Respiratory disease in pregnancy

Mehta, Niharika; Chen, Kenneth; Hardy, Erica; Powrie, Raumond

doi:10.1016/j.bpobgyn.2015.04.005

Cited by 70 publications

(47 citation statements)

References 64 publications

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“…These results are comparable to the study of Firoozi et al [35]. Especially, with severe and poorly controlled asthma, a relationship between fetal growth retardation and asthma has been reported that could be due to the compromised oxygen saturation of hemoglobin in asthmatics, which should be above 90% during pregnancy to guarantee sufficient fetal oxygenation [36, 37]. A possible reason that we could not find indications of fetal growth retardation may be found in the fact that the majority of women were on asthma medication and although not perfectly controlled the worst consequences of impaired breathing and of wheezing episodes might have been avoided [24–26].…”

Section: Discussionsupporting

confidence: 87%

Prospective cohort study of pregnancy complications and birth outcomes in women with asthma

Fazel

Kundi

Jensen‐Jarolim

et al. 2018

Arch Gynecol Obstet

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BackgroundAsthma is the most common potentially serious medical complication in pregnancy. The purpose of this study was to determine the association between maternal asthma and a spectrum of adverse neonatal and maternal outcomes.MethodsEvents during pregnancy and birth outcome were evaluated in 34 asthmatic as well as 1569 non-asthmatic pregnant women who were enrolled in a prospective cohort study undertaken at the antenatal clinics of Mobini Hospital in Iran. The women were interviewed and classified according to clinical severity and asthma control as per GINA guidelines. Information on asthma symptoms was collected by a questionnaire as well as by spirometry and physical examination. All subjects were followed until delivery, and postpartum charts were reviewed to assess neonatal and maternal outcomes. Eosinophil cells counts were obtained and total IgE was measured by ELISA. Results were assessed by multivariate logistic regression adjusting for maternal age and parity, and for birth outcomes, for gestational diabetes, and hypertension/pre-eclampsia.ResultsThe well-known relationship between family history of asthma and asthma in pregnancy was again supported (p < 0.001). Women with asthma had more bleeding events 3 weeks or more before delivery (OR 3.30, 95% CI 1.41–7.26), more often placenta problems (OR 6.86, 95% CI 1.42–33.02), and gestational diabetes mellitus (OR 3.82, 95% CI 1.06–13.75). No significant differences between asthmatic and non-asthmatic mothers regarding duration of gestation, birthweight, low Apgar scores, or neonatal respiratory difficulties were found. Total IgE antibody levels and eosinophil counts did not differ by asthma control and severity.ConclusionsAsthma in pregnancy poses some risk for pregnancy complications and adverse perinatal outcomes. Managing asthma effectively throughout pregnancy could benefit women and their babies and help to reduce the health burden associated with asthma during pregnancy.

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Section: Discussionsupporting

confidence: 87%

Prospective cohort study of pregnancy complications and birth outcomes in women with asthma

Fazel

Kundi

Jensen‐Jarolim

et al. 2018

Arch Gynecol Obstet

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“…Since adequate maternal oxygenation is PaO 2 >70 mmHg, which is equivalent to oxygen saturation of 95%, to avoid any fetal effects of maternal hypoxia in cases of acute respiratory distress syndrome in pregnancy [8], we also performed oxygen supplementation to maintain oxygen saturation at more than 95% of in our case.…”

Section: Discussionmentioning

confidence: 99%

Management of a Pregnant Woman with Idiopathic Interstitial Pneumonia Accompanied by Secondary Pulmonary Hypertension: Case Report and Literature Review

Ohira¹,

Asaka²,

Tanaka³

et al. 2017

Med Case Rep

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Idiopathic interstitial pneumonias (IIPs) typically occur in the fifth and sixth decades, and thus are uncommon in the child-bearing age group. We herein report an extremely rare case of a pregnant woman with IIP accompanied by secondary pulmonary hypertension that had a successful cesarean delivery. A 36-year-old primigravida woman was referred to our Obstetrics department at 6 weeks of gestation. Seven years ago, she had a dry cough and moderate dyspnea, and was diagnosed with non-specific interstitial pneumonia (NSIP), a subtype of IIP. At 11 weeks of gestation, spirometry showed a vital capacity of 1.89 L (60% of predicted). An arterial blood gas analysis showed PaO 2 of 77.2 mmHg and oxygen saturation of 95% in breathing room air at rest. An echocardiogram revealed mild pulmonary hypertension; systolic pulmonary artery blood pressure (PABP) of 44 mmHg. Fetal growth and amniotic fluid volume were normal. Our management plan was to maintain oxygen saturation at more than 95% of oxygen saturation and systolic PABP at less than 50 mmHg. Oxygen therapy was initiated at 13 weeks of gestation because of dyspnea at rest. At 28 weeks of gestation, an echocardiogram showed severe pulmonary hypertension with systolic PABP of 64 mmHg. Therefore, we performed cesarean section at 30 weeks of gestation. The newborn was a male weighing 1.452 g with Apgar scores of 6 and 7 at 1 min and 5 min, respectively. Although the patient's post-operative course was uneventful, she was discharged on a regimen of oxygen therapy. The effects of pregnancy on IIPs remain unclear because of its extreme rarity. In the management of pregnant women with IIPs accompanied by secondary pulmonary hypertension, the maintenance of systolic PABP of less than 50 mmHg on an echocardiogram may be effective.

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“…In addition, the diaphragm shifts 4-5 cm upward due to the growing intrauterine pressure caused by the growing fetus. This leads to a 10%-20% reduction in both functional residual capacity and total lung capacity (3,10,11).…”

Section: Respiratory Systemmentioning

confidence: 99%

Physiological and Pharmacokinetic Alterations and Drug-Nutrient Interactions During Pregnancy

Ede¹,

Ünal²

2017

Istanbul Med J

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During pregnancy, a large part of the body is affected by the physiological and anatomical changes that start in early pregnancy. Many of these changes significantly affect the pharmacokinetic (absorption, distribution, metabolism, and excretion) and pharmacodynamic properties of different drugs (1-3). During treatment, the use of medicines with the content of only some active ingredients is important to ensure maternal and fetal safety during pregnancy (4-6).Drug-nutritional element interactions are defined as the physicochemical, physiological, and pathophysiological relationships between a drug and nutritional element or between a drug and multiple nutritional elements, nutrients, and constituents or the nutritional status in a broader sense (6-8). Drug-nutritional element interactions can occur in four steps: extracellular bioinactivation, decrease/increase in absorption, decrease/increase in efficacy, and decrease/ increase in excretion (elimination) (7). Therefore, the fact that health professionals consider the physiological changes and the factors affecting the distribution of the drug in the body during pregnancy is important to ensure the effectiveness of pharmacotherapy. In this review article, we aimed to investigate the effects of physiological changes during pregnancy on the pharmacokinetic properties of the drug and the interactions of drugs, nutrients, and nutritional elements. Physiological Changes and Drug Metabolism in PregnancyPregnancy is a process in which many physiological differentiations occur in the cardiovascular, respiratory, excretory, gastrointestinal, and circulatory systems, which alter the interactions of nutrition, nutritional element, and drug metabolism. In summary, the rate and volume of the heart increase, lung capacity decreases, glomerular filtration rate (GFR) increases, blood volume increases, blood circulation decreases, and gastrointestinal system (GIS) motility decreases; in addition, changes, such as nausea and vomiting, occur affecting nutrition. The physiological changes associated with pregnancy are summarized in Table 1. During pregnancy, the interactions between drug metabolism and nutrition and nutritional element may be pharmaceutical, pharmacokinetic, and pharmacodynamic. The pharmaceutical interactions occur within the delivery medium, such as enteral tube or gastrointestinal lumen. This can affect the bioavailability of the drug or nutritional element (8). The pharmacokinetic interactions include the processes of absorption, distribution, metabolism, and excretion of the drug or nutritional element. The pharmacodynamic interactions include physiological changes Physiological and Pharmacokinetic Alterations and DrugNutrient Interactions During PregnancyDuring pregnancy, many physiological and metabolic alterations occur to support the requirements of the developing fetus. Alterations associated with the respiratory, cardiovascular, hematological, urinary, and gastrointestinal systems (GIS) may result in pregnancy-related disorders and may change the pharmac...

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Respiratory disease in pregnancy

Cited by 70 publications

References 64 publications

Prospective cohort study of pregnancy complications and birth outcomes in women with asthma

Prospective cohort study of pregnancy complications and birth outcomes in women with asthma

Management of a Pregnant Woman with Idiopathic Interstitial Pneumonia Accompanied by Secondary Pulmonary Hypertension: Case Report and Literature Review

Physiological and Pharmacokinetic Alterations and Drug-Nutrient Interactions During Pregnancy

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