More than 300 million people worldwide are living with asthma, and post-puberty, more women have asthma than men. In Australia, around 12% of women have the condition, and for Indigenous Australian women, this figure reaches around 17% (AIHW).
The impact of asthma seems to be worse for women – they are more likely than men to have severe asthma, other complicating health conditions such as obesity and reflux, and poorer quality of life. Women are more than twice as likely to be admitted to hospital for their asthma than men. The reasons behind these differences are complicated but likely driven by differences in sex hormones, how the immune system functions, and environmental factors. Gender-specific social, cultural and behavioural differences also play a role, through influences on occupational/environmental exposures, and how asthma symptoms are perceived.
Pregnancy brings a whole new set of issues to the table for women living with asthma. Asthma attacks in the mother are associated with harm to the unborn baby, including an increased risk of being born too small, or too early, and an increase in likelihood that a newborn may need to spend time in intensive care. Mothers are also at increased risk of developing complications such as gestational diabetes and pre-eclampsia, a serious condition involving high blood pressure in pregnancy.
But as one mum with asthma, Georgia, explains: “With all the incredible care available during pregnancy, it is hard to believe that there are still many gaps in the care plans of expectant mothers with chronic conditions such as asthma – I certainly found it confronting and frustrating during my recent pregnancy.”
Asthma is a highly treatable condition, so why it is that pregnant women are at risk of poorly controlled asthma?
Most pregnant women are very careful about what they put into their bodies, to make sure their baby isn’t exposed to any potentially harmful substances. Unfortunately a lack of knowledge and/or misinformation means that some mothers, and even healthcare professionals, think it is safer not to use asthma medication, like puffers, when pregnant. However this is not the case – the evidence shows that it is actually much better for mothers and their babies if the mother uses her usual puffers to keep her asthma well controlled. An asthma attack can mean the baby does not receive enough oxygen for a period of time, which can be very serious.
Concerningly, research by our team has also shown that only 2 in 10 pregnant women know how to use their puffers (inhalers) correctly. Only about 15% of pregnant women have a written asthma action plan – which is an essential tool for anyone with asthma, letting a person know what to do and when to act if their symptoms worsen.
Pregnancy is also a time when there are lot of other changes going on in the body and sometimes asthma symptoms can be dismissed as being ‘just part of pregnancy’, and therefore not treated properly. In fact, around 40% of women can expect that their asthma symptoms will worsen with pregnancy, and we currently can’t predict who this will happen to.
So how can we improve asthma management during pregnancy?
Our team at the University of Newcastle / Hunter Medical Research Institute has developed a free online resource, the Asthma in Pregnancy Toolkit which provides an evidence-based source of information to tackle this issue. The Toolkit recognises that to improve awareness around asthma management, both the needs of women and health professionals need to be addressed together. Women need to be empowered to ask questions about their asthma when they are pregnant or planning pregnancy. Health professionals need a central, easily accessed resource to ensure they have up-to-date, evidence-based material to use in clinic.
With the help of an ACT Health Healthy Canberra Grant, we are spreading the word about the Toolkit and providing workshops for healthcare professionals in 2023 to improve awareness and knowledge around asthma management pregnancy. We want to promote the message to GPs, midwives, obstetricians, pharmacists and families that well-managed asthma is best for mum and baby.
A key advantage of this resource is that it can be accessed remotely. Asthma rates in Australia are higher in women living in outer regional areas (~15% of women) than in major cities (11% of women) so it is important to have asthma health information available in areas where specialist health services may be more difficult to access (AIHW).
Through targeted myth-busting, and driving awareness that asthma management is important for both mums and babies, our hope to reduce the incidence of asthma attacks in women with asthma. Well controlled asthma is best for mums and babies.
- Feature image at top is a stock photo.
Associate Professor Vanessa Murphy is a research fellow based at the University of Newcastle/Hunter Medical Research Institute with around 20 years’ experience in studying asthma during pregnancy. She led the development of the Asthma in Pregnancy Toolkit. Vanessa has had asthma for most of her life, and experienced first-hand the worry that comes with having an asthma attack during pregnancy. Her first ever experience of requiring steroid tablets for her asthma was mid-way through her last pregnancy. She is very grateful that she had a written action plan and was able to access specialist help for this serious asthma attack. Vanessa is mum to two healthy teenage daughters who don’t have asthma.
Dr Janet Bristowis a former reproductive biologist who left the lab bench to support asthma research translation projects. She is Project Manager for the Asthma in Pregnancy Toolkit and ACT Health Asthma in Pregnancy campaign.
