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de Carvalho-Pinto RM, Cançado JED, Caetano LSB, Machado AS, Blanco DC, Garcia GF, Figueiredo RG, Bartholo TP. Asthma and pregnancy. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e2023S123. [PMID: 37556642 PMCID: PMC10411707 DOI: 10.1590/1806-9282.2023s123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/17/2023] [Indexed: 08/11/2023]
Affiliation(s)
- Regina Maria de Carvalho-Pinto
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Instituto do Coração, Divisão de Pneumologia – São Paulo (SP), Brazil
| | - José Eduardo Delfini Cançado
- Santa Casa de Misericórdia de São Paulo, Pós-Graduação da Faculdade de Ciências Médicas – São Paulo (SP), Brazil
| | | | - Adelmir Souza Machado
- Universidade Federal da Bahia, 4 D do Instituto de Ciências da Saúde – Bahia (BA), Brazil
| | - Daniela Cavalet Blanco
- Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Medicina – Porto Alegre (RS), Brazil
| | | | - Ricardo Gassmann Figueiredo
- Universidade Estadual de Feira de Santana, Programa de Pós-Graduação em Saúde Coletiva – Feira de Santana (BA), Brazil
| | - Thiago Prudente Bartholo
- Universidade do Estado do Rio de Janeiro, Faculdade de Ciências Médicas, Disciplina de Pneumologia e Tisiologia – Rio de Janeiro (RJ), Brazil
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Abstract
Background: Asthma is a frequent and potentially life-threatening disease that complicates many pregnancies. There are extensive data with regard to the diagnosis and treatment of asthma during pregnancy. Medical providers require an up-to-date summary of the critical aspects of asthma management during pregnancy. Objective: This review aimed to summarize the available data from clinical trials, cohort studies, expert opinions, and guideline recommendations with regard to asthma in pregnancy. Methods: A search through PubMed was conducted by using keywords previously mentioned and MeSH (Medical Subject Headings) terminology. Clinical trials, observational studies, expert opinions, guidelines, and other reviews were included. The quality of the studies was assessed, and data were extracted and summarized. Results: Asthma worsens in ∼40% of pregnant women, which can be associated with maternal and fetal complications. Physiologic changes in the respiratory, cardiovascular, and immune systems during pregnancy play a critical role in the manifestations of asthma. The diagnosis and the treatment of asthma are similar to that of patients who are not pregnant. Nonetheless, concern for fetal malformations, preterm birth, and low birth weight must be considered when managing pregnant patients with asthma. Importantly, cornerstones of the pharmacotherapy of asthma seem to be safe during pregnancy. Conclusion: Asthma in pregnancy is associated with adverse outcomes. Roadblocks to management include associated comorbidities, medication nonadherence, atopy, lack of education, and smoking habits. These need to be acknowledged and addressed for successful asthma management during pregnancy.
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Fazel N, Kundi M, Jensen-Jarolim E, Pali-Schöll I, Kazemzadeh A, Abdizadeh MF, Esmaily H, Akbarzadeh R, Ahmadi R. Prospective cohort study of pregnancy complications and birth outcomes in women with asthma. Arch Gynecol Obstet 2018; 298:279-287. [PMID: 29797075 PMCID: PMC6060764 DOI: 10.1007/s00404-018-4800-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 05/16/2018] [Indexed: 12/03/2022]
Abstract
Background Asthma is the most common potentially serious medical complication in pregnancy. The purpose of this study was to determine the association between maternal asthma and a spectrum of adverse neonatal and maternal outcomes. Methods Events during pregnancy and birth outcome were evaluated in 34 asthmatic as well as 1569 non-asthmatic pregnant women who were enrolled in a prospective cohort study undertaken at the antenatal clinics of Mobini Hospital in Iran. The women were interviewed and classified according to clinical severity and asthma control as per GINA guidelines. Information on asthma symptoms was collected by a questionnaire as well as by spirometry and physical examination. All subjects were followed until delivery, and postpartum charts were reviewed to assess neonatal and maternal outcomes. Eosinophil cells counts were obtained and total IgE was measured by ELISA. Results were assessed by multivariate logistic regression adjusting for maternal age and parity, and for birth outcomes, for gestational diabetes, and hypertension/pre-eclampsia. Results The well-known relationship between family history of asthma and asthma in pregnancy was again supported (p < 0.001). Women with asthma had more bleeding events 3 weeks or more before delivery (OR 3.30, 95% CI 1.41–7.26), more often placenta problems (OR 6.86, 95% CI 1.42–33.02), and gestational diabetes mellitus (OR 3.82, 95% CI 1.06–13.75). No significant differences between asthmatic and non-asthmatic mothers regarding duration of gestation, birthweight, low Apgar scores, or neonatal respiratory difficulties were found. Total IgE antibody levels and eosinophil counts did not differ by asthma control and severity. Conclusions Asthma in pregnancy poses some risk for pregnancy complications and adverse perinatal outcomes. Managing asthma effectively throughout pregnancy could benefit women and their babies and help to reduce the health burden associated with asthma during pregnancy.
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Affiliation(s)
- Nasrin Fazel
- Center for Public Health, Medical University Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria
- Department of Internal Medicine, University of Medical Sciences, Sabzevar, Iran
| | - Michael Kundi
- Center for Public Health, Medical University Vienna, Kinderspitalgasse 15, 1090, Vienna, Austria.
| | - Erika Jensen-Jarolim
- Institute for Pathophysiology and Allergy Research, Medical University Vienna, Vienna, Austria
- The Interuniversity Messerli Research Institute, University of Veterinary Medicine Vienna, Medical University Vienna and University Vienna, Vienna, Austria
| | - Isabella Pali-Schöll
- Institute for Pathophysiology and Allergy Research, Medical University Vienna, Vienna, Austria
- The Interuniversity Messerli Research Institute, University of Veterinary Medicine Vienna, Medical University Vienna and University Vienna, Vienna, Austria
| | - Asghar Kazemzadeh
- Department of Internal Medicine, University of Medical Sciences, Sabzevar, Iran
| | | | - Habibollah Esmaily
- Department of Biostatistics and Epidemiology, Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Roya Akbarzadeh
- Paramedicine College, University of Medical Sciences, Sabzevar, Iran
| | - Raheleh Ahmadi
- Department of Obstetrics and Gynecology, Mobini Hospital, University of Medical Sciences, Sabzevar, Iran
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Lange S, Probst C, Heer N, Roerecke M, Rehm J, Monteiro MG, Shield K, de Oliveira C, Popova S. Actual and predicted prevalence of alcohol consumption during pregnancy in Latin America and the Caribbean: systematic literature review and meta-analysis. Rev Panam Salud Publica 2017. [PMID: 28614487 PMCID: PMC6645189 DOI: 10.26633/rpsp.2017.89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective To estimate the prevalence of alcohol consumption during pregnancy among the general population of Latin America and the Caribbean, by country, in 2012. Methods Three steps were taken: a comprehensive, systematic literature search; meta-analyses, assuming a random-effects model for countries with published studies; and regression modelling (data prediction) for countries with either no published studies or too few to obtain an estimate. Results Based on 24 existing studies, the pooled prevalence of alcohol consumption during pregnancy among the general population was estimated for Brazil (15.2%; 95% confidence interval [95%CI]: 10.4%–20.8%) and Mexico (1.2%; 95%CI: 0.0%–2.7%). The prevalence of alcohol consumption during pregnancy among the general population was predicted for 31 countries and ranged from 4.8% (95%CI: 4.2%–5.4%) in Cuba to 23.3% (95%CI: 20.1%–26.5%) in Grenada. Conclusions Greater prevention efforts and measures are needed in the countries of Latin America and the Caribbean to prevent pregnant women from consuming alcohol during pregnancy and decrease the rates of Fetal Alcohol Spectrum Disorder. Additional high quality studies on the prevalence of alcohol consumption during pregnancy in Latin America and the Caribbean are also needed.
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Affiliation(s)
- Shannon Lange
- Institute for Mental Health Policy Research, Center for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Charlotte Probst
- Institute for Mental Health Policy Research, Center for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Navrose Heer
- Institute for Mental Health Policy Research, Center for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Michael Roerecke
- Institute for Mental Health Policy Research, Center for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Jürgen Rehm
- Institute for Mental Health Policy Research, Center for Addiction and Mental Health, Toronto, Ontario, Canada
| | | | - Kevin Shield
- Institute for Mental Health Policy Research, Center for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Claire de Oliveira
- Institute for Mental Health Policy Research, Center for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Svetlana Popova
- Institute for Mental Health Policy Research, Center for Addiction and Mental Health, Toronto, Ontario, Canada
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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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Patel KK, Caramelli B, Gomes A. A survey of recently published cardiovascular, hematological and pneumological original articles in the Brazilian scientific press. Clinics (Sao Paulo) 2011; 66:2159-68. [PMID: 22189744 PMCID: PMC3226614 DOI: 10.1590/s1807-59322011001200024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Accepted: 11/07/2011] [Indexed: 11/21/2022] Open
Abstract
Recent original scientific contributions published in selected Brazilian periodicals and classifiable under cardiovascular and pulmonary subject categories cover a wide range of sub specialties, both clinical and experimental. Because they appear in journals with only recently enhanced visibility, we have decided to highlight a number of specific items appeared in four Brazilian journals, because we understand that this is an important subsidy to keep our readership adequately informed. These papers cover extensive sub-areas in both fields.
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