Exacerbations of asthma during pregnancy: Impact on pregnancy complications and outcome

Ali, Zarqa; Hansen, Anne Vejen; Ulrik, Charlotte Suppli

doi:10.3109/01443615.2015.1065800

Cited by 24 publications

(14 citation statements)

References 56 publications

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“…However, in practice, medications must be considered for pregnant patients with medical disorders, based on a thorough appreciation of the potential deleterious effects of untreated disease in the mother, and also potential harm for the unborn [ 8 ]. For instance, women suffering from asthma require drug therapy during pregnancy to prevent life threatening episodes to the mother, as asthma exacerbations during pregnancy have been linked to a higher risk of pre-eclampsia, gestational diabetes, placental abruption and placenta praevia [ 9 ]..…”

Section: Introductionmentioning

confidence: 99%

Allergic diseases and asthma in pregnancy, a secondary publication

Pali‐Schöll

Namazy

Jensen‐Jarolim

2017

World Allergy Organization Journal

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Every fifth pregnant woman is affected by allergies, especially rhinitis and asthma. Allergic symptoms existing before pregnancy may be either attenuated, or equally often promoted through pregnancy. Optimal allergy and asthma diagnosis and management during pregnancy is vital to ensure the welfare of mother and baby.For allergy diagnosis in pregnancy, preferentially anamnestic investigation as well as in vitro testing should be applied, whereas skin testing or provocation tests should be postponed until after birth. Pregnant women with confirmed allergy should avoid exposure to, or consumption of the offending allergen. Allergen immunotherapy should not be initiated during pregnancy. In patients on immunotherapy since before pregnancy, maintenance treatment may be continued, but the allergen dose should not be increased further. Applicable medications for asthma, rhinitis or skin symptoms in pregnancy are discussed and listed.In conclusion, i) allergies in pregnancy should preferentially be diagnosed in vitro; ii) AIT may be continued, but not started, and symptomatic medications must be carefully selected; iii) management of asthma and allergic diseases is important during pregnancy for welfare of mother and child.

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Section: Introductionmentioning

confidence: 99%

Allergic diseases and asthma in pregnancy, a secondary publication

Pali‐Schöll

Namazy

Jensen‐Jarolim

2017

World Allergy Organization Journal

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“…Pre-existing medical conditions (e.g. autoimmune and endocrine diseases, thrombophilia) are strongly associated with an aberrant hormonal, metabolic and inflammatory milieu that is detrimental to placentation, and thus, such pregnancies are predisposed to significantly higher rates of complications with poorer neonatal outcomes ( Ali et al , 2016 ; Vannuccini et al , 2016 ; Meakin et al , 2017 ; De Leo and Pearce, 2018 ; De Carolis et al , 2019 ; Mitriuc et al , 2019 ; Stepien and Huttner, 2019 ). Placental transcriptome analysis could thus reveal how such conditions heighten a woman’s susceptibility to obstetric complications, which may lead to new treatments to prevent defective placental function and improve pregnancy outcomes in affected women.…”

Section: Knowledge Gaps and Future Directionsmentioning

confidence: 99%

Current approaches and developments in transcript profiling of the human placenta

Yong

Chan

2020

Human Reproduction Update

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BACKGROUND The placenta is the active interface between mother and foetus, bearing the molecular marks of rapid development and exposures in utero. The placenta is routinely discarded at delivery, providing a valuable resource to explore maternal-offspring health and disease in pregnancy. Genome-wide profiling of the human placental transcriptome provides an unbiased approach to study normal maternal–placental–foetal physiology and pathologies. OBJECTIVE AND RATIONALE To date, many studies have examined the human placental transcriptome, but often within a narrow focus. This review aims to provide a comprehensive overview of human placental transcriptome studies, encompassing those from the cellular to tissue levels and contextualize current findings from a broader perspective. We have consolidated studies into overarching themes, summarized key research findings and addressed important considerations in study design, as a means to promote wider data sharing and support larger meta-analysis of already available data and greater collaboration between researchers in order to fully capitalize on the potential of transcript profiling in future studies. SEARCH METHODS The PubMed database, National Center for Biotechnology Information and European Bioinformatics Institute dataset repositories were searched, to identify all relevant human studies using ‘placenta’, ‘decidua’, ‘trophoblast’, ‘transcriptome’, ‘microarray’ and ‘RNA sequencing’ as search terms until May 2019. Additional studies were found from bibliographies of identified studies. OUTCOMES The 179 identified studies were classifiable into four broad themes: healthy placental development, pregnancy complications, exposures during pregnancy and in vitro placental cultures. The median sample size was 13 (interquartile range 8–29). Transcriptome studies prior to 2015 were predominantly performed using microarrays, while RNA sequencing became the preferred choice in more recent studies. Development of fluidics technology, combined with RNA sequencing, has enabled transcript profiles to be generated of single cells throughout pregnancy, in contrast to previous studies relying on isolated cells. There are several key study aspects, such as sample selection criteria, sample processing and data analysis methods that may represent pitfalls and limitations, which need to be carefully considered as they influence interpretation of findings and conclusions. Furthermore, several areas of growing importance, such as maternal mental health and maternal obesity are understudied and the profiling of placentas from these conditions should be prioritized. WIDER IMPLICATIONS Integrative analysis of placental transcriptomics with other ‘omics’ (methylome, proteome and metabolome) and linkage with future outcomes from longitudinal studies is crucial in enhancing knowledge of healthy placental development and function, and in enabling the underlying causal mechanisms of pregnancy complications to be identified. Such understanding could help in predicting risk of future adversity and in designing interventions that can improve the health outcomes of both mothers and their offspring. Wider collaboration and sharing of placental transcriptome data, overcoming the challenges in obtaining sufficient numbers of quality samples with well-defined clinical characteristics, and dedication of resources to understudied areas of pregnancy will undoubtedly help drive the field forward.

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“…In about 20% of women, there is a need for medical intervention because of acute exacerbation and in approximately 6%, they are being admitted to hospital [39]. They and increase the risk of pre-eclampsia, gestational diabetes, placental abruption and placenta previa [40, 41]. The recommended pharmacotherapy of acute asthma exacerbations during pregnancy is not substantially different from the management in non-pregnant patients [42].…”

Section: Current Treatment Recommendationsmentioning

confidence: 99%

What is safe enough - asthma in pregnancy - a review of current literature and recommendations

Labor

Tir

Plavec

et al. 2018

asthma res and pract

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BackgroundAlthough asthma is one of the most serious diseases causing complications during pregnancy, half of the women discontinue therapy thus diminishing the control of the disease, mostly due to the inadequate education and fear of adverse events. Sadly, this is sometimes encouraged by insufficiently educated physicians. Since the incidence and the prevalence of asthma is increasing, it is important to arouse the importance of proper asthma therapy during pregnancy. Inadequate therapy, as well as interrupting or discontinuing therapy, may result in adverse perinatal outcomes for both mother and child.Main bodyThe main goal of asthma control during pregnancy is control of symptoms and prevention of exacerbations, same as in every asthmatic, but even more important. Maintaining optimal lung function, as well as regular daily activities, ensures maintenance of optimal fetal oxygenation. The therapy should be adapted depending on the frequency and severity of daily and nocturnal symptoms, demand for reliever therapy, by the limitations in everyday activities and the frequency of emergency asthma-related hospitalizations. Pre-conceptual education and therapy are very important and should be supported by an asthma action plan adjusted for the period of pregnancy. It is very important to note that most of the drugs used before pregnancy can be safely continued during pregnancy. Pharmacological and non-pharmacological therapy should be used in parallel. Pregnant women should be informed about the nature of the disease, therapy used during pregnancy, possible complications, avoidance of triggers, proper administration of therapy and, most important, why should the therapy be continued throughout the pregnancy on individual basis. Although drug treatment should be based on using drugs with less harm risk, if control of severe symptoms is needed to be achieved in order to protect both mother and child, any anti-asthmatic drug would have the beneficial benefit/harm ratio.ConclusionThere is no solid evidence that asthma treatment during pregnancy causes adverse outcomes for the mother and child but for many, especially new drugs, there is not enough data gathered. On the other hand, harmfulness of uncontrolled asthma during pregnancy is well documented so every effort should be put on preserving good control of asthma during pregnancy.

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Exacerbations of asthma during pregnancy: Impact on pregnancy complications and outcome

Cited by 24 publications

References 56 publications

Allergic diseases and asthma in pregnancy, a secondary publication

Allergic diseases and asthma in pregnancy, a secondary publication

Current approaches and developments in transcript profiling of the human placenta

What is safe enough - asthma in pregnancy - a review of current literature and recommendations

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