Abstract
BackgroundPoorly controlled asthma can lead to maternal and fetal complications. Despite the known risks of poorly controlled asthma during pregnancy and the need for stepping up therapy when appropriate, there are concerns that management is suboptimal in primary care.Our objective was to investigate the management of asthma during pregnancy by general practitioners providing shared maternity care.MethodsA pre-piloted, anonymous mail survey was sent to all general practitioners (n = 842) involved in shared maternity care at six maternity hospitals in Victoria, Australia. Respondents were asked about their perceived safety of individual asthma medications during pregnancy. Approach to asthma management during pregnancy was further explored using scenarios of pregnant women with stable and deteriorating asthma and poor medication adherence.ResultsInhaled corticosteroids (ICS) were perceived to be the safest and were the preferred preventive medication in first trimester (74.1%), whilst leukotriene receptor antagonists were the least preferred (2.9%). A quarter (25.8%) of respondents would stop or decrease patients' ICS doses during pregnancy, even when their asthma was well controlled by current therapy. In addition, 12.1% of respondents were not sure how to manage deteriorating asthma during pregnancy and opted to refer to another health professional. Almost half the respondents (48.9%) reported encountering medication nonadherence during pregnancy.ConclusionA lack of confidence and/or knowledge among general practitioners in managing deteriorating asthma in pregnancy was observed despite a good understanding of the safety of asthma medications during pregnancy, compliance with evidence-based guidelines in the selection of preventive medications, and self reported good asthma knowledge.
Highlights
Controlled asthma can lead to maternal and fetal complications
Controlled asthma increases the risk of pre-term birth, low birth weight, cesarean section, stillbirth, intrauterine growth restriction (IUGR), congenital malformations, small for gestational age (SGA) infants, pre-eclampsia, chorioamnionitis, low APGAR scores and gestational diabetes [1]
An anonymous mail questionnaire was sent to all general practitioners involved in shared maternity care (n = 842) at six public maternity hospitals in Melbourne, Australia
Summary
Controlled asthma can lead to maternal and fetal complications. Despite the known risks of poorly controlled asthma during pregnancy and the need for stepping up therapy when appropriate, there are concerns that management is suboptimal in primary care. Controlled asthma increases the risk of pre-term birth, low birth weight, cesarean section, stillbirth, intrauterine growth restriction (IUGR), congenital malformations (e.g. ventricular and atrial septal defects, spina bifida), small for gestational age (SGA) infants, pre-eclampsia, chorioamnionitis, low APGAR scores and gestational diabetes [1]. A result of poorly controlled asthma during pregnancy, can lead to severe risks of neonatal respiratory difficulties, fetal brain ischemia and cerebral palsy [2]. Maternal asthma that is well managed has not been associated with any increased risk of complications [8,9]. A promptly treated acute asthma attack during pregnancy is unlikely to have a serious effect on the pregnancy, delivery, or the health of the infant [10]
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