Effect of asthma exacerbation during pregnancy in women with asthma: a population-based cohort study

Abstract

The association between asthma exacerbation during pregnancy and adverse maternal and child health outcomes have not been investigated appropriately. Our objective was to determine the short- and long-term intergenerational effect of asthma exacerbation in pregnant women with asthma.A population cohort study was conducted using data from the Ontario asthma surveillance system and population-level health administrative data. Asthma exacerbation in pregnant women with asthma was defined as at least one of the following criteria: at least five physician visits, or one emergency department visit or one hospital admission for asthma during pregnancy. Pregnancy complications, adverse perinatal outcomes and early childhood respiratory disorders were identified using International Classification of Disease codes (9th and 10th revisions).The cohort consisted of 103 424 singleton pregnancies in women with asthma. Asthma exacerbation in pregnant women with asthma was associated with higher odds of pre-eclampsia (OR 1.30, 95% CI 1.12–1.51) and pregnancy-induced hypertension (OR 1.17, 95% CI 1.02–1.33); babies had higher odds of low birthweight (OR 1.14, 95% CI 1.00–1.31), preterm birth (OR 1.14, 95% CI 1.01–1.29) and congenital malformations (OR 1.21, 95% CI 1.05–1.39). Children born to women with asthma exacerbation during pregnancy had elevated risk of asthma (OR 1.23, 95% CI 1.13–1.33) and pneumonia (OR 1.12, 95% CI 1.03–1.22) during the first 5 years of life.Asthma exacerbation during pregnancy in women with asthma showed increased risk of pregnancy complications, adverse perinatal outcomes and early childhood respiratory disorders in their children, indicating that appropriate asthma management may reduce the risk of adverse health outcomes.

Effect of maternal asthma exacerbations on perinatal outcomes: a population-based study

“…This supports two studies reporting increased risk of preterm birth for women experiencing an asthma exacerbation during pregnancy [9] or women with poorly-controlled asthma in the 90 days prior to delivery [11]. These findings may explain in part the observations for the reduction in birth weight.…”

“…-fold increased risk of having a an infant born SGA. This supports other studies which found increased risk of SGA among those with poorly-controlled asthma vs well-controlled asthma in the 90 days prior to delivery (aRR 1.15, 95%CI 1.03-1.29)[8,9]. Among these women, having an asthma exacerbation during pregnancy may worsen the hypoxic intrauterine environment compared to women with milder asthma, resulting in the increased risk of SGA.…”

“…A recently published study from Canada among women with asthma [9] found an increased risk of LBW (<2500 grams) among those experiencing an exacerbation during pregnancy compared to those who did not. Although we did not find the same result for LBW in our main analysis, we did observe an association of LBW for the sub-group of women who had used ICS/LABA combination ('moderate/severe' asthma) and exacerbated in pregnancy.…”

“…However, few studies have investigated the association between maternal asthma exacerbations and adverse perinatal outcomes [3,[8][9][10][11], and even less so in a large population-based dataset [8,9,11], all with different definitions for exacerbations. This is largely because exacerbations are difficult to measure as they are not often reported, and it is difficult to determine whether the risk of negative outcomes is attributable to exacerbations or asthma severity.…”

Asthma in pregnancy: An update

“…A recent welldesigned Canadian study of 103,424 singleton pregnancies in women with asthma showed that antepartum asthma attacks were associated with significantly higher rates of congenital malformations; preterm births; low birth weights, early life pneumonia and asthma; pregnancy-induced hypertension; and pre-eclampsia ( Figure 3). 3 Are the effects of pregnancy on asthma truly 'unpredictable'?.…”