Respiratory Disease In Pregnancy Research Articles

Pneumonia in pregnancy

Pneumonia is a common disease worldwide and the coexistence with pregnancy increase its morbidity and mortality. Physiologic changes in pregnancy can augment susceptibility to pulmonary diseases and change their clinical course. This review article attempts to make an assessment of current information on the risks, maternal and fetal effects, etiology, clinical features and management of pneumonia in pregnancy. A systematic literature electronic search for journal articles and guidelines regarding pneumonia and respiratory disease in pregnancy was undertaken. Pathogens, clinical course and treatment of pneumonia in pregnancy is similar to the non-pregnant circumstances, with particular consideration on obstetric and fetal outcomes and drug safety during pregnancy. Prompt diagnosis and treatment reduce potential complications. Vaccination may reduce severity of pneumonia in high-risk pregnant patients.

Uncontrolled maternal chronic respiratory diseases in pregnancy: A new potential risk factor suggested to be associated with anorectal malformations in offspring.

BackgroundChronic respiratory diseases and use of antiasthmatic medication during pregnancy may both play a role in the etiology of congenital anorectal malformations (ARM). However, it is unclear, whether the medication use or the underlying condition would be responsible. Therefore, our aim was to unravel the role of maternal chronic respiratory diseases from that of antiasthmatic medication in the etiology of ARM.MethodsWe obtained 412 ARM patients and 2,137 population‐based controls from the Dutch AGORA data‐ and biobank. We used maternal questionnaires and follow‐up telephone interviews to obtain information on chronic respiratory diseases, antiasthmatic medication use, and potential confounders. Multivariable logistic regression analyses were performed to estimate odds ratios (ORs) with 95% confidence intervals (95% CI).RESULTSWe observed higher risk estimates among women with chronic respiratory diseases with and without medication use (1.4 [0.8–2.7] and 2.0 [0.8–5.0]), both in comparison to women without a chronic respiratory disease and without medication use. Furthermore, increased ORs of ARM were found for women using rescue medication (2.4 [0.8–7.3]) or a combination of maintenance and rescue medication (2.5 [0.9–6.7]). In addition, increased risk estimates were observed for women having nonallergic triggers (2.5 [1.0–6.3]) or experiencing exacerbations during the periconceptional period (3.5 [1.4–8.6]).CONCLUSIONSAlthough the 95% CIs of most associations include the null value, the risk estimates all point towards an association between uncontrolled chronic respiratory disease, instead of antiasthmatic medication use, with ARM in offspring. Further in‐depth studies towards mechanisms of this newly identified risk factor are warranted.

Acute respiratory diseases in pregnancy

Pregnant women are known to have an increased morbidity and mortality for certain illnesses due to physiological and immunological changes in pregnancy. However, careful attention should be paid to the fetoplacental unit, with delivery generally indicated for obstetric purposes only. Acute respiratory distress syndrome is an uncommon condition in pregnant patients. An essential component in the management of this condition is a perfect coordination between the obstetrician, the pneumologist and critical care specialists. Pregnancy-associated venous thromboembolism consists of deep vein thrombosis and pulmonary embolism occurring during pregnancy or in the postpartum period. This condition is common and is a major source of morbidity in a population which is young and otherwise relatively healthy. Amniotic fluid embolism remains one of the most devastating conditions in obstetrics practice, with reported mortality of 20% to 60%. The treatment is mainly supportive and involves the delivery of the fetus when indicated, respiratory support and hemodynamic support, with the judicious use of fluids, vasopressors, inotropes and, in some cases, pulmonary vasodilators. Respiratory failure complicates a relatively small number of pregnancies, but carries significant potential risks for both mother and fetus. The causes of respiratory failure may be related to pregnancy-specific conditions or other respiratory diseases, and the management requires a multidisciplinary team approach, involving obstetrics, maternal-fetal medicine, neonatology, obstetric medicine, pulmonology and critical care.

Respiratory Disease in Pregnancy

Pregnancy is associated with many anatomical and physiologic changes that affect the presentation and management of various illnesses. This article deals with several respiratory issues that one may encounter in the gravid patient, including asthma, pneumonia, tuberculosis and acute respiratory distress in pregnancy. Approach to dyspnoea in pregnancy and smoking cessation is also discussed.

Respiratory disease in pregnancy

Many physiological and anatomical changes of pregnancy affect the respiratory system. These changes often affect the presentation and management of the various respiratory illnesses in pregnancy. This article focuses on several important respiratory issues in pregnancy. The management of asthma, one of the most common chronic illnesses in pregnancy, remains largely unchanged compared to the nonpregnant state. Infectious respiratory illness, including pneumonia and tuberculosis, are similarly managed in pregnancy with antibiotics, although special attention may be needed for antibiotic choices with more pregnancy safety data. When mechanical ventilation is necessary, consideration should be given to the maternal hemodynamics of pregnancy and fetal oxygenation. Maintaining maternal oxygen saturation above 95% is recommended to sustain optimal fetal oxygenation. Cigarette smoking has known risks in pregnancy, and current practice guidelines recommend offering cognitive and pharmacologic interventions to pregnant women to assist in smoking cessation.

Respiratory diseases in pregnancy

Pulmonary diseases are one of the major indirect causes of maternal deaths. Pregnancy is a unique physiologi- cal state during which changes occur in all systems of the body to meet metabolic needs of both the mother and growing foetus. Enlarging uterus and increasing hormonal levels cause changes in volumes and mechanics of lungs. Understanding the basic physiology of the cardiovascular and respiratory changes during pregnancy along with the pathology of disease processes are vital in making therapeutic decisions. Pre-existing conditions like asthma, tuberculosis, and acute illnesses like pneumonia, acute respiratory distress syndrome (ARDS), pneumothorax can have calamitous effect on mother and child health. Continual foetal monitoring throughout pregnancy is very important in early recognition of foetal jeopardy.

Episodes of asthma during pregnancy – link with a viral infection and treatment approaches.

Bronchial asthma (BA) is the most common respiratory disease in pregnancy. About 20% of pregnant women experience asthma exacerbations of varying severity, while 5.8 % of them require hospitalization. Objective: to study asthma course during pregnancy by determining clinical and functional cha­racteristics of the disease, taking into account presence of exacerbations and adherence to basic therapy (BT). Materials and methods: The study included 35 pregnant females (Me ± SD) aged 31±5,28 years, gestational age – 34±6,69 weeks. Anamnestic and physical data, spirometry and assessment of asthma control using Control Asthma Test were conducted. Results: In the study group 71% of pregnant women suffered from aggravation of varying severity deve­loping on the background of symptoms of respiratory tract infection. Here with commitment to BT before and during pregnancy significantly did not differ. Inconsistency of BT to severity of the disease in 25% of women with mild and in 36% with moderate asthma course was detected.

Respiratory disease in pregnancy

Breathlessness in the absence of an underlying pathology is common in pregnancy. Asthma affects about 7% of women of child-bearing age. Treatment is the same as for the non-pregnant population and most drugs are safe in pregnancy. Educating women to continue preventer inhaled corticosteroid therapy will reduce the risk of attacks. Respiratory infections are associated with a higher morbidity in pregnancy and should be treated aggressively. Most chronic pulmonary diseases do not alter fertility. Large reserves in respiratory function allow the fetus and mother to survive without compromise in most cases. The use of chest X-rays should not be avoided in pregnancy. Women with a chronic respiratory disease should receive pre-pregnancy counselling and education. Women should be managed in a multidisciplinary setting with the respiratory team. The presence of pulmonary hypertension and cor pulmonale is associated with a high risk of death in pregnancy.

Respiratory disease in pregnancy

Breathlessness in the absence of an underlying pathology is common in pregnancy, but serious causes should be excluded depending on symptoms. The use of chest X-rays should not be avoided in pregnancy. Asthma affects about 7% of women of child-bearing age. Treatment is the same as for the non-pregnant population and most drugs are safe in pregnancy. It is important to educate women to continue inhaled corticosteroid preventer therapy to reduce the risk of attacks. Respiratory infections are associated with a higher morbidity in pregnancy and should be treated aggressively. Women with a chronic respiratory disease should receive pre-pregnancy counselling and education, and during pregnancy managed in a multidisciplinary setting with the respiratory team. Most chronic pulmonary diseases do not alter fertility, and in the majority of cases large reserves in respiratory function allow a good pregnancy outcome for fetus and mother. In contrast, the presence of pulmonary hypertension and cor pulmonale is associated with a high risk of death in pregnancy.

Viral Respiratory Disease in Pregnancy

Postgraduate Obstetrics & Gynecology: November 30, 2007 - Volume 27 - Issue 22 - p 7-8 doi: 10.1097/01.PGO.0000299204.48697.9c

Viral Respiratory Disease in Pregnancy

Viral Respiratory Disease in Pregnancy

Respiratory disease in pregnancy

Breathlessness in the absence of an underlying pathology is common in pregnancy. Asthma affects about 7% of women of childbearing age. Treatment is the same as for the non-pregnant population and most drugs are safe in pregnancy. Educating women to continue preventer inhaled corticosteroid therapy will reduce the risk of attacks. Respiratory infections are associated with a higher morbidity in pregnancy and should be treated aggressively. Most chronic pulmonary diseases do not alter fertility. Large reserves in respiratory function allow the fetus and mother to survive without compromise in most cases. The use of chest X-rays should not be avoided in pregnancy. Women with a chronic respiratory disease should receive pre-pregnancy counselling and education. Women should be managed in a multidisciplinary setting with the respiratory team. The presence of pulmonary hypertension and cor pulmonale is associated with a high risk of death in pregnancy.

Viral respiratory disease in pregnancy

Recently there has been an increased concern over viral respiratory infections and their potential for a pandemic. This concern makes it important to review the most current guidelines for the management of viral respiratory diseases in pregnancy. The topics covered are influenza, avian influenza, and severe acute respiratory syndrome. Pregnant women have an increased susceptibility to viral respiratory diseases. The most common respiratory virus to infect pregnant women is influenza. All women who intend to become pregnant or are pregnant should receive the influenza vaccine. If a pregnant woman develops influenza she should be treated with supportive care. Antiviral medications should be reserved for cases where the benefits outweigh the risks. Avian influenza (H5N1) is a new emerging virus usually contracted from direct contact with diseased birds. There is no commercially available vaccine at this time to prevent infection. Pregnant women should be treated aggressively with supportive care and antiviral medications, as the significant risk of maternal mortality outweighs the potential fetal risks. Pregnant women diagnosed clinically with severe acute respiratory syndrome should be treated empirically, as a serologic diagnosis can take weeks to confirm. The treatment of pregnant women with severe acute respiratory syndrome should be without ribavirin.

Acute and chronic respiratory diseases in pregnancy: Associations with spontaneous premature rupture of membranes

Objective. To examine whether acute and chronic respiratory diseases are associated with an increased risk of spontaneous premature rupture of the membranes (PROM).Methods. We used the 1993–2004 National Hospital Discharge Survey data of singleton deliveries in the USA (N = 41 250 539). The International Classification of Diseases Ninth Revision was utilized to identify acute (acute upper respiratory diseases, viral/bacterial pneumonia, and acute bronchitis/bronchiolitis) and chronic (chronic bronchitis and asthma) respiratory conditions and spontaneous PROM. All analyses were adjusted for potential confounders.Results. The incidence of PROM was 5%, and rates of acute and chronic respiratory conditions were 2.1 and 9.5 per 1000 pregnancies, respectively. Chronic bronchitis was associated with a reduced risk of PROM (RR 0.39, 95% CI 0.31, 0.48). Asthma was significantly associated with PROM at preterm (RR 1.15, 95% CI 1.14, 1.17) and term (RR 1.27, 95% CI 1.23, 1.30). Stratification by race showed that acute upper respiratory disease was associated with preterm PROM in whites (RR 1.90, 95% CI 1.71, 2.11) and blacks (RR 6.76, 95% CI 5.67, 8.07). Viral/bacterial pneumonia was associated with preterm PROM in blacks and term PROM in both races. Asthma was associated with term PROM in blacks but not whites.Conclusions. Acute respiratory diseases and asthma during pregnancy are associated with spontaneous PROM, with substantially stronger association among blacks than whites. We speculate that timely diagnosis and treatment, coupled with closely mentoring of pregnant women may help reduce the rate of PROM and associated complications.

Acute and chronic respiratory diseases in pregnancy: Associations with placental abruption

This study was undertaken to examine the associations between maternal respiratory diseases and placental abruption. A population-based, retrospective cohort study was conducted to examine the associations between maternal respiratory diseases and abruption in the United States. Data on women who delivered singleton births (n = 37,314,022) were derived from the National Hospital Discharge Survey for the years 1993 to 2003. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes were used to identify pregnant women hospitalized for acute upper respiratory diseases, viral and bacterial pneumonia, acute bronchitis, and acute bronchiolitis, chronic bronchitis, asthma, and abruption. Relative risk (RR) and 95% CI were derived from multivariable logistic regression models to evaluate the associations after adjusting for maternal age, race, marital status, smoking, cocaine use, adequacy of prenatal care, maternal insurance status, geographic location, and year of birth (although data on smoking and cocaine use are likely underreported). The rate of abruption was 9.7 per 1,000 singleton births. The overall rate for acute respiratory conditions was 2.2 per 1000 pregnancies. Acute upper respiratory diseases (RR 3.2, 95% CI 3.0-3.4) and viral/bacterial pneumonia (RR 2.2, 95% CI 1.9-2.4) were associated with abruption. The rate of chronic respiratory conditions was 9.0 per 1,000 pregnancies. Chronic bronchitis was strongly associated with abruption (RR 31.8, 95% CI 29.6-34.3), but the association between asthma and abruption was modest (RR 1.1, 95% CI 1.0-1.2). Stratified analysis by maternal race showed that asthma was associated with abruption among black women but not white women. Pregnancies complicated by acute and chronic respiratory diseases requiring hospitalization are associated with placental abruption.

Acute and chronic respiratory diseases in pregnancy: Associations with placental abruption

Placental hypoxia has been speculated as the pathway leading to an association between maternal asthma during pregnancy and risk of abruption. The objective of this study is to examine the associations between acute and chronic respiratory diseases (hypoxic conditions) and abruption. A population-based retrospective cohort study was conducted to examine the associations between maternal respiratory disease (hypoxic conditions) and risk of abruption using the National Hospital Discharge Survey. The study cohort included women that delivered a singleton live birth or stillbirth (n = 37,190,632). International Classification of Diseases Ninth Revision, Clinical Modification (ICD-9-CM) codes were used to identify pregnancies hospitalized for: i) acute conditions (acute upper respiratory diseases, viral/bacterial pneumonia, and acute bronchitis/bronchiolitis) and ii) chronic conditions (chronic bronchitis and asthma) and abruption. All analyses were adjusted for maternal socioeconomic, demographic and behavioral characteristics. The rate of abruption among singleton pregnancies was 1 %. The overall rate for acute respiratory conditions was 2.1 per 1,000. Acute upper respiratory diseases (RR 3.21, 95% CI 3.04, 3.40) and viral/bacterial pneumonia (RR 2.16, 95% CI 1.94, 2.40) were associated with increased risk for abruption. The rate of chronic respiratory conditions was 8.9 per 1,000. Chronic bronchitis was strongly associated with abruption (RR 31.83, 95% CI 29.57, 34.42), but the association between asthma and abruption was weak (RR 1.03, 95% CI 1.00, 1.06). When we further stratified the data by maternal race, asthma was no longer a risk factor for abruption among whites (RR 0.89, 95% CI 0.85, 0.94) but remained a significant risk factor (RR 1.48, 95% CI 1.40, 1.57) among blacks. Pregnancies complicated by acute and chronic respiratory diseases are associated with increased risk for placental abruption. Our result suggests that a pregnancy complicated by chronic bronchitis is severe enough to warrant hospitalization.

Respiratory disease in pregnancy

A variety of respiratory complications can be encountered in pregnancy. An understanding of the pathophysiology of pregnancy is important in the management of such complications. Despite the changes in immunity, the incidence of respiratory infections is not higher in pregnancy. Asthma is the most common preexisting medical disorder encountered in pregnancy, and its prevalence in women of childbearing age is increasing. There is a slight increase in the risk to the pregnancy, but suboptimal therapy is the most common reason for poor control. X-rays should be obtained whenever clinically indicated, and most drugs used in the management of asthma have a long track record of safety. For women with poor control in pregnancy, there should be good liaison between the respiratory physician and the obstetrician. Tuberculosis is increasingly important and may complicate human immunodeficiency virus infection. First-line antituberculous drugs can safely be administered in pregnancy and lactation.

Use of Drugs in Pulmonary Medicine in Pregnant Women

Lung diseases that are frequently seen in young people, such as bronchial asthma, pneumonia, and tuberculosis, occur with comparable prevalence in pregnant women. Their treatments do not greatly differ from those used in the nonpregnant state. However, pharmacokinetics of these drugs undergo changes due to the physiologic variations induced by pregnancy that we must consider. On the other hand, some drugs used for lung disease have a teratogenic potential and thus carry a risk for the fetus. In this article, we review the drugs most commonly used for the treatment of respiratory diseases in pregnancy and lactation and discuss the current data of their possible effects on the fetus and neonate. Asthma is the most common potentially serious medical disease complicating pregnancy and should be treated as aggressively in pregnant women as in nonpregnant women, because the perceived risk to the fetus caused by pharmacologic therapy is much less than the risk of uncontrolled asthma and the resulting hypoxia. Antepartum pneumonia and tuberculosis require prompt evaluation and empiric antimicrobial therapy. The clinician must choose antimicrobial agents considering efficacy as well as safety for both mother and fetus. Among the agents for antithrombotic therapy, heparin is the anticoagulant of choice during pregnancy. Data on the use of low molecular weight heparins are encouraging, but clinical experience with these agents is still limited. Oral anticoagulant therapy should be avoided because of its teratogenic potential and increased risk of fetal complications, and the use of thrombolytic agents must be limited to life-threatening situations.

Respiratory disease in pregnancy

The pregnant patient is at risk of several pregnancy-specific pulmonary complications, including amniotic fluid embolism, tocolytic-associated pulmonary oedema and pulmonary oedema complicating pre-eclampsia. In addition, the pregnant state increases the risk of other respiratory complications, particularly pulmonary embolism and gastric acid aspiration. Community-acquired pneumonia occurs in pregnant women at a similar incidence to the non-pregnant population, but the risk of varicella pneumonitis is increased. AIDS-related pulmonary infections should always be considered in this sexually active population.Management of the pregnant patient with pulmonary disease must take into account the anatomic and physiological changes affecting the respiratory system in pregnancy. Although management is similar to that in the non-pregnant patient, the welfare of the fetus must be considered in radiological investigations and pharmacological therapy.

Respiratory disease in pregnancy

Respiratory diseases are an important cause of morbidity and mortality in pregnant women. Chronic lung diseases, such as asthma and cystic fibrosis, may present unique management problems in pregnancy, and other lung diseases, such as pneumonia and tuberculosis, can target pregnant women just as they target non-pregnant women. Other disease such as pulmonary embolism may be made more likely owing to the pregnant state. In this review we will cover the important lung diseases that are likely to be encountered in pregnancy and highlight any modifications in conventional management which are necessary.