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AND THE ANSWER IS . . .
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Extensive studies by Schatz's group (1) and others have shown that asthma tends to worsen during pregnancy in about 1/3 of individuals and improve during pregnancy in another approximately 1/3 of asthmatic populations. Thus, there is no consistent pattern of worsening/improvement during pregnancy in most asthmatics. However, recent analyses have shown that individuals with more severe asthma at the onset of pregnancy and/or have associated uncontrolled rhinitis tend to experience worse asthma during pregnancy (2).
All this argues for better asthma control at the outset of and during pregnancy. A major concern about uncontrolled asthma is maternal hypoxia which can conceivably lead to hypoxia in the fetus and resultant subtle damage to the developing fetal nervous system. A follow-up study by Schatz's group at 15 months post-partum has shown no difference in the developmental indices in infants born to mothers with well-controlled asthma during pregnancy vs such indices in infants born to mothers with no asthma or other health problems during pregnancy (3).
But what about the concerns about possible deleterious effects on the fetus of anti-asthma and anti-allergy medications taken during pregnancy? Some women are extremely reluctant to take any medication during pregnancy. However, there appears to be little or no adverse effects on the fetus of the inhaled medications customarily used in asthma treatment (4). There is more question about adverse effects of some of the oral anti-asthma medications, including high dose corticosteroids used in the first trimester of pregnancy. Most antihistamines appear to be safe with some first generation antihistamines and some of the more recent non-sedating antihistamines given a "B" rating for safety in pregnancy by the FDA. As Schatz has pointed out, there is much less hazard to the fetus of the use of most anti-asthma medications by the mother than would be if the mother's asthma were uncontrolled with attendant hypoxia.
As reviewed recently by Zeiger (5) avoidance of allergenic foods by the mother during pregnancy has not resulted in a significant reduction in the subsequent incidence of food allergy in children born of such pregnancies. The exception to this pattern may be in peanut avoidance which is advisable, particularly if there is a strong family history of atopy.
References
1. Ann Allergy Asthma Immunol. 2002 ;89:463-6.
2. J Allergy Clin Immunol. 2003 ;112:283-8
3. Pediatr Allergy Immunol. 2001 ;12:149-53.
4. Semin Perinatol. 2001 Jun;25 (3):145-52.
5. Pediatrics. 2003; 111:1662-71.
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