Asthma and pregnancy

Pregnancy can affect your asthma in different ways. Your asthma symptoms could:

• improve during pregnancy
• get worse during pregnancy
• stay the same.

If your symptoms get worse, it may be because of hormones affecting your asthma or physical changes in your body.

• Hormonal changes can affect your breathing patterns. They can also make other conditions like rhinitis worse. Rhinitis is when your nose gets itchy and blocked or runny. Rhinitis can increase your risk of asthma symptoms.
• Normal changes to your body in pregnancy can affect your asthma. This is because as your baby grows, your womb gets bigger and pushes up on your lungs. This may make you feel breathless.

Talk to your GP, nurse, or midwife if you’re worried about asthma symptoms during pregnancy.

Managing asthma symptoms during pregnancy

Asthma symptoms and asthma attacks during pregnancy increase the risk of:

• high blood pressure
• maternal pre-eclampsia
• your baby having a low birth weight
• premature birth (your baby being born early).

But if you manage your asthma well and have good support from your GP, nurse and midwife throughout your pregnancy, the risk to you and your baby is very low.

There are steps you can take to lower your risk of asthma symptoms and asthma attacks during pregnancy:

• Have an asthma review with your GP or nurse. If you can, do this as early as possible in your pregnancy. It’s a great opportunity to talk about managing your asthma well and how pregnancy may affect you. 
• If you smoke, get support to give up . Smoking while you’re pregnant means your baby is more likely to have breathing problems, including asthma. It also puts you more at risk of miscarriage and premature labour. Avoid breathing in second-hand smoke too. There’s lots of support to help you give up.
• Share your asthma action plan with your midwife and make sure asthma is included in your notes and on your birth plan.
• If you have hay fever, ask your GP or pharmacist which hay fever treatments are safe for you to use during your pregnancy. Hay fever (allergic rhinitis) can make your asthma symptoms worse
• Talk to your GP or nurse if you have indigestion. Indigestion and acid reflux are more common during pregnancy and can make your asthma worse. This is because stomach acid can irritate and inflame your airways. Changing what you eat and when you eat can help. There are also medicines you can take. The NHS has more information about indigestion during pregnancy.

If your asthma symptoms get worse

If your asthma symptoms get worse during pregnancy, do not ignore them.

• Use your reliever inhaler.
• Follow your asthma action plan.
• Speak to your GP or nurse.
• Let your midwife and antenatal team know about your asthma.

Your asthma medicines are safe to take when you’re pregnant. You may have concerns about side effects or medicines affecting your baby. But there are more risks to both you and your baby if you stop taking your asthma medicines and your asthma gets worse.

Dr Andy Whittamore, Asthma + Lung UK’s GP

Asthma medicines are safe to use in pregnancy, so it’s important to keep taking them. If you do not take your usual asthma medicines during pregnancy, it increases the risks for you and your baby. This is because when asthma is not well controlled there may not be enough oxygen getting to your baby.

You can continue to take all your usual asthma medicines as prescribed including:

• preventer inhalers
• reliever inhalers
• MART and AIR inhalers
• Montelukast
• Theophylline

Steroid tablets

Asthma guidelines are clear that the benefits of steroid treatments outweigh the risks.

• A short course of steroid tablets (usually prednisolone) is safe in pregnancy.  Oral steroids are an important, life-saving treatment and can help you get back in control of your asthma after an asthma attack.
• If you’re taking steroid tablets long term because you have difficult or severe asthma, talk through any risks and side effects with your GP or specialist. Tell your midwife or antenatal team you’re taking steroid tablets and make sure it’s in your notes and birth plan.
• If you’re still taking steroid tablets when you go into labour, your birthing team will need to make sure you continue to take these medicines during labour. It’s really important these medicines are not stopped suddenly.

A steroid emergency card lets healthcare professionals and emergency doctors know you take steroids. Find out more about steroid cards . 

When you’re pregnant, it can be harder to fight off infections. If you’re pregnant and have asthma, you could be more at risk from getting seriously ill from respiratory infections like flu and Covid-19.

A flu jab will help protect you and your baby from flu. The NHS has more advice about getting the flu jab during pregnancy. Make sure you’re up to date with your Covid-19 vaccinations too.

During pregnancy, you’ll be offered vaccinations to help protect you and your baby:

• A whooping cough vaccine will protect your newborn baby. Whooping cough is a serious infection. Babies in their first few weeks of life are more at risk from serious complications from whooping cough, including pneumonia, brain damage, and even death. The NHS has more information about whooping cough vaccine in pregnancy.
• RSV is a common respiratory virus. It can cause bronchiolitis in very small babies, leading to breathing difficulties. You should be offered the RSV vaccination around the time of your 28-week antenatal appointment. Getting the RSV vaccination during pregnancy protects your baby in their first few months of life, when they’re most at risk of getting seriously ill from RSV and bronchiolitis. Find out more about preventing RSV.

Your baby's vaccinations if you're using biologics

Vaccines help protect your child against serious illness and disease. Once your baby is born they will be offered vaccinations as part of the UK immunisation programme.  

If you’re using biologic treatments, or were using biologic treatments during your pregnancy, these vaccines may not be suitable for your baby: 
•    the rotavirus vaccine, which is usually given to babies at 8 weeks, and again at 12 weeks 
•    the BCG vaccine, which is a vaccine against TB (tuberculosis) and given soon after birth. 

Speak to your asthma team, practice nurse or midwife team for more advice about these vaccinations and when they can safely be given to your baby.
 

Talk to your GP, nurse, or midwife before your due date, and make sure your asthma is included in your birth plan.

If you have severe or difficult to control asthma, you may need extra support from a respiratory physician during your pregnancy and birth.

Where should I give birth if I have asthma?

If your asthma has been managed well during your pregnancy, you can choose to have your baby at home, in a hospital, or in a midwife-led unit.

It’s safer to give birth in hospital if:

• you needed to increase the dose of your asthma medicines during pregnancy
• you’ve had asthma attacks during your pregnancy
• you were treated in hospital because of your asthma during your pregnancy.

Types of birth

• It’s safe to have a vaginal birth if you have asthma. If your labour has to be induced (started artificially) or needs speeding up, make sure you remind your birthing team that you have asthma so they can use the safest medicines for you.
• Having asthma doesn’t mean you need to have a C-section (caesarean). But if you do have one, the anaesthetist will aim to use a spinal block or epidural which is a safer option for women with asthma.
• If you need an emergency C-section under general anaesthetic, the anaesthetist will choose the best anaesthetic medicines for you and your asthma.

Using your asthma medicines during labour

Asthma attacks during labour are very rare because the steroids your body produces naturally to help with labour also help reduce inflammation in your airways.

If you need to you can also use your inhalers during labour, including if you have a C-section. Using your reliever inhalers will not harm your baby in any way.

If you develop asthma symptoms under general anaesthetic, they can give you your reliever inhaler through a special adaptor.

If you’ve been taking steroid tablets, your birthing team can make sure you continue to take your medicines during labour.

Pain relief

Gas and air (Entonox), pain relief injections (usually Pethidine), and epidurals are all safe if you have asthma. If you have severe asthma, your GP, midwife and obstetrician will talk to you about which pain relief is suitable for you. 

Breastfeeding has lots of health benefits for both you and your baby. There’s some evidence that suggests breastfed babies may be less likely to develop asthma.

Only very small amounts of asthma medicines pass into breast milk and these are no risk to your baby.

But if you decide to bottle-feed, for whatever reason, it doesn't mean your baby will necessarily go on to develop asthma. And if they do, it may not be because you didn’t breastfeed. There are lots of different reasons why asthma can be more likely to develop.

Find out more about the causes of asthma. 

If your asthma symptoms got worse during pregnancy, it’s likely they will go back to how they were before you were pregnant. But always speak to your GP or nurse if you notice your symptoms are getting worse.

Have an asthma review soon after your baby is born so you and your GP or nurse can check how your asthma is now and update your asthma action plan.

You may feel tired, anxious or stressed after giving birth. Stress and anxiety can sometimes make your asthma worse.

Try to look after your own wellbeing as much as you can. It’s OK to ask others for support if you need to while you’re adjusting to caring for a new baby.