Asthma and Pregnancy: A Narrative Review.

Abstract

Asthma, the most prevalent respiratory condition in pregnancy, affects up to 12% of pregnant women globally and is associated with adverse perinatal outcomes when poorly controlled. Modern asthma management emphasizes achieving clinical remission through personalized, trait-based approaches targeting modifiable risk factors. Insights into the mechanisms of airway inflammation have led to biomarker-directed therapy and the emergence of biologic agents for severe asthma. An evidence review was conducted to evaluate the applicability of these contemporary principles within the context of pregnancy. Severe or poorly controlled asthma increases the risk of preeclampsia, gestational diabetes, fetal growth restriction, preterm birth, and neonatal morbidity such as transient tachypnea of the newborn, intensive care admission, seizures, and hypoglycemia. Maternal adverse outcomes extend to unplanned hospital admissions, reduced quality of life, and psychological comorbidity. Physiological changes in pregnancy are not expected to worsen asthma severity, and any decline in FEV₁ to FVC ratio should prompt further investigation. Factors that may predict deterioration in pregnancy include increased severity of asthma, suboptimal control, and nonadherence to maintenance therapy. The principles of asthma management include treatment adherence, managing comorbidities, and monitoring for adverse outcomes. Most standard treatments, including biologics if needed, are safe during pregnancy and lactation. Reassuring patients about medication safety is essential to promote adherence and to improve maternal and fetal health. This review updates health care providers on evidence-based strategies for optimizing asthma care in pregnant women and supporting proactive management, personalized treatment, and ongoing inclusion in research.