Effect of Pregnancy on Quantitative Medication Use and Relation to Exacerbations in Asthma

Abstract

Background The quantification of asthma medication reduction and its relation to an aggravation of asthma during pregnancy at an individual level are unclear. Methods We conducted a nationwide retrospective cohort study of asthmatic pregnant women in South Korea. All of the asthma medications were ranked from 1 to 4 according to the guideline-based stepwise approach. We assessed the daily sums of the ranks of the asthma medications and their association with exacerbations during three phases based on the individual's delivery date: before, during, and after pregnancy. Results The study cohort included 115,169 asthmatic pregnant women who gave birth between 2011 and 2013. The subjects were clustered into four groups according to the daily rank sums of their asthma medication. Asthma medications were rapidly reduced at the beginning of the pregnancy and then slowly increased after delivery. Exacerbations were more frequent in the group with higher rank-sum values than in the group with lower values. Overall exacerbations were reduced during pregnancy compared to before or after delivery. Conclusions Asthmatic pregnant women tended to reduce their asthma medication use during pregnancy. This led to a greater number of exacerbations in a small part of the study population.

Inhaled corticosteroid use during pregnancy among women with asthma: A systematic review and meta‐analysis

“…The change in dispensed ICS prescriptions before, during and after pregnancy was reported from 12 databases (Table ) in eight publications . Two studies collected data on ICS use before, during and after pregnancy using comparable methods and therefore were pooled for analysis/reporting (data from eight European databases).…”

“…Of the six database studies that could not be included in the pooled analysis due to differences in data collection, two used the same Korean data set but examined different outcomes . The first, by Koo et al reporting on 115 169 pregnant women with asthma, assigned ranks to controller medication for asthma, with low ranks (“1” and “2”) for ICS only inhalers and low ICS dose combination inhalers, rank “3” for medium‐to‐high ICS dose combination inhalers and the highest rank “4” to OCS . Authors reported a drop in daily rank‐sum values in early pregnancy compared with the year before pregnancy, indicating cessation of medication and/or change from higher ranked to lower ranked medications .…”

“…The first, by Koo et al reporting on 115 169 pregnant women with asthma, assigned ranks to controller medication for asthma, with low ranks (“1” and “2”) for ICS only inhalers and low ICS dose combination inhalers, rank “3” for medium‐to‐high ICS dose combination inhalers and the highest rank “4” to OCS . Authors reported a drop in daily rank‐sum values in early pregnancy compared with the year before pregnancy, indicating cessation of medication and/or change from higher ranked to lower ranked medications . The second publication, by Lee et al, restricted analyses to women with asthma (N = 5589) needing healthcare utilization (hospital visit and a physician's diagnosis and care) during pregnancy.…”

“…Of the six database studies 6,16-20 that could not be included in the pooled analysis due to differences in data collection, two used the same Korean data set but examined different outcomes. 16,17 The first, by Koo pregnancies complicated by asthma in Canada reported that 41% of women were using ICS during pregnancy and 44% during the year before conception. 19 A subset of pregnancies (n = 4920) included in this study were examined further in a 2012 study by Blais et al, comparing ICS use during pregnancy and pre-pregnancy.…”

“…The change in dispensed ICS prescriptions before, during and after pregnancy was reported from 12 databases (Table 3) in eight publications. 6,7,[15][16][17][18][19][20] Two studies 7,15 collected data on ICS use before, during and after pregnancy using comparable methods and therefore were pooled for analysis/reporting (data from eight European databases). Overall, ICS prescription rate remained stable in the preconception period (12 months preceding last menstrual period (LMP)).…”