Severity of asthma and perinatal outcome

Perlow, Jordan H.; Montgomery, Douglas M.; Morgan, Mark A.; Towers, Craig V.; Pronto, Manuel

doi:10.1016/s0002-9378(12)80020-2

Cited by 205 publications

(125 citation statements)

References 10 publications

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“…Other groups have also found that corticosteroid-dependent asthmatic women have significantly higher risks of premature rupture of membranes, preterm labour and delivery, Caesarean delivery and other maternal complications (Perlow et al, 1992;Doucette and Bracken, 1993;Demissie et al, 1998). Furthermore, corticosteroid-dependent women had a significantly higher incidence of low birth weight babies (Schatz et al, 1990;Perlow et al, 1992;Jana et al, 1995;Demissie et al, 1998).…”

Section: Birth -An Integrated Series Of Autocrine-paracrine Loops?mentioning

confidence: 97%

“…The effects of exogenous corticosteroids on labour and delivery problems and neonatal outcomes in asthmatic women have been well researched. Perlow et al (1992) showed that preterm delivery and premature rupture of membranes are more common among asthmatic women with data demonstrating a preterm delivery incidence of 54.8% for corticosteroid-dependent women and 14% for non-corticosteroid-dependent women. Other groups have also found that corticosteroid-dependent asthmatic women have significantly higher risks of premature rupture of membranes, preterm labour and delivery, Caesarean delivery and other maternal complications (Perlow et al, 1992;Doucette and Bracken, 1993;Demissie et al, 1998).…”

Section: Birth -An Integrated Series Of Autocrine-paracrine Loops?mentioning

confidence: 99%

“…Perlow et al (1992) showed that preterm delivery and premature rupture of membranes are more common among asthmatic women with data demonstrating a preterm delivery incidence of 54.8% for corticosteroid-dependent women and 14% for non-corticosteroid-dependent women. Other groups have also found that corticosteroid-dependent asthmatic women have significantly higher risks of premature rupture of membranes, preterm labour and delivery, Caesarean delivery and other maternal complications (Perlow et al, 1992;Doucette and Bracken, 1993;Demissie et al, 1998). Furthermore, corticosteroid-dependent women had a significantly higher incidence of low birth weight babies (Schatz et al, 1990;Perlow et al, 1992;Jana et al, 1995;Demissie et al, 1998).…”

Section: Birth -An Integrated Series Of Autocrine-paracrine Loops?mentioning

confidence: 99%

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Prostaglandins and mechanisms of preterm birth

Challis¹,

Sloboda²,

Alfaidy³

et al. 2002

Reproduction

311

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Preterm birth (birth before week 37 of gestation) occurs in approximately 5-10% of all pregnancies. This value may be higher in certain population groups and has not decreased over the past 20-30 years. Although some preterm births may be elective, approximately 30% occur in association with an underlying infectious process, and about 50% are idiopathic preterm births of unknown cause. Preterm birth is associated with 70% of neonatal deaths, and up to 75% of neonatal morbidity. Infants born preterm have an increased incidence of blindness, deafness, cerebral palsy, neurological disorders and pulmonary disorders (Morrison, 1990;

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Section: Birth -An Integrated Series Of Autocrine-paracrine Loops?mentioning

confidence: 97%

Section: Birth -An Integrated Series Of Autocrine-paracrine Loops?mentioning

confidence: 99%

Section: Birth -An Integrated Series Of Autocrine-paracrine Loops?mentioning

confidence: 99%

See 1 more Smart Citation

Prostaglandins and mechanisms of preterm birth

Challis¹,

Sloboda²,

Alfaidy³

et al. 2002

Reproduction

311

112

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“…Increased risks of low birth weight (LBW), small for gestational age (SGA), and preterm delivery have been reported with asthma. [4][5][6][7][8] Larger studies, however, have identifi ed fewer signifi cant adverse obstetric outcomes. 1,9,10 A multicenter prospective observational cohort study performed by the Maternal-Fetal Medicine Units Network evaluated the relationship between asthma severity and maternal and fetal morbidity among pregnant women with asthma and matched controls.…”

mentioning

confidence: 99%

The Effect of Active and Passive Household Cigarette Smoke Exposure on Pregnant Women With Asthma

Newman

Momirova

Dombrowski

et al. 2010

Chest

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A sthma is a common medical complication of pregnancy, affecting 6% to 8% of women. 1,2 Both the prevalence and morbidity of asthma are increasing in the general population. 3 The literature has been inconsistent regarding the relationship between asthma and adverse pregnancy outcomes. Increased risks of low birth weight (LBW), small for gestational age (SGA), and preterm delivery have been reported with asthma. [4][5][6][7][8] Larger studies, however, have identifi ed fewer signifi cant adverse obstetric outcomes. 1,9,10 A multicenter prospective observational cohort study performed by the Maternal-Fetal Medicine Units Network evaluated the relationship between asthma severity and maternal and fetal morbidity among pregnant women with asthma and matched controls. 11 This study demonstrated a strong relationship between asthma severity and exacerbation during pregnancy, as well as associations with nonpulmonary pregnancy outcomes, including cesarean delivery, preeclampsia, gestational diabetes, and Background: The article was designed to estimate the effect of active and passive household cigarette smoke exposure on asthma severity and obstetric and neonatal outcomes in pregnant women with asthma. Methods: We used a secondary observational analysis of pregnant women with mild and moderatesevere asthma enrolled in a prospective observational cohort study of asthma in pregnancy and a randomized clinical trial (RCT) comparing inhaled beclomethasone and oral theophylline. A baseline questionnaire detailing smoking history and passive household smoke exposure was given to each patient. Smoking status was confi rmed in the RCT using cotinine levels. Data on asthma severity and obstetric and neonatal outcomes were collected and analyzed with respect to self-reported tobacco smoke exposure. Kruskal-Wallis and Pearson x 2 statistics were used to test for signifi cance. Results: A total of 2,210 women were enrolled: 1,812 in the observational study and 398 in the RCT. Four hundred and eight (18%) women reported current active smoking. Of the nonsmokers, 790 (36%) women reported passive household smoke exposure. Active smoking was associated with more total symptomatic days ( P , .001) and nights of sleep disturbance ( P , .001). Among the newborns of active smokers, there was a greater risk of small for gestational age , 10th percentile ( P , .001), and a lower mean birth weight ( P , .001). There were no differences in symptom exacerbation or outcome between nonsmokers with and without passive household cigarette smoke exposure. Conclusions: Among pregnant women with asthma, active but not passive smoking is associated with increased asthma symptoms and fetal growth abnormalities. CHEST 2010; 137(3):601-608Abbreviations: ETS 5 environmental tobacco smoke; LBW 5 low birth weight; MFMU 5 Maternal-Fetal Medicine Units Network; OR 5 odds ratio; PROM 5 premature rupture of membranes; RCT 5 randomized clinical trial; SGA 5 small for gestational age

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“…A persistência da piora alérgica por até mais de um ano após o fim da gestação talvez seja causada pela manutenção das alterações imunitárias ocorridas na gravidez 26 . No entanto, esse fenômeno não é constante 27,28 . Schatz e Zeiger 29 observaram, em estudo com mulheres grávidas alérgicas, que em 34% delas pioram os sintomas nasais, 15% apresentaram melhora e 45% não tiveram alterações em sua alergia.…”

Section: Discussionunclassified

Associação entre alergia prévia, infertilidade e abortamento

Zac¹,

Machado²,

Alberti³

et al. 2005

Rev. Assoc. Med. Bras.

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INTRODUÇÃOO conceito de que o feto está completamente separado da mãe, especialmente pelo trofoblasto que envolve a placenta, está sendo questionado. Células fetais são detectadas não apenas no sangue periférico, mas também na pele e no fígado maternos 1 . Portanto, a gestação bem sucedida depende da tolerância que o sistema imunitário materno tem por um novo organismo com características próprias diferentes das encontradas no ser que o abriga. Se não houver essa adaptação imunitária, o embrião é destruído e expulso 2 . Manifestações alérgicas decorrem de resposta exacerbada do sistema imune a substâncias antigênicas 3 . Estudos recentes sugerem que células T CD4+ atuariam regulando a atividade de outros linfócitos, limitando sua agressividade 4 , e a alergia poderia ser parcialmente decorrente de insuficiência funcional desses linfócitos controladores. Por outro lado, a gravidez tem um efeito benéfico sobre várias doenças auto-imunes órgão-específicas mediadas por células T, tais como artrite reumatóide, esclerose múltipla e doença inflamatória intestinal 5,6 . A expressão molecular de citocinas revelou diminuição dos níveis de mRNA da IL-18, do IFN-gama e da IL-2 nos primeiros seis meses da gestação 7,8 . Durante a gravidez, ocorrem mudanças no sistema imune para proteger o feto, sem comprometer as defesas maternas. A secreção local de corticosteróides, provenientes da glândula supra-renal, e mudanças na concentração de citocinas no sistema reprodutor protegem o feto contra rejeição 9 . Ocorrem também alterações no balanço de citocinas Th1 / Th2, com predominância de Th2, que faz parte das reações alérgicas 10 . Apesar de o número de leucócitos estar aumentado, suas funções são deprimidas e o sistema humoral é afetado pela hemodiluição fisiológica da gravidez. Essas modificações no sistema imunitário podem facilitar a instalação de infecções e mudanças no padrão das reações alérgicas durante o período gestacional 11 . Os fatores imunitários mais importantes na perda gestacional de repetição são os auto-anticorpos antifosfolipídios, denominados anticoagulante lúpico e anticardiolipina. Essas substâncias interferem nos mecanismos de coagulação dependentes dos fosfolipídios, causando desequilíbrio da produção de prostaglandinas, com predominância do tromboxane (vasoconstritor e agregante plaquetário) em detrimento da prostaciclina (vasodilatadora e antiagregante plaquetária). Esse fenômeno determina aumento dos eventos trombóticos, levando à ocorrência de infarto e trombose placentária 12 . Segundo alguns trabalhos, os abortamentos e a dificuldade para engravidar constituem uma falha ocasional dos mecanismos protetores da gestação. São fatores que contribuem para a perda do embrião e do feto:• anormalidades cromossômicas do embrião e más-formações fetais, que se associam a degeneração hidrópica da placenta e dificuldade de nidação e desenvolvimento do ovo; • ativação de mecanismos da coagulação, que provocam vasculite, com conseqüente redução do suprimento sangüíneo para o embrião implantado; • distúrbios hormona...

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Severity of asthma and perinatal outcome

Cited by 205 publications

References 10 publications

Prostaglandins and mechanisms of preterm birth

Prostaglandins and mechanisms of preterm birth

The Effect of Active and Passive Household Cigarette Smoke Exposure on Pregnant Women With Asthma

Associação entre alergia prévia, infertilidade e abortamento

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