Perinatal Outcomes Associated with Maternal Asthma and Its Severity and Control During Pregnancy

Yland, Jennifer J; Bateman, Brian T.; Huybrechts, Krista F.; Brill, Gregory E.; Schatz, Michael; Wurst, Keele; Hernández–Dı́az, Sonia

doi:10.1016/j.jaip.2020.01.016

Cited by 25 publications

(35 citation statements)

References 41 publications

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“…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.…”

Section: Discussionsupporting

confidence: 88%

“…These same risks were not seen for single use therapy as a proxy for mild asthma, except for an increased risk of reduced birth weight in those whose mothers used only SABA prior to pregnancy. A recent paper also used treatment stratification as a proxy for asthma severity, however they used medications prescribed during pregnancy [11], whereas we did not due to the change in medication prescribing and/or use in pregnancy [7], which may introduce exposure misclassification. They concluded based on their results that exacerbations increase the risk of adverse perinatal outcomes rather than the underlying asthma severity.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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BackgroundAlthough there is a growing body of literature about the impact of asthma exacerbations during pregnancy on adverse perinatal outcomes, it is still unclear whether asthma exacerbations themselves or asthma severity are the driving factor for negative outcomes. This study aimed to estimate the associations between maternal asthma exacerbations and perinatal outcomes; and whether this differed by asthma treatment regime as a proxy for severity.MethodsWe included births of women with asthma in Sweden from July 2006-November 2013 (N=33 829). Asthma exacerbations were defined as unplanned emergency visits/hospitalisations, or a short course of oral corticosteroids. Adjusted odds ratios (aOR) were estimated for the associations between exacerbations during pregnancy and perinatal outcomes (small for gestational age (SGA), preterm birth, birth weight and mode of delivery), stratified by pre-conception treatment regime.ResultsExacerbations occurred in 1430 (4.2%) pregnancies. Exacerbations were associated with reduced birth weight (aOR 1.45, 95%CI 1.24–1.70), and elective (aOR 1.50, 95%CI 1.25–1.79) and emergency caesarean section (aOR 1.35, 95%CI 1.13–1.61). Multiple exacerbations were associated with a 2.6-fold increased odds of SGA (95%CI 1.38–4.82). Amongst women treated pre-pregnancy with combination therapy (proxy for moderate-severe asthma), exacerbators were at increased odds of elective (aOR 1.69, 95%CI 1.30–2.2) and emergency (aOR 1.62, 95%CI 1.26–2.08) caesarean section; and SGA (aOR 1.74, 95%CI 1.18–2.57) versus non-exacerbators.ConclusionMaternal asthma exacerbations increase the risk of SGA and caesarean sections, particularly in women with multiple exacerbations or moderate-severe asthma. Adequate antenatal asthma care is needed to reduce exacerbations and reduce risks of poor outcomes.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…Increased risk of a low birth weight has been reported in newborns of mothers treated by corticosteroids (1,10,19,20). Yland et al found an association between asthma severity and small gestational age (47).…”

Section: Figure 3 Malformations In Chick Embryos Exposed To Budesonide Control (A C) and Malformed (B D E F) Chick Embryos After A Singlementioning

confidence: 99%

Anti-asthma Drugs Formoterol and Budesonide (Symbicort) Induce Orofacial Clefts, Gastroschisis and Heart Septum Defects in anIn VivoModel

Peterka

Heringová

Sukop

et al. 2021

In Vivo

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Background: We had a case in which three consecutive pregnancies resulted in birth of three children with an orofacial cleft. Their mother suffered from bronchial asthma and was treated using symbicort (corticosteroid budesonide plus bronchodilator formoterol) during her pregnancies. A hypothesis was assessed: these antiasthmatics can induce an orofacial cleft in experimental model. Materials and Methods: A single administration of one of five increasing doses (including therapeutically used ones) of Symbicort, budesonide or formoterol was injected into the amnion of a chick embryo on day 4 or 5 of incubation. The teratogenic/lethal effects of the antiasthmatics were assessed on a total of 600 embryos. Results: For budesonide, the teratogenic/lethal effect started at a dose 0.003 μg per embryo, for formoterol at 0.3 μg and for Symbicort 0.03 μg. Orofacial clefts and gastroschisis after exposure were found for all three anti-asthmatics. Heart septum defects occurred after exposure to formoterol. Conclusion: The present results support those clinical/epidemiological studies pointing out that antiasthmatics have the potential to induce orofacial clefts, gastroschisis and heart malformations during prenatal development in human.Bronchial asthma affects between 7 to 16% of pregnant women and its prevalence exhibits an increasing trend (1-3).

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“…Approxi- mately 70% of pregnant women in Japan had IgE sensitization to common allergens, and nearly half of them had a past history of allergic diseases [1]. Previous studies demonstrated that maternal asthma can affect adverse pregnancy outcomes such as preterm birth [2][3][4][5][6][7][8][9]. Our group also found that IgE production and a history of atopic dermatitis were positively associated with smallfor-gestational-age (SGA) births in a nationwide birth cohort study (Japan Environment and Children's Study: JECS) [10].…”

Section: Introductionmentioning

confidence: 99%

Association of Maternal History of Allergic Features with Preterm Pregnancy Outcomes in the Japan Environment and Children’s Study

Saito-Abe

Yamamoto‐Hanada

Pak

et al. 2021

Int Arch Allergy Immunol

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Introduction: Previous studies have reported that maternal asthma increases the risk of preterm birth. We hypothesized that inflammatory reactions caused by allergic diseases might affect the uterine environment and, subsequently, perinatal outcomes. The objective of this study was to examine the associations between allergic features among mothers and preterm pregnancy outcomes in a nationwide birth cohort. Methods: We analyzed data from pregnant women obtained from the Japanese Environment and Children’s Study (JECS), a nationwide general birth cohort study. We used binomial and multinomial logistic regression models to examine the associations between maternal allergic features and preterm birth, threatened preterm labor (TPL), and preterm premature rupture of the membrane (PPROM). Results: A total of 97,683 pregnant women were included. Prevalence of preterm birth, TPL, and PPROM was 4.7, 19.6, and 1.2%, respectively. Maternal history of allergic diseases (asthma, allergic rhinitis, allergic conjunctivitis, food allergy, drug allergy, and contact dermatitis) increased the risk of TPL(adjusted odds ratio [aOR] = 1.11 [95% CI: 1.06–1.17], aOR = 1.12 [1.08–1.16], aOR = 1.10 [1.04–1.16], aOR = 1.17 [1.09–1.26], aOR = 1.35 [1.23–1.48], and aOR = 1.34 [1.20–1.49], respectively). Although some maternal allergic features showed a negative association with preterm birth, the variables affecting preterm birth differed according to the gestational age of the fetus (22–33 weeks vs. 34–36 weeks). There were no significant associations between maternal allergic features and PPROM. Conclusion: Maternal allergic disease, except atopic dermatitis, may increase the risk of TPL. Comorbidity of maternal allergic disorders and perinatal adverse outcomes require further investigation.

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Perinatal Outcomes Associated with Maternal Asthma and Its Severity and Control During Pregnancy

Cited by 25 publications

References 41 publications

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

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

Anti-asthma Drugs Formoterol and Budesonide (Symbicort) Induce Orofacial Clefts, Gastroschisis and Heart Septum Defects in anIn VivoModel

Association of Maternal History of Allergic Features with Preterm Pregnancy Outcomes in the Japan Environment and Children’s Study

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