A study of neonatal and maternal outcomes of asthma during pregnancy

Abstract

INTRODUCTIONAsthma is a common problem around the world with variable prevalence ranging from 1%-18% 1 in different age and geographical distribution. There are proximately 300 million affected individuals in the world. Study by Kwon HL et al suggests that approximately 4.1% of all pregnant women had experienced an asthma attack in previous year.2 Recent study in USA suggests 3.7-8.4% of women had asthma in 1997-2001, as compared to 3.2% according to data in 1988-1994. 3 There are growing prevalence and morbidity, due to asthma associated with pregnancy. Course of asthma in pregnancy is unpredictable, studies suggest that about 1/3rd have exacerbation, 1/3rd improve and rest of 1/3rd show no change in symptoms. 4,5 On the contrary asthma also had adverse effect on fetus and maternal outcomes in pregnant women. Various historical and prospective cohort studies have investigated the effect of maternal asthma on pregnancy outcomes, studies suggest that asthmatic women are more at risk of low birth neonate, preterm delivery, IUGR, congenital deformities and increased hospital stay. Maternal risks includes; preterm labor, preeclampsia, hypertension, antepartum and postpartum hemorrhage, increased cesarean section and forceps delivery. There are fewer studies on asthma & its ABSTRACTBackground: Asthma is a common problem all around the world with variable prevalence ranging from 1%-18% in different age and geographical distribution. There are proximately 300 million affected individuals. There are growing prevalence and morbidity, due to asthma associated with pregnancy. The course of asthma in pregnancy is unpredictable. Methods: 2400 consecutive pregnant women attending the antenatal clinic of S.P. Medical College and AG of Hospitals, Bikaner, were screened using asthma questionnaire translated in Hindi based on the questionnaire developed for International Union against Tuberculosis and Lung Disease. 52 patients diagnosed as asthma were subjected for PFT and classified according to clinical severity as per GINA guidelines, 2006. All subjects were followed till delivery and postpartum charts reviewed to see neonate and maternal outcome. Results: The prevalence of asthma during pregnancy was 2.1%, among them, 25 (48.1%) were categorized as having intermittent asthma, 6 (11.5%) with mild persistent asthma, 10 (19.2%) with moderate persistent asthma and 11 (21.2%) having severe persistent asthma. During the course of pregnancy, 36% had no change in the symptomatology, while (32.5%) experienced improvement and (32.5%) of worsening of asthma. 22 (42.31%) women were newly diagnosed during our study. There was no significant adverse maternal and fetal outcome in asthmatic group compared to control. Conclusions: Asthma is an under diagnosed and under treated disorder, especially during pregnancy and overall morbidity of asthma among women & neonates does not change during pregnancy.

Exacerbation of Asthma during Pregnancy: Fetomaternal Outcomes

“…Another study done by Gustaf Rejno et al had a significant association between maternal asthma and emergency cesarean section (adj OR 1.29;95% CI 1.23-1.34) [14]. In our study we found that 11(10.1%) of asthmatic women and 9(8.3%) non asthma had antepartum haemorrhage which is consistent with finding of Meena BL et al [15]. The effect of asthma exacerbations on reduced fetal growth is independent of any changes in gestational age at delivery.…”

Prevalence of asthma and other allergic diseases in pregnant women

“…The results showed that the prevalence of asthma in pregnant women living in the Sabzevar region was 2.1%. That is similar to the prevalence in India, according to Meena's study (14). In a 2007 study, Karimi et al identified circa 5.6% of pregnant women as being asthmatic (12).…”

Prospective cohort study of pregnancy complications and birth outcomes in women with asthma

“…There was also an increased incidence of caesarean delivery in asthmatic women. One possible reason for this is that pregnant asthmatics are considered high-risk patients, and so are more likely to undergo surgery, as compared to healthy pregnant women [ 33 ]. In this study [ 33 ], caesarean was performed in 52.9 and 34.2% of asthmatics and non-asthmatics, respectively, in close agreement with our results of 52.9 and 33.0%.…”

“…One possible reason for this is that pregnant asthmatics are considered high-risk patients, and so are more likely to undergo surgery, as compared to healthy pregnant women [ 33 ]. In this study [ 33 ], caesarean was performed in 52.9 and 34.2% of asthmatics and non-asthmatics, respectively, in close agreement with our results of 52.9 and 33.0%. Our results are also comparable to those of Dombrowski et al [ 34 ], where the highest rate of caesarean sections occurred in cases of intermittent and mild persistent asthmatics, at the rates of 53.8 and 70.0%, respectively.…”

“…In general, asthma prevalence depends on geographical area, local environmental and climatic conditions, lifestyle factors, vegetation, and air pollution. Demissie reported that asthma affected between 0.4 and 1.3% of pregnant women in New Jersey [ 41 ], whereas the prevalence of AP in Australia was calculated to be 12% [ 33 ]. It is also possible that variations in asthma prevalence are in part due to epigenetic factors and environmental exposures during the early childhood [ 16 ].…”