Impact of maternal use of asthma-controller therapy on perinatal outcomes

Cossette, Benoȋt; Forget, Amélie; Beauchesne, Marie-France; Rey, Évelyne; Lemière, Catherine; Larivée, Pierre; Battista, Marie-Claude; Blais, Lucie

doi:10.1136/thoraxjnl-2012-203122

Cited by 58 publications

(78 citation statements)

References 30 publications

(36 reference statements)

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“…Use of ICS/LABA therapy increased from 3.5% of females with asthma in 1999 to 13.4% in 2008. Adjusted odds ratio showed no increased odds of preterm birth (OR 0.84, 95% CI 0.61-1.15), low birth weight (OR 0.81, 95% CI 0.58-1.12) or small for gestational age (OR 0.92, 95% CI 0.70-1.20) with LABA exposure, and no significant relationship with ICS use at any dose, although there was a trend towards an increased prevalence of adverse outcomes at doses .125 mg?day -1 [8]. Further evidence is needed on the association of high-dose ICS use with adverse perinatal outcomes, but confounding by indication (more severe asthma) may explain this trend.…”

Section: Safety Of Medications During Pregnancymentioning

confidence: 92%

“…Effects on preterm birth and size at birth A recent study from COSSETTE et al [8] examined the relationship between asthma controllers and preterm birth, low birth weight and small for gestational age. This was a database study of 7376 pregnancies in females with asthma, where 8.8% were exposed to LABA and 56.9% were exposed to ICS.…”

Section: Safety Of Medications During Pregnancymentioning

confidence: 99%

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Asthma in pregnancy: a hit for two

Murphy

Schatz

2014

European Respiratory Review

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Asthma commonly occurs in pregnant females, and recent data have outlined the risks of adverse perinatal outcomes among this population. There is an increased risk of low birth weight and small for gestational age, particularly among females with moderate-to-severe asthma and exacerbations during pregnancy. There is also an increased risk of preterm birth, especially with oral steroid use, a small but statistically significant increased risk of congenital malformations, particularly of cleft lip with or without cleft palate, and an increased risk of neonatal hospitalisation and death. Active management may reduce these risks, possibly through reductions in exacerbations.Additional reassuring data have been presented for asthma medication use, which support the benefits outweighing the risks of indicated asthma medication use in pregnancy. Viral infections are an important trigger of asthma exacerbations in pregnancy, and recent data provides possible immunological changes that may explain this. Poor medication adherence despite worsening asthma symptoms in pregnancy is a problem which continues to be demonstrated in the literature. Improving asthma control in pregnancy has the potential to improve not only the mother's health but also that of her child. @ERSpublications Improving asthma control in pregnancy has the potential to improve the mother's health and that of her child

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Section: Safety Of Medications During Pregnancymentioning

confidence: 92%

Section: Safety Of Medications During Pregnancymentioning

confidence: 99%

Asthma in pregnancy: a hit for two

Murphy

Schatz

2014

European Respiratory Review

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“…Three binary fetal growth outcomes (

Y

), analyzed separately: low‐birth‐weight (LBW; <2500 g), premature birth (delivery before 37‐week gestation), and small for gestational age (SGA; below the 10th percentile) (Cossette et al ., ). These outcomes are measured at delivery, which can occur in the second or third trimester.…”

Section: The Delivery Cohort Dataset and Structurementioning

confidence: 97%

Data‐adaptive longitudinal model selection in causal inference with collaborative targeted minimum loss‐based estimation

et al. 2019

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Causal inference methods have been developed for longitudinal observational study designs where confounding is thought to occur over time. In particular, one may estimate and contrast the population mean counterfactual outcome under specific exposure patterns. In such contexts, confounders of the longitudinal treatment‐outcome association are generally identified using domain‐specific knowledge. However, this may leave an analyst with a large set of potential confounders that may hinder estimation. Previous approaches to data‐adaptive model selection for this type of causal parameter were limited to the single time‐point setting. We develop a longitudinal extension of a collaborative targeted minimum loss‐based estimation (C‐TMLE) algorithm that can be applied to perform variable selection in the models for the probability of treatment with the goal of improving the estimation of the population mean counterfactual outcome under a fixed exposure pattern. We investigate the properties of this method through a simulation study, comparing it to G‐Computation and inverse probability of treatment weighting. We then apply the method in a real‐data example to evaluate the safety of trimester‐specific exposure to inhaled corticosteroids during pregnancy in women with mild asthma. The data for this study were obtained from the linkage of electronic health databases in the province of Quebec, Canada. The C‐TMLE covariate selection approach allowed for a reduction of the set of potential confounders, which included baseline and longitudinal variables.

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“…In 2013 we learnt again that women who use inhaled long-acting β agonists or steroids, at low or moderate doses, to treat their asthma while they are pregnant do not need to fear that this will harm their baby,32 but there is some residual concern over higher doses of steroids. From Canada we were reminded that the use of inhaled steroids in patients with COPD increases their risk of developing severe pneumonia,33 an effect that may be peculiar to fluticasone.…”

Section: Epidemiologymentioning

confidence: 99%