If you have asthma, come up with a plan to manage it throughout your pregnancy.

RODALE NEWS, EMMAUS, PA—Few mothers want to risk an unborn baby’s health by taking harsh medications during pregnancy, but not taking them could pose even more serious threats, says Michael Schatz, MD, chief of the Department of Allergy at Kaiser Permanente Medical Center in San Diego. In the most recent issue of the New England Journal of Medicine, Dr. Schatz writes that poor asthma control during pregnancy (usually brought on by women not wanting to take medications) could lead to pregnancy-induced high blood pressure, premature births, and birth defects.

THE DETAILS: Asthma affects about 8 percent of pregnant women in this country, many of whom forgo treatment over concerns about the affects of inhaled steroids on their unborn babies. That can lead to a gamble when it comes to a baby’s health. “The most extreme risk is the mother dying or the baby dying,” Dr. Schatz says, adding that babies of asthmatic mothers could also be born prematurely or having low birth weight, both of which come with additional risks for a baby’s development.

Observational studies of mothers who take asthma medications during pregnancy, on the other hand, have found that, in most cases, the babies are born healthy. “There are a lot of misconceptions about the safety of medicines compared to the risk of uncontrolled asthma,” he says. “There are some [medications] that have more safety data than others,” he notes, but leaving asthma uncontrolled is not a healthy alternative.

WHAT IT MEANS: Asthmatic mothers-to-be should continue to take their medications for the duration of their pregnancy, even during labor and delivery, writes Dr. Schatz, and his opinion is seconded by the American College of Obstetrics and Gynecology. “One general rule that should resonate is that anything women can do to keep themselves healthy during pregnancy will be healthier for their babies,” Dr. Schatz says.

Here are a few things to keep in mind if you’re worried about asthma medications and your baby:

• Make sure your asthma is under control. “The data are clear that a lot of people think their asthma is controlled and it really isn’t,” says Dr. Schatz. You need to confirm with your doctor that your asthma is adequately controlled, he says. “If it is and can be controlled without medications, that’s best.” If it isn’t, he says, you can talk with your doctor about choosing medications that will pose the lowest threat to the baby.

• Follow the tried-and-true advice. “In terms of the nonmedicine approaches to asthma, there isn’t anything unique to pregnancy,” he says. Standard advice still holds true: Avoid tobacco smoke, smog, and other environmental triggers; keep pets out of the bedroom; encase your mattress and pillows in allergen and dust mite encasements; and, if your asthma is triggered by acid reflux, eat smaller meals and avoid foods that trigger the acid reflux.

• Pay attention to your baby’s movements. Dr. Schatz and his coauthor recommend regular fetal monitoring, such as ultrasounds, to keep an eye on the baby, and the American College of Obstetrics and Gynecology cautions asthmatic pregnant women to be extra-attentive to the activity of the baby. Call your doctor if you notice your baby is less active than usual, or if it has stopped moving altogether.