Increased Antibiotic Utilization among Pregnant Women with Asthma in a Medicaid Population

Abstract

Antibiotics are the most commonly prescribed medication in the prenatal period and prenatal antibiotic exposure has been associated with risk of childhood asthma. The role of maternal asthma status in prenatal antibiotic utilization has yet to be determined. We investigated the association of maternal asthma status and prenatal antibiotic use in women enrolled in a state Medicaid program. Our outcome was prenatal antibiotics from prescription fill data. Maternal asthma status was defined by ICD-9 codes and asthma medication utilization. Using multivariable regression analysis, we determined the association of women’s asthma status with antibiotic fills adjusting for factors including mother’s age at delivery, parity, maternal race, maternal education, maternal smoking and GBS status. Among 84,214 pregnant women, 4.5 % had asthma. Overall, 64% received antibiotics during pregnancy: 82% among women with asthma, 63% among those without asthma. Women with asthma had a 2.5-fold increase in odds of ever being prescribed antibiotics compared to those without asthma (adjusted OR: 2.46, 95% CI: 2.26, 2.67). Among antibiotic users, women with asthma were also at increased odds of receiving greater number of courses of antibiotics (aOR: 1.89, 95% CI: 1.77, 2.02) and had earlier time to first antibiotic fill in pregnancy. Maternal asthma was associated with increased antibiotic utilization during pregnancy. Women with asthma had higher cumulative dose and received antibiotics earlier in pregnancy than women without asthma. Future assessment to determine whether pregnant asthmatics are at higher infection risk or antibiotics are being used to treat asthma exacerbations may inform clinical decision making.