Pregnant Asthmatic Women Research Articles

Analyzing spirometry profile of pulmonary function pattern among gestating women with bronchial asthma: A case–control study

Asthma is a widespread respiratory illness that affects millions of people worldwide, including pregnant women. Using spirometry testing, this study examines the effects of pregnancy on the lungs of pregnant women with and without bronchial asthma. The survey included 200 asthmatic pregnant women overall and 100 pregnant healthy women. FEV1, PEFR, FVC, and FEV1/FVC ratio, among other lung function indicators, were measured during the second and third trimesters of pregnancy. The findings show that pregnant women with asthma have significantly worse lung function than healthy pregnant women, with lower FEV1, PEFR, and FEV1% values. In addition, changes in lung function and body mass index (BMI) were observed between the second and third trimesters. The FEV1/FVC ratio remained largely stable, although both FVC and FEV1% decreased significantly. These results highlight the dynamic nature of lung function and BMI during pregnancy and also highlight the importance of monitoring these changes for the health of expectant mothers and their unborn children. To ensure maternal and fetal health, it is essential to understand these physiological changes, especially in people with asthma. Future evaluation of spirometry data should consider reference equations tailored to pregnant women. This will provide important insights into the complex relationship between respiratory health and pregnancy.

Акушерские осложнения в III триместре беременности у пациенток с бронхиальной астмой

Aim: to analyze the rate of asthma-associated obstetric complications in the third trimester of pregnancy, with attention to the severity and level of symptom control Patients and Methods: a retrospective phase involved the analysis of the course of the third trimester of pregnancy in 120 women with asthma. The women were divided into five groups: mild intermittent asthma (n=34), mild persistent controlled asthma (n=40), mild persistent poorly controlled asthma (n=10), moderate to severe persistent controlled asthma (n=26), and moderate to severe persistent poorly controlled asthma (n=10). The prospective phase included examination and treatment of pregnant women in the groups with uncontrolled asthma (n=20). The level of symptom control was assessed using the Asthma Control Test (ACT). Additionally, nitric oxide in exhaled air (NOex) was measured. The control group included 20 women without allergic disorders. Results: the study demonstrated an association between the level of symptom control and the development of associated hypertensive disorders. Severe preeclampsia was reported only in moderate to severe poorly controlled asthma. A significant correlation was revealed between ACT, NOex level, and de novo increase in systolic blood pressure (BP) in the third trimester (Rs=0.581; Rs=0.828). C-section was most often performed for fetal indications (acute hypoxia) in women with moderate to severe persistent poorly controlled asthma. These findings indicate that the choice of delivery method should be based on the level of symptom control at the end of the third trimester, rather than disease severity. Achieving complete control of asthma in pregnant women reduces the risk of acute fetal hypoxia and the rate of emergency C-sections. Conclusions: achieving and maintaining complete asthma control during pregnancy reduces the risk of associated obstetric complications and improves perinatal and maternal outcomes KEYWORDS: asthma, pregnancy, obstetric complications, hypertension, asthma-associated obstetric complications, C-section. FOR CITATION: Pashchenko A.A., Dobrokhotova Yu.E., Fomina D.S. Obstetric complications in the 3rd trimester of pregnancy in women with asthma. Russian Journal of Woman and Child Health. 2024;7(2):98–103 (in Russ.). DOI: 10.32364/2618-8430-2024-7-2-2.

Asthma in Pregnancy: A Critical Review of Impact, Management, and Outcomes.

Asthma is a common chronic respiratory condition that can significantly impact the health of pregnant women and their developing fetuses. This comprehensive review provides insights into the prevalence of asthma in pregnant women, the physiological changes during pregnancy, and the multifaceted impact of asthma on maternal and fetal health. It emphasizes the importance of proper asthma diagnosis, medication management, and the development of personalized asthma action plans during pregnancy. Lifestyle modifications, trigger avoidance, and stress reduction are essential to effective management. Healthcare providers are pivotal in educating, monitoring, and individualized care to ensure optimal asthma control. The review underscores the critical significance of managing asthma during pregnancy, as it improves maternal and fetal outcomes and potentially influences long-term health for both mother and child. Future directions in this field involve ongoing research, personalized treatment, early intervention, and precision medicine to enhance the understanding and care of asthma during pregnancy.

Asthma care during pregnancy in South Asia

Bronchial asthma is among the commonest chronic inflammatory respiratory diseases affecting women of reproductive age group. Adequate attention has not been given to the diagnosis and the management of asthma in countries of South Asia. Management of asthma in pregnant women is more or less same as that of in non-pregnant women and stepwise approach is recommended. To confirm the diagnosis of asthma during pregnancy, spirometry can be used. Patients suffering from very severe asthma or difficult-to control asthma are more prone to develop exacerbations during pregnancy needs hospitalization for care. Well-controlled asthma during pregnancy prevents complications of pregnancy and results in better pregnancy outcomes. It better to follow the guidelines for management of asthma during pregnancy. The pregnant women must be educated regarding the care of asthma during pregnancy, delivery, in postpartum period and thereafter.

Asthma in a prospective cohort of rural pregnant women from Sri Lanka: Need for better care during the pre-conceptional and antenatal period.

To describe the epidemiology and the effect of asthma on pregnancy outcomes in pregnant women from a rural geography. We conducted a prospective cohort study in Anuradhapura district, Sri Lanka enrolling all eligible pregnant women registered in the maternal care program. An interviewer-administered questionnaire-based symptom analysis and clinical assessment was conducted in the first and second trimesters. We recruited 3374 pregnant women aged 15-48 years at conception. Self-reported physician-diagnosed asthma prevalence was 6.6% (n = 223) with only 41.7% (n = 93) on regular medical follow-up for asthma. The prevalence of wheeze reduced from pre-pregnancy (67.0%) to the first (46.4%) and second trimesters (47.7%; p<0.01). Of the 73 asthmatic women who did not have wheeze in the last 3 months preceding pregnancy, new-onset wheeze was reported by 6(8.2%) and 12(16.4%) in the first and second trimester, respectively. Pregnant women who sought medical care for asthma in the private sector had a lower likelihood of developing new-onset wheeze in the first trimester (p = 0.03; unadjusted OR = 0.94;95%CI 0.89-0.99). Thirty-four (33.3%) pregnant women had at least one hospital admission due to exacerbation of wheeze during the first and second trimester. The prevalence of low birth weight (16.0%) was higher among pregnant asthmatic women. This study reports the high prevalence of asthma and asthma-associated pregnancy outcomes in women from a rural geography signifying the importance of targeted management.

Combined exposure to heavy metals in PM2.5 and pediatric asthma

Asthma is the most common chronic allergic disease in children; it affects more than 300 million people worldwide. Information on the association between exposure to ambient heavy metals and incidence of pediatric asthma is limited. We sought to evaluate the effects of heavy metals during pregnancy and infancy periods with asthma and identify a sensitive time window, clarifying the effect of ambient heavy metals on lung development. A total of 171,281 children, who were born from 2004 to 2011 in Taichung City, were followed until 2014. Concentrations of ambient heavy metals such as arsenic (As), cadmium (Cd), mercury (Hg), and lead (Pb) were obtained from the Weather Research and Forecasting/Chem model, considering the top 75 emission sources in Taiwan. The distributed lag nonlinear model was used to investigate the relationship between combined exposure to heavy metals in 2.5μm particulate matter and asthma in pregnant women and1-year-old infants. We identified 31,277 new asthma cases from the birth cohort. After adjustment for socioeconomic status, maternal age, maternal atopy, maternal anemia, and maternal kidney disease, distributed lag nonlinear model results revealed positive associations of asthma with exposure to Pb during gestational weeks 1 to 14 and 21 to 40, and 1 to 3 weeks after birth. Regarding the sensitivity analyses, coexposure to Pb and As, coexposure to Pb and Cd, and coexposure to Pb and Hg were positively associated with asthma onset as well. Our study suggested that combined exposure to Pb with As, Cd, and Hg during early and late gestational weeks was associated with the incidence of pediatric asthma.

Фармакотерапия бронхиальной астмы у беременных: проблемы безопасности

Фармакотерапия бронхиальной астмы у беременных: проблемы безопасности

Monitoring Asthma in Pregnancy: Diagnosis and Treatment

Asthma is one of the most common problems that complicate pregnancy. Several maternal and fetal complications make it difficult for the physician to treat asthmatic pregnant women. Asthma not only affects the maternal quality of life but also increases the risk of adverse perinatal outcomes. Managing asthma along with proper diagnosis should be given special emphasis during pregnancy. Pregnant asthmatic patients are at an increased risk of preterm birth, congenital malformations, respiratory disorders, and other complications. Thus, optimum management of asthma along with appropriate pharmacological therapies during pregnancy helps in improving asthmatic exacerbations. This review provides insights with regard to the diagnosis, management, and safety of commonly used medications of asthma during pregnancy.

Maternal and infants outcomes in asthmatic pregnant women in Mosul

Background: Asthma affects between 3% and 12% of pregnant women worldwide and the prevalence among pregnant women is rising, its often unrecognized and suboptimal treated. The course of asthma during pregnancy varies; it improves, remains stable, or worsens in similar proportion of women. The risk of an asthma exacerbation is high immediately postpartum, but the severity of asthma usually returns to the preconception level after delivery and often follows a similar course during subsequent pregnancies. Good control of asthma is essential for maternal and fetal wellbeing. Patients and Methods: A prospective cohort study was adopted to achieve the study aim. The study conducted from January 2003 through September 2003. Asthmatic and non-asthmatic pregnant women were randomly selected from the outpatient clinics, in patient clinics and emergency department of Al-Razi Teaching Hospital in Mosul city, the data obtained including age, height and weight, parity and gravid, history with a clinical examination of respiratory system and history of maternal and fetal complications. These points were recorded in an especially designed collection form for all women examined after they were consent a form 102 asthmatics pregnant and 115 non-asthmatics pregnant were enrolled in the study; 92 and 93 of them respectively were followed to delivery by researcher and the assessment of maternal and fetal outcomes was done. Percentages, relative risk ratio, p-value and 95% confidence interval were calculated with SPSS version 18.Results: The age interval (25-34) represents 58.7% of the asthmatic pregnant. The first, second and third trimesters correspond to 6.2%, 32.6% and 60.8% of asthmatic pregnant respectively. Regarding the symptoms, the study shows that Dyspnoae is the most common symptoms among them follows by wheeze, cough and chest tightness and lastly expectoration with percentage of 65.2%. Moreover finds out that 59 (64.2%) had worsening of symptoms during the three trimesters of pregnancy, 28 (30.4%) had No change in the severity of asthma and remainder 5 (5.4%) of them show improvement. The adverse maternal outcomes; hyperemesis gravid arum (RR of 1.43), recurrent hospital admission (RR= 2.26) and the severity of asthma in pregnant women with boys (RR= 2.29) occurs with high significant association. Also the infant outcomes; that the wheezy chest, fetal death and congenital anomalies occur in high significant statistical association among the asthmatic pregnant group with RR (1.66, 1.72, and 1.66 respectively).Conclusion: Symptoms of asthmatic patients during the pregnancy are more severe than without pregnancy. The symptoms are more sever in third trimester, which are caused by mechanical factors and the severity of asthma is more in mothers bearing boys. More over some adverse maternal and infant outcomes were significant statistically associated with asthma.

Errors in Aerosol Inhaler Use and Their Effects on Maternal and Fetal Outcomes among Pregnant Asthmatic Women (Subanalysis from QAKCOP Study).

Data on inhaler technique and its effects on maternal and fetal outcomes during pregnancy are seldom reported. The primary objective of this study was to evaluate inhaler technique and identify errors in inhaler use among pregnant women with asthma. Secondary objectives were to identify factors associated with poor inhaler technique and study the association between inhaler technique and maternal and fetal outcomes. This was a cross-sectional, face-to-face, prospective study of 80 pregnant women with physician-diagnosed asthma. Seventy-three and 41 asthmatic pregnant women reported using pressurized metered dose inhalers (pMDIs) and dry powder inhalers (DPIs), respectively. Overall, wrong inhaler technique was observed in 47 (64.4%) subjects. Among pMDI users, correct inhaler use was observed in only 26/73 (35.6%) of the patients, with lack of coordination between inhalation and generation of the aerosol and failure to breathe out gently before using the inhaler, being the most common errors. Among DPI users, 21 (51.2%) demonstrated correct inhaler use, with failure to perform a breath-hold for 10 seconds after inhaling the powder and to exhale gently before using the inhaler being the most common errors. Significant associations between inhaler technique and patient's understanding of asthma medications and the kind of follow-up clinic (respiratory versus nonrespiratory clinic) were found. No significant associations between inhaler technique and various maternal and fetal outcomes or asthma control were found. In conclusion, improper inhalation technique is significantly prevalent in pregnant asthmatic women, particularly among those being followed in nonspecialized respiratory clinics. The lack of significant association between the inhaler technique and asthma control (and hence maternal and fetal outcomes) may simply reflect the high prevalence of uncontrolled asthma and significant contribution of other barriers to poor asthma control in the current patient's cohort. Multidisciplinary management of asthma during pregnancy with particular emphasis on patient's education is imperative.

Methods for the assessment of selection bias in drug safety during pregnancy studies using electronic medical data.

Electronic health data are routinely used for population drug studies. Due to the ethical dilemma in carrying out experimental drug studies on pregnant women, the effects of medication usage during pregnancy on fetal and maternal outcomes are largely evaluated using this data collection medium. One major limitation in this type of study is the delayed inclusion of pregnancies in the cohort. For example, in the province of Quebec, Canada, a major pregnancy cohort only captured pregnancies after 20 weeks gestation. The purpose of this study was to demonstrate three methods that can be used to assess the extent of selection bias due to the delayed inclusion of pregnancies. We use causal directed acyclic graphs to explain the source of this selection bias. In an example involving a cohort of pregnant asthmatic women reconstructed from the linkage of administrative health databases from the province of Quebec, we use numerical derivations, a simulation study and a sensitivity analysis to investigate the potential for bias and loss of power due to the delayed inclusion. We find that this selection bias can be partially mitigated by controlling for variables related to (spontaneous or therapeutic) abortion and the outcome of interest. The three proposed methods allow for the pre and post hoc ascertainment of the bias. While delayed pregnancy inclusion selection bias (which includes “live birth bias”) can produce substantial bias in pregnancy drug studies, all three methods are effective at producing estimates of the size of the bias.

Asthma knowledge, care, and outcome during pregnancy: The QAKCOP study.

Asthma is the most common chronic medical condition affecting pregnancy. Optimizing asthma management in pregnancy is paramount for the well-being of both the mother and the baby. The primary objectives of this study were to assess patient’s knowledge about asthma, the level of asthma care, and fetal and maternal outcomes among pregnant asthmatic women in this wealthy country with tremendous improvement in maternal and fetal health care. The secondary objective was to identify barriers to asthma control. This was a cross-sectional, face-to-face, prospective study of 80 pregnant women with physician-diagnosed asthma. About 56% of patients reported worsening of their asthma control during pregnancy, of which 52.3% felt this worsening in the third trimester. About 65% of patients had uncontrolled asthma during their pregnancy, and inhaler technique was incorrect in 64.4%. Only 38% of patients knew the difference between controller and reliever asthma medications, 12.7% of patients had received written asthma action plan, 17% had a spirometry done in the previous 5 years, and 3.8% had peak expiratory flow meter at home. The main reasons for uncontrolled asthma were lack of knowledge about right asthma medications in 30% and fear of side effects of inhaled corticosteroids in 19% of patients. No financial reason was reported. Significant associations between total number of pregnancies, poor perception of asthma medications, asthma exacerbation during delivery and poor asthma control were observed. Preeclampsia and congenital anomalies occurred at higher rates than previously reported among general population in this country. The tremendous improvements in maternal health care and socioeconomic status do not seem to be a barrier to the globally recognized poor asthma care in pregnancy. Important strategies are much needed.

Managing Asthma in Pregnancy (MAP) trial: FENO levels and childhood asthma

The single-center double-blind, randomized controlled Managing Asthma in Pregnancy (MAP) trial in Newcastle, Australia, compared a treatment algorithm using the fraction of exhaled nitric oxide (FENO) in combination with asthma symptoms (FENO group) against a treatment algorithm using clinical symptoms only (clinical group) in pregnant asthmatic women (Australian New Zealand Clinical Trials Registry, no. 12607000561482). The primary outcome was a 50% reduction in asthma exacerbations during pregnancy in the FENO group. However, the effect of FENO-guided management on the development of asthma in the offspring is unknown. We sought to investigate the effect of FENO-guided asthma management during pregnancy on asthma incidence in childhood. A total of 179 mothers consented to participate in the Growing into Asthma (GIA) double-blind follow-up study with the primary aim to determine the effect of FENO-guided asthma management on childhood asthma incidence. A total of 140 children (78%) were followed up at 4 to 6years of age. FENO-guided as compared to symptoms-only approach significantly reduced doctor-diagnosed asthma (25.9% vs 43.2%; odds ratio [OR], 0.46, 95% CI, 0.22-0.96; P=.04). Furthermore, frequent wheeze (OR, 0.27; 95% CI, 0.09-0.87; P=.03), use of short-acting β-agonists (OR, 0.49; 95% CI, 0.25-0.97; P=.04), and emergency department visits for asthma (OR, 0.17; 95% CI, 0.04-0.76; P=.02) in the past 12months were less common in children born to mothers from the FENO group. Doctor-diagnosed asthma was associated with common risk alleles for early onset asthma at gene locus 17q21 (P=.01 for rs8069176; P=.03 for rs8076131), and higher airways resistance (P=.02) and FENO levels (P=.03). Acausal mediation analysis suggested natural indirect effects of FENO-guided asthma management on childhood asthma through "any use" and "time to first change in dose" of inhaled corticosteroids during the MAP trial (OR: 0.83; 95% CI: 0.59-0.99, and OR: 0.90; 95% CI: 0.70-1.03, respectively). FENO-guided asthma management during pregnancy prevented doctor-diagnosed asthma in the offspring at preschool age, in part mediated through changes in use and dosing of inhaled corticosteroids during the MAP trial.

Regulatory T and B Cells in Asthmatic Women: Variations From Pregnancy to Postpartum.

Allergic asthma and rhinitis are common in pregnancy. The immune mechanisms underlying the effects of asthma on pregnancy and vice versa are not completely understood. The aim of this study was to investigate changes in regulatory T and B cells in asthmatic women from late pregnancy to postpartum. Four groups of women were enrolled for this study: asthmatic (n=23) and healthy (n=43) third trimester-pregnant women and asthmatic (n=33) and healthy (n=35) nonpregnant women. Pregnant women were also evaluated postpartum (>6 weeks after delivery). Blood samples were taken from each woman and flow cytometry was used to characterize circulating regulatory T cells (Tregs) and regulatory B cells (Bregs). Foxp3 expression was assessed in CD4DimCD25Hi Tregs. Tregs did not vary significantly from pregnancy to postpartum in asthmatic or healthy women, but CD24HiCD38Hi Bregs decreased in pregnancy and increased significantly postpartum. Foxp3 expression in Tregs was also impaired during pregnancy in both asthmatic and healthy women, but recovered postpartum. Asthmatic pregnant women had higher Foxp3 expression levels than healthy pregnant women (P=.007), probably due to the use of control medication. Women with controlled asthma showed variations in regulatory cell subsets during pregnancy and postpartum. A similar pattern was observed for Foxp3 expression and CD24HiCD38Hi Bregs during this period, corroborating the interaction between Tregs and Bregs in immune responses. Considering the immunomodulatory potential of these immune mediators, more studies are needed to evaluate their relationship with asthma and rhinitis complications in pregnancy.

Effect of Pregnancy on Quantitative Medication Use and Relation to Exacerbations in Asthma.

Background The quantification of asthma medication reduction and its relation to an aggravation of asthma during pregnancy at an individual level are unclear. Methods We conducted a nationwide retrospective cohort study of asthmatic pregnant women in South Korea. All of the asthma medications were ranked from 1 to 4 according to the guideline-based stepwise approach. We assessed the daily sums of the ranks of the asthma medications and their association with exacerbations during three phases based on the individual's delivery date: before, during, and after pregnancy. Results The study cohort included 115,169 asthmatic pregnant women who gave birth between 2011 and 2013. The subjects were clustered into four groups according to the daily rank sums of their asthma medication. Asthma medications were rapidly reduced at the beginning of the pregnancy and then slowly increased after delivery. Exacerbations were more frequent in the group with higher rank-sum values than in the group with lower values. Overall exacerbations were reduced during pregnancy compared to before or after delivery. Conclusions Asthmatic pregnant women tended to reduce their asthma medication use during pregnancy. This led to a greater number of exacerbations in a small part of the study population.

Consistency of maternal telephone administration of the asthma control test using postpartum recall compared to repeated measures during pregnancy

ABSTRACTBackground: Suboptimal asthma control during pregnancy may impact perinatal outcomes. U.S. guidelines recommend questionnaires to assess asthma control including the Asthma Control Test (ACT). It is unknown in a research setting to what extent recall differs by the time between symptom occurrence and the administration of the questionnaire. Methods: Between 2009–2014, 196 pregnant asthmatic women were recruited by the Organization of Teratology Information Specialists (OTIS) MotherToBaby Pregnancy Studies. Participants were administered the ACT at enrollment, gestational weeks 20 and 32, and shortly after delivery. The same women were also administered the ACT retrospectively at approximately 6 months postpartum. Results: The Pearson correlation coefficients between the in-pregnancy and retrospective continuous ACT scores for the 1st, 2nd and 3rd trimesters were: 0.67 (95% CI: 0.58, 0.74), 0.61 (0.52, 0.70) and 0.65 (0.56, 0.72), respectively. When dichotomized into well-controlled asthma (ACT score ≥ 20) versus otherwise, the chi-square test for all three trimesters resulted in p values <0.0001. Cohen's Kappa statistics for the same dichotomized scores were 0.51, 0.45 and 0.40 for each trimester respectively. There was no evidence that adverse outcome of pregnancy (recall bias) influenced postpartum responses. Conclusions: The retrospectively recalled ACT score obtained postpartum was substantially different compared to in-pregnancy administration of the same questionnaire which could reflect test-retest variability as well as attenuation of recall. Documentation of the magnitude and direction of these differences could be useful in interpretation of the impact of asthma control when the ACT is used in retrospective case-control studies for pregnancy outcomes.

Pregnancy alters the circulating B cell compartment in atopic asthmatic women, and transitional B cells are positively associated with the development of allergy manifestations in their progeny.

Maternal atopy is a risk factor for allergy. B cells are poorly studied in reproduction and atopy. We aimed to assess how pregnancy affects B cells in atopic women and whether B cells relate to allergic manifestations in offspring. Women with and without atopic asthma, pregnant and non-pregnant were enrolled for the study, and circulating B cells were evaluated by flow cytometry, using CD19, CD27, CD38, IgD, and IgM. Compared to healthy non-pregnant, atopic asthmatic non-pregnant (ANP) women presented increased B cell counts, enlarged memory subsets, less transitional cells, and plasmablasts. Atopic asthmatic pregnant (AP) and healthy pregnant (HP) women showed similarities: reduced B cell counts and percentages, fewer memory cells, especially switched, and higher plasmablast percentages. Transitional B cell percentages were increased in AP women with allergic manifestations in their progeny. Atopic asthmatic non-pregnant women have a distinctive B cell compartment. B cells change in pregnancy, similarly in AP and HP women. The recognition that AP women with allergy in their progeny have a typical immune profile may help, in the future, the adoption of preventive measures to avoid the manifestation of allergic diseases in their newborns.

EXPERIENCE OF LONG-TERM USE OF SYMBICORT IN THE REGIME OF A SIGNLE INHALER FOR BRONCHIAL ASTHMA, INCLUDING DURING PREGNANCY

A regime of the single inhaler for basic therapy and arresting of asthma with the help of a fixed combination of budesonide and formoterol is an effective, safe and convenient method of treatment for patients. Bronchial asthma in pregnant women requires use of drugs with a high safety and effectiveness profile. A clinical study of the long-term successful use of Symbicort in the regime of a single inhaler, including during pregnancy.

An observational study of the impact of an antenatal asthma management service on asthma control during pregnancy

ObjectiveWe sought to investigate the impact of introducing an antenatal asthma management service (AMS) on asthma control during pregnancy and subsequent perinatal outcomes. Study designProspective, observational cohort study of pregnant asthmatic women attending a tertiary hospital antenatal clinic. Asthmatic women were recruited from the antenatal clinic and were followed prospectively with visits at 12, 20, 28 and 36 weeks gestation. A new nurse-led AMS was introduced offering asthma self-management education and support. Outcomes were compared between women recruited before and after the AMS was introduced (n=89 and 80, respectively) and included; prevalence of exacerbations during pregnancy, asthma control throughout pregnancy and perinatal outcomes, including preterm birth and small-for-gestational-age (SGA). ResultsThe relative risk for exacerbations (0.69; CI: 0.33–1.42), loss of control (0.67; CI 0.46–0.99) and persistent uncontrolled asthma (0.48; CI 0.26–0.9) were all reduced with attendance to AMS during pregnancy. AMS was associated with non-statistically significant reductions in asthma exacerbations (19.1–15.0%; p=0.480) and uncontrolled asthma at ≥2 study visits (21.3–11.3%; p=0.078). ConclusionsThese findings demonstrate the potential impact of an AMS in improving asthma control during pregnancy, supporting the need for an adequately powered RCT to determine its clinical- and cost-effectiveness.

Effect of pregnancy in asthma on health care use and perinatal outcomes

It is generally known that pregnancy in asthmatic patients increases the risk of asthma exacerbations and poor perinatal outcomes. However, the effect of pregnancy in asthmatic patients on health care use is not known well. In addition, its effect on perinatal outcomes is still controversial because of study limitations caused by ethical issues. National Health Insurance claim data are an ideal resource for studying real-world health care use patterns of asthma. We sought to evaluate the effect of pregnancy on asthma in terms of asthma-related health care use and prescription patterns in concert with the effect of asthma exacerbations on adverse pregnancy outcomes. Among all asthmatic patients in the Korean National Health Insurance claim database from January 2009 to December 2013, pregnant women who delivered in 2011 with pre-existing asthma were enrolled. Analyses included asthma-related health care use and prescription patterns compared between pregnant asthmatic women and nonpregnant female asthmatic control subjects, as well as within the pregnant subjects from before pregnancy throughout postpartum periods. In addition, the association between asthma exacerbation during pregnancy and adverse pregnancy outcomes was assessed. A total of 3,357 pregnant asthmatic patients were compared with 50,355 nonpregnant asthmatic patients, and 10,311 pregnant patients were included to determine the effect of asthma exacerbations on adverse pregnancy outcome in the study. Pregnant asthmatic patients underwent more asthma-related hospitalizations (1.3% vs 0.8%, P = .005) but had significantly fewer outpatient visits and prescriptions for most asthma medications than nonpregnant asthmatic patients. The proportion of patients ever hospitalized gradually increased throughout pregnancy (first trimester, 0.2%; second trimester, 0.5%; and third trimester, 0.7%; P = .018). The prevalence of asthma exacerbation during pregnancy was 5.3%, and the patients who had acute exacerbation during pregnancy had significantly higher asthma-related health care use in terms of hospitalization, intensive care unit admission, and emergency department and outpatient visits within 1 year before delivery than those who had not. However, asthma exacerbation during pregnancy was not significantly related to adverse perinatal outcomes, except for cesarean section (27.1% vs 18.9%, P < .001). All exacerbations were managed with systemic corticosteroids, and the patients who ever experienced acute exacerbations maintained asthma medications, including inhaled corticosteroid-based inhalers, throughout the pregnancy period. Pregnancy profoundly affects asthma-related health care use but to a different degree depending on whether the patient experienced an exacerbation. Asthma exacerbation during pregnancy is not associated with adverse pregnancy outcomes while managed appropriately with systemic corticosteroids. However, further studies are needed to clarify the effect of asthma control on perinatal outcome and delivery method.