Book Review

Asthma and Allergy in Pregnancy and Early Infancy

N Engl J Med 1994; 330:1396-1397May 12, 1994

Article

Asthma and Allergy in Pregnancy and Early Infancy
Edited by Michael Schatz and Robert S. Zeiger. 636 pp. New York, Marcel Dekker, 1993. $165. ISBN: 0-8247-8795-1

The patients dealt with in this interesting book are particularly problematic and are often forgotten in discussions of both asthma and allergy. They are pregnant or suffer from asthma and allergic disorders in early infancy. It is argued in the preface that although pregnancy and early motherhood represent a special time -- often a time of joy and fulfillment -- the mother and infant may face formidable challenges if either has asthma. The strength of this book is its logical organization: the editors have attempted to make the material presented clinically relevant while also giving readers a solid scientific basis for making clinical decisions. For example, the first four chapters concentrate on the physiology of normal pregnancy and give the reader the basis for an understanding of the problems of allergy and asthma in pregnant women.

It is evident that we need to understand more clearly how pregnancy affects pulmonary physiology both mechanically and hormonally, as well as the specific risks imposed on the fetus by the disease and, even more, the treatment of the disease. The care of the pregnant woman is not merely a vexing problem in clinical medicine; I am just as happy to see a chapter on medical and legal issues as I am sad that it is necessary. The book covers pulmonary function in both healthy women and women with asthma, but readers would have benefited from a broader and more detailed discussion of the specific changes that occur in lung function during pregnancy.

The chapter on fetal oxygenation adequately summarizes normal physiology, although it makes no links between the health of the fetus and maternal illness. One of the key issues of concern to the internist, obstetrician, and pediatrician is the use of medication during pregnancy and lactation and how it influences the fetus and newborn. As a pediatrician, I would have preferred to see more discussion of how asthma drugs and allergy therapy affect the fetus and more on the safety of drugs during lactation and breast-feeding. The discussion of the effect of asthma on pregnancy and the effect of pregnancy on asthma is clear and very helpful, as is Michael Shatz's chapter on the specifics of asthma management during pregnancy.

Later, the book focuses on the infant, covering genetic factors in allergic disorders, environmental factors in the development of allergy, and the role of prevention in the management of allergy. I would have preferred more discussion of the development of asthma, which would have balanced the discussion of allergic disease and allergy in childhood; this is a fascinating and important area that is the focus of much work in pediatrics today. The same prejudice in favor of pediatric topics colored my reaction to the chapter on the wheezing infant. Two acknowledged world experts cover this topic very well, but they do not address lung-function testing in infants or the development of airway hyperreactivity in infants and children.

This book will aid those whose primary responsibilities involve the treatment of infants and pregnant women. The authors handle an extraordinarily complex area very well, considering the paucity of books that discuss asthma or allergy in either children or adults.

Howard Eigen, M.D.
Riley Hospital for Children, Indianapolis, IN 46202