Asthma is one of the most common chronic diseases affecting pregnant women with variable prevalence around the world. Hormonally mediated and physical changes to the respiratory system occur during pregnancy and can impact asthma status unpredictably—some women improve, some worsen and some are stable. Increased maternal and foetal adverse outcomes are observed with uncontrolled asthma. Medication non-adherence increases in pregnancy, often because of concerns regarding the effect of medications on the developing foetus and is a major contributor to loss of asthma control. Certain comorbidities, particularly metabolic comorbidities, are more common in pregnant women with asthma and are increasingly understood to impact asthma and pregnancy outcomes. There is reassuring observational data to suggest the safety of omalizumab and dupilumab in pregnancy, but more studies are needed. This review highlights the current evidence regarding epidemiology, pregnancy-related respiratory changes, comorbidities and treatment of asthma in pregnancy.

BackgroundThis study is aimed at identifying early-life modifiable factors associated with allergic rhinitis to assist in reducing the public health burden of allergic rhinitis on young children and their families.MethodsChildren of mothers with asthma in the Breathing for Life Trial cohort were followed over 4 years. Potential risk and preventative exposures (outdoor, home environment and early life) were measured at 12 months using a validated parent-reported questionnaire. Validated questionnaires and a skin prick test were administered to collect outcome data at 4 years-allergic rhinitis symptoms (n = 285), hay fever (n = 276), airborne allergen sensitisation (n = 142) and persistent rhinitis (n = 285). Multivariate logistic regression assessed associations, and population attributable fractions (PAFs) and prevented fractions for the population (PFPs) were calculated.ResultsParent-reported bronchiolitis before 12 months of age was associated with allergic rhinitis symptoms (adjOR 1.95, 95% CI 1.07-3.57, PAF 17.6%). Additionally, hospitalised bronchiolitis was associated with hay fever (PAF 13.5%). Cat ownership was associated with lower odds for allergic rhinitis symptoms and persistent allergic rhinitis (PFP 17% and 24.2%, respectively), and dog ownership was associated with lower odds for hay fever (PFP 23.7%). Additionally, gas cooking was associated with reduced persistent allergic rhinitis (PFP 22.5%) and total breastfeeding for 4-6 months with reduced hay fever (PFP 14.9%). Associations with traffic frequency, second-hand smoking, type of heating and childcare attendance were not significant.ConclusionEarly respiratory infection and cat and dog exposure were identified as potentially modifiable exposures to reduce the risk of childhood allergic rhinitis.

RATIONALE:Prenatal exposure to air pollution is linked to impaired infant lung function. At-risk infants, such as those born to mothers with asthma during pregnancy, may be more vulnerable. OBJECTIVES:Investigate whether prenatal particulate matter ⩽2.5 μm in aerodynamic diameter (PM2.5) exposure is associated with lung function and cord blood proteins in infants of mothers with asthma during pregnancy compared to those of non-asthmatics. METHODS:In the Swiss Basel-Bern Lung Development and the Australian Breathing for Life Trial cohorts, we investigated associations between prenatal PM2.5 exposure, lung function, and cord blood proteins (n = 433 infants of asthmatic mothers; n = 620 of non-asthmatic mothers). RESULTS:PM2.5 exposure was inversely associated with functional residual capacity, with stronger reductions among infants of asthmatic mothers (β -0.19 SD, p < 0.001) than those of non-asthmatics (β -0.08 SD, p = 0.059; p for interaction = 0.031). Exposure was associated with increased FeNO in infants of asthmatic mothers (β = 0.12 SD, p = 0.050), but decreased FeNO (β -0.15 SD, p = 0.003) for those of non-asthmatics (p for interaction = 0.001). The association between maternal PM2.5 exposure and cord blood protein levels differed by maternal asthma status. Infants of asthmatic mothers had higher VEGF-A (1.02 SD, p = 0.016), IL-9 (0.44 SD, p = 0.042), IL-10 (0.41 SD, p = 0.048), and IL-13 (0.43 SD, p = 0.046) concentrations than those of non-asthmatics who only had higher TNF-α (0.08 SD, p = 0.041). However, after multiple-comparison correction, these associations did not remain significant. CONCLUSION:Lung function in infants of mothers with asthma during pregnancy is more affected by PM2.5 compared to those of non-asthmatic mothers. Different PM2.5 association patterns for FeNO and cord blood proteins may indicate different host response mechanisms.

BACKGROUND:Prenatal exposure to air pollutants may increase the risk of adverse respiratory outcomes, particularly in offspring of asthmatic mothers. Evidence on wildfire-related PM2.5 exposure during pregnancy remains limited. This study investigated associations between early gestational wildfire-related PM2.5 exposure, infant lung function, and respiratory outcomes at 6 years. METHODS:Gestational wildfire-related PM2.5 exposure patterns were characterised using group-based trajectory modelling and linked to infant lung function outcomes. Infant respiratory measurements were obtained at six weeks of age during behaviourally defined quiet sleep using tidal-breathing flow-volume loops (TBFVL). Airway mechanics at six years were assessed by impulse oscillometry (IOS) following international guideline standards. Trajectory modelling of PM2.5 during gestation was conducted in SAS (PROC TRAJ); all additional statistical analyses were performed in Stata IC 16.1. RESULTS:Increased mean tidal inspiratory flow (MTIF, beta coefficient [β]: 10.51 mL/s, 95% CI: 3.66 to 17.36, p = 0.003) and peak tidal inspiratory flow (PTIF, β: 12.49 mL/s, 95% CI: 2.48 to 22.51, p = 0.014) were observed in infants born to mothers with higher wildfire-related PM2.5 exposure during early gestation (n = 420; n = 411 not exposed, n = 9 exposed). β-coefficients from infant mixed models were then used as proxy indicators and applied in linear regression models and associated with higher reactance at 5 Hz frequency (n = 73) at 6 years of age (PTIF: β: 9.88 mL/s, 95% CI: 0.10 to 19.67, p = 0.048 and MTIF: β: 13.43 mL/s, 95% CI: 1.43 to 25.44, p = 0.029). PTIF was further associated with asthma diagnoses at 6 years (aOR: 1.36, 95% CI: 1.07 to 1.73, p = 0.012; n = 259; n = 116 asthma). CONCLUSION:Early gestational exposure to wildfire-related PM2.5 may be linked with altered respiratory patterns in infancy and differences in airway reactance during childhood. Findings also suggest a relationship with asthma risk, although mechanisms remain uncertain.

Background Inhaled corticosteroid (ICS) use in pregnancy has shown associations with decreased offspring asthma in childhood, whereas exacerbations in pregnancy may increase the risk. However, these findings have not been tested in population-based cohorts with rigorous assessment of confounding structures. The aim was to describe asthma exacerbations and ICS utilisation during pregnancy and to assess causal pathways between pregnancy exacerbations, ICS use and offspring asthma.Methods Register-based cohort study of pregnancies in New South Wales (NSW), Australia and Sweden. Maternal monthly asthma exacerbations (hospital visits and/or oral corticosteroid (OCS) dispensings) and ICS dispensing rates were calculated 12 months prepregnancy to 12 months post partum. Among mothers with asthma (35 194 NSW, 102 248 Sweden), Hazard Ratios (HR)s were calculated for pregnancy exacerbations or ICS use and offspring asthma adjusting for confounders including asthma severity. Associations between paternal exposures and offspring asthma and sibling analyses assessed the likelihood of unmeasured confounding.Results Maternal asthma prevalence was 8.6% in NSW and 7.1% in Sweden. While ICS use was maintained over the course of pregnancy, a postpartum decline was observed, accompanied by a rise in OCS use. Adjusted HRs for offspring asthma were 1.47 (95% CI 1.32 to 1.64, NSW) and 1.30 (95% CI 1.24 to 1.36, Sweden) following maternal exacerbations, and 1.37 (95% CI 1.26 to 1.49, NSW) and 1.23 (95% CI 1.19 to 1.27, Sweden) following maternal ICS use. Paternal exposures were also associated with offspring asthma, while associations in sibling analyses were not significant.Conclusions Observed associations between maternal exacerbations, ICS use and offspring asthma appear to be due to unmeasured confounding. Management of maternal asthma remains a priority in pregnancy and post partum.

BACKGROUND:Climate change is contributing to more frequent wildfires. Exposure to wildfire smoke during pregnancy increases the risk of adverse neonatal outcomes. Pregnant women with asthma and their newborns are particularly at risk of negative effects from wildfire smoke exposure and remain understudied. Determining critical windows of exposure during pregnancy could help inform mitigation strategies for this high-risk group. OBJECTIVE:This study aimed to assess the association of prenatal wildfire smoke exposure with adverse neonatal outcomes in mothers with asthma and to determine which period of pregnancy is most critical. STUDY DESIGN:This was a multicenter cohort study (Breathing for Life Trial) including mothers and newborns from 6 antenatal clinics across 4 cities in Australia (Sydney, Brisbane, Newcastle, Canberra). Pregnant women (n=1275) with asthma were recruited at 12 to 23 weeks of gestation. Chronic lung disease (other than asthma), miscarriages, and perinatal deaths were excluded. Prenatal wildfire smoke exposure days and daily wildfire-related particulate matter ≤2.5 μm concentrations were determined by residence. Exposure over pregnancy was assessed in 3 ways: (1) cumulative days of wildfire smoke (0, 1-4, 5-9, ≥10 days); (2) wildfire smoke-affected days and wildfire-related particulate matter ≤2.5 μm as continuous variables for each gestational month; and (3) a natural experiment comparing exposure during the 2019-2020 summer extreme wildfire period with historical controls. Neonatal outcomes included birthweight, low birthweight (<2500 g), gestational length, preterm birth (<37 weeks), neonatal intensive care unit admission, and cesarean delivery. RESULTS:The mean age of women was 30.7 years (SD, 5.5), 85% were White, 15% were smokers, and 69% were overweight or obese. The prenatal mean daily particulate matter ≤2.5 μm concentration (all sources) was 7.6 μg/m3 (SD, 1.42); the median daily wildfire-related particulate matter ≤2.5 μm concentration was 0.1 μg/m3 (range, 0-7.7 μg/m3); and the median number of prenatal cumulative days of wildfire smoke exposure was 3 (range, 0-71 days). Prenatal exposure to ≥10 cumulative wildfire smoke days was associated with low birthweight (adjusted odds ratio, 4.2; 95% confidence interval, 1.2-13.9), preterm birth (adjusted odds ratio, 2.8; 95% confidence interval, 1.1-7.2), and neonatal intensive care unit admission (adjusted odds ratio, 5.0; 95% confidence interval, 1.4-17.8). Exposure to wildfire-related particulate matter ≤2.5 μm in the second and third gestational months was associated with preterm birth, small for gestational age, and neonatal intensive care unit admission. In the natural experiment, prenatal exposure was associated with low birthweight (adjusted odds ratio, 2.6; 95% confidence interval, 1.1-6.2), preterm birth (adjusted odds ratio, 2.5; 95% confidence interval, 1.2-5.2), and neonatal intensive care unit admission (adjusted odds ratio, 4.8; 95% confidence interval, 2.0-11.2). CONCLUSION:In pregnant women with asthma, prenatal exposure to wildfire smoke early in pregnancy increases the risk of adverse neonatal outcomes. Measures to reduce wildfire smoke exposure early in pregnancy could be beneficial.

Asthma affects 8% to 13% of pregnant individuals and worsens in approximately 30% to 40% during pregnancy. Exacerbations during pregnancy are associated with adverse maternal and infant outcomes. Despite extensive evidence supporting the safety and efficacy of asthma medications during pregnancy, medication nonadherence is common for myriad reasons, even among previously adherent patients, and presents an important modifiable risk factor for asthma control. Asthma management during pregnancy is accompanied by other unique complexities regarding diagnosis, potential need for increased maternal and fetal monitoring, and delivery considerations. In this Grand Rounds Review, we discuss the clinical perspective in managing patients with asthma, including presentation, diagnosis, treatment and exposure mitigation, medication adherence, assessment of control, and how to address common concerns unique to pregnancy, delivery, and the postpartum period. Health care professionals are encouraged to take a holistic approach, considering the multiple factors that may influence asthma control and medication adherence, and using shared decision-making to address barriers to asthma control. Factors such as obstetric history, comorbidities, and structural factors, including housing, air pollution, and poverty, can impact management.

Introduction Asthma is one of the most prevalent long-term health conditions affecting pregnant women. Poorly controlled asthma during pregnancy is associated with adverse maternal and fetal outcomes and may predispose offspring to long-term respiratory morbidity. The current ‘one size fits all’ approach to asthma management during pregnancy is not optimally effective for approximately half of the pregnant women with asthma. A personalised medicine approach to managing airways disease is required. The treatable traits approach focuses on the identification and treatment of traits in the pulmonary, extra-pulmonary and behavioural domains, which are identifiable, measurable, clinically relevant (linked to exacerbation risk or poor asthma control) and treatable. This manuscript outlines the protocol for the Treatable Traits for Asthma Management in Pregnancy (TTAP) study. The purpose of the TTAP study is to prospectively determine the prevalence of a range of treatable traits from these three domains in pregnant women with asthma and determine which traits are associated with exacerbation risk, poor asthma control and poor asthma-related quality of life. Additionally, this study will assess differences in trait prevalence and clinical relevance in pregnant women from regional versus metropolitan hospitals in Australia and in different antenatal models of care.Methods and analysis The TTAP study is a multicentre, prospective observational cohort study. Study participants are pregnant women with asthma attending antenatal clinics at 10 metropolitan and regional hospitals (public and private) in NSW and Victoria, Australia. Assessment of traits from the pulmonary, extrapulmonary and behavioural domains as well as asthma outcomes is conducted at three gestational timepoints: 12–16 weeks, 22–26 weeks and 32–36 weeks of pregnancy. A follow-up assessment of asthma outcomes is conducted at 2–4 weeks postpartum. The outcomes assessed are asthma exacerbations requiring medical intervention (primary outcome), asthma symptom control and asthma-related quality of life. Traits and outcomes will be assessed using questionnaires, direct questioning, measurement of biomarkers, physical measurements and assessment of routinely collected data from medical records.Ethics and dissemination The Hunter New England Human Ethics Committee (2024/ETH01289) has approved the TTAP study protocol. Outcomes will be published in peer-reviewed journals, presented at scientific conferences and disseminated online to participants, clinicians and other pregnant women with asthma and their families via the Asthma in Pregnancy Toolkit website https://asthmapregnancytoolkit.org.au/.

Background Maternal asthma during pregnancy is associated with an increased risk of bronchiolitis and asthma in offspring, but the mechanisms remain poorly understood. We aimed to assess whether impaired postnatal infant lung function independently influences the risk of bronchiolitis and asthma in childhood or whether it mediates the association between maternal asthma during pregnancy and respiratory outcomes.Methods We analysed harmonised infant lung function data from two birth cohorts: the Australian Breathing for Life Trial and the Swiss Basel-Bern Infant Lung Development. Bronchiolitis hospitalisation (verified through medical records) and asthma at age six (parent-reported) were primary outcomes. Lung function measured included the ratio of maximum tidal inspiratory flow to maximum tidal expiratory flow (MTIF/MTEF) and the time to peak tidal expiratory flow to total expiratory time ratio, tPTEF/tE. Multivariable logistic regression assessed associations, and generalised structural equation modelling was used for mediation analyses.Results The study included 1203 term infants with 89 cases of bronchiolitis hospitalisation. Tidal breathing lung function ratios were associated with bronchiolitis hospitalisations: MTIF/MTEF adjusted ORs (aORs) 2.90, 95% CI 1.20 to 7.02, p=0.018; asthma in childhood: tPTEF/tE aOR 0.97, 95% CI 0.94 to 0.99, p=0.013 and MTIF/MTEF aOR 2.94, 95% CI 1.07 to 8.02, p=0.036. MTIF/MTEF ratio mediated 11% of the total effect of asthma during pregnancy on bronchiolitis risk, and MTIF/MTEF and tPTEF/tE ratios mediated 3% of the effect of asthma during pregnancy on childhood asthma risk.Conclusion Postnatal lung function was associated with subsequent bronchiolitis and childhood asthma. Additionally, the effect of maternal asthma during pregnancy on the outcomes was partially mediated by impaired lung function.

BACKGROUND:Asthma and gestational diabetes mellitus (GDM) are prevalent in pregnancy, with asthma previously associated with an increased GDM risk. Each independently increases the risk of adverse perinatal outcomes, but the effect of dual exposure is unknown. OBJECTIVE:To compare clinical, demographic, and perinatal outcome data between women with and without asthma, who do and do not develop GDM. METHODS:Data for singleton births to mothers aged 18 years or older were extracted from electronic records across 2 Australian Health Districts (2018-2020). The effects of asthma and/or GDM on perinatal outcomes were estimated using generalized estimating equations. RESULTS:Of 40,149 pregnancies, 9.6% had asthma only, 9.6% had GDM only, and 1.4% had asthma and GDM. Asthma was not associated with GDM risk, following adjustment for confounders (adjusted relative risk [aRR] 1.04; 95% confidence interval [95% CI] 0.96-1.13). Compared with neither exposure, asthma and/or GDM was associated with an increased risk for each cesarean birth and infant respiratory distress. Asthma was also associated with an increased risk of preterm birth (aRR 1.15; 95% CI 1.03-1.29), low birth weight (aRR 1.15; 95% CI 1.03-1.29), and congenital anomalies (aRR 1.15; 95% CI 1.03-1.29). There was also an increased risk of hypertensive disorders of pregnancy (aRR 1.36; 95% CI 1.05-1.77) with dual exposure. No multiplicative interactions between asthma and GDM were detected. CONCLUSIONS:Asthma and/or GDM increased the risk of adverse perinatal outcomes, but no synergistic effect was observed for asthma+GDM exposure. Asthma was not associated with an increased risk of GDM after adjusting for important confounders, including obesity.

Maternal asthma has been linked to child autism. In this study, we systematically reviewed observational studies published between July 2001 and February 2024 that assessed maternal asthma during pregnancy (exposure) and child autism (outcome). Databases searched included MEDLINE, CINAHL, EMBASE, and PsycINFO. Of the 350 potential studies, 19 met the inclusion criteria (2,530,716 participants; 73,065 autistic participants). Quality was assessed with the Newcastle-Ottawa Scale. Meta-analyses using proportions and odds ratios were conducted using the Mantel-Haenszel method with a random-effects model. Compared to women without asthma, there was an increased odds of child autism with any history of maternal asthma (OR = 1.32; 95% CI = 1.21, 1.44; I2 = 61%, n = 14), with current asthma during pregnancy (OR = 1.23; 95% CI = 1.12, 1.35; I2 = 35%, n = 10) and with medication use during pregnancy (OR = 1.48; 95% CI = 1.30, 1.68; I2 = 0%, n = 3). However, when women with asthma who used asthma medication were compared to those with asthma who did not use medication, there were no increased odds for child autism (OR = 1.07; 95% CI = 0.89, 1.27; I2 = 34%, n = 2). Maternal asthma is associated with an increased odds of child autism. Future studies should consider neurodivergence in the parents, the severity of asthma, and the effectiveness of prescribed medication in managing the mother's asthma to improve our understanding of this association. Trial Registration: PROSPERO registration: CRD42021265060.

INTRODUCTION:Poor respiratory health in childhood is common, and asthma is the most common chronic disease among children, for which there is no known cure. Maternal intake of vitamins (A, C, E) may be a modifiable nutritional exposure to reduce adverse respiratory health in offspring. OBJECTIVE:We aimed to systematically review the evidence for the association between maternal vitamin (A, C, E) intake during pregnancy (via questionnaire or blood assay) and respiratory outcomes in the offspring. METHODS:Studies identified through electronic databases were eligible if they assessed maternal levels and/or intake of vitamins A, C and/or E via dietary intake or supplements in pregnancy and respiratory outcomes in the first 5 years of life. Meta-analyses were conducted where possible. Outcomes included wheeze, cough, asthma, infant respiratory distress syndrome (RDS), respiratory tract infection (RTI) and lung function measurement. RESULTS:Of 1170 articles screened, 12 observational studies and six RCTs met the inclusion criteria (total sample size n = 58,769). Meta-analysis could not be performed for vitamin A; however, there was no evidence to suggest that maternal vitamin A intake improves early life respiratory outcomes in offspring. Two RCTs found that vitamin C supplementation (500 mg/day vs. placebo) reduced the incidence of wheeze at 12 months (n = 206 children) and 5 years (n = 213 children) in pregnancies exposed to smoking. In meta-analyses, maternal intake in the highest vitamin E quartile versus lowest reduced the odds of wheeze at 2 years by 36% (aOR: 0.64, 95% CI: 0.47-0.87, n = 2 observational studies, very low certainty); this was not true for vitamin C intake (aOR: 0.85, 95% CI: 0.63-1.16, n = 2 observational studies, very low certainty). Vitamin supplementation (C + E) was not associated with infant RDS (OR: 1.15, 95% CI: 0.80-1.64, n = 2 studies, moderate certainty) relative to placebo. CONCLUSION:There may be some benefit to vitamin C supplementation during pregnancy in the context of maternal smoking or higher maternal vitamin E intake during pregnancy, for reducing the risk of childhood wheeze in early life. This emerging evidence warrants further studies to enable translation into dietary guidelines.

Background Improved maternal asthma management in pregnancy may reduce recurrent bronchiolitis and wheeze outcomes in infancy. We assessed whether infant bronchiolitis and wheeze outcomes are influenced by inflammation-guided management intervention, inhaled corticosteroid (ICS) use or exacerbations in pregnancy. Methods A randomised controlled trial (RCT) secondary analysis and observational cohort analysis using the same study population was carried out. Pregnant women (12–23 weeks’ gestation) from six centres in Australia were recruited and randomised to inflammation-guided asthma management or usual care between 2013 and 2023. ICS use and asthma exacerbations were reported during pregnancy and postnatally. When infants were 6 (n=691) and 12 (n=606) months of age, respiratory information was collected from parents and medical records. Associations for the RCT and observational analyses were assessed with logistic regression. Results Guided asthma management in pregnancy was not associated with bronchiolitis or wheeze-related outcomes, for example for recurrent bronchiolitis at 12 months, the intervention OR was 1.04 (95% CI 0.62–1.73). In the observational analyses, ICS use in pregnancy was not associated with respiratory outcomes; however, asthma exacerbations in pregnancy were associated with at least one bronchiolitis episode (adjusted odds ratio (adjOR) 2.20, 95% CI 1.28–3.76) or croup episode (adjOR 4.34, 95% CI 1.89–9.96) at 6 months, and wheeze (adjOR 1.80, 95% CI 1.14–2.84) and increasing wheeze episodes at 12 months (adjOR 1.81, 95% CI 1.17–2.79). Conclusion Although there was no evidence that guided asthma management or ICS use in pregnancy reduces infant bronchiolitis or wheeze, maternal asthma exacerbations are an important risk factor for these outcomes. Further research is needed to reduce exacerbations in pregnancy.

Asthma is one of the most common chronic diseases affecting pregnant women with variable prevalence around the world. Hormonally mediated and physical changes to the respiratory system occur during pregnancy and can impact asthma status unpredictably—some women improve, some worsen and some are stable. Increased maternal and foetal adverse outcomes are observed with uncontrolled asthma. Medication non‐adherence increases in pregnancy, often because of concerns regarding the effect of medications on the developing foetus and is a major contributor to loss of asthma control. Certain comorbidities, particularly metabolic comorbidities, are more common in pregnant women with asthma and are increasingly understood to impact asthma and pregnancy outcomes. There is reassuring observational data to suggest the safety of omalizumab and dupilumab in pregnancy, but more studies are needed. This review highlights the current evidence regarding epidemiology, pregnancy‐related respiratory changes, comorbidities and treatment of asthma in pregnancy.

BACKGROUND:Optimal management of asthma during pregnancy is an important element in improving maternal and neonatal outcomes. Asthma effects 12.7 % of pregnant women in Australia. Despite consistent management recommendations available via clinical practice guidelines for asthma in pregnancy, pregnant women with asthma are not receiving guideline recommended care. This study builds on previous research and aims to explore the asthma management experiences of pregnant women with asthma. Specifically, to gain insight into pregnant women's understanding of their asthma; previous and current exposure to asthma education; and attitudes towards their asthma management and medication use. METHODS:This qualitative descriptive study involved individual semi-structured interviews with pregnant women with asthma. Data were transcribed and analysed using content analysis. The participants were recruited from those enrolled in the Breathing For Life Trial (BLT), an RCT of inflammation-guided asthma management in pregnancy versus usual care. RESULTS:A total of 24 women were interviewed between June 2018 and May 2020. Three main themes: "Did not think asthma was an issue", "If I'm not getting oxygen in then neither is my baby" and "Beyond pregnancy care" were identified along with 9 sub-themes which showed asthma knowledge, attitude and medication adherence variation depending on experiences with asthma management. CONCLUSIONS:This study highlighted the varied experiences of this cohort of pregnant women with asthma and identified the need for ongoing consistent asthma management to improve the knowledge, attitude, and medication adherence of women with asthma before during and after pregnancy, and in turn improve maternal and neonatal outcomes.