Abstract
BackgroundAsthma is common during pregnancy, however research is limited regarding the extent and timing of changes in asthma management associated with pregnancy.ObjectiveTo determine the prevalence of asthma during pregnancy and identify changes in treatment and asthma exacerbation rates associated with pregnancy, while controlling for seasonal influences.MethodsPregnant women with asthma were identified from the UK General Practice Research Database between 2000 and 2008. For each woman asthma medication prescribed during the study period was identified; for each product combination the British Thoracic Society medication-defined asthma treatment step was identified. Asthma exacerbations were identified during pregnancy and in the corresponding 12 months prior. Analyses of changes in asthma treatment and exacerbation rates during pregnancy relative to the corresponding period 12 months prior, to control for seasonality, were stratified by trimester and asthma treatment intensity level.ResultsThe prevalence of treated asthma in pregnancies resulting in a delivery was 8.3%. From 14,141 pregnancies, in 12,828 women with asthma, 68.4% received prescriptions for a short-acting β2-agonist and 41.2% for inhaled corticosteroids; 76.5% were managed with asthma treatment Step 1 or 2. Poor persistence to inhaled corticosteroids, defined as a gap of up to 60 days between prescriptions, was common. In 45.0% of pregnancies, an increase in average treatment step was observed whereas in 25.6% the treatment step decreased. Treatment intensity remained the same in 29.5% of pregnancies. Exacerbations occurred in 4.8% of pregnancies compared to 5.9% in the same season the year before (p<0.001).ConclusionExacerbation rates during pregnancy were slightly lower than in the year before. However, treatment patterns and exacerbation rates in this study suggest asthma control during pregnancy is variable, and women may require close monitoring especially in those with evidence of poor control before pregnancy.
Highlights
Estimates from published studies suggest that asthma affects between 3–14% of pregnancies [1,2,3,4] and asthma medicines are commonly used during pregnancy
In 68.4% of pregnancies among women with evidence of asthma ending in a delivery, a prescription was issued for a short-acting b2 agonists (SABAs)
Prescriptions were issued for an inhaled corticosteroids (ICS), long-acting b2 agonists (LABAs), or a combination product in 41.2%, 4.9% and 8.9% of pregnancies respectively
Summary
Estimates from published studies suggest that asthma affects between 3–14% of pregnancies [1,2,3,4] and asthma medicines are commonly used during pregnancy. [10,11] some studies have suggested anecdotally that women with severe asthma are more likely to experience exacerbations during pregnancy than women with mild asthma, [6] the relationship with pre-pregnancy asthma severity has not been evaluated systematically with methods to control for seasonal differences. Insight in these matters will inform women with asthma who want to become pregnant and their clinicians regarding anticipated changes in disease activity in pregnancy and associated needs for alterations in disease management. Asthma is common during pregnancy, research is limited regarding the extent and timing of changes in asthma management associated with pregnancy
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