Aim To explore the changes regarding the incidence, risk factors, and outcome of bronchial asthma (BA) exacerbation in pregnancy in the setting of advancements in the management and pharmacotherapy of asthma compared with that previously reported. Patients and methods A prospective cohort study recruited 308 pregnant asthmatic patients in the period from January 2015 to January 2018. All patients received asthma health education (adherence to medications, proper usage of inhalers, written action plan, trigger avoidance, and smoking cessation counseling) and a monthly revision and adjustment of asthma medications according to its control together with treatment of exacerbation when present until 36 weeks of gestation. BA exacerbation was the primary outcome of the present study. Results Seventy-seven (25%) patients experienced exacerbations, and 25 of them were hospitalized, with ICU admissions in 11 (3.5%) patients. Exacerbation was evident in those with higher;Deg;BM;Deg;I (32.86±3.53 kg/m2, P=0.01), current smoker (28.6%, P<0.001), low education level (42.9%, P=0.01), and severe baseline asthma (57.1%, P<0.001). Multivariate logistic analysis identified certain independent predictors of exacerbation and hospitalization in pregnant asthmatics. Pregnant asthmatic with;Deg;BM;Deg;I more than 32.5 kg/m2 [odds ratio (OR), 1.6; 95% confidence interval (CI), 1.67–3.99; P=0.026) and current smoker (OR, 1.4; 95% CI, 1.39–4.79; P=0.03) were more likely to have exacerbation. Moreover, those with baseline severe asthma (OR, 1.2; 95% CI, 1.12–2.31; P=0.028) were at increased risk of hospitalization owing to exacerbation. There was no association between adverse perinatal outcomes and;Deg;BA;Deg; exacerbation in pregnant asthmatics. Conclusion The incidence of BA exacerbation during pregnancy is observed to be reduced in the present study compared with the previously reported. Being smoker and having higher BMI were predictors of exacerbation, whereas severe baseline asthma was predictor of hospitalization in pregnant asthmatics.