A Population-Based Case-Control Study on the Effect of Bronchial Asthma During Pregnancy for Congenital Abnormalities of the Offspring

Abstract

Bronchial asthma is one of the most common maternal diseases complicating pregnancy. We assessed the risks of congenital abnormalities in a case-control population-based analysis using the dataset of the Hungarian Case-Control Surveillance of Congenital Abnormalities between 1980 and 1996. Of the 22,843 cases with congenital abnormalities, 511 (2.2%) had mothers with bronchial asthma, while of the 38,151 matched control subjects without congenital abnormalities 757 (2.0%) had mothers with bronchial asthma (unadjusted prevalence odds ratios [POR] 1.2; 95% CI: 1.0-1.3). In all mothers with bronchial asthma, a higher incidence of respiratory tract infections and higher drug intake could be observed. In the case group of medically recorded bronchial asthma, a slightly increased risk for club foot has been revealed. However, this weak association could be explained by the higher proportion of preterm births in this group. The main limitation of the analysis was that at the time of data collection only a small proportion of pregnant mothers were using anti-asthma medications recommended by the actual guidelines.

Effect of maternal asthma on the risk of specific congenital malformations: A population‐based cohort study

“…In the study by Tata et al based on 704 cases of malformation born to women with asthma, there were 44 comparisons with hypothesis testing and two comparisons (circulatory system: OR 5 1.20 [95%CI:1.01-1.43] and musculoskeletal malformations: OR 5 1.25 [95%CI:1.06-1.47]) were found to be significant at the 5% and the 1% level, respectively (Tata et al, 2008). Similarly, in the study by Tamasi were found to be significant both at the 5% level (Tamasi et al, 2006). However, neither of these two studies has made adjustments for multiple testing.…”

“…However, most of these studies were underpowered and were conducted over 20 years ago resulting in the use of older asthma therapies not reflective of current asthma treatment. Regarding the three case-control studies, two of them assessed the composite outcome as well as the risk for specific congenital malformations (Tamasi et al, 2006;Tata et al, 2008) while the third one only evaluated the risk for heart defects (Lin et al, 2009). Only one study showed a greater (although small) risk for any congenital malformation (OR 5 1.10; 95%CI: 1.01-1.20) (Tata et al, 2008), but all of them found a greater risk for at least one group of specific malformations.…”

“…Among the nine cohort studies that examined the association between maternal asthma and the risk of any congenital malformation (Alexander et al, 1998;Demissie et al, 1998;Dombrowski et al, 2004;Enriquez et al, 2007;Liu et al, 2001;Perlow et al, 1992;Schatz et al, 1995;Sobande et al, 2002;SteniusAarniala et al, 1996), only one reported a significantly greater risk among women with asthma (Demissie et al, 1998). The remaining case-control studies evaluated defects related to specific organ systems and even though they were limited in power, all of them reported a significantly greater risk for at least one specific congenital malformation among women with asthma (Lin et al, 2009;Tamasi et al, 2006;Tata et al, 2008). However, these three studies were impeded by other methodological weaknesses, such as the use of multiple testing without adjustment, recall bias, and earlier study periods resulting in a limited use of newer asthma controller therapies such inhaled corticosteroids (ICS) and long-acting inhaled beta 2 -agonists which are implicated in the current management of asthma (Lin et al, 2009;Tamasi et al, 2006;Tata et al, 2008).…”

“…We identified twelve studies, with conflicting results, that had investigated whether or not women with asthma were at greater risk of having a baby with a congenital malformation than women without asthma (Alexander et al, 1998;Demissie et al, 1998;Dombrowski et al, 2004;Enriquez et al, 2007;Liu et al, 2001;Perlow et al, 1992;Schatz et al, 1995;Sobande et al, 2002;Stenius-Aarniala et al, 1996;Tamasi et al, 2006;Tata et al, 2008;Wen et al, 2001). Among the nine cohort studies that examined the association between maternal asthma and the risk of any congenital malformation (Alexander et al, 1998;Demissie et al, 1998;Dombrowski et al, 2004;Enriquez et al, 2007;Liu et al, 2001;Perlow et al, 1992;Schatz et al, 1995;Sobande et al, 2002;SteniusAarniala et al, 1996), only one reported a significantly greater risk among women with asthma (Demissie et al, 1998).…”

“…The remaining case-control studies evaluated defects related to specific organ systems and even though they were limited in power, all of them reported a significantly greater risk for at least one specific congenital malformation among women with asthma (Lin et al, 2009;Tamasi et al, 2006;Tata et al, 2008). However, these three studies were impeded by other methodological weaknesses, such as the use of multiple testing without adjustment, recall bias, and earlier study periods resulting in a limited use of newer asthma controller therapies such inhaled corticosteroids (ICS) and long-acting inhaled beta 2 -agonists which are implicated in the current management of asthma (Lin et al, 2009;Tamasi et al, 2006;Tata et al, 2008).…”