Pregnancy Outcomes among Women with Intermittent Asthma: A Retrospective Cohort Study (original) (raw)
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ERJ open research, 2016
There exists a paucity of data for socially disadvantaged populations describing patterns and predictors of asthma control status and exacerbations during pregnancy, and their relationship to adverse perinatal outcomes. Asthmatic women (n=189) were followed prospectively during pregnancy, with visits at 12, 20, 28 and 36 weeks gestation. Data on loss of control, recurrent uncontrolled asthma and moderate/severe exacerbations were collected at each visit and their relationship to perinatal outcomes examined following stratification for fetal sex. 50% of asthmatic women experienced a loss of control or moderate/severe exacerbation during pregnancy, with 22% of women experiencing a moderate/severe exacerbation. Factors associated with an increased risk of women experiencing recurrent uncontrolled asthma during pregnancy included smoking (relative risk 2.92, 95% CI 1.53-5.58), inhaled corticosteroid use at the beginning of pregnancy (relative risk 2.40, 95% CI 1.25-4.60) and increasing ...
Respiratory Medicine, 2016
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%, OR adj 1.60, 95% CI 1.07e2.38; p ¼ 0.02) and small for gestational age neonates (SGA) (OR adj 1.30, 95% CI 1.10e1.54; p < 0.01) compared to controls. Compared to mild asthma, more severe asthma was associated with a higher risk of SGA (60% vs 53%, OR adj. 1.30, 95% CI 1.10e1.54; p < 0.01). Women with asthma exacerbation during pregnancy tended to have a higher risk of severe pre-eclampsia (OR adj 3.33 95% CI 0.96e11.65, p ¼ 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.
Prospective cohort study of pregnancy complications and birth outcomes in women with asthma
Archives of gynecology and obstetrics, 2018
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. 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 outcome...
Incidence of asthma exacerbations during pregnancy have evaluated the relationship between asthma severity and risk of exacerbations during preg-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.
Adverse maternal outcomes in women with asthma versus women without asthma
Applied Nursing Research, 2010
The purpose of this retrospective cohort study was to examine differences in adverse maternal outcomes between pregnant women with asthma and pregnant women without asthma. A total of 7,777 pregnant patients with asthma were abstracted from a national database. The comparison group was 31,108 women, randomly selected from 541,719 pregnant women without asthma. Logistic regression was used to examine the relationship of asthma to 12 maternal outcome measures. Odds ratios were used to approximate the association of how much more likely pregnant women with asthma were to have adverse maternal outcomes. Pregnant women with asthma were more likely to have adverse maternal outcomes than did the pregnant women without asthma.
Maternal asthma and pregnancy outcomes: A retrospective cohort study
American Journal of Obstetrics and Gynecology, 2001
We examined the relationship between asthma during pregnancy and selected infant and maternal outcomes. STUDY DESIGN: A retrospective cohort study was conducted on mother-infant dyads identified from a linked infant and maternal hospital discharge database in the Canadian province of Quebec between fiscal years 1991-1992 and 1995-1996. Mothers with asthma (n = 2193) were compared with a randomly selected control sample (n = 8772) from the remaining population of mothers. RESULTS: After important confounding variables were accounted for, maternal asthma was significantly associated with several adverse infant outcomes, including preterm birth and birth of infants who are very small for gestational age, and adverse maternal outcomes, such as idiopathic preterm labor, early idiopathic preterm labor, preeclampsia, transient hypertension of pregnancy, pregnancy-associated hypertension, chorioamnionitis, and cesarean delivery. CONCLUSION: Our results demonstrated that pregnant women with asthma are at substantially increased risk for several adverse infant and maternal outcomes and suggest the need for extra attention to mothers with asthma and their infants. (Am J Obstet Gynecol 2001;184:90-6.)
2010
Asthma is known as one of the most frequent chronic diseases encountered during pregnancy with prevalence estimated between 4 and 8%. The high prevalence of asthma during pregnancy results in some concerns about the impact of pregnancy on maternal asthma and also the impact of maternal asthma on perinatal outcomes. The literature presents conflicting results concerning the impact of maternal asthma during pregnancy on perinatal outcomes, such as preterm birth, low-birth-weight (LBW) infant and smallfor-gestational-age (SGA) infant. Also, scientific evidence is scarce regarding the impact of asthma severity and control during pregnancy on these perinatal outcomes. We thus conducted a research project composed of five studies to achieve the following objectives: 1. to develop and validate two database indexes, one to measure the control of asthma and the other to measure asthma severity; 2. to evaluate the effect of fetal gender on maternal asthma exacerbations and the use of asthma m...
Incidence and risk factors for exacerbations of asthma during pregnancy
Journal of Asthma and Allergy, 2013
Background: Asthma is one of the most common chronic diseases among pregnant women. Acute exacerbations of asthma during pregnancy have an unfavorable impact on pregnancy outcome. This review provides an overview of current knowledge of incidence, mechanisms, and risk factors for acute exacerbations of asthma during pregnancy. Methods: A narrative literature review was carried out using the PubMed database. Results: During pregnancy, up to 6% of women with asthma are hospitalized for an acute exacerbation. The maternal immune system is characterized by a very high T-helper-2:T-helper-1 cytokine ratio during pregnancy and thereby provides an environment essential for fetal survival but one that may aggravate asthma. Cells of the innate immune system such as monocytes and neutrophils are also increased during pregnancy, and this too can exacerbate maternal asthma. Severe or difficult-to-control asthma appears to be the major risk factor for exacerbations during pregnancy, but studies also suggest that nonadherence with controller medication and viral infections are important triggers of exacerbations during pregnancy. So far, inconsistent findings have been reported regarding the effect of fetal sex on exacerbations during pregnancy. Other risk factors for exacerbation during pregnancy include obesity, ethnicity, and reflux, whereas atopy does not appear to be a risk factor. Discussion: The incidence of asthma exacerbations during pregnancy is disturbingly high. Severe asthma -better described as difficult-to-control asthma -nonadherence with controller therapy, viral infections, obesity, and ethnicity are likely to be important risk factors for exacerbations of asthma during pregnancy, whereas inconsistent findings have been reported with regard to the importance of sex of the fetus.
Maternal Asthma, Pregnancy, Delivery and Birth Outcomes: A Retrospective Cohort Study
Iranian journal of allergy, asthma, and immunology, 2017
The aim of current study was to determine women´s maternal asthma in pregnancy, delivery and birth outcomes. Using a retrospective cohort design, data of 580 pregnant women were gathered form a large teaching hospital in Tehran, Iran. The medical records of pregnant women who had attended this hospital between 2009 and 2011 were assessed. Data of delivery and birth outcomes were gathered by observation and medical records of women. Multiple logistic regression and adjusted odds ratio (OR) were used to assess the independent association of asthma and outcomes. 274 patients (47.2%) were in "asthmatic group" and 306 patients (52.8%) were in the "non-asthmatic group". Basic and demographic variables showed the same distribution across two groups. Maternal asthma showed an adjusted relationship with gestational diabetes (OR=2.64), gestational hypertension (OR=3.79), cesarean delivery (OR=2.68), small for gestational age (OR=2.86), premature rupture of membrane (OR=2.1...
A meta-analysis of adverse perinatal outcomes in women with asthma
BJOG: An International Journal of Obstetrics & Gynaecology, 2011
Background Asthma is a common condition during pregnancy and may be associated with adverse perinatal outcomes. Objective This meta-analysis sought to establish if maternal asthma is associated with an increased risk of adverse perinatal outcomes, and to determine the size of these effects. Search strategy Electronic databases were searched for the following terms: (asthma or wheeze) and (pregnan* or perinat* or obstet*). Selection criteria Cohort studies published between 1975 and March 2009 were considered for inclusion. Studies were included if they reported at least one perinatal outcome in pregnant women with and without asthma. Data collection and analysis A total of 103 articles were identified, and of these 40 publications involving 1 637 180 subjects were included. Meta-analysis was conducted with subgroup analyses by study design and active asthma management. Main results Maternal asthma was associated with an increased risk of low birthweight (RR 1.46, 95% CI 1.22-1.75), small for gestational age (RR 1.22, 95% CI 1.14-1.31), preterm delivery (RR 1.41, 95% CI 1.22-1.61) and pre-eclampsia (RR 1.54, 95% CI 1.32-1.81). The relative risk of preterm delivery and preterm labour were reduced to non-significant levels by active asthma management (RR 1.07, 95% CI 0.91-1.26 for preterm delivery; RR 0.96, 95% CI 0.73-1.26 for preterm labour). Author's conclusions Pregnant women with asthma are at increased risk of perinatal complications, including pre-eclampsia and outcomes that affect the baby's size and timing of birth. Active asthma management with a view to reducing the exacerbation rate may be clinically useful in reducing the risk of perinatal complications, particularly preterm delivery.