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Warintaksa P, Lertrat W, Romero R, Vivithanaporn P, Mongkolsuk P, Kamlungkuea T, Settacomkul R, Pongchaikul P, Chaemsaithong P. Anaphylaxis-induced premature uterine contractions: a case report and literature review. BMC Pregnancy Childbirth 2024; 24:197. [PMID: 38481196 PMCID: PMC10935842 DOI: 10.1186/s12884-024-06297-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 01/28/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Preterm labor is caused by multiple etiologies, including intra-amniotic infection and/or intra-amniotic inflammation, vascular disorders, cervical disease, decidual senescence, and breakdown of maternal-fetal tolerance. Accumulating evidence in vivo and in vitro has shown that an allergic reaction, including anaphylaxis, can induce preterm uterine contractions. This report describes a case of a pregnant woman who developed anaphylaxis and regular uterine contractions after the ingestion of a strawberry-coated biscuit. We also review the mechanism of allergic reaction (hypersensitivity)-induced preterm labor. Case presentation A 31-year-old woman (gravida 1, para 0) at 30+2 weeks of gestation was admitted to the labor and delivery unit with regular uterine contractions and anaphylactic symptoms after she ingested a strawberry-coated biscuit as a snack. The uterine contractions resolved after the treatment of anaphylaxis by administering antihistamines and epinephrine. The patient subsequently delivered at 39+3 weeks of gestation. The amniotic fluid profile showed no infection or inflammation. A postpartum skin-prick test confirmed a positive type 1 hypersensitivity reaction to the strawberry-coated biscuit. CONCLUSIONS We report a case of anaphylaxis-induced uterine contractility in which uterine contractions subsided after the treatment of anaphylaxis. The absence of intra-amniotic infection and/or intra-amniotic inflammation and the cause of the anaphylaxis were confirmed. Our findings indicate that maternal allergic reactions may be one of the mechanisms of preterm labor.
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Affiliation(s)
- Puntabut Warintaksa
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Waranyu Lertrat
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Roberto Romero
- Pregnancy Research Branch, Division of Obstetrics and Maternal-Fetal Medicine, Division of Intramural Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, U.S, Department of Health and Human Services (NICHD/NIH/DHHS), Bethesda, MD, 20892, USA.
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, 48109, USA.
- Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI, 48824, USA.
| | - Pornpun Vivithanaporn
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital Mahidol University, Samut Prakan, 10540, Thailand
| | - Paninee Mongkolsuk
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital Mahidol University, Samut Prakan, 10540, Thailand
| | - Threebhorn Kamlungkuea
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand
| | - Rapeewan Settacomkul
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital Mahidol University, Samut Prakan, 10540, Thailand
| | - Pisut Pongchaikul
- Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital Mahidol University, Samut Prakan, 10540, Thailand.
- Integrative Computational BioScience Center, Mahidol University, Nakhon Pathom, 73170, Thailand.
- Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, L69 3BX, UK.
| | - Piya Chaemsaithong
- Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, 10400, Thailand.
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Robijn AL, Harvey SM, Jensen ME, Atkins S, Quek KJD, Wang G, Smith H, Chambers C, Namazy J, Schatz M, Gibson PG, Murphy VE. Adverse neonatal outcomes in pregnant women with asthma: An updated systematic review and meta-analysis. Int J Gynaecol Obstet 2024. [PMID: 38327138 DOI: 10.1002/ijgo.15407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/22/2024] [Accepted: 01/25/2024] [Indexed: 02/09/2024]
Abstract
BACKGROUND A systematic review and meta-analysis from 2013 reported increased risks of congenital malformations, neonatal death and neonatal hospitalization amongst infants born to women with asthma compared to infants born to mothers without asthma. OBJECTIVE Our objective was to update the evidence on the associations between maternal asthma and adverse neonatal outcomes. SEARCH STRATEGY We performed an English-language MEDLINE, Embase, CINAHL, and COCHRANE search with the terms (asthma or wheeze) and (pregnan* or perinat* or obstet*). SELECTION CRITERIA Studies published from March 2012 until September 2023 reporting at least one outcome of interest (congenital malformations, stillbirth, neonatal death, perinatal mortality, neonatal hospitalization, transient tachypnea of the newborn, respiratory distress syndrome and neonatal sepsis) in a population of women with and without asthma. DATA COLLECTION AND ANALYSIS The study was reported following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) and the Meta-Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Quality of individual studies was assessed by two reviewers independently using the Newcastle-Ottawa Scale. Random effects models (≥3 studies) or fixed effect models (≤2 studies) were used with restricted maximum likelihood to calculate relative risk (RR) from prevalence data and the inverse generic variance method where adjusted odds ratios (aORs) from individual studies were combined. MAIN RESULTS A total of 18 new studies were included, along with the 22 studies from the 2013 review. Previously observed increased risks remained for perinatal mortality (relative risk [RR] 1.14, 95% confidence interval [CI]: 1.05, 1.23 n = 16 studies; aOR 1.07, 95% CI: 0.98-1.17 n = 6), congenital malformations (RR 1.36, 95% CI: 1.32-1.40 n = 17; aOR 1.42, 95% CI: 1.38-1.47 n = 6), and neonatal hospitalization (RR 1.27, 95% CI: 1.25-1.30 n = 12; aOR 1.1, 95% CI: 1.07-1.16 n = 3) amongst infants born to mothers with asthma, while the risk for neonatal death was no longer significant (RR 1.33, 95% CI: 0.95-1.84 n = 8). Previously reported non-significant risks for major congenital malformations (RR1.18, 95% CI: 1.15-1.21; aOR 1.20, 95% CI: 1.15-1.26 n = 3) and respiratory distress syndrome (RR 1.25, 95% CI: 1.17-1.34 n = 4; aOR 1.09, 95% CI: 1.01-1.18 n = 2) reached statistical significance. CONCLUSIONS Healthcare professionals should remain aware of the increased risks to neonates being born to mothers with asthma.
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Affiliation(s)
- Annelies L Robijn
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
- The Asthma and Breathing Research Program, Hunter Medical Research Institute, Newcastle, Australia
| | - Soriah M Harvey
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
- The Asthma and Breathing Research Program, Hunter Medical Research Institute, Newcastle, Australia
| | - Megan E Jensen
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
- The Asthma and Breathing Research Program, Hunter Medical Research Institute, Newcastle, Australia
| | - Samuel Atkins
- Department of Health, Launceston General Hospital, Launceston, Australia
| | - Kiah J D Quek
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Gang Wang
- Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital, Sichuan University, Chengdu, China
- Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease-related Molecular Network, Sichuan University, Chengdu, China
| | - Hannah Smith
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
| | - Christina Chambers
- Pediatrics and Family and Preventative Medicine, University of California, San Diego, California, USA
| | - Jennifer Namazy
- Department of Allergy-Immunology, Scripps Clinic, San Diego, California, USA
| | - Michael Schatz
- Department of Allergy, Kaiser Permanente Medical Center, San Diego, California, USA
| | - Peter G Gibson
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
- The Asthma and Breathing Research Program, Hunter Medical Research Institute, Newcastle, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
| | - Vanessa E Murphy
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
- The Asthma and Breathing Research Program, Hunter Medical Research Institute, Newcastle, Australia
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Stevens DR, Yeung E, Hinkle SN, Grobman W, Williams A, Ouidir M, Kumar R, Lipsky LM, Rohn MCH, Kanner J, Sherman S, Chen Z, Mendola P. Maternal asthma in relation to infant size and body composition. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2023; 2:100122. [PMID: 37485032 PMCID: PMC10361394 DOI: 10.1016/j.jacig.2023.100122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
Background Asthma affects 10% of pregnancies and may influence offspring health, including infant size and body composition, through hypoxic and inflammatory pathways. Objective We sought to determine associations between maternal asthma and asthma phenotypes during pregnancy and infant size and body composition. Methods The B-WELL-Mom study (2015-19) is a prospective cohort of 418 pregnant persons with and without asthma recruited in the first trimester of pregnancy from 2 US obstetric clinics. Exposures were maternal self-reported active asthma (n = 311) or no asthma (n = 107), and asthma phenotypes were classified on the bases of atopy, onset, exercise induced, control, severity, symptomology, and exacerbations. Outcomes were infant weight, length, head circumference, and skinfold measurements at birth and postnatal follow-up, as well as fat and lean mass assessed by air displacement plethysmography at birth. Adjusted multivariable linear regression examined associations of maternal asthma and asthma phenotypes with infant outcomes. Results Offspring were born at a mean ± SD of 38 ± 2.3 weeks' gestation and were 18 ± 2.2 weeks of age at postnatal follow-up. Infants of participants with asthma had a mean ± SD fat mass of 11.0 ± 4.2%, birth weight of 3045.8 ± 604.3 g, and postnatal follow-up weight of 6696.4 ± 964.2 g, which were not different from infants of participants without asthma (respectively, β [95% confidence interval]: -0.1 [-1.4, 1.3], -26.7 [-156.9, 103.4], and 107.5 [-117.3, 332.3]). Few associations were observed between asthma or asthma phenotypes and infant size or body composition. Conclusions In a current obstetric cohort, maternal asthma during pregnancy was not associated with differential infant size or body composition.
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Affiliation(s)
- Danielle R. Stevens
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park
- Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda
| | - Edwina Yeung
- Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda
| | - Stefanie N. Hinkle
- Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - Andrew Williams
- School of Medicine and Health Sciences, University of North Dakota, Grand Forks
| | - Marion Ouidir
- Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda
| | - Rajesh Kumar
- Feinberg School of Medicine, Northwestern University, Chicago
| | - Leah M. Lipsky
- Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda
| | - Matthew C. H. Rohn
- Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda
- Department of Obstetrics and Gynecology, George Washington University, Washington
| | - Jenna Kanner
- Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda
| | | | - Zhen Chen
- Biostatistics Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda
| | - Pauline Mendola
- Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo
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Lao TT, Annie Hui SY. The obstetric aspects of maternal asthma. Best Pract Res Clin Obstet Gynaecol 2022; 85:57-69. [PMID: 36210285 DOI: 10.1016/j.bpobgyn.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/26/2022] [Accepted: 08/20/2022] [Indexed: 12/14/2022]
Abstract
Asthma is the commonest chronic medical condition encountered in pregnancy. Poor asthma control and exacerbations are frequently encountered due to treatment non-adherence, pregnancy-related aggravating factors such as increased susceptibility to viral infections, and comorbidities that are commonly associated. Asthma-related inflammatory reactions and placental effects, the effect of medications, and respiratory symptoms and hypoxia are probably to interact to result in an increased adverse obstetric outcomes including miscarriage, foetal congenital anomalies, pregnancy hypertensive disorders, gestational diabetes, preterm labour and birth, antepartum haemorrhage, low birthweight and foetal growth restriction (FGR), caesarean delivery, postpartum haemorrhage (PPH), maternal intensive care admission, and even mortality, while the offspring also has increased long-term morbidity. Interdisciplinary management with frequent assessment by symptoms, spirometry, and biomarkers, together with removal of risk factors such as smoking and appropriate instigation of treatment including short courses of systemic corticosteroid, could ensure optimal and tailored treatment to control symptoms, prevent exacerbations, and ultimately enhancing maternal and perinatal outcomes.
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Affiliation(s)
- Terence T Lao
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
| | - Shuk-Yi Annie Hui
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
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5
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Yland JJ, Crowe HM, Hatch EE, Willis SK, Wang TR, Mikkelsen EM, Savitz DA, Walkey AJ, Rothman KJ, Wise LA. A prospective study of preconception asthma and spontaneous abortion. Ann Epidemiol 2022; 69:27-33. [PMID: 35235814 PMCID: PMC9081168 DOI: 10.1016/j.annepidem.2022.02.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 02/04/2022] [Accepted: 02/22/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE To evaluate the relationships among history of asthma, asthma severity, and spontaneous abortion (SAB). METHODS Pregnancy Study Online is a preconception cohort study of North American couples. During the preconception period, female participants reported their history of physician-diagnosed asthma, age at first diagnosis, and use of asthma medications in the previous 4 weeks. Asthma severity was classified by medication use proximal to conception, from level 0 to 3 in increasing severity. Pregnancy and SAB were identified using data from follow-up questionnaires. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS Among 6325 participants who conceived, 19% experienced SAB and 17% reported a history of asthma. There was no appreciable association between asthma history and SAB incidence (HR = 0.98; 95% CI: 0.84, 1.14). HRs comparing severity levels 0, 1, and 2-3 with no asthma were 0.82 (95% CI: 0.67, 1.01), 1.20 (95% CI: 0.91, 1.60), and 1.31 (95% CI: 0.97, 1.78), respectively. Among women who conceived without the use of fertility treatment, level 2-3 severity was associated with SAB (HR = 1.39; 95% CI: 1.02, 1.89). CONCLUSIONS While history of asthma diagnosis was not materially associated with SAB, having severe asthma (based on medication use) was associated with greater SAB risk.
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Raherison-Semjen C, Guilleminault L, Billiart I, Chenivesse C, De Oliveira A, Izadifar A, Lorenzo A, Nocent C, Oster JP, Padovani M, Perez T, Russier M, Steinecker M, Didier A. [Update of the 2021 recommendations for the management and follow-up of adult asthmatic patients under the guidance of the French Society of Pulmonology and the Paediatric Society of Pulmonology and Allergology. Long version]. Rev Mal Respir 2021; 38:1048-1083. [PMID: 34799211 DOI: 10.1016/j.rmr.2021.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 06/17/2021] [Indexed: 11/22/2022]
Affiliation(s)
- C Raherison-Semjen
- Université de Bordeaux, INSERM UMR 1219, Epicene Team, Bordeaux, France.
| | - L Guilleminault
- Pôle des voies respiratoires, CHU de Toulouse, Toulouse, France; Institut toulousain des maladies infectieuses et inflammatoires (Infinity), INSERM, UMR1291, CNRS UMR5051, université Toulouse III, CRISALIS F-CRIN, Toulouse, France
| | | | - C Chenivesse
- CHRU de Lille, service de pneumo-allergologie, 59000 Lille, France
| | - A De Oliveira
- Sorbonne université, département de médecine générale, Paris, France
| | - A Izadifar
- Département de pneumologie, centre cardiologique du Nord, Saint-Denis, France
| | - A Lorenzo
- Sorbonne université, département de médecine générale, Paris, France
| | - C Nocent
- CHG Côte Basque, Bayonne, France
| | - J P Oster
- Service de pneumologie, centre hospitalier Louis-Pasteur, Colmar, France
| | - M Padovani
- Espace Santé Ii, La Seyne-sur-Mer, France
| | - T Perez
- CHRU de Lille, service d'explorations fonctionnelles, 59000 Lille, France
| | - M Russier
- Service de pneumo-allergologie, CHR Orléans, Orléans, France
| | - M Steinecker
- Sorbonne université, département de médecine générale, Paris, France
| | - A Didier
- Université de Bordeaux, INSERM UMR 1219, Epicene Team, Bordeaux, France; Pôle des voies respiratoires, CHU de Toulouse, Toulouse, France
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7
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Kamyshanskiy Y, Kostyleva O, Tussupbekova M, Stabayeva L, Imanbayeva G, Nygyzbayeva R, Kotov E, Kossitsyn D. Аllergic Basal Deciduitis as a Reason of Recurrent Antenatal Fetal Death. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Allergic diseases of pregnant women are associated with chronic placental insufficiency and the development of immunopathological conditions of unknown etiology in a child in postnatal life. Pregnancy with bronchial asthma is often complicated by intrauterine growth retardation, preeclampsia, and antenatal fetal death.
AIM: The objective was to present a clinical case of recurrent antenatal fetal death in the third trimester in women with bronchial asthma under controlled course.
CASE REPORT: Pregnancy proceeded without clinical signs of exacerbation of bronchial asthma and allergic status. However, chronic inflammation with eosinophilia in the intervillous space and the basal lamina was revealed in the placenta tissue. Eosinophilia of the intervillous area was accompanied by obliteration of the intervillous area by fibrin deposits.
CONCLUSION: We suppose that immunological inflammation at the fetoplacental unit level can occur regardless of the mother’s allergic status. Moreover, it is likely that the objective state of the mother in the presence of an allergic disease does not reflect the presence/absence of an immunological process in the placenta, as the immunological inflammatory process can develop in different compartments (at the level of the mother’s body and the placental-fetal compartment) with varying degrees of severity.
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Walshe M, McDonald C, Taylor M, Zhao J, Sham P, Grech A, Schulze K, Bramon E, Murray RM. Obstetric complications in patients with schizophrenia and their unaffected siblings. Eur Psychiatry 2020; 20:28-34. [PMID: 15642440 DOI: 10.1016/j.eurpsy.2004.07.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2003] [Accepted: 07/21/2004] [Indexed: 10/26/2022] Open
Abstract
AbstractObjectiveWe sought to explore whether obstetric complications (OCs) are more likely to occur in the presence of familial/genetic susceptibility for schizophrenia or whether they themselves represent an independent environmental risk factor for schizophrenia.MethodsThe presence of OCs was assessed through maternal interview on 216 subjects, comprising 36 patients with schizophrenia from multiply affected families, 38 of their unaffected siblings, 31 schizophrenic patients with no family history of psychosis, 51 of their unaffected siblings and 60 normal comparison subjects. We examined the familiality of OCs and whether OCs were commoner in the patient and sibling groups than in the control group.ResultsOCs tended to cluster within families, especially in multiply affected families. Patients with schizophrenia, especially those from multiply affected families, had a significantly higher rate of OCs compared to normal comparison subjects, but there was no evidence for an elevated rate of OCs in unaffected siblings.ConclusionOur data provides little evidence for a link between OCs and genetic susceptibility to schizophrenia. If high rates of OCs are related to schizophrenia genes, this relationship is weak and will only be detected by very large sample sizes.
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Affiliation(s)
- M Walshe
- Division of Psychological Medicine, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, London, United Kingdom
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Yland JJ, Bateman BT, Huybrechts KF, Brill G, Schatz MX, Wurst KE, Hernández-Díaz S. Perinatal Outcomes Associated with Maternal Asthma and Its Severity and Control During Pregnancy. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 8:1928-1937.e3. [PMID: 31981730 DOI: 10.1016/j.jaip.2020.01.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/10/2020] [Accepted: 01/10/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Estimates of the effects of maternal asthma on pregnancy outcomes are inconsistent across studies, possibly because of differences in exposure definition. OBJECTIVE To evaluate the risk of adverse perinatal outcomes associated with maternal asthma diagnosis, severity, and control in a large, nationally representative cohort. METHODS This study was conducted within the IBM Health MarketScan Commercial Claims and Encounters Database (2011-2015) and the Medicaid Analytic eXtract database (2000-2014). Asthma was identified by diagnosis and treatment codes, severity was based on medications dispensed, and control was based on short-acting β-agonist dispensations and exacerbations. We estimated the relative risks (RRs) of stillbirth, spontaneous abortion, preterm birth, small for gestational age (SGA), neonatal intensive care unit (NICU) admission, and congenital malformations, comparing pregnancies with differing asthma disease status. RESULTS We identified 29,882 pregnancies complicated by asthma in the MarketScan database and 160,638 in the Medicaid Analytic eXtract database. We observed no consistent associations between asthma diagnosis, severity, or control, and stillbirth, abortions, or malformations. However, we observed increased risks of prematurity, SGA, and NICU admission among women with asthma compared with those without asthma. Compared with women with well-controlled asthma, women with poor control late in pregnancy had an increased risk of preterm birth (relative risk, 1.39; 95% CI, 1.32-1.46) and NICU admission (relative risk, 1.26; 95% CI, 1.17-1.35). More severe asthma was associated with SGA (relative risk, 1.18; 95% CI, 1.07-1.30). CONCLUSIONS We did not observe an increased risk of pregnancy losses or malformations among women with asthma. However, we found an association between asthma severity and SGA, and between exacerbations late in pregnancy and preterm delivery and NICU admission.
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Affiliation(s)
- Jennifer J Yland
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass.
| | - Brian T Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass; Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
| | - Krista F Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Gregory Brill
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Michael X Schatz
- Department of Allergy, Kaiser Permanente Medical Center, San Diego, Calif
| | - Keele E Wurst
- Department of Epidemiology and Real-World Evidence, GSK, Collegeville, Pa
| | - Sonia Hernández-Díaz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass
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10
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Wang M, He W, Li M, Li F, Jiang L, Wang J, Wang H, Liu X, Yang K, Qiu J. Maternal asthma and the risk of hypertensive disorders of pregnancy: a systematic review and meta-analysis of cohort studies. Hypertens Pregnancy 2019; 39:12-24. [PMID: 31762345 DOI: 10.1080/10641955.2019.1693591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Objective: The aim of this study was to demonstrate the association between maternal asthma and the risk of hypertensive disorders of pregnancy.Methods: A systematic search of seven databases was conducted. A meta-analysis was performed to calculate risk ratios and 95% CI using random-effects models.Results: Asthma was associated with an increased risk of pregnancy-induced hypertension (RR 1.45, 95%CI 1.29-1.63), transient hypertension of pregnancy (RR 2.00, 95%CI 1.52-2.63), preeclampsia or eclampsia (RR 1.28, 95%CI 1.25-1.32), preeclampsia (RR 1.43, 95%CI 1.31-1.57) and eclampsia (RR 1.56, 95%CI 1.13-2.15).Conclusion: The meta-analysis illustrated that asthma was significantly increased risk of hypertension during pregnancy.
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Affiliation(s)
- Meng Wang
- School of Public Health, Lanzhou University, Lanzhou, China.,Department of scientific research center, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, Gansu, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Wenbo He
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Meixuan Li
- School of Public Health, Lanzhou University, Lanzhou, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Evidence Based Social Science Research Center, Lanzhou University, Lanzhou, China.,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Fuyun Li
- School of Public Health, Lanzhou University, Lanzhou, China.,Department of scientific research center, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, Gansu, China
| | - Lili Jiang
- School of Public Health, Lanzhou University, Lanzhou, China
| | - Jiabin Wang
- School of Public Health, Lanzhou University, Lanzhou, China.,Department of scientific research center, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, Gansu, China
| | - Hui Wang
- School of Public Health, Lanzhou University, Lanzhou, China.,Department of scientific research center, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, Gansu, China
| | - Xudong Liu
- School of Public Health, Lanzhou University, Lanzhou, China.,Department of scientific research center, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, Gansu, China
| | - Kehu Yang
- School of Public Health, Lanzhou University, Lanzhou, China.,Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China.,Evidence Based Social Science Research Center, Lanzhou University, Lanzhou, China.,Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
| | - Jie Qiu
- School of Public Health, Lanzhou University, Lanzhou, China.,Department of scientific research center, Gansu Provincial Maternity and Child Care Hospital, Lanzhou, Gansu, China
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Cohen JM, Bateman BT, Huybrechts KF, Mogun H, Yland J, Schatz M, Wurst KE, Hernandez-Diaz S. Poorly Controlled Asthma During Pregnancy Remains Common in the United States. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:2672-2680.e10. [PMID: 31257187 DOI: 10.1016/j.jaip.2019.05.043] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/15/2019] [Accepted: 05/15/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Asthma is among the most common preexisting medical conditions in pregnancy. Uncontrolled asthma may increase the risk of adverse pregnancy outcomes. OBJECTIVES To describe the prevalence, severity, and control of asthma during pregnancy in the United States. METHODS We identified 2 cohorts of pregnancies ending in a live birth within 2 large US health care claims databases: the Truven Health MarketScan Commercial Claims and Encounters Database (MarketScan, private insurance) for the period 2011 to 2015 and the nationwide Medicaid Analytic eXtract (MAX, public insurance) for the period 2000 to 2013. We defined asthma prevalence, severity, and control on the basis of International Classification of Diseases, 9th Revision diagnoses and asthma-related treatments. Severe asthma was defined as dispensing of 1 or more medium/high-dose inhaled corticosteroid plus additional therapy within the 12 months preceding delivery. Poor control was defined as having at least 1 of the following: 1 or more exacerbation (asthma-related hospitalization or emergency room visit, or a course of oral corticosteroids) or 5 or more filled prescriptions for short-acting β-agonists between the last menstrual period and delivery. RESULTS Among 604,420 pregnant women in MarketScan and 2,071,359 in MAX, 20,104 (3.3%) and 120,745 (5.8%) had asthma, respectively. Among pregnant women with asthma, 19.0% and 18.8% had severe asthma and 16.5% and 28.0% had poorly controlled asthma in MarketScan and MAX, respectively. Many women with poorly controlled asthma during pregnancy were not dispensed a long-term controller (38.4% in MarketScan and 43.3% in MAX). Within both cohorts, women with poor control were more often smokers and obese, had more comorbidities, and used more concomitant nonasthma medications. CONCLUSIONS Poorly controlled asthma is more frequent among publicly versus privately insured pregnancies in the United States. Dispensing of long-term controller medications during pregnancy remains low, even for symptomatic patients.
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Affiliation(s)
- Jacqueline M Cohen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Brian T Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass; Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
| | - Krista F Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Helen Mogun
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Jennifer Yland
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Michael Schatz
- Department of Allergy, Kaiser Permanente Medical Center, San Diego, Calif
| | - Keele E Wurst
- Department of Epidemiology and Real-World Evidence, GSK, Collegeville, Pa
| | - Sonia Hernandez-Diaz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass.
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12
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Papadogiannakis N, Joerink M, Rindsjö E, Scheynius A, Alm J. Placental inflammation, lifestyle, maternal and early child sensitisation to allergens - the assessment of lifestyle and allergic disease during infancy birth cohort. Acta Paediatr 2019; 108:927-932. [PMID: 30338564 DOI: 10.1111/apa.14618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/12/2018] [Accepted: 10/12/2018] [Indexed: 12/14/2022]
Abstract
AIM To investigate (i) whether maternal sensitisation to allergens, and lifestyle can influence the risk of acute and chronic inflammation of the placenta, in the forms of chorioamnionitis and villitis, respectively, and (ii) whether these placental inflammations are associated with the outcome of sensitisation for the child during preschool age. METHODS Placentas from term uncomplicated pregnancies (n = 275) in the assessment of lifestyle and allergic disease during infancy study were analysed for the presence of acute chorioamnionitis and chronic villitis. Stepwise logistic regression was performed to estimate the relative risk of placental inflammation in relation to maternal allergic sensitisation and lifestyle, and the association between placental inflammation and sensitisation of the child up to five years of age. RESULTS Parity and delivery at home were independently associated with chorioamnionitis, home delivery only with the low grade. Maternal allergic sensitisation was associated with increased risk of villitis in the bivariable model, however, not in the multivariable model. No significant associations were detected between placental inflammation and the outcome of sensitisation to allergens at five years of age. CONCLUSION Our data do not support the hypothesis that the increased risk for sensitisation of a child when the mother is allergic is mediated via placental inflammation.
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Affiliation(s)
- Nikos Papadogiannakis
- Department of Laboratory Medicine Division of Pathology Section of Perinatal Pathology Karolinska Institutet and Karolinska University Hospital Huddinge Stockholm Sweden
| | - Maaike Joerink
- Translational Immunology Unit Department of Medicine Solna Karolinska Institutet and University Hospital Stockholm Sweden
| | - Erika Rindsjö
- Department of Laboratory Medicine Division of Pathology Section of Perinatal Pathology Karolinska Institutet and Karolinska University Hospital Huddinge Stockholm Sweden
- Department of Oncology‐Pathology Karolinska Institutet Stockholm Sweden
| | - Annika Scheynius
- Department of Clinical Science and Education Sachs’ Children and Youth Hospital Södersjukhuset Karolinska Institutet Stockholm Sweden
- Clinical Genomics Science for Life Laboratory Stockholm Sweden
| | - Johan Alm
- Department of Clinical Science and Education Sachs’ Children and Youth Hospital Södersjukhuset Karolinska Institutet Stockholm Sweden
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13
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Rahman ML, Liang L, Valeri L, Su L, Zhu Z, Gao S, Mostofa G, Qamruzzaman Q, Hauser R, Baccarelli A, Christiani DC. Regulation of birthweight by placenta-derived miRNAs: evidence from an arsenic-exposed birth cohort in Bangladesh. Epigenetics 2018; 13:573-590. [PMID: 30099960 PMCID: PMC6140906 DOI: 10.1080/15592294.2018.1481704] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 05/07/2018] [Indexed: 01/01/2023] Open
Abstract
Altered expression of microRNAs (miRNAs) is implicated in fetal growth. However, the mechanisms by which placenta-derived miRNAs regulate birthweight are not well understood. In Phase 1, we compared the expression of 754 miRNAs in the placenta of mothers from two extreme birthweight groups (0.8-2.2 kg vs. 3.3-3.9 kg, n = 77 each) selected from an arsenic-exposed Bangladeshi birth cohort (n = 1,141). We identified 49 miRNAs associated with the extreme birthweight groups and/or gestational age in Phase 1, which were further analyzed in Phase 2 among 364 randomly selected mother-infant pairs. Gestational age was determined by ultrasound. Causal mediation analysis was used to estimate the effect of miRNAs on birthweight considering gestational age a mediator, adjusting for core blood arsenic and other risk factors. miR-1290, miR-195, and let-7g showed significant inverse associations with gestational age, while miR-328 showed significant positive association [false discovery rate (FDR) <0.05]. Via changing gestational age, miR-1290, miR-195, and miR-27a showed significant inverse associations with birthweight, while miR-328 and miR-324-5p showed significant positive associations (FDR <0.05). The effect of miRNAs on birthweight varied by gestational age (for miR-1290, miR-195, miR-328) and in utero arsenic exposure (for miR-1290): stronger effect was observed among infants delivered early in gestation or exposed to higher concentrations of arsenic in cord blood. Gene enrichment analysis with in silico predicted targets identified cell proliferation, inflammation, apoptosis, insulin, and IGF family signaling cascades associated with these miRNAs. Future studies are warranted to replicate these findings and assess these miRNAs as early biomarkers of fetal growth.
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Affiliation(s)
- Mohammad L. Rahman
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Liming Liang
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Linda Valeri
- Department of Psychiatry, McLean Hospital, Laboratory of Psychiatric Biostatistics, Belmont and Harvard Medical School, Boston, MA, USA
| | - Li Su
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Zhaozhong Zhu
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Shangzhi Gao
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Golam Mostofa
- Department of Medicine, Dhaka Community Hospital Trust, Dhaka, Bangladesh
| | - Qazi Qamruzzaman
- Department of Medicine, Dhaka Community Hospital Trust, Dhaka, Bangladesh
| | - Russ Hauser
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Andrea Baccarelli
- Department of Environmental Health, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - David C. Christiani
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Etwel F, Faught LH, Rieder MJ, Koren G. The Risk of Adverse Pregnancy Outcome After First Trimester Exposure to H1 Antihistamines: A Systematic Review and Meta-Analysis. Drug Saf 2017; 40:121-132. [PMID: 27878468 DOI: 10.1007/s40264-016-0479-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION H1 antihistamines are used for the treatment of nausea and vomiting during pregnancy as well as the symptomatic relief of asthma, urticaria, allergy, and the common cold. Although they are overall felt to be safe during pregnancy, recently several studies have challenged this assumption, as millions of women are exposed to them in the first trimester. METHODS Following the guidelines of PRISMA, a systematic review was performed to retrieve all published articles involving H1-antihistamine exposure during pregnancy. Electronic databases including PubMed and EMBASE were searched for possibly relevant articles published in any language up to December 2015. RESULTS After removing duplicate publications, and excluding animal studies and studies on drug effectiveness, 342 articles were reviewed in detail and 37 studies fulfilled the inclusion criteria for the meta-analysis. In cohort studies, the risk of major malformation in the offspring of women exposed to H1 antihistamines was not higher than that of the control population (OR 1.07; 95% CI 0.98-1.16). The Q-statistic for heterogeneity of effects was not significant (p > 0.05, I 2 < 25%) and there was no evidence of publication bias. Similar results were achieved with case-control studies (OR 1.05; 95% CI 0.90-1.23). Similarly, H1 antihistamines were not associated with more spontaneous abortions (OR 1.00; 95% CI 0.83-1.20), prematurity (OR 0.96; 95% CI 0.76-1.20), stillbirth (OR 1.23; 95% CI 0.48-3.18) or low birth weight (OR 1.20; 95% CI 0.63-2.29). CONCLUSIONS Based on our meta-analyses, which included a large number of studies, H1 antihistamines are not associated with an increased risk of major malformation or other adverse fetal outcomes. This study provides important information to both pregnant women and their healthcare providers regarding the safety and risk of H1 antihistamine use during this sensitive time.
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Affiliation(s)
- Fatma Etwel
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, Health Sciences Addition Room 222, London, ON, N6A 5C1, Canada
| | - Lauren H Faught
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, Health Sciences Addition Room 222, London, ON, N6A 5C1, Canada
| | - Michael J Rieder
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, Health Sciences Addition Room 222, London, ON, N6A 5C1, Canada
| | - Gideon Koren
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, Western University, Health Sciences Addition Room 222, London, ON, N6A 5C1, Canada.
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15
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Lefebvre G, Samoilenko M. On the use of the outcome variable "small for gestational age" when gestational age is a potential mediator: a maternal asthma perspective. BMC Med Res Methodol 2017; 17:165. [PMID: 29228913 PMCID: PMC5725795 DOI: 10.1186/s12874-017-0444-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 11/27/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The variable "small for gestational age," frequently defined as birth weight below the 10th percentile in a gestational age and sex-normalized population, is nowadays generally perceived as a more adequate measure than birth weight or low birth weight (birth weight < 2500 g) to capture fetal growth. However, the use of small for gestational age rather than birth weight or low birth weight as an outcome (dependent) variable may have important impacts on the interpretation of analyses aimed at estimating the causal effect of an exposure of interest on infants. We hypothesized potential differences in both types of effects estimated (direct or total) and in ability to control for confounding bias. METHODS We first examined the use of outcome variables birth weight and small for gestational age to get insights on modeling practices within the field of maternal asthma. Using directed acyclic graph simulations where gestational age was a potential mediator, we then compared estimated exposure effects in regression models for birth weight, low birth weight, and small for gestational age. Graphs with and without confounding were considered. RESULTS Our simulations showed that the variable small for gestational age captures the direct effect of exposure on birth weight, but not the indirect effect of exposure on birth weight through gestational age. Interestingly, exposure effect estimates from small for gestational age models were found unbiased whenever exposure effect estimates from birth weight models were affected by collider bias due to conditioning on gestational age in the models. CONCLUSIONS The sole consideration of the outcome small for gestational age in a study may lead to suboptimal understanding and quantification of the underlying effect of an exposure on birth weight-related measures. Instead, our results suggest that both outcome variables (low) birth weight and small for gestational age should minimally be considered in studies investigating perinatal outcomes.
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Affiliation(s)
- Geneviève Lefebvre
- Department of Mathematics, Université du Québec à Montréal, C.P. 8888, Succursale Centre-ville, Montréal, Québec, H3C 3P8, Canada. .,Faculty of Pharmacy, Université de Montréal, Montréal, Canada.
| | - Mariia Samoilenko
- Department of Mathematics, Université du Québec à Montréal, C.P. 8888, Succursale Centre-ville, Montréal, Québec, H3C 3P8, Canada
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16
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Baghlaf H, Spence AR, Czuzoj-Shulman N, Abenhaim HA. Pregnancy outcomes among women with asthma. J Matern Fetal Neonatal Med 2017; 32:1325-1331. [PMID: 29166819 DOI: 10.1080/14767058.2017.1404982] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE The purpose of this study is to examine the association between maternal asthma and pregnancy, delivery and neonatal outcomes. MATERIALS AND METHODS We carried out a retrospective cohort study using the Health Care Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) database from 2003 to 2011. Among women who delivered during this time period, we compared pregnancy, delivery, and neonatal outcomes in asthmatics versus non-asthmatics. Multivariate logistic regression was used to estimate adjusted odds ratios and 95% confidence intervals. RESULTS In a cohort of 7,772,999 pregnant women, 223,236 (2.9%) had asthma. The prevalence of asthma-complicated pregnancies rose over the study period from 1.9% in 2003 to 3.7% in 2011 (p < .001). Pregnant asthmatics had more pre-existing health conditions, such as diabetes, chronic hypertension, obesity, and thyroid disease, and were more likely to smoke. Even after adjustment for these comorbidities, and other covariates, within statistical models, asthma was found to be associated with greater risk of several pregnancy complications: gestational hypertension, preeclampsia, gestational diabetes, placenta previa, preterm premature rupture of membranes, placental abruption, chorioamnionitis, preterm delivery, postpartum hemorrhage, venous thromboembolism, caesarean section delivery, and maternal mortality. Neonates born to asthmatics had greater risk of being small for gestational age and for having congenital anomalies, and lower risk of intrauterine fetal death. CONCLUSIONS Asthma is associated with an increase in adverse pregnancy, labor, and neonatal outcomes. Close surveillance of asthmatic patients during the prenatal period is warranted and care in a tertiary hospital is advised.
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Affiliation(s)
- Haitham Baghlaf
- a Department of Obstetrics and Gynecology , Jewish General Hospital, McGill University , Montreal , Canada
| | - Andrea R Spence
- b Center for Clinical Epidemiology , Jewish General Hospital, McGill University , Montreal , Canada
| | - Nicholas Czuzoj-Shulman
- b Center for Clinical Epidemiology , Jewish General Hospital, McGill University , Montreal , Canada
| | - Haim Arie Abenhaim
- a Department of Obstetrics and Gynecology , Jewish General Hospital, McGill University , Montreal , Canada.,b Center for Clinical Epidemiology , Jewish General Hospital, McGill University , Montreal , Canada
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17
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Goedicke-Fritz S, Härtel C, Krasteva-Christ G, Kopp MV, Meyer S, Zemlin M. Preterm Birth Affects the Risk of Developing Immune-Mediated Diseases. Front Immunol 2017; 8:1266. [PMID: 29062316 PMCID: PMC5640887 DOI: 10.3389/fimmu.2017.01266] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 09/22/2017] [Indexed: 12/12/2022] Open
Abstract
Prematurity affects approximately 10% of all children, resulting in drastically altered antigen exposure due to premature confrontation with microbes, nutritional antigens, and other environmental factors. During the last trimester of pregnancy, the fetal immune system adapts to tolerate maternal and self-antigens, while also preparing for postnatal immune defense by acquiring passive immunity from the mother. Since the perinatal period is regarded as the most important “window of opportunity” for imprinting metabolism and immunity, preterm birth may have long-term consequences for the development of immune-mediated diseases. Intriguingly, preterm neonates appear to develop bronchial asthma more frequently, but atopic dermatitis less frequently in comparison to term neonates. The longitudinal study of preterm neonates could offer important insights into the process of imprinting for immune-mediated diseases. On the one hand, preterm birth may interrupt influences of the intrauterine environment on the fetus that increase or decrease the risk of later immune disease (e.g., maternal antibodies and placenta-derived factors), whereas on the other hand, it may lead to the premature exposure to protective or harmful extrauterine factors such as microbiota and nutritional antigen. Solving this puzzle may help unravel new preventive and therapeutic approaches for immune diseases.
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Affiliation(s)
- Sybelle Goedicke-Fritz
- Laboratory of Neonatology and Pediatric Immunology, Department of Pediatrics, Philipps University Marburg, Marburg, Germany.,Department of General Pediatrics and Neonatology, Saarland University Medical School, Homburg, Germany
| | | | | | - Matthias V Kopp
- Department of Pediatric Allergy and Pulmonology, University of Lübeck, Airway Research-Center North (ARCN), Lübeck, Germany
| | - Sascha Meyer
- Department of General Pediatrics and Neonatology, Saarland University Medical School, Homburg, Germany
| | - Michael Zemlin
- Department of General Pediatrics and Neonatology, Saarland University Medical School, Homburg, Germany
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18
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Shaked E, Wainstock T, Sheiner E, Walfisch A. Maternal asthma: pregnancy course and outcome. J Matern Fetal Neonatal Med 2017; 32:103-108. [PMID: 28847192 DOI: 10.1080/14767058.2017.1372414] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To evaluate the association between maternal asthma and perinatal outcome. STUDY DESIGN In this retrospective population-based cohort study, all pregnancies between 1991 and 2014 in a tertiary medical center, were included. Multiple pregnancies and congenital malformations were excluded. Pregnancy course and outcomes were compared between women with and without asthma, and multivariable generalized estimating equations were used to control for confounders. RESULTS During the study period, 243,363 deliveries met the inclusion criteria, 1.35% of which (n = 3283) occurred in women diagnosed with asthma. Multiple perinatal complications were found to be associated with maternal asthma, including hypertensive disorders, preterm delivery, and cesarean delivery. However, no significant differences between the groups were noted in neonatal outcomes, including perinatal mortality rates and low Apgar scores. In the regression model, maternal asthma was noted as an independent risk factor for preterm delivery, hypertensive disorders of pregnancy, and cesarean delivery (aOR = 1.21, 95%CI 1.1-1.4, p = .007; aOR = 1.35, 95%CI 1.2-1.6, p < .001; and aOR = 1.27, 95%CI 1.2-1.4, p < .001, respectively) while controlling for multiple confounders. CONCLUSIONS Maternal asthma is associated with an increased risk for adverse pregnancy outcome. This association remains significant while controlling for variables considered to coexist with maternal asthma. Nevertheless, perinatal outcome is generally favorable.
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Affiliation(s)
- Einat Shaked
- a Joyce and Irving Goldman Medical School , Faculty of Health Sciences, Ben-Gurion University of the Negev , Beer-Sheva , Israel
| | - Tamar Wainstock
- b Department of Public Health , Faculty of Health Sciences, Ben-Gurion University of the Negev , Beer-Sheva , Israel
| | - Eyal Sheiner
- c Department of Obstetrics and Gynecology , Soroka University Medical Center, Ben-Gurion University of the Negev , Beer-Sheva , Israel
| | - Asnat Walfisch
- c Department of Obstetrics and Gynecology , Soroka University Medical Center, Ben-Gurion University of the Negev , Beer-Sheva , Israel
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19
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Blais L, Kettani FZ, Forget A, Beauchesne MF, Lemière C, Rey E. Long-Acting β 2-Agonists and Risk of Hypertensive Disorders of Pregnancy: A Cohort Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 6:555-561.e2. [PMID: 28847655 DOI: 10.1016/j.jaip.2017.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 06/15/2017] [Accepted: 07/07/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Maternal asthma has been found to be associated with an increased risk of hypertensive disorders of pregnancy (HDP), that is, gestational hypertension, preeclampsia, and eclampsia. There is limited data, however, regarding the relationship between the use of long-acting beta-agonists (LABAs) during pregnancy and these outcomes. OBJECTIVE To investigate whether exposure to a LABA in addition to an inhaled corticosteroid increases the risk of HDP or preeclampsia/eclampsia, as compared with nonexposure to LABAs, in pregnant women with asthma. METHODS A cohort of 8,936 pregnancies in women with asthma who delivered between 1998 and 2010 was reconstructed using Quebec (Canada) health administrative databases. Cox proportional hazard regression models, adjusted for potential confounders, were used for statistical analyses. The primary exposure was LABA use (yes/no) measured on the first day of the 20th week of pregnancy. HDP were identified on the basis of recorded diagnoses and on prescriptions of antihypertensive drugs filled on or after the first day of week 20 of gestation. RESULTS There were 567 (6.3%) cases of HDP and 256 (2.9%) cases of preeclampsia/eclampsia in the cohort, and the rates of both disorders were similar in women exposed or not exposed to LABAs. LABA use was not associated with increased risks of HDP (adjusted hazard ratio, 0.96; 95% CI, 0.69-1.33) or preeclampsia/eclampsia (adjusted hazard ratio, 0.89; 95% CI, 0.53-1.50). CONCLUSIONS The results of this study provide evidence suggesting the safety of LABAs for the treatment of asthma in pregnancy, in terms of the risks of HDP and preeclampsia/eclampsia.
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Affiliation(s)
- Lucie Blais
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada; Research Centre, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada; Endowment Pharmaceutical Chair AstraZeneca in Respiratory Health, Montreal, Quebec, Canada.
| | - Fatima-Zohra Kettani
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada; Research Centre, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | - Amélie Forget
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada; Research Centre, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | - Marie-France Beauchesne
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada; Endowment Pharmaceutical Chair AstraZeneca in Respiratory Health, Montreal, Quebec, Canada; Pharmacy Department, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada; Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec, Canada
| | - Catherine Lemière
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada; Research Centre, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | - Evelyne Rey
- Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
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20
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McCall SJ, Nair M, Knight M. Factors associated with maternal mortality at advanced maternal age: a population-based case-control study. BJOG 2017; 124:1225-1233. [PMID: 27412153 PMCID: PMC5484371 DOI: 10.1111/1471-0528.14216] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study aimed to examine the factors associated with maternal mortality among women aged ≥35 years. DESIGN Unmatched population based case-control study. SETTING United Kingdom. POPULATION Between 2009 and 2012, 105 cases of maternal deaths aged ≥35 years were extracted from the surveillance database of the MBRRACE-UK confidential enquiries into maternal deaths in the UK. In addition, 766 controls aged ≥35 years were identified from the UK Obstetric Surveillance System (2005-2012). METHODS Risk factors known to be associated with maternal mortality and morbidity and for which data were available were examined for their association with maternal mortality among women ≥35 years using logistic regression analysis. MAIN OUTCOME MEASURES Odds ratios and 95% confidence intervals associated with maternal death. RESULTS Five factors were found to be significantly associated with increased odds of death among women aged ≥35 years: smoking during pregnancy (adjusted odds ratio (aOR) 2.06, 95% CI 1.13-3.75), inadequate use of antenatal care (aOR 23.62, 95% CI 8.79-63.45), medical co-morbidities (aOR 5.92, 95% CI 3.56-9.86) and previous pregnancy problems (aOR 2.06, 95% CI 1.23-3.45). The odds associated with death increased by 12% per year increase in age (aOR 1.12, 95% CI 1.02-1.22). CONCLUSION Age was associated with maternal mortality even after adjusting for other known risk factors. Importantly, this study showed an association between maternal mortality and smoking among women aged 35 years or older. It emphasises the importance of public health action to reduce smoking levels and address trends in rising maternal age. TWEETABLE ABSTRACT Smoking is a risk factor for maternal death for those aged over 35 years.
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Affiliation(s)
- SJ McCall
- Policy Research Unit in Maternal Health and CareNational Perinatal Epidemiology Unit (NPEU)Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - M Nair
- Policy Research Unit in Maternal Health and CareNational Perinatal Epidemiology Unit (NPEU)Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - M Knight
- Policy Research Unit in Maternal Health and CareNational Perinatal Epidemiology Unit (NPEU)Nuffield Department of Population HealthUniversity of OxfordOxfordUK
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21
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Low risk of adverse obstetrical and perinatal outcome in pregnancies complicated by asthma: A case control study. Respir Med 2016; 120:124-130. [PMID: 27817809 DOI: 10.1016/j.rmed.2016.10.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 09/20/2016] [Accepted: 10/10/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND Asthma in pregnancy have been associated with an increased risk of pregnancy complications. Our aim was to estimate incidence and describe risk factors for adverse obstetrical and perinatal outcomes in pregnant women with asthma. METHODS Women enrolled in the Management of Asthma during Pregnancy (MAP) program were each matched with three controls (i.e. consecutive women giving birth at our obstetrical service). Asthma severity was classified according to treatment step. Data on obstetrical and perinatal outcomes were obtained from medical records. Logistic regression analysis was applied, and findings expressed as odds ratios (OR) unadjusted and adjusted (adj) for BMI, age, parity, smoking, ethnicity and marital status. RESULTS Nine-hundred-thirty-nine pregnancies in women with asthma (i.e. cases) were compared to 2.782 controls. Overall, the incidence of complications was low, although women with asthma had a statistically significant higher risk of pre-eclampsia (5% vs. 3%, ORadj 1.60, 95% CI 1.07-2.38; p = 0.02) and small for gestational age neonates (SGA) (ORadj 1.30, 95% CI 1.10-1.54; p < 0.01) compared to controls. Compared to mild asthma, more severe asthma was associated with a higher risk of SGA (60% vs 53%, ORadj. 1.30, 95% CI 1.10-1.54; p < 0.01). Women with asthma exacerbation during pregnancy tended to have a higher risk of severe pre-eclampsia (ORadj 3.33 95% CI 0.96-11.65, p = 0.06) compared to pregnancies without any exacerbations. CONCLUSION The overall risk of adverse obstetrical and perinatal outcomes in pregnancies complicated by asthma is low compared to non-asthmatic women. Our observations suggest that enrollment into an asthma management program has a positive impact on overall pregnancy outcome.
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Beau AB, Didier A, Hurault-Delarue C, Montastruc JL, Lacroix I, Damase-Michel C. Prescription of asthma medications before and during pregnancy in France: An observational drug study using the EFEMERIS database. J Asthma 2016; 54:258-264. [PMID: 27657554 DOI: 10.1080/02770903.2016.1214731] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Asthma affects between 3% to 8% of pregnant women. Previous studies have suggested that women's prescriptions for asthma medications change during pregnancy. The aim was to describe the prescription of asthma medications before and during pregnancy in France. METHODS Women from the EFEMERIS, a French database assessing the drugs prescribed, dispensed and reimbursed during pregnancy, delivering between July 2004 and December 2012, were included. Women, who were dispensed asthma medications on at least two dates from 3 months prior to pregnancy through delivery, were considered. RESULTS 2,977 women out of 69,205 (4%) were selected. They were prescribed 2.4 ± 1.2 different anti-asthmatic drugs with 3.5 ± 2.7 different dispensing dates. Almost 62% of the women were dispensed at least one prescription for short-acting β2-agonist (SABA), 63% at least one inhaled corticosteroid (IC), 42% a fixed-combination of an IC and a long-acting β2-agonist (LABA) and 8% a LABA. An increase in SABA and IC prescriptions and a decrease in fixed-combination prescriptions were observed during pregnancy compared to pre-pregnancy period. A rapid drop in prescriptions for montelukast was observed. Among the 1,507 women who were prescribed asthma medication before pregnancy, one third had a drop in dispensed asthma medications from the beginning of pregnancy. CONCLUSIONS The prevalence of dispensed asthma medications varies during pregnancy. There is a decrease in the prescriptions of fixed-combinations during pregnancy and an increase in the prescriptions of ICs. It appears important to study the potential impact of such changes on fetuses and newborns.
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Affiliation(s)
- Anna-Belle Beau
- a Service de Pharmacologie Médicale et Clinique, CHU Toulouse, Pharmacopôle Midi-Pyrénées, Faculté de Médecine, INSERM , Toulouse , France
| | - Alain Didier
- b Service de Pneumologie, Pôle des Voies Respiratoires, Hôpital Larrey, CHU Toulouse , France
| | - Caroline Hurault-Delarue
- a Service de Pharmacologie Médicale et Clinique, CHU Toulouse, Pharmacopôle Midi-Pyrénées, Faculté de Médecine, INSERM , Toulouse , France
| | - Jean-Louis Montastruc
- a Service de Pharmacologie Médicale et Clinique, CHU Toulouse, Pharmacopôle Midi-Pyrénées, Faculté de Médecine, INSERM , Toulouse , France
| | - Isabelle Lacroix
- a Service de Pharmacologie Médicale et Clinique, CHU Toulouse, Pharmacopôle Midi-Pyrénées, Faculté de Médecine, INSERM , Toulouse , France
| | - Christine Damase-Michel
- a Service de Pharmacologie Médicale et Clinique, CHU Toulouse, Pharmacopôle Midi-Pyrénées, Faculté de Médecine, INSERM , Toulouse , France
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Rahimi R, Nikfar S, Abdollahi M. Meta-Analysis Finds Use of Inhaled Corticosteroids During Pregnancy Safe: A Systematic Meta-Analysis Review. Hum Exp Toxicol 2016; 25:447-52. [PMID: 16937916 DOI: 10.1191/0960327106het647oa] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Inhaled corticosteroids (ICs) are the drug of choice for asthmatic women during pregnancy, but the results on the effects of these medications on obstetrical and perinatal outcomes are not conclusive. Meta-analysis is the statistical analysis of a collection of analysis results from individual studies for the purpose of integrating the findings. Meta-analysis techniques are necessary because only summary statistics are available in the literature. In order to determine the risk of exposure to ICs, we pooled data from all clinical studies that evaluated the pregnancy and perinatal outcomes in women exposed to this group of drugs during pregnancy by the meta-analytic technique. PUBMED, OVID, EMBASE and SCOPUS databases were searched for studies that investigated birth outcome following exposure to ICs during pregnancy. Data were collected from 1997 to 2005 (up to 31 December). Types of outcome investigated were major malformations, pre-term delivery, low birth weight and pregnancy-induced hypertension. The criteria for inclusion of studies in this meta-analysis were exposure of women to any therapeutic dosage of any ICs (fluticasone, beclomethasone, budesonide, triamcinolone and flunisolide) during pregnancy. The results showed that ICs do not increase the risk of major malformations, preterm delivery, low birth weight and pregnancy-induced hypertension. In conclusion, ICs do not increase the rates of any obstetrical outcomes investigated in the present study and interestingly improve the symptoms and are helpful in the management of asthma and thus can be used comfortably during pregnancy.
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Affiliation(s)
- R Rahimi
- Faculty of Pharmacy, and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
Pregnancy does not appear to have a consistent effect on the frequency or severity of asthma. The most common cause of worsening asthma in pregnancy is likely to be noncompliance with medication. Emphasizing to the patient in advance that fetal well-being is dependent on maternal well-being may help prevent this.In general, well controlled asthma is not associated with a higher risk of adverse pregnancy outcomes. Essential to successful asthma management is patient education that helps to ensure effective medication use, avoidance of triggers, and prompt treatment. This education should include measurement of peak expiratory flow rate and a written asthma action plan. Most of the medications that are used to control asthma in the general population can be safely used in pregnant women. Inhaled beta-adrenoceptor agonists (beta-agonists), cromolyn sodium (sodium cromoglycate), and inhaled and systemic corticosteroids all appear to be very well tolerated by the fetus. Budesonide and beclomethasone should be considered as the preferred inhaled corticosteroids for the treatment of asthma in pregnancy. Use of the leukotriene receptor antagonists zafirlukast and montelukast in pregnancy is probably safe but should be limited to special circumstances, where they are viewed essential for asthma control. Zileuton should not be used in pregnancy.Acute asthma exacerbations in pregnant women should be treated in a similar manner to that in non-pregnant patients. Maternal blood glucose levels should be monitored periodically in pregnant women receiving systemic corticosteroids because of the deleterious effects of hyperglycemia upon embryos and fetuses. During pregnancy, maternal arterial oxygen saturations should be kept above 95% if possible for fetal well-being. Ambulatory oxygenation should be checked prior to discharge to ensure that women do not desaturate with their daily activities.Acute exacerbations of asthma during labor and delivery are rare. Dinoprost, ergometrine, and other ergot derivatives can cause severe bronchospasm, especially when used in combination with general anesthesia, and should be avoided in asthmatic patients. Pregnant women who have been treated with corticosteroids in the past year may require stress-dose corticosteroids during labor and delivery. Most asthma medications, including oral prednisone, are considered compatible with breast-feeding.
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Palmsten K, Schatz M, Chan PH, Johnson DL, Chambers CD. Validation of the Pregnancy Asthma Control Test. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2016; 4:310-5.e1. [PMID: 26776373 PMCID: PMC4789157 DOI: 10.1016/j.jaip.2015.11.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 10/28/2015] [Accepted: 11/02/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Suboptimal asthma control during pregnancy may affect perinatal outcomes. US guidelines recommend questionnaires to assess asthma control including the Asthma Control Test (ACT). OBJECTIVE To validate telephone administration of a modified version of ACT during pregnancy. METHODS MotherToBaby Pregnancy Studies (2011-2013) enrolled 159 pregnant women with asthma. Participants were interviewed by telephone at intake, at approximately gestational weeks 20 and 32, and postpartum. The ACT was modified to address dyspnea specifically due to asthma; the modified version is the Pregnancy Asthma Control Test (p-ACT). Women answered the p-ACT and guideline-based asthma impairment questions and reported asthma course changes and exacerbations. Possible p-ACT scores ranged from 5 to 25; higher score indicated better control. Reliability, criterion validity, construct validity, prospective validity, and responsiveness were assessed. RESULTS Cronbach's alpha for internal consistency was similar across time points (0.84-0.90). The p-ACT score varied by impairment; for example, at intake, the mean score was 23.2 for well-controlled versus 13.7 for very poorly controlled asthma. The p-ACT score change between interviews differed by asthma course; for example, women reporting that their asthma was much better at week 20 than at intake had a mean score increase of 4.7; women reporting that their asthma was a little worse had a mean score decrease of 1.3. Lower p-ACT score was associated with previous exacerbations, whereas intake p-ACT score was not associated with future exacerbations during pregnancy. CONCLUSIONS The p-ACT demonstrated good internal consistency, varied in the expected direction by impairment level, and was responsive to changes in asthma course. Telephone administration of the p-ACT is reliable and valid for assessing asthma control during pregnancy.
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Affiliation(s)
- Kristin Palmsten
- Department of Pediatrics, University of California, San Diego, La Jolla, Calif.
| | - Michael Schatz
- Department of Allergy, Kaiser Permanente Medical Center, San Diego, Calif
| | - Priscilla H Chan
- Department of Pediatrics, University of California, San Diego, La Jolla, Calif
| | - Diana L Johnson
- Department of Pediatrics, University of California, San Diego, La Jolla, Calif
| | - Christina D Chambers
- Department of Pediatrics, University of California, San Diego, La Jolla, Calif; Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, Calif
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Shaheen SO, Macdonald-Wallis C, Lawlor DA, Henderson AJ. Hypertensive disorders of pregnancy, respiratory outcomes and atopy in childhood. Eur Respir J 2016; 47:156-65. [PMID: 26541530 PMCID: PMC4884643 DOI: 10.1183/13993003.00643-2015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2014] [Accepted: 08/27/2015] [Indexed: 11/05/2022]
Abstract
Few epidemiological studies have investigated the role of hypertensive disorders of pregnancy in the aetiology of childhood respiratory and atopic outcomes.In the Avon Longitudinal Study of Parents and Children we examined associations of maternal gestational hypertension, hypertension before pregnancy and pre-eclampsia with wheezing at 18 months, wheezing and asthma at 7 years and lung function at 8-9 years, after controlling for potential confounders (n=5322-8734, depending on outcome).Gestational hypertension was not associated with any of the outcomes. There was weak evidence for a positive association between pre-eclampsia and early wheezing (adjusted OR 1.31, 95% CI 0.94-1.82, compared to normotensive pregnancies) and for negative associations between pre-eclampsia and forced expiratory volume in 1 s (adjusted mean difference in sd score -0.14, 95% CI -0.33-0.06) and maximal mid-expiratory flow (-0.15, 95% CI -0.34-0.04). Hypertension before pregnancy was positively associated with wheezing (OR 1.63, 95% CI 1.16-2.31) and asthma (OR 1.34, 95% CI 1.00-1.79).Gestational hypertension is unlikely to be a risk factor for childhood respiratory disorders; hypertension before pregnancy may be a risk factor for childhood wheezing and asthma, but this finding needs replication. Larger studies are needed to confirm whether pre-eclampsia is associated with impaired childhood lung function.
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Affiliation(s)
- Seif O Shaheen
- Centre for Primary Care and Public Health, Barts and The London School of Medicine and Dentistry, London, UK
| | - Corrie Macdonald-Wallis
- School of Social and Community Medicine, University of Bristol, Bristol, UK MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Debbie A Lawlor
- School of Social and Community Medicine, University of Bristol, Bristol, UK MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - A John Henderson
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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Bhatia PK, Biyani G, Mohammed S, Sethi P, Bihani P. Acute respiratory failure and mechanical ventilation in pregnant patient: A narrative review of literature. J Anaesthesiol Clin Pharmacol 2016; 32:431-439. [PMID: 28096571 PMCID: PMC5187605 DOI: 10.4103/0970-9185.194779] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Physiological changes of pregnancy imposes higher risk of acute respiratory failure (ARF) with even a slight insult and remains an important cause of maternal and fetal morbidity and mortality. Although pregnant women have different respiratory physiology and different causes of ARF, guidelines specific to ventilatory settings, goals of oxygenation and weaning process could not be framed due to lack of large-scale randomized controlled trials. During the 2009 H1N1 pandemic, pregnant women had higher morbidity and mortality compared to nonpregnant women. During this period, alternative strategies of ventilation such as high-frequency oscillatory ventilation, inhalational of nitric oxide, prone positioning, and extra corporeal membrane oxygenation were increasingly used as a desperate measure to rescue pregnant patients with severe hypoxemia who were not improving with conventional mechanical ventilation. This article highlights the causes of ARF and recent advances in invasive, noninvasive and alternative strategies of ventilation used during pregnancy.
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Affiliation(s)
- Pradeep Kumar Bhatia
- Department of Anaesthesiology and Critical Care, All Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Ghansham Biyani
- Department of Anaesthesiology and Critical Care, All Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sadik Mohammed
- Department of Anaesthesiology and Critical Care, Dr. S.N. Medical College, Jodhpur, Rajasthan, India
| | - Priyanka Sethi
- Department of Anaesthesiology and Critical Care, All Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pooja Bihani
- Department of Anaesthesiology and Critical Care, All Institute of Medical Sciences, Jodhpur, Rajasthan, India
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28
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Shedd GC, Hays CN. The Pregnant Patient With Asthma: Assessment and Management. J Nurse Pract 2016. [DOI: 10.1016/j.nurpra.2015.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Ali Z, Hansen AV, Ulrik CS. Exacerbations of asthma during pregnancy: Impact on pregnancy complications and outcome. J OBSTET GYNAECOL 2015; 36:455-61. [PMID: 26467747 DOI: 10.3109/01443615.2015.1065800] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Asthma is common among pregnant women, and the incidence of asthma exacerbations during pregnancy is high. This literature review provides an overview of the impact of exacerbations of asthma during pregnancy on pregnancy-related complications. The majority of published retrospective studies reveal that asthma exacerbations during pregnancy increase the risk of pre-eclampsia, gestational diabetes, placental abruption and placenta praevia. Furthermore, these women also have higher risk for breech presentation, haemorrhage, pulmonary embolism, caesarean delivery, maternal admission to the intensive care unit and longer postpartum hospital stay. Asthma has been associated with increased risk of intrauterine growth retardation, small-for-gestational age, low birth weight, infant hypoglycaemia and preterm birth, but more recent prospective studies have not revealed significant associations with regard to these outcomes. In conclusion, asthma exacerbations during pregnancy are associated with complications of pregnancy, labour and delivery. Prevention of exacerbations is essential to reduce the risk of complications and poor outcome.
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Affiliation(s)
- Z Ali
- a Department of Pulmonary Medicine , Hvidovre Hospital , Hvidovre , Denmark
| | - A V Hansen
- a Department of Pulmonary Medicine , Hvidovre Hospital , Hvidovre , Denmark
| | - C S Ulrik
- a Department of Pulmonary Medicine , Hvidovre Hospital , Hvidovre , Denmark.,b University of Copenhagen , Copenhagen , Denmark
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Van Zutphen AR, Bell EM, Browne ML, Lin S, Lin AE, Druschel CM. Maternal asthma medication use during pregnancy and risk of congenital heart defects. ACTA ACUST UNITED AC 2015; 103:951-61. [PMID: 26408052 DOI: 10.1002/bdra.23437] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/30/2015] [Accepted: 08/02/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Asthma affects 4% to 8% of pregnant women and studies suggest maternal asthma, particularly when uncontrolled, may be associated with adverse reproductive outcomes. METHODS We examined self-reported asthma medication use and the risk of congenital heart defects (CHD) in the National Birth Defects Prevention Study, a multi-center, population-based case-control study of selected major structural defects. We evaluated maternal use of bronchodilators and anti-inflammatories during the periconceptional period (1 month before conception through the first 3 pregnancy months) among 7638 infants with CHDs and 8106 nonmalformed controls with estimated delivery dates from 1997 to 2007. We used logistic regression to estimate odds ratios and 95% confidence intervals for 20 types of CHDs. RESULTS Among asthma medications reported during the periconceptional period among controls, albuterol accounted for 85.1% of all bronchodilator use, and fluticasone, prednisone, and montelukast accounted for 46.1%, 15.6%, and 14.9% of anti-inflammatory use, respectively. Of the women who reported bronchodilators during the periconceptional period, 71.1% reported use throughout pregnancy and only 29.4% reported concurrent use of an anti-inflammatory. We observed one statistically significant association between maternal bronchodilator use only and anomalous pulmonary venous return (odds ratio 2.3, 95% confidence interval 1.1-4.8) among numerous comparisons. CONCLUSION We did not observe statistically significant associations between the reported use of asthma medications during pregnancy and most specific types of CHDs. Despite limitations in our inability to evaluate asthma status and severity, our study suggests that maternal asthma medication use does not substantially, if at all, increase the risk of CHDs.
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Affiliation(s)
- Alissa R Van Zutphen
- University at Albany School of Public Health, One University Place, Rensselaer, New York.,Bureau of Environmental & Occupational Epidemiology, New York State Department of Health, Empire State Plaza, Corning Tower, Albany, New York
| | - Erin M Bell
- University at Albany School of Public Health, One University Place, Rensselaer, New York
| | - Marilyn L Browne
- University at Albany School of Public Health, One University Place, Rensselaer, New York.,Bureau of Environmental & Occupational Epidemiology, New York State Department of Health, Empire State Plaza, Corning Tower, Albany, New York
| | - Shao Lin
- University at Albany School of Public Health, One University Place, Rensselaer, New York.,Bureau of Environmental & Occupational Epidemiology, New York State Department of Health, Empire State Plaza, Corning Tower, Albany, New York
| | - Angela E Lin
- Medical Genetics, MassGeneral Hospital for Children, Boston, Massachusetts
| | - Charlotte M Druschel
- University at Albany School of Public Health, One University Place, Rensselaer, New York.,Bureau of Environmental & Occupational Epidemiology, New York State Department of Health, Empire State Plaza, Corning Tower, Albany, New York
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Abstract
OBJECTIVES To assess whether a structured employee protection program for pregnant workers at a chemical company has an impact on pregnancy outcomes. METHODS Reported pregnancies (n = 1402) between 2003 and 2010 and their outcomes were documented using questionnaires at the time of pregnancy report, end of pregnancy, and 1 year later. Potential maternal exposures were assessed using job histories, workplace inspections, and questionnaires. RESULTS Participation was 86% overall and was consistently high across subgroups.Pregnancy losses (10.9%), pregnancy complications, and preterm births (8.1%) were in agreement with rates in the general population and were independent of type of work and maternal exposure category. CONCLUSIONS Pregnancy complication rates in this chemical company are not statistically elevated than that in the general population, as suggested in a previous study. The protection program may play a role in preventing complications that may have occurred.
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Kim S, Kim J, Park SY, Um HY, Kim K, Kim Y, Park Y, Baek S, Yoon SY, Kwon HS, Cho YS, Moon HB, Kim TB. Effect of pregnancy in asthma on health care use and perinatal outcomes. J Allergy Clin Immunol 2015; 136:1215-23.e1-6. [PMID: 26071938 DOI: 10.1016/j.jaci.2015.04.043] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 04/21/2015] [Accepted: 04/22/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND It is generally known that pregnancy in asthmatic patients increases the risk of asthma exacerbations and poor perinatal outcomes. However, the effect of pregnancy in asthmatic patients on health care use is not known well. In addition, its effect on perinatal outcomes is still controversial because of study limitations caused by ethical issues. National Health Insurance claim data are an ideal resource for studying real-world health care use patterns of asthma. OBJECTIVE We sought to evaluate the effect of pregnancy on asthma in terms of asthma-related health care use and prescription patterns in concert with the effect of asthma exacerbations on adverse pregnancy outcomes. METHODS Among all asthmatic patients in the Korean National Health Insurance claim database from January 2009 to December 2013, pregnant women who delivered in 2011 with pre-existing asthma were enrolled. Analyses included asthma-related health care use and prescription patterns compared between pregnant asthmatic women and nonpregnant female asthmatic control subjects, as well as within the pregnant subjects from before pregnancy throughout postpartum periods. In addition, the association between asthma exacerbation during pregnancy and adverse pregnancy outcomes was assessed. RESULTS A total of 3,357 pregnant asthmatic patients were compared with 50,355 nonpregnant asthmatic patients, and 10,311 pregnant patients were included to determine the effect of asthma exacerbations on adverse pregnancy outcome in the study. Pregnant asthmatic patients underwent more asthma-related hospitalizations (1.3% vs 0.8%, P = .005) but had significantly fewer outpatient visits and prescriptions for most asthma medications than nonpregnant asthmatic patients. The proportion of patients ever hospitalized gradually increased throughout pregnancy (first trimester, 0.2%; second trimester, 0.5%; and third trimester, 0.7%; P = .018). The prevalence of asthma exacerbation during pregnancy was 5.3%, and the patients who had acute exacerbation during pregnancy had significantly higher asthma-related health care use in terms of hospitalization, intensive care unit admission, and emergency department and outpatient visits within 1 year before delivery than those who had not. However, asthma exacerbation during pregnancy was not significantly related to adverse perinatal outcomes, except for cesarean section (27.1% vs 18.9%, P < .001). All exacerbations were managed with systemic corticosteroids, and the patients who ever experienced acute exacerbations maintained asthma medications, including inhaled corticosteroid-based inhalers, throughout the pregnancy period. CONCLUSION Pregnancy profoundly affects asthma-related health care use but to a different degree depending on whether the patient experienced an exacerbation. Asthma exacerbation during pregnancy is not associated with adverse pregnancy outcomes while managed appropriately with systemic corticosteroids. However, further studies are needed to clarify the effect of asthma control on perinatal outcome and delivery method.
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Affiliation(s)
- Sujeong Kim
- Department of Allergy and Clinical Immunology, Asthma Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jinhee Kim
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea; Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea
| | - So Young Park
- Department of Allergy and Clinical Immunology, Asthma Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hye-Yeon Um
- Korea Institute of Drug Safety and Risk Management, Seoul, Korea
| | - Kyoungjoo Kim
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Yuri Kim
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Yunjin Park
- Department of Statistics, Dongguk University, Seoul, Korea
| | - Seunghee Baek
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Korea
| | - Sun-Young Yoon
- Department of Allergy and Clinical Immunology, Asthma Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyouk-Soo Kwon
- Department of Allergy and Clinical Immunology, Asthma Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - You Sook Cho
- Department of Allergy and Clinical Immunology, Asthma Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee-Bom Moon
- Department of Allergy and Clinical Immunology, Asthma Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Bum Kim
- Department of Allergy and Clinical Immunology, Asthma Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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Flores KF, Robledo CA, Hwang BS, Leishear K, Laughon Grantz K, Mendola P. Does maternal asthma contribute to racial/ethnic disparities in obstetrical and neonatal complications? Ann Epidemiol 2015; 25:392-397.e1. [PMID: 25724829 PMCID: PMC4433572 DOI: 10.1016/j.annepidem.2015.01.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 12/03/2014] [Accepted: 01/22/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE To examine whether maternal asthma contributes to racial/ethnic differences in obstetrical and neonatal complications. METHODS Data on white (n = 110,603), black (n = 50,284), and Hispanic (n = 38,831) singleton deliveries came from the Consortium on Safe Labor. Multilevel logistic regression models, with an interaction term for asthma and race/ethnicity, estimated within-group adjusted odds ratios (aORs) for gestational diabetes, gestational hypertension, pre-eclampsia, placental abruption, premature rupture of membranes, preterm delivery, maternal hemorrhage, neonatal intensive care unit admissions, small for gestational age, apnea, respiratory distress syndrome, transient tachypnea of the newborn, anemia, and hyperbilirubinemia after adjustment for clinical and demographic confounders. Nonasthmatics of the same racial/ethnic group were the reference group. RESULTS Compared with nonasthmatics, white asthmatics had increased odds of pre-eclampsia (aOR, 1.28; 95% confidence interval [CI], 1.15-1.43) and maternal hemorrhage (aOR, 1.14; 95% CI, 1.04-1.23). White and Hispanic infants were more likely to have neonatal intensive care unit admissions (aOR, 1.19; 95% CI, 1.11-1.28; aOR, 1.16; 95% CI, 1.02-1.32, respectively) and be small for gestational age (aOR, 1.11; 95% CI, 1.02-1.20; aOR, 1.26; 95% CI, 1.10-1.44, respectively), and Hispanic infants were more likely to have apnea (aOR, 1.32; 95% CI, 1.02-1.69). CONCLUSIONS Maternal asthma did not affect most obstetrical and neonatal complication risks within racial/ethnic groups. Despite their increased risk for both asthma and many complications, our findings for black women were null. Asthma did not contribute to racial/ethnic disparities in complications.
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Affiliation(s)
- Katrina F Flores
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD
| | - Candace A Robledo
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD
| | - Beom Seuk Hwang
- Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD
| | - Kira Leishear
- Division of Epidemiology, Office of Surveillance and Epidemiology, Office of Pharmacovigilance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD
| | - Katherine Laughon Grantz
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD
| | - Pauline Mendola
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, MD.
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Blackburn HK, Allington DR, Procacci KA, Rivey MP. Asthma in pregnancy. World J Pharmacol 2014; 3:56-71. [DOI: 10.5497/wjp.v3.i4.56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 08/01/2014] [Accepted: 09/17/2014] [Indexed: 02/06/2023] Open
Abstract
Asthma affects approximately 8% of women during pregnancy. Pregnancy results in a variable course for asthma control, likely contributed to by physiological changes affecting the respiratory, immune, and hormonal systems. While asthma during pregnancy has been associated with an increased risk of maternal and fetal complications including malformations, available data also suggest that active asthma management and monitoring can decrease the risk of adverse outcomes. The diagnosis, disease classification, and goals for asthma management in the pregnant woman are the same as for nonpregnant patients. However, evidence shows that pregnant asthmatics are more likely to be undertreated, resulting in asthma exacerbations occurring in approximately one third and hospitalization in one tenth of patients. Pharmacotherapeutic management of asthma exacerbations in pregnant patients follows standard treatment guidelines. In contrast, the principles of asthma maintenance therapy are slightly modified in the pregnant patient. Patients and practitioners may avoid use of asthma medications due to concern for a risk of fetal complications and malformations. A variable amount of information is available regarding the risk of a given asthma medication to cause adverse fetal outcomes, and it is preferable to use an inhaled product. Nevertheless, based on available data, the majority of asthma medications are regarded as safe for use during pregnancy. And, any increased risk to either the mother or fetus from medication use appears to be small compared to that associated with poor asthma control.
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Bain E, Pierides KL, Clifton VL, Hodyl NA, Stark MJ, Crowther CA, Middleton P. Interventions for managing asthma in pregnancy. Cochrane Database Syst Rev 2014; 2014:CD010660. [PMID: 25331331 PMCID: PMC6599853 DOI: 10.1002/14651858.cd010660.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Asthma is the most common respiratory disorder complicating pregnancy, and is associated with a range of adverse maternal and perinatal outcomes. There is strong evidence however, that the adequate control of asthma can improve health outcomes for mothers and their babies. Despite known risks of poorly controlled asthma during pregnancy, a large proportion of women have sub-optimal asthma control, due to concerns surrounding risks of pharmacological agents, and uncertainties regarding the effectiveness and safety of different management strategies. OBJECTIVES To assess the effects of interventions (pharmacologic and non-pharmacologic) for managing women's asthma in pregnancy on maternal and fetal/infant outcomes. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (2 June 2014) and the Cochrane Airways Group's Trials Register (4 June 2014). SELECTION CRITERIA Randomised and quasi-randomised controlled trials comparing any intervention used to manage asthma in pregnancy, with placebo, no intervention, or an alternative intervention. We included pharmacological and non-pharmacological interventions (including combined interventions). Cluster-randomised trials were eligible for inclusion (but none were identified). Cross-over trials were not eligible for inclusion.We included multi-armed trials along with two-armed trials. We also included studies published as abstracts only. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed trial eligibility and quality and extracted data. Data were checked for accuracy. MAIN RESULTS We included eight trials in this review, involving 1181 women and their babies. Overall we judged two trials to be at low risk of bias, two to be of unclear risk of bias, and four to be at moderate risk of bias.Five trials assessed pharmacological agents, including inhaled corticosteroids (beclomethasone or budesonide), inhaled magnesium sulphate, intravenous theophylline, and inhaled beclomethasone verus oral theophylline. Three trials assessed non-pharmacological interventions, including a fractional exhaled nitric oxide (FENO)-based algorithm versus a clinical guideline-based algorithm to adjust inhaled corticosteroid therapy, a pharmacist-led multi-disciplinary approach to management versus standard care, and progressive muscle relaxation (PMR) versus sham training.The eight included trials were assessed under seven separate comparisons. Pharmacological interventionsPrimary outcomes: one trial suggested that inhaled magnesium sulphate in addition to usual treatment could reduce exacerbation frequency in acute asthma (mean difference (MD) -2.80; 95% confidence interval (CI) -3.21 to -2.39; 60 women). One trial assessing the addition of intravenous theophylline to standard care in acute asthma did not report on exacerbations (65 women). No clear difference was shown in the risk of exacerbations with the use of inhaled beclomethasone in addition to usual treatment for maintenance therapy in one trial (risk ratio (RR) 0.36; 95% CI 0.13 to 1.05; 60 women); a second trial also showed no difference, however data were not clearly reported to allow inclusion in a meta-analysis. No difference was shown when inhaled beclomethasone was compared with oral theophylline for maintenance therapy (RR 0.88; 95% CI 0.59 to 1.33; one trial, 385 women). None of these trials reported on neonatal intensive care admissions. SECONDARY OUTCOMES inhaled magnesium sulphate in acute asthma was shown to improve lung function measures (one trial, 60 women); intravenous theophylline in acute asthma was not associated with benefits (one trial, 65 women). No clear differences were seen with the addition of inhaled corticosteroids to routine treatment in three trials (374 women). While inhaled beclomethasone, compared with oral theophylline, significantly reduced treatment discontinuation due to adverse effects in one trial (384 women), no other differences were observed, except for higher treatment adherence with theophylline. Four of the five trials did not report on adverse effects. Non-pharmacological interventionsPrimary outcomes: in one trial, the use of a FENO-based algorithm was shown to significantly reduce asthma exacerbations (RR 0.61; 95% CI 0.41 to 0.90; 220 women); and a trend towards fewer neonatal hospitalisations was observed (RR 0.46; 95% CI 0.21 to 1.02; 214 infants). No exacerbations occurred in one trial assessing pharmacist-led management; this approach did not reduce neonatal intensive care admissions (RR 1.50; 95% CI 0.27 to 8.32; 58 infants). One trial (64 women) assessing PMR did not report on exacerbations or neonatal intensive care admissions. SECONDARY OUTCOMES the use of a FENO-based algorithm to adjust therapy led to some improvements in quality of life scores, as well as more frequent use of inhaled corticosteroids and long-acting β-agonists, and less frequent use of short-acting β-agonists (one trial, 220 women). The FENO-based algorithm was associated with fewer infants with recurrent episodes of bronchiolitis in their first year of life, and a trend towards fewer episodes of croup for infants. Pharmacist-led management improved asthma control scores at six months (one trial, 60 women); PMR improved lung function and quality of life measures (one trial, 64 women). No other differences between comparisons were observed. AUTHORS' CONCLUSIONS Based on eight included trials, of moderate quality overall, no firm conclusions about optimal interventions for managing asthma in pregnancy can be made. Five trials assessing pharmacological interventions did not provide clear evidence of benefits or harms to support or refute current practice. While inhaled magnesium sulphate for acute asthma was shown to reduce exacerbations, this was in one small trial of unclear quality, and thus this finding should be interpreted with caution. Three trials assessing non-pharmacological interventions provided some support for the use of such strategies, however were not powered to detect differences in important maternal and infant outcomes. While a FENO-based algorithm reduced exacerbations, the effects on perinatal outcomes were less certain, and thus widespread implementation is not yet appropriate. Similarly, though positive effects on asthma control were shown with PMR and pharmacist-led management, the evidence to date is insufficient to draw definitive conclusions.In view of the limited evidence base, further randomised trials are required to determine the most effective and safe interventions for asthma in pregnancy. Future trials must be sufficiently powered, and well-designed, to allow differences in important outcomes for mothers and babies to be detected. The impact on health services requires evaluation. Any further trials assessing pharmacological interventions should assess novel agents or those used in current practice. Encouragingly, at least five trials have been identified as planned or underway.
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Affiliation(s)
- Emily Bain
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyAdelaideSouth AustraliaAustralia5006
| | - Kristen L Pierides
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyAdelaideSouth AustraliaAustralia5006
| | - Vicki L Clifton
- Lyell McEwin HospitalClinical Research DevelopmentHaydown RoadAdelaideAustralia5112
- The University of AdelaideRobinson Research InstituteAdelaideAustralia
| | - Nicolette A Hodyl
- The University of AdelaideRobinson Research InstituteAdelaideAustralia
| | - Michael J Stark
- The University of AdelaideRobinson Research InstituteAdelaideAustralia
- Women's and Children's HospitalDepartment of Neonatal Medicine72 King William RoadAdelaideAustralia5005
| | - Caroline A Crowther
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyAdelaideSouth AustraliaAustralia5006
- The University of AucklandLiggins InstitutePrivate Bag 9201985 Park RoadAucklandNew Zealand
| | - Philippa Middleton
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyAdelaideSouth AustraliaAustralia5006
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Rejnö G, Lundholm C, Gong T, Larsson K, Saltvedt S, Almqvist C. Asthma during pregnancy in a population-based study--pregnancy complications and adverse perinatal outcomes. PLoS One 2014; 9:e104755. [PMID: 25141021 PMCID: PMC4139314 DOI: 10.1371/journal.pone.0104755] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 07/16/2014] [Indexed: 12/02/2022] Open
Abstract
Background Asthma is one of the most common chronic diseases, and prevalence, severity and medication may have an effect on pregnancy. We examined maternal asthma, asthma severity and control in relation to pregnancy complications, labour characteristics and perinatal outcomes. Methods We retrieved data on all singleton births from July 1, 2006 to December 31, 2009, and prescribed drugs and physician-diagnosed asthma on the same women from multiple Swedish registers. The associations were estimated with logistic regression. Results In total, 266 045 women gave birth to 284 214 singletons during the study period. Maternal asthma was noted in 26 586 (9.4%) pregnancies. There was an association between maternal asthma and increased risks of pregnancy complications including preeclampsia or eclampsia (adjusted OR 1.15; 95% CI 1.06–1.24) and premature contractions (adj OR 1.52; 95% CI 1.29–1.80). There was also a significant association between maternal asthma and emergency caesarean section (adj OR 1.29; 95% CI 1.23–1.34), low birth weight, and small for gestational age (adj OR 1.23; 95% CI 1.13–1.33). The risk of adverse outcomes such as low birth weight increased with increasing asthma severity. For women with uncontrolled compared to those with controlled asthma the results for adverse outcomes were inconsistent displaying both increased and decreased OR for some outcomes. Conclusion Maternal asthma is associated with a number of serious pregnancy complications and adverse perinatal outcomes. Some complications are even more likely with increased asthma severity. With greater awareness and proper management, outcomes would most likely improve.
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Affiliation(s)
- Gustaf Rejnö
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Obstetrics and Gynaecology Unit, Södersjukhuset, Stockholm, Sweden
- * E-mail:
| | - Cecilia Lundholm
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Tong Gong
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kjell Larsson
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sissel Saltvedt
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Obstetrics and Gynaecology Unit, Karolinska University Hospital, Stockholm, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Lung and Allergy Unit, Karolinska University Hospital, Stockholm, Sweden
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Omalizumab in pregnant women treated due to severe asthma: two case reports of good outcomes of pregnancies. Postepy Dermatol Alergol 2014; 31:104-7. [PMID: 25097476 PMCID: PMC4112254 DOI: 10.5114/pdia.2014.40975] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 01/09/2014] [Accepted: 01/14/2014] [Indexed: 11/17/2022] Open
Abstract
The article presents case reports of 2 women who became pregnant during therapy with omalizumab. Both subjects suffered from very severe asthma and were treated chronically with all available medications including systemic steroids (first - 20 mg prednisolone/day, second - 40 mg prednisolone/day). Both were enrolled into treatment with omalizumab and started regular therapy in 2007. The course of asthma significantly improved in both cases (withdrawal of oral steroids or significant reduction of their dose, better asthma control). The first woman, 32-year-old, became pregnant in 2010 and gave birth in Oct 2010 - it was her 3(rd) pregnancy, and 3(rd) labor. The second woman, 31-year-old, also became pregnant in 2010 and gave birth in Jan 2011 - it was her 5(th) pregnancy and 2(nd) labor. Both had severe asthma exacerbations during previous pregnancies and labors, and decided to continue therapy with omalizumab. The first woman, besides omalizumab, was treated with high doses of inhaled corticosteroids (ICS) and long-acting β agonists (LABA) while the second one was treated with high doses of ICS, LABA and 2.5 mg to 5 mg prednisone/day. The pregnancies proceeded without asthma exacerbations. The first woman delivered a healthy girl (Apgar 9, weight 3200 g, length 56 cm) in the 40(th) week of pregnancy by caesarean section due to the narrow pelvis. The second one delivered a healthy boy (Apgar 9, weight 3800 g, length 56 cm) in week 40 by caesarean section due to the aggravating obstetrical history. In both cases, treatment with omalizumab did not affect pregnancies and newborns.
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Blais L, Kettani FZ, Forget A. Associations of maternal asthma severity and control with pregnancy complications. J Asthma 2014; 51:391-8. [PMID: 24404798 DOI: 10.3109/02770903.2013.879880] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To assess the associations of maternal asthma severity and control with pregnancy-induced hypertension (PIH), gestational diabetes and cesarean delivery. METHODS A cohort of 41 660 pregnancies from women with and without asthma who delivered between 1990 and 2002 was constructed by linking Québec's administrative databases. Maternal asthma was defined by at least one asthma diagnosis and one dispensed prescription for an asthma medication in the 2 years before or during pregnancy. Asthma severity and control were assessed using validated indexes during the entire pregnancy to study cesarean delivery and 1-year prior to week 20 of gestation to study PIH and gestational diabetes. Generalized Estimation Equation models were used to obtain odds ratios (OR) for PIH, gestational diabetes and cesarean in association with maternal asthma severity and control. RESULTS Almost one-third of the women had uncontrolled asthma and up to 5% had severe asthma. Severe asthma increased the risk of cesarean delivery (OR = 1.35; 95% CI: 1.11-1.63) compared with mild asthma, but no association was found between asthma severity and the other outcomes. The level of asthma control was not associated with any of the outcomes, except for a near-significant increased risk of PIH among uncontrolled women (OR = 1.18; 95% CI: 0.97-1.42). CONCLUSIONS The risk of gestational diabetes was not associated with asthma severity or control, and the risk of PIH was not associated with asthma severity. However, further studies are needed to clarify the association between asthma control and PIH. The increased risk of cesarean among women with severe asthma may be explained by the physician's and patient's concerns over the safety of normal delivery.
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Affiliation(s)
- Lucie Blais
- Faculty of Pharmacy, Université de Montréal , Montréal, Québec , Canada and
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Koshy G, Akrouf KAS, Kelly Y, Delpisheh A, Brabin BJ. Asthma in children in relation to pre-term birth and fetal growth restriction. Matern Child Health J 2014; 17:1119-29. [PMID: 22903307 DOI: 10.1007/s10995-012-1114-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
To assess the impact of parental asthma on risk of pre-term birth (PTB) and intrauterine growth restriction, and their subsequent association with childhood asthma. Three sequential cross-sectional surveys were conducted in 1993 (3,746), 1998 (1,964) and 2006 (1,074) in the same 15 schools among 5-11 year old children in Merseyside using the same respiratory health questionnaire completed by parents (sample size in brackets). Between 1993 and 2006, prevalence of PTB varied between 12.4 and 15.2 %, and of small for gestational age (SGA or growth restricted) babies between 2.1 and 4.6 %, and maternal asthma prevalence between 8.1 and 13.4 %. For the combined surveys mothers with asthma were more likely to have a PTB than non-asthmatic mothers (OR 1.39, 95 % CI 1.10-1.95, p < 0.001), and in the 2006 survey were more likely to have an SGA baby. 40.9 % of PTBs of asthmatic mothers developed doctor diagnosed asthma compared to 34.3 % for term babies (adjusted OR 1.65, 1.34-2.04, p < 0.001). The corresponding estimates for the symptom triad of cough, wheeze and breathlessness were 19.4 and 17.6 % (adjusted OR 1.78, 0.79-3.98). Conversely SGA babies were less likely to develop doctor diagnosed asthma (adjusted OR 0.49, 0.27-0.90, p < 0.021), or the symptom triad of cough, wheeze and breathlessness (adjusted OR 0.22, 0.05-0.97, p < 0.043), whether or not the mother was asthmatic. Maternal asthma is an independent risk factor for PTB which predisposes to childhood asthma. Intrauterine growth restriction was protective against childhood asthma.
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Affiliation(s)
- Gibby Koshy
- Child and Reproductive Health Group, Liverpool School of Tropical Medicine, Liverpool, UK
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[Asthma during pregnancy: effects on fetal well-being, and maternal and perinatal complications]. Rev Assoc Med Bras (1992) 2013; 59:113-9. [PMID: 23582551 DOI: 10.1016/j.ramb.2012.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2012] [Revised: 07/18/2012] [Accepted: 08/12/2012] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To assess the effects of maternal asthma on pregnancy, analyzing the consequences of the severity of the disease in the impairment of fetal well-being, as well as the related maternal and perinatal complications. METHODS A retrospective study with 117 pregnancies complicated by maternal asthma and with no other comorbidities, in the period from January, 2005 to December, 2010. Inclusion criteria were as follows: singleton pregnancy; pregnant women diagnosed with asthma prior to pregnancy; initiation of prenatal care before the 28(th) week of pregnancy; birth at this institution; newborn weighing over 500 g and gestational age at delivery of 22 weeks or more; absence of fetal malformations or chromosomal abnormalities; absence of maternal comorbidities. Asthma was classified as intermittent, mild persistent, moderate persistent, or severe persistent. The results of fetal biophysical profile and of Doppler velocimetry of the umbilical artery performed 14 days prior to birth were analyzed. RESULTS Of the total of 117 pregnant women with asthma, 41 (35.0%) had intermittent, 33 (28.2%) mild persistent, 21 (17.9%) moderate persistent, and 22 (18.8%) severe persistent asthma. There was no significant difference among the groups as to the type of birth: cesarean section was performed in 65.8% of the cases, maternal corticosteroid therapy was used at the moment of birth in 20.5%, the gestational age at birth averaged 38.6 weeks (SD 1.9 weeks), and birth weight averaged 3,056 g (SD 581g). The fetal biophysical profile performed during the antepartum period (n=90, 76.9%) showed a normal result (8 or 10) in 99% of the cases. Doppler velocimetry of the umbilical artery was assessed in 23.9% (n=28) of the pregnant women, and delivered normal results in 100% of the cases. The use of systemic corticosteroid therapy was significantly (p<0.001) different among the intermittent (4.9%), mild persistent (9.1%), moderate persistent (28.6%), and severe persistent (45.5%) groups. Regarding the beginning of birth, there was a higher proportion of elective cesarean section in the groups with moderate persistent asthma (52.5%) and severe persistent (54.6%) when compared to the intermittent (21.9%) and mild persistent (24.2%) groups (p=0.039). CONCLUSION The severity of maternal asthma does not appear to have any direct influence on perinatal outcomes, and does not compromise fetal well-being. Active conduct to enable a better maternal clinical condition provides a favorable prognosis for pregnancy complicated by asthma.
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Wang G, Murphy VE, Namazy J, Powell H, Schatz M, Chambers C, Attia J, Gibson PG. The risk of maternal and placental complications in pregnant women with asthma: a systematic review and meta-analysis. J Matern Fetal Neonatal Med 2013; 27:934-42. [PMID: 24111742 DOI: 10.3109/14767058.2013.847080] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To investigate if maternal asthma is associated with an increased risk of maternal and placental complications in pregnancy. METHODS Electronic databases were searched for the following terms: (asthma or wheeze) and (pregnan* or perinat* or obstet*). Cohort studies published between January 1975 and March 2012 were considered for inclusion. Forty publications met the inclusion criteria, reporting at least one maternal or placental complication in pregnant women with and without asthma. Relative risk (RR) with 95% confidence intervals (CIs) was calculated. RESULTS Maternal asthma was associated with a significantly increased risk of cesarean section (RR = 1.31, 95%CI = [1.22-1.39]), gestational diabetes (RR = 1.39, 95%CI = [1.17-1.66]), hemorrhage (antepartum: RR = 1.25, 95%CI = [1.10-1.42]; postpartum: RR = 1.29, 95%CI = [1.18-1.41]), placenta previa (RR = 1.23, 95%CI = [1.07-1.40]), placental abruption (RR = 1.29, 95%CI = [1.14-1.47]) and premature rupture of membranes (RR = 1.21, 95%CI = 1.07-1.37). Moderate to severe asthma significantly increased the risk of cesarean section (RR = 1.19, 95%CI = [1.09-1.31]) and gestational diabetes (RR = 1.19, 95%CI = [1.06-1.33]) compared to mild asthma. Bronchodilator use was associated with a significantly lowered risk of gestational diabetes (RR = 0.64, 95%CI = [0.57-0.72]). CONCLUSIONS Pregnant women with asthma are at increased risk of maternal and placental complications, and women with moderate/severe asthma may be at particular risk. Further studies are required to elucidate whether adequate control of asthma during pregnancy reduces these risks.
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Affiliation(s)
- Gang Wang
- Centre for Asthma and Respiratory Diseases, University of Newcastle and Hunter Medical Research Institute , Newcastle, NSW , Australia
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Kitsantas P, Christopher KE. Smoking and respiratory conditions in pregnancy: associations with adverse pregnancy outcomes. South Med J 2013; 106:310-5. [PMID: 23644639 DOI: 10.1097/smj.0b013e318290c6e8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Acute and chronic respiratory conditions affect a large segment of pregnant women. The purpose of the current study was to examine the concomitant effects of respiratory conditions and smoking during pregnancy on gestational age, birth weight, fetal distress, infant mortality, premature rupture of membranes, placenta abruption, and mode of delivery. METHODS This study used data (n = 1,064,969) from the North Carolina linked birth/infant death files from 1999 to 2007. Logistic regression was used to compute odds ratios and 95% confidence intervals (CIs) in assessing risk of adverse pregnancy outcomes. RESULTS We found that women with respiratory conditions/smoking status were significantly more likely than nonsmokers with no respiratory conditions to have a low-birth-weight infant, an infant with fetal distress, and experience preterm birth and an infant's death. Adjusted odds ratios also revealed that smokers with respiratory conditions were 2.37 (95% CI 1.69-3.32) times more likely than women with no respiratory conditions/nonsmoking status to have placenta abruption and 2.20 (95% CI 1.85-2.61) times more likely to have premature rupture of membranes. Regardless of smoking status, women with respiratory conditions were less likely to have a vaginal delivery. CONCLUSIONS These findings underscore the need for clinical and public health programs to educate women, particularly those with respiratory diseases, of the immense array of adverse outcomes that may occur as a consequence of active maternal smoking during gestation. It is important for interventions to target mothers with respiratory conditions early on to ensure favorable birth outcomes.
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Affiliation(s)
- Panagiota Kitsantas
- College of Health and Human Services, George Mason University, Fairfax, Virginia 22030, USA.
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Chang A, Zhang Z, Jia L, Zhang L, Gao Y, Zhang L. Alteration of heat shock protein 70 expression levels in term and preterm delivery. J Matern Fetal Neonatal Med 2013; 26:1581-5. [DOI: 10.3109/14767058.2013.795535] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Murphy VE, Wang G, Namazy JA, Powell H, Gibson PG, Chambers C, Schatz M. The risk of congenital malformations, perinatal mortality and neonatal hospitalisation among pregnant women with asthma: a systematic review and meta-analysis. BJOG 2013; 120:812-22. [PMID: 23530780 DOI: 10.1111/1471-0528.12224] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2013] [Indexed: 12/30/2022]
Abstract
BACKGROUND There is conflicting literature on the effect of maternal asthma on congenital malformations and neonatal outcomes. OBJECTIVES This review and meta-analysis sought to determine if maternal asthma is associated with an increased risk of adverse neonatal outcomes. SEARCH STRATEGY We searched electronic databases for: (asthma or wheeze) and (pregnan* or perinat* or obstet*). SELECTION CRITERIA Cohort studies published between 1975 and March 2012 reporting at least one perinatal outcome of interest (congenital malformations, neonatal complications, perinatal mortality). DATA COLLECTION AND ANALYSIS In all, 21 studies met inclusion criteria in pregnant women with and without asthma. Further analysis was conducted on 16 studies where asthmatic women were stratified by exacerbation history, corticosteroid use, bronchodilator use or asthma severity. MAIN RESULTS Maternal asthma was associated with a significantly increased risk of congenital malformations (relative risk [RR] 1.11, 95% confidence interval [95% CI] 1.02-1.21, I(2) = 59.5%), cleft lip with or without cleft palate (RR 1.30, 95% CI 1.01-1.68, I(2) = 65.6%), neonatal death (RR 1.49, 95% CI 1.11-2.00, I(2) = 0%), and neonatal hospitalisation (RR 1.50, 95% CI 1.03-2.20, I(2) = 64.5%). There was no significant effect of asthma on major malformations (RR 1.31, 95% CI 0.57-3.02, I(2) = 70.9%) or stillbirth (RR 1.06, 95% CI 0.9-1.25, I(2) = 35%). Exacerbations and use of bronchodilators and inhaled corticosteroids were not associated with congenital malformation risk. AUTHORS' CONCLUSIONS Despite limitations related to the observational nature of the primary studies, this review demonstrates a small increased risk of neonatal complications among pregnant women with asthma. Further investigations into mechanisms and potential preventive interventions to improve infant outcomes are required.
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Affiliation(s)
- V E Murphy
- Centre for Asthma and Respiratory Diseases, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia.
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Blais L, Kettani FZ, Forget A. Relationship between maternal asthma, its severity and control and abortion. Hum Reprod 2013; 28:908-15. [PMID: 23427230 DOI: 10.1093/humrep/det024] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
STUDY QUESTION Are women with asthma, and more specifically those with severe or uncontrolled asthma, at higher risk of spontaneous and induced abortions? SUMMARY ANSWER Pregnant women with asthma, notably when uncontrolled, are at higher risk of spontaneous abortion. WHAT IS KNOWN ALREADY Only one study has examined the association between asthma and spontaneous and induced abortions and revealed a modest increase in the risk of spontaneous abortions, particularly in women with more severe asthma and those with previous exacerbations, and a marginal decrease in the risk of induced abortions. STUDY DESIGN, SIZE, DURATION A cohort of pregnancies from asthmatic (n = 15,107) and non-asthmatic (n = 34,331) women was reconstructed by linking three administrative databases from Quebec (Canada), between 1992 and 2002. The cohort included 7870 spontaneous abortions, 14,596 induced abortions and 26,972 live births. PARTICIPANTS/MATERIALS, SETTING, METHODS Pregnant women with and without asthma were analyzed. Asthma was defined by at least one asthma diagnosis and one dispensed prescription for an asthma medication in the 2 years prior to or during pregnancy. Asthma severity and control were assessed using validated indexes in the year before the 20th week of pregnancy or the termination of the pregnancy. Logistic polytomous regression models were used to estimate the relationship between asthma and asthma severity and control on the risk of abortion, while adjusting for potential confounders. MAIN RESULTS AND THE ROLE OF CHANCE The prevalence of spontaneous and induced abortions was 15.9 and 29.5%, respectively. Maternal asthma was associated with an increased risk of a spontaneous abortion [odds ratio (OR) = 1.41; 95% confidence interval (CI): 1.33-1.49] and a decreased risk of induced abortions (OR = 0.92; 0.88-0.97). No association was observed between asthma severity and abortion, while uncontrolled asthma increased the risk of a spontaneous abortion by 26% (95% CI: 14-41%) and the risk of induced abortions by 11% (95% CI: 1-21%). LIMITATIONS, REASONS FOR CAUTION It is possible that the study results were confounded by imbalances between groups in variables that are not recorded in the databases, but that are known to be associated with spontaneous abortions, such as alcohol consumption, obesity or maternal smoking. However, we performed sensitivity analyses which revealed that these factors are unlikely to explain the observed increased risk for a spontaneous abortion. It is also possible that women with asthma are more likely to have abortions recorded in the databases, because subjects with a chronic disease tend to visit a physician more often than those without asthma. Therefore, our odds estimates for these outcomes may be overestimated when asthmatic women were compared with non-asthmatic women. A further limitation of the study is that it would have been more appropriate to measure the severity and control of asthma only during the pregnancy. WIDER IMPLICATIONS OF THE FINDINGS Our cohort is less representative of women in the upper socio-economic level. This is not a threat to internal validity, but it could limit the external validity if the impact of asthma on the risk of abortion differed according to the socio-economic status of the mother. Despite the absence of supporting data, this possibility cannot be completely excluded. STUDY FUNDING/COMPETING INTEREST(S) This study was funded by the Canadian Institutes of Health Research and Genentech. L.B. received research grants from Astra-Zeneca, Pfizer, sanofi-aventis, Novartis and Merck for research projects and co-chairs the Astra-Zeneca Endowment Pharmaceutical Chair in Respiratory Health. F.Z.K and A.F. have no competing interests to declare.
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Affiliation(s)
- Lucie Blais
- Faculté de pharmacie, Université de Montréal, CP 6128, succursale Centre-ville, Montréal, QC, Canada H3C 3J7.
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Affiliation(s)
- Alois Gessl
- Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
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Streck MR, Blaiss MS. Quality of care of asthma during pregnancy. Expert Rev Pharmacoecon Outcomes Res 2012; 6:67-77. [PMID: 20528540 DOI: 10.1586/14737167.6.1.67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The goal of asthma management during pregnancy is to keep the mother symptom free and to prevent complications in the fetus. Asthma is a common chronic condition in pregnancy that, if inadequately treated, has the potential to cause adverse effects for both mother and fetus. Aggressive treatment during pregnancy can decrease costs associated with asthma now and additional costs later if the fetus has a poor outcome due to maternal asthma. A stepwise approach to the management of asthma during pregnancy has been developed and is not unlike the management of the nonpregnant patient. Although there are no double-blind, placebo-controlled studies on asthma medications in pregnant women, large cohort studies have shown the efficacy of aggressive management. With adequate control of asthma from the preconception time through delivery, studies have shown similar outcomes in asthmatic patients compared with nonasthmatics, thus obtaining the goal of a symptom-free mother and a healthy baby.
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Affiliation(s)
- Maria R Streck
- University of Tennessee Center for the Health Sciences, College of Medicine, 50 North Dunlap Street, 4th Floor, West Patient Tower, Memphis, TN 38103, USA.
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Migraine-asthma comorbidity and risk of hypertensive disorders of pregnancy. J Pregnancy 2012; 2012:858097. [PMID: 22934185 PMCID: PMC3425816 DOI: 10.1155/2012/858097] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 06/16/2012] [Indexed: 12/26/2022] Open
Abstract
Background. To evaluate the association of migraine and asthma and to estimate the risk of hypertensive disorders of pregnancy in relation to maternal comorbid migraine and asthma. Methods. Reproductive age women (N = 3.731) were interviewed during early pregnancy. At the time of interview, we ascertained participants' migraine and asthma status. From medical records, we collected information to allow the diagnosis of pregnancy-induced hypertension (PIH) and preeclampsia. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression procedures. Results. After adjusting for confounders, migraineurs had 1.38-fold increased odds of asthma as compared with nonmigraineurs (95% CI 1.09–1.38). The odds of hypertensive disorders of pregnancy were highest among women with comorbid migraine-asthma. The ORs for PIH preeclampsia and the two disorders combined were 2.53 (95% CI 1.39–4.61), 3.53 (95% CI 1.51–8.24), and 2.64 (95% CI 1.56–4.47), respectively, for women with comorbid migraine-asthma as compared with those who had neither disorder. Conclusion. These findings confirm prior reports and extend the literature by documenting particularly high odds of pregnancy-induced hypertension and preeclampsia among women with comorbid migraine-asthma. Increased knowledge about the prevalence and sequelae of comorbidities during pregnancy may lead to improved symptom management and perinatal outcomes.
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Firoozi F, Lemière C, Beauchesne MF, Perreault S, Forget A, Blais L. Impact of maternal asthma on perinatal outcomes: a two-stage sampling cohort study. Eur J Epidemiol 2012; 27:205-14. [PMID: 22286718 DOI: 10.1007/s10654-012-9654-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 01/16/2012] [Indexed: 11/24/2022]
Abstract
There are conflicting results concerning the impact of maternal asthma during pregnancy on perinatal outcomes. The present study investigated the associations between maternal asthma during pregnancy and the risk of a small-for-gestational-age (SGA) infant, a low-birth-weight (LBW) infant, and preterm birth. A population-based cohort of 40,788 pregnancies from asthmatic and non-asthmatic women was reconstructed through the linking of three Quebec (Canada) administrative databases between 1990 and 2002. A two-stage sampling cohort design was used to collect additional information by way of a mailed questionnaire. The generalized estimation equation models were used to obtain adjusted odds ratios of SGA, LBW and preterm birth comparing asthmatic and non-asthmatic women. The cohort included 13,007 pregnancies from asthmatic and 27,781 pregnancies from non-asthmatic women. Final estimates showed that the odds of SGA (odds ratio: 1.27, 95% confidence interval: 1.14, 1.41), LBW (1.41: 1.22, 1.63) and preterm delivery (1.64: 1.46, 1.83) were significantly higher among asthmatic than non-asthmatic women. Mothers with asthma during pregnancy are more likely to have SGA, LBW, or preterm birth infants than non-asthmatic women. These results can be more easily generalized to women with lower socio-economic status since the cohort under represents women with high socio-economic status.
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Affiliation(s)
- Faranak Firoozi
- Faculty of Pharmacy, Université de Montréal, succursale Centre-ville, C.P. 6128, Montréal, QC, H3C 3J7, Canada
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Carter RM, Symons Downs D, Bascom R, Dyer AM, Weisman CS. The moderating influence of asthma diagnosis on biobehavioral health characteristics of women of reproductive age. Matern Child Health J 2012; 16:448-55. [PMID: 21400202 DOI: 10.1007/s10995-011-0749-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Promoting healthy behaviors to improve pregnancy outcomes requires an understanding of the factors influencing health behaviors among at-risk populations. We hypothesized that women with an asthma diagnosis would have poorer biobehavioral health risk factors and pregnancy outcomes compared to women without an asthma diagnosis. The Central Pennsylvania Women's Health Study (CePAWHS) included a population-based survey examining health status indicators, risk factors and outcomes, and detailed pregnancy histories among 2,002 women (ages 18-45). 213 asthmatics were identified. Compared with Non-asthmatic women (NA), Asthmatic (A) women reported lower rates of excellent health status (45% A vs. 65% NA, P < 0.001), were more likely to be overweight or obese (68% A vs. 50% NA, P < 0.001), and were more likely to have smoked cigarettes during their first pregnancy (25% A vs. 17% NA, P < 0.01). Psychological measures (psychosocial hassles, low self-esteem, depression) were reported more often in asthmatics than non-asthmatics. Also, asthmatics reported a higher incidence of gestational diabetes (10% A vs. 6% of NA, P = 0.05), preterm births (25% A vs. 16% NA, P < 0.01), and had a higher proportion of low birth weight infants (20% A vs. 13% NA, P = 0.03) compared with non-asthmatics. As predicted, asthmatics had poorer biobehavioral risk factors and outcomes compared to non-asthmatics. These findings illustrate the need to target asthmatic women of reproductive age, particularly in this largely rural setting, with interventions to reduce biobehavioral risk factors as part of a strategy to improve pregnancy outcomes.
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Affiliation(s)
- RyaLynn M Carter
- Department of Obstetrics and Gynecology, The Pennsylvania State University College of Medicine, Penn State Hershey Medical Center, Hershey, PA 17033, USA.
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