Professional Documents
Culture Documents
%3,7-8,4
18% 62 %
Women
Juniper EF, Newhouse MT. Asthma and Immunological Diseases in Pregnancy and Early Infancy. NY, MD, 1993: 401-427
Asthma that is not adequately controlled during pregnancy can result in serious complications for both the mother and the fetus
Maternal Complications Preeclampsia Hypertension Toxemia Hyperemesis gravidorum Fetal Complications Perinatal mortality Intrauterine growth retardation Premature birth Low birth weight Neonatal hypoxia
18% 62 %
The study included women who delivered prior to the completion of 37 weeks gestation in a cohort population of 3253 pregnant women
Serensen et a l(2003)
To Achive Goals
Maternal lung function monitoring Symptoms Spirometry Peak flows Fetal monitoring Ultrasound monitoring Elektronic fetal hearts
Drug efficacy Route of administration Duration of clinical exprience with the drug
Negative
Studies not done Studies not done Studies and Rep.
Reports Pozitive
Studies and Reports Pozitive
FDA Category
B B B B B B B C C C C C C
Budesonide Cromolyn Nedocromil Montelukast Zafirlukast Terbutaline Ipratropium Beclamethasone Fluticasone Albuterol Theophylline Salmeterol Formoterol
Congenital anomalies NS Low birht weight Perinatal death Preterm delivery Preeclamsia NS NS NS NS NS NS NS NS
Shatz Et al 2004
Cohort
Cohort Database
Bracken et al 2005
NS
OR:1,1 (C1,1,1,011,1)
Cohort
91 Salmetorol 65 exposed
1.trimester
Cohort
31 Farmoterol
8%
10%
preterm delivery
20%
Brockenet al 2005
Cohort
NS
20%
Avoid Zileuton Consider montelukast or Zafirlukast for patients with recalcitrant asthma who have shown a uniquely favorable response prior to pregnancy
ICS associated with decreased exacerbation risk and increased FEV1 ICS no associated with congenital anomolies or perinatal outcomes Budesonide is preferred although no data indicate others are unsafe that other formulations may be continued in those who were well maintained on these agents prior to pregnancy.
START study support the finding that treatment with low dose budesonide (400mcg) during the full course of pregnancy in individuals with mild to moderate persistent asthma had no adverse effects on the fetus or newborn Outcomes of the 313 pregnancies Analyzed
Budesonide n:196 %81 %19 Placebo n:117 %77 %23
Preeclampsia
Recommendations
Do not begin immunotherapy during pregnancy Carefully continue ongoing effective immunotherapy (avoid sistemic reactions)
Step Therapy
Inhaled 2 agonist as needed
Low dose inhaled corticosteroid Alternative: Cromolyn, leukotriene receptor antogonist or theophylline
Mild persistant
Moderate Persistent:
Medium dose inhaled corticosteroid or (if neeeded) medium dose long acting agonist
Severe Persistent:
High dose inhaled corticosteroid and long acting agonist and if needed oral corticosteroid and theophylline
Oxygen supplementation (SaO2>95%) ntravenous fluid hydration (if necessary) Inhale albuterol (every 20 mins up to three doses in the first hour) Ipratropium bromide (500g) (in severe cases) Systemic corticostreoids either intravenously or orally (in moderate/severe cases)
Allergic diseases effect 20 % of women in childbearing years Nasal symptoms occur in at least 20-30 % of pregnant women.
Allergic Rhinitis* Infectious Sinusitis Rhinitis medicamentosa Pregnancy rhinitis Eosinophilic nonallergic* rhinitis Nasal polyps* Structural nasal obstruction *History of some often precedes
pregnancy
Antihistamines
Oral and Intranasal
Tripelennamine Chlorpheniramine Loratadine Cetirisine Fexofenadine Azelastine Desloratadine Antezoline Azelastine Ketotifen Levocobastine Olopatodine Pheniramine
B B B B C C C C C C C C C
Ophtalmic Antihistamines
C C C C C C
Flutikazon
Mometazon
B C C C
Mild:
Modarate- severe
(mpairmen of sleep, daily activities, school or work or trouble some symptoms):
Mild:
Moderate-Severe:
Thank you..
Prof.Dr.Zeynep MISIRLIGL