The relationship of asthma medication use to perinatal outcomes

Schatz, Michael; Dombrowski, Mitchell P.; Wise, Robert A.; Momirova, Valerija; Landon, Mark B.; Mabie, William C.; Newman, Roger B.; Hauth, John C.; Lindheimer, Marshall D.; Caritis, Steve N.; Leveno, Kenneth J.; Meis, Paul J.; Miodovnik, Menachem; Wapner, Ronald J.; Paul, Richard H.; Varner, Michael W.; OʼSullivan, Mary J.; Thurnau, Gary R.; Conway, Deborah L.

doi:10.1016/j.jaci.2004.03.017

Cited by 187 publications

(173 citation statements)

References 25 publications

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“…Asthma is now recognized to be a risk factor for preterm birth and preeclampsia, although the physiopathogenic process involved is still a matter of debate [17]. The role of asthma medication is also the subject of discussion and Schatz et al [18] reported an association between ingested corticosteroids, but not inhaled drugs, and the risk of preterm birth. In our population, asthma was more specifically associated with an increased risk of induced preterm birth.…”

Section: Discussionmentioning

confidence: 99%

Medical and Sociodemographic Risk Factors for Preterm Birth in a French Caribbean Population of African Descent

Rouget

Lebreton

Kadhel

et al. 2012

Matern Child Health J

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There appears to be an incompressible high rate of preterm births among populations of African origin irrespective of their geographic location. The objective of this study was to assess the risk factors for preterm birth in a French Caribbean population of African descent, offered medical care comparable to that on the French mainland, but presenting a higher rate of preterm birth. The study was based on a birth cohort at maternity hospitals in Guadeloupe (French West Indies) including 911 singleton pregnancies enrolled during their third trimester check-up visits. Associations between risk factors and the risk of preterm delivery (spontaneous and induced) were assessed using a multivariate Cox model. In addition, prevalences of sociodemographic and medical factors in Guadeloupe were compared with those on the French mainland. 144 women (15.8 %) delivered preterm, medically induced in 52 %. Women delivering preterm were more often over 35 years old (37 %), single (54 %), and had higher prevalence of prior preterm birth (20 %), prior miscarriage (37 %), lupus (3 %), asthma (14 %), gestational hypertension (26 %), gestational diabetes (13 %) and urinary tract infection (24 %) than women with term births. In the whole cohort, these risk factors were also more frequent than in mainland France. Our results suggest highly prevalent medical risk factors for preterm births in Guadeloupe. This observation combined with specific social risk factors (older maternal age, single living) less frequent on the French mainland probably explains a large part of a higher prevalence of preterm births in this population despite similar medical provision.

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Section: Discussionmentioning

confidence: 99%

Medical and Sociodemographic Risk Factors for Preterm Birth in a French Caribbean Population of African Descent

Rouget

Lebreton

Kadhel

et al. 2012

Matern Child Health J

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“…However, significant heterogeneity was present (I 2 571.1%, p50.06). Low birth weight Data on low birth weight was included in two prospective studies [17,20] with 267 subjects who used OCS during pregnancy and 2341 subjects who did not use OCS. Overall, there was a significant increased risk of low birth weight infants to those females using OCS during pregnancy (RR 1.41, 95% CI 1.04-1.93).…”

Section: Low Birth Weightmentioning

confidence: 99%

“…There were two prospective studies [17,20] of small for gestational age, with 267 subjects who used OCS during pregnancy and 2341 subjects who did not use OCS during pregnancy. Overall, there was no significant increased risk of small for gestational age among females using OCS during pregnancy (RR 0.81, 95% CI 0.48-1.34).…”

Section: Small For Gestational Agementioning

confidence: 99%

“…One recent meta-analysis found that pregnant asthmatic females with a history of severe exacerbation during pregnancy are at a significantly increased risk of perinatal complications including low birth weight [19]. The use of asthma medications such as oral corticosteroids (OCS) during pregnancy may also play a potential role in leading to pre-term delivery or low birth weight infants [20] and have been suggested as contributing factors by several large cohort studies [9,13].…”

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confidence: 99%

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Effects of asthma severity, exacerbations and oral corticosteroids on perinatal outcomes

et al. 2012

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This systematic review and meta-analysis sought to investigate whether asthma exacerbations, oral corticosteroid use or asthma severity are associated with prematurity and intrauterine growth restriction.Cohort studies published between 1975 and March 11, 2012 were considered for inclusion. 138 publications were identified for possible inclusion, and nine papers met the inclusion criteria, by reporting perinatal outcomes of interest (low birth weight, ,2500 g), pre-term birth (,37 weeks gestation unless otherwise stated) and small for gestational age (,10th percentile for gestational age and sex) in groups of asthmatic patients stratified by history of exacerbations, oral corticosteroid use or asthma severity.Maternal asthma exacerbations and oral corticosteroid use had a significant effect on outcomes, including low birth weight (RR 3.02, 95% CI 1.87-4.89 and RR 1.41, 95% CI 1.04-1.93, respectively) and pre-term delivery (RR 1.54, 95% CI 0.89-2.69 and RR 1.51, 95% CI 1.15-1.98, respectively). Moderate-to-severe asthma during pregnancy was associated with an increased risk of small for gestational age (RR 1.24, 95% CI 1.15-1.35) and low birth weight (RR 1.15, 95% CI 1.05-1.26) infants.These data suggest that asthma exacerbations, oral corticosteroid use or asthma severity defined as moderate-to-severe may be associated with pre-term delivery, low birth weight, and small for gestational age infants. Further studies on the effect of maternal asthma control on perinatal outcomes are warranted.

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“…Using this definition of maternal asthma, the mother might or might not have had asthma during pregnancy. The monitoring of the asthma status during pregnancy is important, as associations have been reported between the increased asthma severity and/or lack of maternal asthma control during pregnancy and perinatal mortality and low birthweight [9][10][11][12][13], whereas inconsistent associations have also been reported for prematurity and intra-uterine growth restriction [13][14][15][16].…”

mentioning

confidence: 99%

Control and severity of asthma during pregnancy are associated with asthma incidence in offspring: two-stage case-control study

Martel

Rey²,

Beauchesne³

et al. 2009

European Respiratory Journal

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The extent to which childhood asthma incidence is influenced by asthma control and severity during pregnancy is unknown. We have studied this association during the child's first 10 yrs of life.A two-stage, case-control study, nested in a cohort of 8,226 children of asthmatic mothers, was conducted using three interlinked databases of Quebec, Canada, and mailed questionnaires. A total of 2,681 asthmatic children and 30,318 age-matched controls were selected (f20 controls?case -1 ; stage 1), and 3,254 selected mothers were mailed questionnaires to obtain additional information (stage 2). Asthma control and severity was defined using validated indexes and childhood asthma incidence based on at least one asthma-related diagnosis and prescription received within 2 yrs. A total of 44 confounders were considered.Compared with children of mild controlled asthmatic mothers, children whose mothers had moderate-to-severe uncontrolled asthma during pregnancy had an increased risk of asthma (adjusted OR 1.27, 95% CI 1.06-1.52). No increased risk was observed for children of mild uncontrolled and moderate-to-severe controlled mothers.Based on one of the largest studies of children of asthmatic mothers, a significant increase in asthma risk was demonstrated among children whose mothers had poor control and increased severity of asthma during pregnancy, indicating that this element should be added to the expanding list of determinants of childhood asthma. As it constitutes a risk factor where pregnant asthmatic females can intervene, it is of great importance for physicians to optimally treat asthmatic females during pregnancy and to encourage females to be adherent to the prescribed asthma medications.

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The relationship of asthma medication use to perinatal outcomes

Cited by 187 publications

References 25 publications

Medical and Sociodemographic Risk Factors for Preterm Birth in a French Caribbean Population of African Descent

Medical and Sociodemographic Risk Factors for Preterm Birth in a French Caribbean Population of African Descent

Effects of asthma severity, exacerbations and oral corticosteroids on perinatal outcomes

Control and severity of asthma during pregnancy are associated with asthma incidence in offspring: two-stage case-control study

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