A meta-analysis of adverse perinatal outcomes in women with asthma

Abstract

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.Keywords Asthma, meta-analysis, perinatal outcomes, pregnancy.Please cite this paper as: Murphy V, Namazy J, Powell H, Schatz M, Chambers C, Attia J, Gibson P. A meta-analysis of adverse perinatal outcomes in women with asthma.

Asthma During Pregnancy and Clinical Outcomes in Offspring: A National Cohort Study

“…Our results are in line with previous human studies on short-term reproductive failures after asthma during pregnancy, which have shown associations of asthma during pregnancy with adverse obstetric outcomes and congenital malformation, [4][5][6] and extend knowledge to an overview of potential long-term consequences. Indeed, previous studies on long-term consequences of asthma during pregnancy with regard to selected child diseases also demonstrated an increased risk of asthma, bronchiolitis, atopic dermatitis, and autism spectrum disorder, in offspring of mothers with asthma.…”

“…2,3 A recent meta-analysis, including 40 publications from cohort studies, showed that maternal asthma was associated with an increased risk of low birth weight, small for gestational age, preterm delivery, and preeclampsia. 4 Moreover, in a cohort including .40 000 pregnancies, maternal asthma during pregnancy was related to an increased risk of any congenital malformation in the offspring, and, specifically, to an increased risk of malformations of the nervous system, respiratory system, and digestive system. 5 Maternal asthma during pregnancy was also shown to play a role in cardiac malformations in the offspring.…”

Asthma control in pregnancy is associated with pre-conception dietary patterns

“…Worldwide, asthma represents one of the most common chronic diseases to affect pregnancies, affecting between 8 and 13 % of the population (1)(2)(3) . A meta-analysis from 2011 demonstrated that asthma in pregnancy was associated with up to 54 % increased risk for low birth weight, small for gestational age, preterm delivery and pre-eclampsia (4) .…”

“…Worldwide, asthma represents one of the most common chronic diseases to affect pregnancies, affecting between 8 and 13 % of the population (1)(2)(3) . A meta-analysis from 2011 demonstrated that asthma in pregnancy was associated with up to 54 % increased risk for low birth weight, small for gestational age, preterm delivery and pre-eclampsia (4) .A subsequent meta-analysis revealed that asthma exacerbations in pregnancy increased the risk for low birth weight (relative risk (RR) = 3·02; 95 % CI 1·87, 4·89) and compared with women with mild asthma, women with moderate to severe asthma were at increased risk for babies born with low birth weight (RR = 1·15; 95 % CI 1·05, 1·26) or small for gestational age (RR = 1·24; 95 % CI 1·15, 1·35) (5) . These studies suggest that worsening asthma during pregnancy may contribute to poor outcomes for the fetus and that approaches to improve asthma control may be of benefit (6) .…”

Pre-birth origins of allergy and asthma

“…Maternal asthma worsens during pregnancy in ~50% of women, and 20% of asthmatic women undergo exacerbations requiring medical intervention (Murphy et al 2005, Murphy et al 2006. Asthma during pregnancy substantially increases risks of adverse pregnancy outcomes, including preeclampsia (↑54%), preterm birth (↑41%), SGA (↑22%), and LBW (↑46%) (Murphy et al 2011). Risks of adverse neonatal outcomes including admission to neonatal intensive care (↑12%), respiratory distress syndrome (↑9%) and transient tachypnoea of the newborn (↑10%) are also increased when the mother has asthma, even after correction for prematurity as a comorbidity (Mendola et al 2014).…”