Preterm birth and intrauterine growth restriction remain leading contributors to perinatal mortality and morbidity. Preterm birth is the leading cause of neonatal death, and over half of term stillbirths are associated with impaired fetal growth. Beyond the perinatal period, survivors of preterm birth and fetal growth restriction face a range of long term adverse health outcomes through infancy and childhood
], and many adult diseases are now recognised to have their origins in fetal life
]. Accordingly, continued efforts are necessary to identify interventions that may reduce the burden of preterm birth, and improve in utero fetal growth.
Poorly controlled asthma during pregnancy has been shown to be associated with an increased risk of preterm birth, low birth weight, and pre-eclampsia
]. This data suggests that improved asthma control may be a means of reducing these important perinatal outcomes and that proper asthma management among pregnant women should be regarded as a health priority. In general, they should be managed in the same way as non-pregnant women with asthma, with the exception their asthma should be monitored at least monthly, as pregnancy can have a significant effect on asthma control
]. A lack of knowledge amongst women regarding the risks of uncontrolled asthma during pregnancy is evident. Furthermore, there is a lack of confidence amongst health professionals when deciding the best management strategy for these women
]. These concerns need to be addressed, as a starting point to optimise asthma control during pregnancy. Strategies to improve asthma management during pregnancy are warranted.
Preventive asthma medications at regular doses have been shown to be safe to use during pregnancy and the risks of reduction or discontinuation of these medications are far worse
]. Asthma guidelines around the world strongly recommend that women continue their asthma medications during pregnancy to maintain adequate control
]. However, women are still choosing to cease their asthma medications during pregnancy, many without consulting their doctors
]. Reasons for this include concern over using any medication use during pregnancy, a desire for alternative therapies, perceptions of negative outcomes associated with steroid use, lack of support and guidance from health professionals regarding what to do with their asthma medications and the risks of poorly controlled asthma during pregnancy
]. Moreover, women overestimate the teratogenic risks of asthma medication especially the steroid medications, with one report citing women perceived a 42% teratogenic risk for oral corticosteroid versus 12% risk for inhaled corticosteroid
Prescribers have also been shown to be hesitant to prescribe and encourage use of asthma medications during pregnancy. Over a quarter of family physicians have said they would instruct their pregnant patients to decrease or discontinue asthma medication during pregnancy, when asthma was well controlled by current therapy
], potentially jeopardizing asthma control. Pregnant women are also less likely to be treated with systemic corticosteroids for acute asthma exacerbations than non-pregnant women (50.8% versus 72.4%)
The uncertainty and anxiety surrounding medication use and asthma control during pregnancy emphasise the crucial role of doctors, pharmacists and midwives in ensuring patient adherence to asthma medications during pregnancy and educating them on the risks of uncontrolled asthma during pregnancy. A collaborative approach between the pregnant women, doctors, midwives and pharmacists is needed to maintain adequate asthma control. Monthly monitoring has been recommended by guidelines
] to maintain optimal asthma control as different stages of pregnancy can have an effect on asthma control
]. We aim to test an intervention that allows for regular patient self-monitoring and a multidisciplinary health professional approach for asthma management during pregnancy; if successful it could justify funding for more support services for these women.
There also needs to be more detailed guidelines and objective measures for monitoring lung function for the treatment of pregnant women with asthma. The exhaled fraction of nitric oxide (FeNO) has been investigated as a marker for asthma control during pregnancy, but is expensive and not easily accessible
]. Forced Expiratory Volumes in one and six seconds (FEV1
) has shown to be effective in detecting airway obstruction in the elderly and could be helpful in pregnancy
may be a way of differentiating the shortness of breath associated with pregnancy from worsening asthma symptoms and a more convenient and affordable way of monitoring and guiding therapy in pregnant asthmatic women.
To determine whether a multidisciplinary approach involving asthma education and regular monitoring during pregnancy will decrease asthma exacerbations with associated maternal and perinatal benefits. We hypothesis that the intervention group will have a better mean asthma control score than the control group at three and six months.