Pregnant woman surrounded by health symbols

Navigating Illness During Pregnancy: A Comprehensive Guide for Expectant Mothers

"Expert advice on managing common conditions like asthma, migraines, and thyroid disorders to ensure a healthy pregnancy."


Pregnancy is a transformative experience, marked by anticipation and joy. However, it also presents unique health challenges. Expectant mothers and their healthcare providers must navigate illnesses unrelated to pregnancy with extra care, as treatments can impact both the mother and the developing fetus.

This article addresses common health issues that can arise during pregnancy, offering guidance on safe and effective management strategies. We'll explore conditions such as bronchial asthma, migraines, thyroid disorders (hypothyroidism and hyperthyroidism), and varicose veins, providing insights into diagnosis, treatment, and potential impacts on pregnancy.

Our goal is to empower pregnant women with the knowledge they need to make informed decisions about their health. By understanding the potential risks and available treatments, you can work closely with your healthcare team to ensure a healthy and happy pregnancy.

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From Fetal Origins to Safer Treatment

Research on asthma has examined early-life origins, including structural airway abnormalities and measurements at birth that may help identify infants at risk of future asthma. Asthma is also described as the most common chronic disease affecting pregnancy, while poor control has been associated with adverse pregnancy outcomes. More recent reviews report that most standard treatments, including biologics when needed, are considered safe during pregnancy and lactation.

Managing Asthma During Pregnancy

Pregnant woman surrounded by health symbols

Asthma, a common chronic lung disease, affects 4-8% of pregnant women. The course of asthma during pregnancy varies; it remains stable in one-third of patients, worsens in another third, and improves in the remaining third. Factors like viral infections, discontinuing inhaled corticosteroids, and smoking can exacerbate asthma.

It’s crucial to maintain optimal asthma control during pregnancy. Poorly controlled asthma increases the risk of pre-eclampsia, intrauterine growth restriction, preterm delivery, and birth defects. However, these risks shouldn't deter women from pregnancy. Because no current German guideline exists, the Global Initiative for Asthma (GINA) guideline is recommended.

  • Continue asthma treatment used before pregnancy.
  • Get vaccinated against influenza.
  • Periodically assess medication needs and adherence.
  • Address comorbidities like rhinitis or reflux.
  • Undergo monthly pulmonary function testing.
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Evidence-Based Treatment Reviews

A hospital-based cross-sectional survey notes that medications may be necessary during pregnancy for conditions including gestational diabetes, preeclampsia, eclampsia, hypothyroidism, and asthma to promote maternal and child health. A German review searched PubMed and specialty guidelines from 2007 to 2016 for standards concerning bronchial asthma, migraine, hypothyroidism, hyperthyroidism, and varicose veins. Recent asthma reviews emphasize diagnostic certainty, medication management during pregnancy and lactation, multidisciplinary care, and shared decision-making.

Risks of Undertreatment

Asthma is not a benign condition for maternal and fetal health, yet pregnant women or their clinicians may stop or reduce optimal asthma treatment. Pregnancy-related hormonal, anatomical, and physiological changes increase the work of breathing, which can make respiratory failure particularly serious. At the same time, reviews emphasize that safe medications and appropriate clinical knowledge are available, while asthma can significantly affect pregnant women and their developing fetuses.

Different Tools for Understanding Illness

A 1976 study compared blood levels with migraine attacks and suggested that plasma 5-hydroxyindoles might rise during attacks. The FRAMIG 3 study was the first nationwide population-based survey in France to assess probable migraine using the 2004 International Headache Society classification, while another study examined menstrual migraine among 289 headache-clinic patients and changes during pregnancy. In asthma, diagnosis is determined in the same way for pregnant and non-pregnant women, and spirometry is described as safe during pregnancy both before and after bronchodilator use.

Inhaled corticosteroids are the cornerstone of persistent asthma treatment and are safe to use during pregnancy, particularly budesonide. Short-acting beta2-agonists like salbutamol are also considered safe. For acute asthma attacks, prompt in-hospital treatment with supplemental oxygen and escalated pharmacotherapy is essential. Remember, spontaneous delivery is preferred, and most anti-asthmatic medications are safe during breastfeeding.

Empowering Your Pregnancy Journey

Pregnancy is a unique and personal journey. By staying informed, working closely with your healthcare provider, and prioritizing your well-being, you can confidently navigate any health challenges that arise. Remember, a healthy pregnancy leads to a healthier future for both you and your child.

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Precision-Guided Asthma Care

A contemporary review emphasizes asthma control with a goal of complete remission of symptoms to optimize maternal-fetal outcomes. It identifies precision-guided asthma care during pregnancy as an area for future research. The review also highlights biologic therapies as a possible approach to preventing active disease.

About this Article -

Written with AI assistance from published research, and reviewed by the Mystum team. See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.3238/arztebl.2017.0616, Alternate LINK

Title: The Treatment Of Illnesses Arising In Pregnancy

Subject: General Medicine

Journal: Deutsches Ärzteblatt international

Publisher: Deutscher Arzte-Verlag GmbH

Authors: Michael Bolz, Sabine Körber, Toralf Reimer, Johannes Buchmann, Hans-Christof Schober, Volker Briese

Published: 2017-09-15

Everything You Need To Know

1

How does asthma affect pregnancy and what can be done to manage it?

Asthma can behave differently during pregnancy. For about a third of women, it remains stable. Another third may experience a worsening of their asthma, while the remaining third might see improvements. Factors such as viral infections, stopping inhaled corticosteroids, and smoking can lead to asthma flare-ups. Poorly managed asthma can raise the risk of complications such as pre-eclampsia, intrauterine growth restriction, preterm delivery, and even birth defects. To manage asthma, it's important to continue any asthma treatments used before pregnancy and get vaccinated against influenza. Regular assessments of medication needs, addressing other conditions like rhinitis or reflux, and undergoing monthly pulmonary function testing are also vital. Inhaled corticosteroids, especially budesonide, and short-acting beta2-agonists like salbutamol are considered safe during pregnancy. For acute attacks, prompt in-hospital treatment is essential.

2

What are the common causes and treatments for migraines during pregnancy?

Migraines during pregnancy can be influenced by hormonal changes, especially a decrease in estrogen levels in the first trimester. This can trigger migraines in some women. Lifestyle adjustments like stress reduction, regular sleep, and identifying dietary triggers are important first steps in management. For acute migraine attacks, paracetamol is generally considered safe. If stronger medication is needed, NSAIDs might be considered with caution, especially in the first and second trimesters, avoiding them in the third trimester due to potential risks to the fetus. Triptans should be used cautiously, considering the specific risks and benefits. Preventative treatments might be necessary for severe or frequent migraines, but the options are limited due to safety concerns during pregnancy. Beta-blockers like propranolol or metoprolol may be considered, but their effects on fetal growth and heart rate should be monitored.

3

Why are thyroid disorders a concern during pregnancy, and how are they managed?

Thyroid disorders during pregnancy can have significant impacts on both the mother and the developing fetus. Hypothyroidism, or an underactive thyroid, can lead to complications like pre-eclampsia, preterm birth, and neurodevelopmental issues in the baby if left untreated. Hyperthyroidism, or an overactive thyroid, can result in similar complications, as well as thyroid storm. Treatment for hypothyroidism typically involves thyroid hormone replacement with levothyroxine, adjusting the dosage based on regular TSH level monitoring. For hyperthyroidism, treatment options may include anti-thyroid medications like propylthiouracil (PTU) or methimazole, though PTU is generally preferred in the first trimester due to a lower risk of birth defects associated with methimazole. Regular monitoring of thyroid hormone levels is crucial to ensure proper management and minimize risks.

4

Why do varicose veins often appear or worsen during pregnancy, and what are the management strategies?

Varicose veins commonly develop or worsen during pregnancy due to increased blood volume and pressure on the veins in the lower body, as well as hormonal changes that relax vein walls. While they are often considered a cosmetic issue, they can cause discomfort, pain, and swelling. Severe cases may lead to complications like thrombophlebitis or skin changes. To manage varicose veins, lifestyle modifications such as regular exercise, elevating the legs, and wearing compression stockings are recommended. These measures help improve blood flow and reduce pressure on the veins. While treatment options like sclerotherapy or surgery are available, they are typically postponed until after pregnancy unless complications arise. Compression stockings are safe and effective and can significantly alleviate symptoms.

5

What is the overall approach to managing health and potential illnesses during pregnancy?

Staying informed, collaborating with healthcare providers, and prioritizing well-being are essential for navigating health challenges during pregnancy. Expectant mothers should educate themselves about potential risks and available treatments to make informed decisions. Regular communication with doctors is crucial for personalized care and addressing any concerns. A healthy pregnancy involves managing conditions like asthma, migraines, and thyroid disorders effectively, which contributes to a healthier future for both the mother and the child. Remember, each pregnancy is unique, and individual needs should be addressed with professional guidance.

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