients whose allergic rhinitis complaints cannot be controlled, it is also difficult to control their asthma. Therefore, pregnant women with allergic asthma must take necessary and appropriate medication for allergic rhinitis. It is necessary to use the following precautions.
If the patient has been previously diagnosed with allergic rhinitis and the treatment is applied, it should be arranged in a way that will cause the least harm to the pregnant patient and the fetus during the pregnancy.
During the pregnancy process, the complaints must first be resolved. If it has started and allergic rhinitis has not been diagnosed, it would be appropriate to first perform allergy tests by allergists to detect allergens that may cause allergic complaints. Since performing allergy tests on the arm during pregnancy may be risky, they can be performed by looking for specific IgE from the blood. The treatment of the patient diagnosed with allergic rhinitis must be arranged by allergists.
The nasal steroids we use in the treatment of allergic rhinitis can also be used during pregnancy. There is more information about whether nasal sprays containing budesonide can be administered more safely. Nasal steroids, which were used to control allergic rhinitis before pregnancy, can be used again when allergic rhinitis occurs.
If patients with allergic rhinitis complaints need antihistamines that have less effect on nasal congestion and postnasal drip, second generation antihistamines should be preferred. It would be appropriate to choose the preparations containing loratadine and cetirizine in this group because these preparations have fewer side effects than the first generations. If antihistamines are to be used in the first ear, drugs containing diphenhydramine can be given safely.
If nasal decongestants are required in pregnant women, preparations containing oxymetazoline can be given for less than 5 days.
Result.
The course of asthma may vary during pregnancy. It may get worse, continue the same, or get better.
Those whose asthma was under control before pregnancy can continue to be under control during pregnancy. Asthma is more severe in pregnant women whose asthma is not under control.
Asthma medications used before pregnancy may also need to be used during pregnancy. Medications used in pregnant women with asthma should be administered in a way that provides the best control for pregnant women while causing the least side effects on the fetus.
Asthma throughout pregnancy.
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