The Effect of Asthma Severity on Perinatal Outcomes: A Tertiary Hospital Experience

Abstract

Objective To evaluate the effect of asthma severity and disease exacerbation on pregnancy outcomes. Materials and Methods Pregnancies were classified into 3 groups as mild (n=195), moderate (n=63), and severe (n=26) according to preconceptional asthma severity. Demographic features, clinical characteristics, and perinatal outcomes were compared between the groups. Delivery characteristics and pregnancy outcomes were also compared between the pregnancies with or without asthma exacerbation (43 and 241 pregnancies, respectively). Results Worsening of symptoms during pregnancy was higher in moderate and severe asthma groups (p<0.001). Rates of spontaneous abortion, fetal structural anomaly, preterm delivery, preeclampsia, fetal growth restriction (FGR), oligohydramnios, gestational diabetes, and intrauterine fetal demise were higher in moderate and severe asthma groups (p-values were < 0.001, 0.01, 0.008, 0.02, 0.01, < 0.001, < 0.001, and 0.007, respectively). Admissions to neonatal intensive care units and neonatal complication rates were higher among moderate and severe asthma groups (p=0.035 and < 0.001). Spontaneous abortion, preterm delivery, preeclampsia, FGR, oligohydramnios, and neonatal complication rates were higher (p<0.001) in the group with exacerbated symptoms. Conclusion Moderate to severe asthma before pregnancy and the exacerbation of asthma symptoms during pregnancy may lead to increased rates of perinatal complications.

Asthma severity and impact on perinatal outcomes: an updated systematic review and meta‐analysis

“…Some of the studies had controlled for potential confounders either in the study design (e.g. the control group was matched for some factors such as maternal age) or in the data analysis, [8][9][10][11][12]17,[28][29][30][31][32][33][34][35][36] and some studies did not control for any confounders, 27,[37][38][39][40] If some confounders had been controlled for in the study design, the ORs were considered as adjusted ORs. 31,34,35 Where two or more studies provided information for a research question, the data were combined in a meta-analysis.…”

“…The specific definitions of asthma, asthma exacerbation and asthma severity varied across the included studies (Tables S3 and S4). In the seven studies examining asthma severity, medication usage was used to define asthma severity in five studies, 9,10,30,32,40 and two studies used a combination of asthma symptoms, lung function and medication use. 28,37 Firoozi et al 41 developed an index to define asthma severity based on medication use (mainly oral corticosteroids, inhaled corticosteroids and beta-agonists), and this index was used in their later study and a Swedish study.…”

“…12,29,33,34,36 One of the 20 studies was a Chinese study. 39 Two studies explored the effects of both asthma exacerbation and severity on perinatal outcomes 10,40 and one study explored the effects of both asthma exacerbations and medication use on perinatal outcomes. 34 Nine of the 20 studies included in the present review were also included in the 2013 review mentioned above, 4,27,28,[30][31][32][33][34][35] and nine studies, most of which were large-scale studies, were published after 2012.…”

“…34 Nine of the 20 studies included in the present review were also included in the 2013 review mentioned above, 4,27,28,[30][31][32][33][34][35] and nine studies, most of which were large-scale studies, were published after 2012. [8][9][10][11][12]17,29,39,40 Another two studies published before 2012 which were included in the present review were not included in the 2013 review. 36,37…”

“…28,37 Firoozi et al 41 developed an index to define asthma severity based on medication use (mainly oral corticosteroids, inhaled corticosteroids and beta-agonists), and this index was used in their later study and a Swedish study. 9,30 In nine of the 11 studies examining asthma exacerbations, 8,10,17,27,31,34,35,38,40 the definition of an asthma exacerbation was an event requiring medical intervention, such as an emergency department visit or a hospitalisation due to asthma.…”