Pregnancy is a special time in a woman's life, but can be complicated by preexisting allergy and asthma. I have found that some simple reassurance before a woman becomes pregnant or early in the pregnancy provides cooperation and good compliance.Educational handouts are important since the patient will not remember everything you tell her.
Take a few minutes to explain to your patient that many women develop "stuffy nose of pregnancy" or rhinitis and it can be controlled with simple measures such as nasal rinsing or breathing strips outside the nose at night. If the patient knows the stuffiness may occur, then she will not be worried. Medication can be used to relieve symptoms, especially when sleep is affected.
Asthmatic women should be told that asthma can get worse during pregnancy, especially in the 2nd trimester, but good control before pregnancy (or as early as possible during pregnancy) can reduce this problem. Medications should be reviewed and the patient should be told which medications are safe (most are and should not be changed if the patient is well controlled) and the importance of continuing her treatment. A treatment plan for possible exacerbations should be given.
All pregnant women should receive a flu shot. It is safe to continue immunotherapy, but not recommended to start treatment during pregnancy.
Another common problem in pregnancy, which can affect asthma, is gastroesophageal reflux. Simple suggestions such as elevating the head end of the bed 30 degrees or not eating for three hours before bedtime can be helpful. Avoidance of spicy, fatty foods as well as alcohol is also useful.
Keep in communication with your patient's obstetrician, so together you can reach the best outcome for the patient and the pregnancy.
Joan C Gluck, MD