This week Allergy Cosmos spoke with Dr. Patrick O’Brien as part of our series of interviews with allergy and asthma experts across the UK. It is our hope that reading about these experts' opinions and research work will provide you with valuable insight into your own life with allergy, asthma and general air pollution.
Dr. Patrick O’Brien is the spokesperson for the Royal College of Obstetricians & Gynaecologists and Consultant & Senior Lecturer in Obstetrics and Gynaecology at University College London Hospitals. He spoke to Allergy Cosmos about allergy and asthma during pregnancy.
Q. If you are pregnant and you suffer with asthma or another allergic condition, is it safe to carry on with your medication? Do any of the drugs you might be using pose a risk to the unborn child?
Dr. Patrick O’Brien: In pregnancy, one-third of women with asthma find their condition improves, in another third, it gets worse, and in the rest, there is no change. Most asthma medicines, like Ventolin, come as inhalers and they are completely safe for the baby. In fact, if you do have an asthma attack in pregnancy it is very important to treat it because if your oxygen levels are low, that is bad for the baby. Some women with asthma will be prescribed steroid tablets. These two are completely safe for the baby.
Q. What is the latest thinking on what causes babies to be born with asthma or allergy?
Dr. Patrick O’Brien: This is a difficult question to answer! The whole basis of what causes asthma or allergy in new-borns is still unclear. The best we can say at the moment is that there is often an underlying genetic predisposition to asthma or allergy and contact with some factor in the environment triggers it.
Q. Is there anything a woman can do during pregnancy to protect her baby from asthma or allergies?
Dr. Patrick O’Brien: We used to advise women to avoid peanuts to prevent their babies from developing a peanut allergy. New research looked at this again and showed that peanut consumption in pregnancy does not, in fact, increase the risk of babies being born with an allergy. Smoking in pregnancy is bad, of course, for so many reasons - it damages the placenta, reduces the baby’s oxygen supply and causes all sorts of other complications. But there is not a lot of evidence that smoking in pregnancy increases the risk of allergies.
Q. What about breastfeeding? Does that have any bearing on whether your baby will develop asthma or any other allergic disease?
Dr. Patrick O’Brien: It has always been believed that long-term breastfeeding protects a baby from allergy. But recent research published in the British Medical Journal suggests that delaying the introduction of solid foods actually increased the risk of allergy and breastfeeding should perhaps be stopped at around six months rather than continued for longer. [note that RCOG has not changed its advice on breastfeeding, as yet, in the light of this new evidence]
Q. Any other advice for women who are pregnant, or trying to get pregnant, on managing allergies and protecting their baby from allergy?
Dr. Patrick O’Brien: A woman’s skin is often more sensitive during pregnancy. If you have a skin allergy, like eczema, do carry on using your steroid creams, E45, diprobase and so on - they are all safe for your baby. Women should also be aware of a liver problem called cholestasis which can harm the unborn child. Cholestasis can cause itching to get worse. If this happens, don’t assume it is your skin allergy flaring up - check with your midwife or doctor straight away.
Dr. Patrick O’Brien has been a Consultant & Honorary Senior Lecturer in Obstetrics and Gynaecology at University College London Hospitals since 1999. He qualified as a doctor in Ireland, but all his postgraduate training has been in London. He specialises in Maternal Medicine and high-risk obstetrics, and at UCLH jointly runs a multi-disciplinary antenatal clinic involving consultants in Fetal Medicine, Cardiology, Haematology, Diabetes, Anaesthesia, and an Obstetric Physician. He has a particular interest in complications of pregnancy. He lectures widely in the UK and abroad, and runs courses on fetal monitoring, medical problems in the delivery suite, and psychiatric problems in pregnancy.
He is the Chair of the International Division of the Institute for Women’s Health in London, and a spokesperson for the Royal College of Obstetricians & Gynaecologists. He is a reviewer for the Cochrane Collaboration and several medical journals. He examines for the DRCOG examination. He is a member of the obstetric guideline development group of the National Institute for Clinical Excellence in the UK. He also works with BBC Television (British Broadcasting Corporation) as an obstetric advisor.
To learn more about allergies and asthma during pregnancy, visit our Asthma During Pregnancy Information Page.