FacebookTwitter

 

Artículo de Revisión

Asma y embarazo

Gabriela Andrea Rosenberg

ARCHIVOS DE ALERGIA E INMUNOLOGÍA CLÍNICA 2007;( 2):0050-0057 

Texto completo solo disponible en PDF

El asma bronquial durante el embarazo se relaciona con diferentes enfermedades y efectos adversos para el producto de la gestación. En esta revisión se analiza el impacto que tiene el asma durante el embarazo, tanto para la madre como para el producto, y la medicación adecuada y de
menor riesgo para ser utilizada durante este período. Es importante destacar que el peligro de resultados adversos para el producto de la gestación se relaciona con el padecimiento de asma moderado y severo, el feto femenino, las exacerbaciones agudas y la falta de medicación. El asma, debe ser tratada durante la gestación, para beneficio de la madre y el feto, ya que el uso de medicación disminuye el riesgo de resultados adversos. Los fármacos de primera línea, propuestos en las guías realizadas por entidades científicas reconocidas, son los corticoides inhalatorios y β2 agonistas, que, junto con la educación de la paciente, deben constituir los pilares del tratamiento.


Palabras clave: asma, embarazo, feto, corticoides, pretérmino, β2-agonistas.

Asthma during pregnancy is related with different maternal morbilities and pregnancy product adverse outcomes. This revision of literature analyze the impact of asthma in pregnancy and the treatment that should be used in this period with lowest risk and better benefits for mother and fetus. It is important to emphasize that the risks of adverse outcome has been related to the moderate and severe asthma condition, the presence of female fetus, acute exacerbations, and inadequate or absence of medications used for asthma treatment. Asthma should be treated during pregnancy, with mother and fetus benefits because the use of medications decreases the risk of adverse outcomes. The first line medications indicated by guidelines are β2-agonist and inhaled corticosteroids added to patient’s education, should be the basement of asthma treatment.


Keywords: asthma, pregnancy, fetus, corticosteroids, preterm delivery, β2-agonists.


Los autores declaran no poseer conflictos de intereses.

Fuente de información Asociación Argentina de Alergia e Inmunología Clínica. Para solicitudes de reimpresión a Archivos de Alergia e Inmunología Clínica hacer click aquí.

Recibido | Aceptado | Publicado 2007-08-01

1. Kown HL, Belanger K, Bracken MB. Asthma prevalence among pregnant
and child bearing aged woman in United States: estimates for national
health surveys. Ann Epidemiol 2003; 13: 317-324.
2. Kurinczuk JJ, Parsons DE, Dawes V, Burton PR. The relationship between
asthma and smoking during pregnancy. Women Health 1999;
29:31-47.
3. Olensen C, StefFensen FH, Nielsen GL et al. Drug use in the first pregnancy
and lactation: A population survey among Danish women the euromap
group. Eur J Clin Pharmacol 1999; 55: 39-44.
4. Szczeklik A, Milner PC, Birtch J et al. Prolonged bleeding time, reduced
platelet agregation, altered PAF-acether sensitivity and increase platelet
mass are a trait of asthma and hay fever. Tromb Haemost 1986; 56:283-
287.
5. Szczeklik A, Schmitz-Schumann M, Krzanowski M. et Virchow C Sr.
Delayed generation of thrombin in clotting blood of atopic patients with
hayfever and asthma. Clin Exp Allergy 1991;21:411-415.6. Wen SW, Demisse K, Liu S. Adverse outcomes in pregnancies of women:
results from a Canadian population. Ann Epidemiol 2001; 11:7-12.
7. Tan KS, Thomson NC. Asthma and pregnancy. Am J Med 2000;
109:727-733.
8. Lidia Velásquez. Fármacos aceptados en la rintis alérgica de la embarazada.
Archivos de Alergia e Inmunlogía Clínica 2006; 37 (2):74-79.
9. Powrie RO; Larson L. Miller. Managing asthma in expectant mothers.
Treat Respir Med 2006; 5(1):1-10.
10. Tai E, Read J. Bood-gas tensions in bronchial asthma. Lancet 1967;
1:644-646.
11. Rudolf M, Riordan JF, Grant BJ, Maberly DJ, Saunders KB. Arterial bood
gas tension in acute severe asthma. Eur J Clin Invest 1980;10:55-62.
12. McClure JH, James JM. Oxygen administration to the mother and the
relations to blood oxygen in the newborn infant. Am J Obstet Gynecol
1960; 80: 554- 556.
13. Clifton VL, Giles WB, Smith R et al. Alteration of placental vascular
function in asthmatic pregnancies. Am J Resp Crit Care Med 2002;
164:546-553.
14. Murphy BE, Zakar T, Smith R, Gibson PG, Giles WB Clifton VL. Reduced
11 beta-hydroxysteroid dehydrogenase type 2 activity is associated with
decreased birth weight centile in pregnancies complicated by asthma. J
Clin Endocrinol Metab 2002; 87:1660-1668.
15. Schatz M, Harden K, Forsythe A, et al. The course of asthma during
pregnancy, post partum and with sucessives preganancie pregnancies. A
prospective analysis. J Allergy Clin Immunol 1988, 81:509-17.
16. Gelber M, Sidi Y, Gassner S, et al. Uncontrollable life threaninig status
asthmatics- for termination of pregnancy by cesarean section. Respiratory
1984;46:320-322.
17. Shanies HM, Venkataraman MT, Peter T. Reversal of intractable acute
severe asthma by first thrimestre termination of pregnancy. J Asthma
1997; 34:167-172.
18. Murphy VE, Clifton VL, Gibson PG. Asthma exacerbations during
pregnancy: incidence and association with adverse pregnancy outcomes.
Thorax. 2006; 61(2):169-76.
19. Keklíkían RI. Asma y Embarazo. ASAPER. EMC 2004-2005;(1): 1-23.
20. Kircher S, Schatz M, Long L et al. Variables affecting asthma course during
pregnancy. Ann Alergy Asthma Immunol 2002; 89:463-466.
21. Henderson CE, Ownby DR, Trumble A et al. Predicting asthma severity
from allergic sensitivity to cockroaches in pregnant inner city women. J
Reprod Med 2000; 45:341-344.
22. Kramer MS, Coates A, Michoud MC, et al. Maternal asthma and idiopathic
pre-term labor. Am J Epidemol 1995;142: 1078-1088.
23. Demissie K, Breckenridge MB, Rohads G. Infant and maternal outcomes
in the pregnancies of asthmatic women .Am J Respir Crit Care
Med 1998;158.:1091-1095.
24. Braken MB, Triche EW, Belanger KA, et al. Asthma symptoms, severity
and drugs therapy: a prospective study of effects on 2225 pregnancies.
Obstet Gynecol 2003; 102: 739 – 752.
25. Park_Wyllie L, Mazzota P, Patuszkak A et al. Birth defects after maternal
exposure to corticosteroids: prospective cohorte study and metanalysis of
epidemiological studies. Teratology 2000;62:385-92.
26. Stennius_Aarniala, B, Piirila P, Teramo k. Asthma and pregnancy a
prospective study of 198 pregnancies.Thorax.1988;43:12-18.
27. Schatz M, Zeiger RZ, Harden K, Hoffman CC, Chillingar L, Petitti D.
The safety of asthma and allergies medicactions during pregnancy. J Allergy
Clin Inmunol 1997;100:301-306.
28. Martel MJ, Rey E, Beauchesne MF, Perreault S, Lefreve G, Forget A,
Blais L. Use of inhaled corticosteroid during preganancy and risk of induced
pregnancy: nested case-control study. Primare
Care.BMJ,doi:10.1136/bmj.38313.624352.8F (published 20 january
2005)
29. Working Group Report on Managing Asthma During Pregnancy: Recomendations
for Pharmacologic treatment. Up date2004.J Allergy Clin
Immunol 2005;115:34. http://www.nhlbi.nih.gov/prof/asthma/astpreg.htm
30. Cockcroft D W. Treatment of Asthma during pregnancy. Annals of Allergy,
Asthma and Inmunology; Sep2005;95 ,3; pg.213CINAHL .
31. Schatz M, Zeiger RS, Harden K, Hoffman CC, Chillingar L, Petitti D.
The safety of asthma and allergies medicactions during pregnancy. J Allergy
Clin Inmunol 1997;100:301-306.
32. Briggs GG, Freeman RA, Yaffe SJ. Michigan Medicaid Study. Drugs in
pregnancy and lactation. 4th ed. Baltimore, MD: Williams and Wilkins;
1994.
33. Rahimi R, Nikfar S and Abdollahi M. Meta-analysis finds use of inhaled
corticosteroids during pregnancy safe: a systematic metaanalysis review.
Human & Experimental Toxicology 2006; 25: 447-452.
34. Bakhireva LN, Jones KL, Schatz M, Johnson D, Chambers CD and the
Organization of Teratology Information Research Group. Asthma medication
use in pregnancy and fetal growth. J Allergy Clin Inmunol 2005;
116(3):503-508.
35. American College of Obstetricians and Gynecologists and American
College of Allergy Asthma and Inmunology (ACAAI). The use of newer
asthma and allergies medications during pregnancy. Ann Allergy Asthma
Inmunol.2000;84:475-480.
36. Silberman M, Scheffer A, Diaz PV, Lindmark B, Radner F, Broddene
RN et al. Outcome of pregnancy in a randomized controlled study of patient
with asthma exposed to budesonide. Ann Allergy Asthma Inmunol.
2005 ;95 :566-570.
37. Dombrowski MP, Schatz M, Wise R. Randomized trial of inhaled beclomethasone
dipropionate versus theophylline for moderate asthma
during pregnancy. Am J Obstet Gynecol 2004; 190:737-744.
38. Wilton LV, Pearce GL, Martin RM et al. The outcomes of pregnancy in
women exposed to newly marketed drugs in general practice in England.
Br J Obstet Gynecol 1998; 105:882-889.
39. Wilton LV, Shakir SA. A post-marketing surveillance study of formoterol
(Foradil). Drug Safety 2002; 25:213-223.
40. Czeizel AE, Rockenbauer M. Population-based-case-control study of teratogenic
potential of the corticosteroids. Teratology1997;56:335-40.
41. Stenius-Aarniala B,Riikonen S, Teramo K. Slow_realease theophylline in
pregnant asthmatis.Chest 1995;107:643-7.
42. Bracken MB, Triche EW, Belanger K, et al. Asthma symptoms, severity,
and drug therapy: a prospective study of effects on 2205 pregnancies.
Obstet Gynecol 2003; 102:739-752.
43. Triche EW, Saftlas AF, Belanger K, et al. Association of asthma diagnosis,
severity, symptoms, and treatment with risk of preeclampsia. Obstet Gynecol
2004; 104:585-593.
44. Schatz M. Asthma during pregnancy: interrelationships and management.
Ann Allergy 1992;68:123-33.
45. Wilson J. Utilization de cromoglycate de sodium a course de la grssessa
[Use osodium cromoglycate during pregnancy]. Acta Thor 1982; 8:45-51.
46. Schuh S, Johnson DW, Callahan S, et al. Efficacy of frequent nebulized
ipratropium bromide added to frequent high-dose albuterol therapy in
severe childhood asthma. J Pediatr 1995; 126:639-645.
47. Lin RY, Pesola GR, Bakalchuk L, et al. Superiority of ipratropium plus
albuterol over albuterol alone in the emergency department management
of adult asthma: a randomized clinical trial. Ann Emerg Med 1998;
31:208-213.
48. Murphy VE, Clifton VL, Gibson PG. Asthma exacerbations during
pregnancy: incidence and association with adverse pregnancy outcomes.
Thorax. 2006; 61(2):169-76.
49. Nannini LJ. Terapeútica del Asma 39-49. Programa de Educación Médica
Continúa 2005. Módulo 2. pág.:39-49.
50. Adriana Marcipar. Selección de los pacientes para la administración de
vacunas con aerolergenos. Curso de postgrado Buenas prácticas clínicas
en diagnóstico y tratamiento alergológico. Alergovirtual 2003.
51. Dombrowski MP. Asthma and pregnancy. Obstet Gynecol. 2006; 108(3
Pt 1):667-81.

Autores

Gabriela Andrea Rosenberg
Médica Especialista en Asma, Alergia e Inmunología Clínica. Servicio de Asma, Alergia e Inmunología Clínica. Hospital de Clínicas “Pte. Dr. Nicolás Avellaneda”. San Miguel de Tucumán. Tucumán..

Autor correspondencia

Gabriela Andrea Rosenberg
Médica Especialista en Asma, Alergia e Inmunología Clínica. Servicio de Asma, Alergia e Inmunología Clínica. Hospital de Clínicas “Pte. Dr. Nicolás Avellaneda”. San Miguel de Tucumán. Tucumán..

Correo electrónico: gaba33200@yahoo.com.ar

Para descargar el PDF del artículo
Asma y embarazo

Haga click aquí


Para descargar el PDF de la revista completa
Archivos de Alergia e Inmunología Clínica , Volumen Año 2007 Num 2

Haga click aquí

Archivos de Alergia e Inmunología Clínica
Número 2 | Volumen 38 | Año 2007

Titulo
Asma y embarazo

Autores
Gabriela Andrea Rosenberg

Publicación
Archivos de Alergia e Inmunología Clínica

Editor
Asociación Argentina de Alergia e Inmunología Clínica

Fecha de publicación
2007-08-01

Registro de propiedad intelectual
© Asociación Argentina de Alergia e Inmunología Clínica

Reciba la revista gratis en su correo


Suscribase gratis a nuestra revista y recibala en su correo antes de su publicacion impresa.


Publicación Oficial de las Asociaciones:

Asociación Argentina de Alergia e Inmunología Clínica
Moreno 909 - CABA, Argentina | Argentina | tel./fax +54 11 4334 7680, +54 11 4331-7356 | e-mail secretaria@aaaeic.org.ar | www.alergia.org.ar/

Registro de propiedad intelectual en tramite | ISSN 1515-9825 | ISSN digital 2718- 8280

La plataforma Meducatium es un proyecto editorial de Publicaciones Latinoamericanas S.R.L.
Piedras 1333 2° C (C1240ABC) C1515-9825iudad Autónoma de Buenos Aires | Argentina | tel./fax (5411) 4362-1600 | e-mail info@publat.com.ar | www.publat.com.ar

Meducatium versión 2.2.1.3 ST