Abstract/Summary

Objectives To investigate the management of asthma in pregnant women from the perspectives of both pregnant women and prescribers, and to explore the reasons for their behaviours. Methods In-depth interviews with a purposive sample of women (n=25) at various stages of pregnancy and with varying severity of asthma were conducted in June-Sept 2011. A pre-piloted, anonymous questionnaire was sent to all general practitioners (GPs) (n=842) involved in shared maternity care at six maternity hospitals in Victoria, Australia. Results Pregnant women were found to decrease or discontinue their asthma medications, without consulting their doctors. Reasons behind their decisions included lack of support and information, concerns about the safety of medications, past experiences and a desire for an “all natural” pregnancy. Asthma monitoring and communication between pregnant women and health professionals regarding asthma management were poor. GPs were hesitant to continue asthma medications during pregnancy. In response to vignettes, a quarter (25.8%) of GP respondents would stop or decrease patients’ inhaled corticosteroid doses during pregnancy, even when asthma was well controlled by current therapy. In addition, 12.1% were not sure how to manage deteriorating asthma during pregnancy and opted to refer to a specialist. Conclusions Despite the evidence for rigorously managing pregnant women with asthma; management of asthma in pregnant women is still suboptimal. A lack of confidence and/or knowledge among GPs in managing deteriorating asthma in pregnancy was observed. Furthermore, pregnant women have not been well supported in managing their asthma during pregnancy, causing them concern. Interventions targeting pregnant women should be developed and evaluated, with a focus on the balance of risks and benefits of taking asthma medication during pregnancy versus the potential harm of uncontrolled asthma.