Patterns, predictors and outcomes of asthma control and exacerbations during pregnancy: a prospective cohort study

Abstract

There exists a paucity of data for socially disadvantaged populations describing patterns and predictors of asthma control status and exacerbations during pregnancy, and their relationship to adverse perinatal outcomes.Asthmatic women (n=189) were followed prospectively during pregnancy, with visits at 12, 20, 28 and 36 weeks gestation. Data on loss of control, recurrent uncontrolled asthma and moderate/severe exacerbations were collected at each visit and their relationship to perinatal outcomes examined following stratification for fetal sex.50% of asthmatic women experienced a loss of control or moderate/severe exacerbation during pregnancy, with 22% of women experiencing a moderate/severe exacerbation. Factors associated with an increased risk of women experiencing recurrent uncontrolled asthma during pregnancy included smoking (relative risk 2.92, 95% CI 1.53–5.58), inhaled corticosteroid use at the beginning of pregnancy (relative risk 2.40, 95% CI 1.25–4.60) and increasing maternal age (relative risk 1.06, 95% CI 1.01–1.11). No factors were associated with moderate/severe exacerbations. Asthma control rather than exacerbations during pregnancy appeared to be most strongly correlated with perinatal outcomes. Following stratification by fetal sex, the presence of recurrent uncontrolled asthma was associated with an increased risk of being small for gestational age in women pregnant with females (33.3% versus 9.5%; p=0.018). In contrast, there was a nonsignificant increased risk of preterm birth in women with recurrent uncontrolled asthma that were pregnant with males (25.0% versus 11.8%; p=0.201)These results suggest that the key to improving perinatal outcomes lies in improving asthma control as early as possible in pregnancy and monitoring throughout pregnancy, rather than focusing on preventing exacerbations alone.

Maternal allergic asthma during pregnancy alters fetal lung and immune development in sheep: potential mechanisms for programming asthma and allergy

“…A strength of this study is the consistency between the allergic asthmatic phenotype induced by this protocol in sheep and that seen in human asthmatics (Bischof et al 2003(Bischof et al , 2008Clifton et al 2015). Reduced fetal growth in allergic ewes (Clifton et al 2015) is also consistent with effects of poorly controlled asthma in humans (Murphy, 2015;Grzeskowiak et al 2016). Importantly, developmental timing and maturity at birth in sheep are more similar to that of humans than are rodents, so sheep provide an excellent model in which to investigate programming of postnatal health and function by in utero exposures (Morrison et al 2018).…”

“…) is also consistent with effects of poorly controlled asthma in humans (Murphy, ; Grzeskowiak et al . ). Importantly, developmental timing and maturity at birth in sheep are more similar to that of humans than are rodents, so sheep provide an excellent model in which to investigate programming of postnatal health and function by in utero exposures (Morrison et al .…”

“…However, approximately 50% of pregnant women have poorly controlled asthma (Grzeskowiak et al . ). This may be due, at least in part, to problems with compliance with ongoing use of inhaled corticosteroids.…”

“…; Murphy, ; Grzeskowiak et al . ). As many as 20% of pregnant women with asthma require medical intervention for treatment of exacerbations, and approximately 6% require hospitalization (Murphy et al .…”

“…Asthma is common in pregnant women, affecting ß12% of pregnancies in Australia (Clifton et al 2009). Up to half of asthmatic women experience worsening of the disease during pregnancy (Schatz et al 1988;Murphy, 2015;Grzeskowiak et al 2016). As many as 20% of pregnant women with asthma require medical intervention for treatment of exacerbations, and approximately 6% require hospitalization (Murphy et al 2006).…”