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BRONCHIAL ASTHMA IS A DISEASE THAT LEADS TO INTRAUTERINE HYPOXIA
Temirova Dilnoza Olimzhonovna
Asian International University.
https://doi.org/10.5281/zenodo.15252516
Abstract. The incidence of bronchial asthma (BA) in the world is from 4 to 10% of the
population [6, 14]; in the Russian Federation, the prevalence among adults it ranges fr om
2.2 t o 5 –7% [15] , i n the pediatric population thi s figur e is about 10% [9] . In
pregnant w omen, bronchial asthma i s the most common dis eas e of the pulmonary
syst em, t he fr equency of di agnosis of w hi ch i n t he worl d ranges f rom 1 to 4% [3] ,
in Russi a – from 0.4 to 1% [8]. In recent years , st andard int er national diagnos tic
crit eri a and met hods of pharmacotherapy have been developed, whi ch can
signifi cantl y incr eas e the effecti veness of treat ment of pati ent s with ast hma and
improve their quali t y of lif e (Global Init iative for the Pr evention and T reatment
of Asthma (GIN A), 2014) [14] . How ever , moder n phar macother apy and
monit ori ng of ast hma in pregnant women are more complex t asks, si nce t hey ar e
aimed not onl y at maintaini ng the heal th of the mot her, but al so at pr eventing the
adver se eff ects complicat ions of t he dis ease and side effect s of tr eatment on the
fetus.
Keywords: bronchial asthma, hypoxia, complications, dyspnea.
Pregnancy affects the course of bronchial asthma in different ways. Changes in the course
of the disease vary widely: improvement in 18–69% of women, deterioration in 22–44%, and the
absence of an effect of pregnancy on the course of bronchial asthma was detected in 27–43% of
cases [7, 8]. This is explained, on the one hand, by the fact that on the one hand, the multidirectional
dynamics in patients with varying degrees of severity of asthma (with mild and moderate severity,
worsening of the course of asthma is observed in 15–22%, improvement – in 12–22%), on the
other hand – insufficient diagnostics and not always correct therapy. In practice, asthma is often
diagnosed only in the late stages of the disease. In addition, if its onset coincides with the
gestational period, then the disease may remain unrecognized, since the respiratory disorders
observed in this case are often attributed to changes caused by pregnancy. At the same time, with
adequate therapy for asthma, the risk of an unfavorable outcome of pregnancy and childbirth is no
higher than in healthy women [7, 10].
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368
In this regard, most authors do not consider asthma as a contraindication to pregnancy [13],
and monitoring its course is recommended to be ensured using modern treatment principles [14].
The combination of pregnancy and bronchial asthma requires close attention from doctors
due to the possible change in the course of bronchial asthma during pregnancy, as well as the
impact of the disease on the fetus. In this regard, the management of pregnancy and childbirth in
a patient suffering from bronchial asthma requires careful monitoring and joint efforts of doctors
of many specialties, in particular therapists, pulmonologists, obstetricians-gynecologists and
neonatologists [7].
Changes in the respiratory system in bronchial asthma during pregnancy
During pregnancy, under the influence of hormonal and mechanical factors, the respiratory
system undergoes significant changes: the mechanics of breathing are restructured, ventilation
changes perfusion relations [2]. In the first trimester of pregnancy, hyperventilation may develop
due to hyperprogesteronemia, changes in the gas composition of the blood - an increase in the
content of PaCO2 [1]. The appearance of shortness of breath in the late stages of pregnancy is
largely due to the development of a mechanical factor, which is a consequence of an increase in
the volume of the uterus. As a result of these changes, impairment of external respiration function
worsens, vital capacity of the lungs, forced vital capacity of the lungs, forced expiratory volume
in 1 second (FEV1) decrease [11]. As the gestational age increases, the resistance of the vessels of
the pulmonary circulation increases, which also contributes to the development of dyspnea [1]. In
this regard, dyspnea causes certain difficulties in conducting differential diagnostics between
physiological changes in the function of external respiration during pregnancy and manifestations
of broncho-obstruction. Often, pregnant women without somatic pathology develop edema of the
mucous membranes of the nasopharynx, trachea and large bronchi [7]. These manifestations in
pregnant women with bronchial asthma can also aggravate the symptoms of the disease.
Low compliance contributes to the worsening of the course of bronchial asthma: many
patients try to refuse to take inhaled glucocorticosteroids (IGCS) due to fear of their possible side
effects. In such cases, the doctor should explain to the woman the need for basic anti-inflammatory
therapy due to the negative impact of uncontrolled bronchial asthma on the fetus.
Asthma symptoms may first appear during pregnancy due to altered reactivity of the div
and increased sensitivity to endogenous prostaglandin F2α (PGF2α) [15]. Asthma attacks that first
appear during pregnancy may disappear after delivery, but may also transform into true bronchial
asthma. Among the factors contributing to asthma are:
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369
improvement of the course of bronchial asthma during pregnancy, it is necessary to note
the physiological increase in the concentration of progesterone, which has bronchodilator
properties. The increase in the concentration of free cortisol, cyclic amino monophosphate, and
the increase in histaminase activity have a beneficial effect on the course of the disease. These
effects are confirmed by the improvement of the course of bronchial asthma in the second half of
pregnancy, when glucocorticoids of fetoplacental origin enter the mother's bloodstream in large
quantities [7].
Pregnancy course and fetal development in bronchial asthma
Relevant issues include studying the effect of bronchial asthma on the course of pregnancy
and the possibility of giving birth to healthy offspring in patients suffering from bronchial asthma.
Pregnant women with asthma have an increased risk of developing early toxicosis (37%),
gestosis (43%), threatened miscarriage (26%), premature birth (19%), and fetoplacental
insufficiency (29%) [1]. Obstetric complications usually occur in severe cases of the disease.
Adequate drug control of bronchial asthma is of great importance. Lack of adequate therapy
for the disease leads to the development of respiratory failure, arterial hypoxemia of the mother's
div, constriction of the placental vessels, resulting in fetal hypoxia. A high incidence of
fetoplacental insufficiency, as well as miscarriage, is observed against the background of damage
to the vessels of the uteroplacental complex by circulating immune complexes, and suppression of
the fibrinolysis system [1, 7].
Women suffering from asthma are more likely to give birth to children with low birth
weight, neurological disorders, asphyxia, and congenital defects [12]. In addition, the interaction
of the fetus with the mother's antigens through the placenta affects the formation of the child's
allergic reactivity. The risk of developing an allergic disease, including asthma, in a child is 45–
58% [12]. Such children are more likely suffer from respiratory viral diseases, bronchitis,
pneumonia. Low birth weight is observed in 35% of children born to mothers with asthma. The
highest percentage of low birth weight babies is observed in women suffering from steroid-
dependent asthma. The reasons for low birth weight in newborns are insufficient control of asthma,
which contributes to the development of chronic hypoxia, as well as long-term taking systemic
glucocorticoids. It has been proven that the development of severe exacerbations of asthma during
pregnancy significantly increases the risk of giving birth to children with low birth weight [7, 12].
Management and treatment of pregnant women suffering from asthma
According to the provisions of GINA-2014 [14], the main tasks of asthma control in
pregnant women are:
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370
clinical assessment of the mother and fetus;
• elimination and control of trigger factors;
• pharmacotherapy of asthma during pregnancy;
• educational programs;
• psychological support for pregnant women.
Considering the importance of achieving control over asthma symptoms Mandatory
examinations by a pulmonologist are recommended during the period of 18–20 weeks of gestation,
28–30 weeks and before delivery, in case of unstable course of bronchial asthma – as needed.
When managing pregnant women with bronchial asthma, one should strive to maintain
lung function close to normal. Peak flow metry is recommended for monitoring respiratory
function.
Due to the high risk of developing fetoplacental insufficiency, it is necessary to regularly
assess the condition of the fetus and the uteroplacental complex using ultrasound fetometry,
ultrasound Doppler of the uterine vessels, placenta and umbilical cord. In order to increase the
effectiveness of therapy, patients are recommended to take measures to limit contact with
allergens, quit smoking, incl.
passive, strive to prevent acute respiratory viral infections, and eliminate excessive
physical activity. An important part of treating bronchial asthma in pregnant women is the creation
of educational programs that allow the patient to establish close contact with the doctor, increase
the level of knowledge about her illness and minimize its impact on the course of pregnancy, and
teach the patient self-control skills.
The patient should be taught peak flowmetry to monitor the effectiveness of treatment and
recognize early symptoms of exacerbation of the disease. Patients with moderate and severe
asthma are recommended to perform peak flowmetry in the morning and evening hours every day,
calculate daily fluctuations in peak expiratory flow rate and record the obtained values in the
patient's diary.
According to the 2013 Federal Clinical Guidelines for the Diagnosis and Treatment of
Bronchial Asthma, it is necessary to adhere to certain provisions (Table 1) [10].
Conclusion. Bronchial asthma is a serious disease of pregnant women. The disease has
many complications, especially if it seriously harms the fetus. The fetus suffers from intrauterine
infection. To prevent this, women should be under constant supervision of a specialist.
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371
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