Uncontrolled Asthma during pregnancy linked to Autism and Cerebral Palsy Risks:

Gaining good asthma control is absolutely crucial for healthy and stress-free pregnancy and birth. But simply having medicine on hand to gain control over uncontrolled symptoms without actually considering breathing behaviour is not always enough to prevent asthma attacks from happening. Some medicines, especially when over used, may be putting developing babies at risk of Autism and other neural disorders.

Bronchodilator medicines (B2A Agonists) that are commonly used to reduce and rescue asthma attacks are able to cross the placenta barrier and may affect developing neural tissue.

Lung Disease news reported this information in 2016, but many expectant mothers are still unaware that overuse of their rescue inhalers and use of long acting bronchodilators (LABA) may affect their unborn child. And the evidence suggests that the more rescue medicine expectant mothers with asthma use and the longer they use them; the more they may be putting their unborn children at risk.

Studies have suggested that Short Acting Bronchodilator (SABA) inhaler medications like Albuterol and Long Acting Bronchodilators (LABA) such as Salmeterol; are able to cross the placenta barrier and may affect developing neurons of unborn children – potentially increasing the risk of developing Autism. These medicines are commonly used as rescue inhalers to open the airways in an asthma emergency, and as maintenance, preventer or controller medications in combination with inhaled cortico-steroids. These medicines are life saving and should not be over looked, but increased use leads to increased risks of adverse outcomes.

Because mothers with uncontrolled asthma are already at greater risk of poor birth outcomes due to stress and other factors such as medicine over use, getting control of asthma symptoms with the least amount of medicine is of utmost importance – so this is usually the number one goal for healthy conception and pregnancy – and a healthy baby.

The “catch-22” is that during  pregnancy, hormones and restrictions on the diaphragm can lead to breathlessness and  hyperventilation episodes. Increased or altered breathing patterns due to these changes is stressful for both mom and baby. Compensatory breathing behaviour that is subconsciously enacted – like oral breathing due to stress or effort – will likely increase particle load leading to inflammation and histamine responses that have most asthmatics reaching for rescue inhalers. But being aware of triggers and being able to make modifications that could arrest an asthma attack before it gets to the stage where medical control is needed, may mean the difference between pregnancy being a special time and not a burden. Asthma shouldn’t stop any woman considering pregnancy or enjoying pregnancy, but better control over asthma symptoms makes for an easier time.

Breathing behaviour has a massive role to play in assisting asthma management, reducing stressful breathing reactivity and the safe and sustained reduction of medicine for attacks. This is also the one factor that the asthmatic has some measure of control over and can become empowered to better manage their condition. Breathing behaviour alters with stress, environment, speech patterns, sleep patterns, diet, exercise preferences and so on. It is unfortunate that this major factor is often overlooked when determining where an asthmatic is losing their carefully, and often hard won, control.

Pregnancy is not the ideal time to begin engaging in “breathing gymnastics” or “retreats” that encourage hyperventilation and deep breathing. But most expectant mothers instinctively know their breathing patterns have changed (breathlessness, more effort on mobilizing, etc) and will often research social media and online forums to find relief for their symptoms. 
But, when moms don’t know that breathing exercises can be harmful as well as helpful, it’s hard to know where to look for the correct information. The internet is littered with examples of “pop-psychology” or “relaxation” exercises that involve long breath holds, extended or deep breaths. Many of these techniques are not part of Normal Breathing patterns. Some techniques may even work to destabilize an already dysfunctional breathing pattern if done too often. Any stress – including stressful breathing – may exacerbate asthma symptoms and decrease control.

Buteyko techniques offered by a trained and experienced in person Buteyko practitioner are able to help most asthmatics gain control of asthma symptoms more naturally by Normalizing and Restoring breathing pattern. The restoration and recovery techniques are delivered as a program that is suited to your specific breathing pattern after a full assessment is done via questionnaires and your practitioner’s careful observance over several days.

Buteyko does not advocate abstinence from any prescribed medicines, especially as this also puts asthmatics at risk of increased asthma symptoms. Trained Buteyko Educators help to encourage an awareness of behaviour and triggers that cause attacks; and to create a personalized strategic adjunct health plan that can reduce symptoms and allow for better control with fewer interventions. Asthmatic women who want to have healthy pregnancies may find that getting control of their resting breathing – before they begin the process of growing and nurturing their baby – is a worthwhile health focus. All asthmatics who are thinking of conceiving or who are expecting should have regular health checkups with their asthma doctors to ensure that symptoms are as well controlled as possible with the least medicine.

Buteyko techniques teach how to arrest an asthma attack the second it begins, allowing asthmatics to reduce their reliance on inhaled bronchodilators and giving them other things to do when allergies strike. Symptom control using non-invasive breathing modifications that use relaxation to achieve normalized breathing patterns along with mindfulness and awareness of triggers is a form of self-care that effectively reduces reliance on medications that may be putting pregnancies at risk.

Other risk factors associated with poorly managed asthma include an increase in risk for hypoxia which may increase risk for the developing foetus. Increased rescue medicine use for uncontrolled asthma attacks without the use of controller or preventer medications was the focus of one large cohort study which shows a potentially concerning increase risk of cerebral palsy in female infants of Danish mothers although, because asthma in pregnancy is still poorly understood, it’s not clear how much of this risk may be due to the disease itself.

Some support resources and information hub for Cerebral Palsy can be found here.

Buteyko techniques (like those taught by Buteyko South Africa and the Buteyko Institute of Breathing and Health and BBEA senior educators) have shown to be a safe and effective adjunct intervention to assist medically uncontrolled asthmatics to regain control without increasing medicine use in several clinical and RC trials in the UK, Australia, New Zealand, Egypt, India (and also improved lung function scores here) and Canada.

©Buteyko South Africa

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