Asthma and female reproductive health: implications for fertility and pregnancy

PURPOSE OF REVIEW: Asthma is a chronic respiratory disease prevalent among women of reproductive age and has important implications for fertility, pregnancy, and offspring health. This review summarizes current evidence on the bidirectional interactions between asthma and female reproductive physiology, with particular emphasis on fertility and pregnancy. RECENT FINDINGS: Perimenstrual asthma represents a distinct phenotype associated with greater disease severity and increased healthcare utilization. Asthma impairs fertility and is associated with longer time to conception, higher rates of infertility, and greater use of fertility treatment, although appropriately controlled asthma does not appear to adversely affect fertility rates or assisted reproductive technique outcomes. During pregnancy, poor asthma control and exacerbations are the principal drivers of adverse maternal and fetal outcomes, including hypertensive disorders, preterm birth, fetal growth restriction, and neonatal morbidity. Contemporary evidence supports continuation of guideline-directed asthma therapy, including inhaled corticosteroids and selected biologics when indicated. Prenatal vitamin D supplementation has shown a reduction in early childhood asthma or recurrent wheeze in pooled analyses, while omega-3 fatty acid supplementation has demonstrated variable benefit and is being evaluated in an ongoing confirmatory trial. SUMMARY: Asthma influences multiple aspects of female reproductive health. Optimizing disease control before conception and throughout pregnancy remains the most effective strategy for improving maternal and offspring outcomes. Although asthma has been associated with delayed conception and greater use of fertility treatment, appropriate disease control does not reduce overall fertility.