Asthma in pregnancy – Immunological changes and clinical management

Tamási, Lilla; Horváth, Ildikó; Bohács, Anikó; Müller, Veronika; Losonczy, György; Schatz, Michael

doi:10.1016/j.rmed.2010.11.006

Cited by 46 publications

(44 citation statements)

References 37 publications

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“…This latter possibility is especially important during pregnancy in order to maintain optimal asthma control and thus prevent unwanted effects of the disease on pregnancy outcomes. 6 For the first time, in the present study, we investigated 2 major proteins of the complement cascade, C5a and complement factor H, in pregnant subjects with asthma compared with non-pregnant subjects with asthma and with healthy pregnant and non-pregnant subjects. C5a levels were increased solely in pregnant women with asthma, and higher C5a levels implied worse lung function in these subjects with regard to both FEV 1 and FVC.…”

Section: Discussionmentioning

confidence: 96%

“…3,4 In addition, pregnancy may also influence asthma control with the deterioration of symptoms in one third of all pregnant women with asthma. 5 Notably, if the disease is well controlled, the risks of poor pregnancy outcomes decrease 6 ; therefore, maintaining optimal control in this period is crucial. Hence, it would be especially important to understand the immune interactions between asthma and gestation and to have a more detailed view into inflammatory processes of asthma during pregnancy.…”

Section: Introductionmentioning

confidence: 99%

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Relationship of Circulating C5a and Complement Factor H Levels With Disease Control in Pregnant Women With Asthma

et al. 2016

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BACKGROUND: Asthma often complicates pregnancy and represents a risk of serious pregnancy complications. The complement system contributes to asthma pathogenesis and is up-regulated in healthy gestation as well. The anaphylatoxin C5a has a major pro-inflammatory role, and the complement factor H is a main soluble regulator protein both in asthma and during pregnancy; however, peripheral levels of these complement factors and their relationship to disease control have not yet been evaluated in pregnant subjects with asthma. METHODS: The present study aimed to investigate circulating C5a and complement factor H levels in asthma (non-pregnant subjects with asthma; n ‫؍‬ 19) and in pregnancy with asthma (pregnant subjects with asthma; n ‫؍‬ 22), compared with healthy non-pregnant (n ‫؍‬ 21) and healthy pregnant women (n ‫؍‬ 13) and to test their relationship to clinical parameters of asthma (lung function, airway inflammation, and symptoms). RESULTS: Circulating C5a levels were higher in the pregnant asthma subject group compared with the healthy non-pregnant, healthy pregnant, and non-pregnant asthma groups: median 2.629 (interquartile range [IQR] 2.257-3.052) ng/mL versus 1.84 (IQR 1.576 -2.563), 1.783 (IQR 0.6064 -2.786), and 2.024 (IQR 1.232-2.615) ng/mL, respectively (P ‫؍‬ .02 in all cases). C5a correlated negatively with FEV 1 (r ‫؍‬ ؊0.44, P ‫؍‬ .039) and FVC values (r ‫؍‬ ؊0.64, P ‫؍‬ .001) in the pregnant asthma group and positively with fraction of exhaled nitric oxide levels in the nonpregnant asthma group (n ‫؍‬ 12, r ‫؍‬ 0.78, P ‫؍‬ .004). Complement factor H levels were elevated in both the healthy pregnant and pregnant asthma subject groups compared with the healthy non-pregnant group (median 1,082 [IQR 734.9 -1,224] and 910.7 [IQR 614.5-1076] g/mL vs 559.7 [IQR 388.7-783.1] g/mL, P ‫؍‬ .002 and P ‫؍‬ .004, respectively) but not in the pregnant asthma group compared with the non-pregnant asthma group (median 687.4 [IQR 441.6 -947.6] g/mL, P ‫؍‬ .10). CONCLUSIONS: Asthma during pregnancy increases the circulating level of pro-inflammatory C5a, which is accompanied by impaired lung function and partly counteracted by the gestation-specific elevation of regulatory complement factor H level (detected in pregnancy both in healthy and subjects with asthma).

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Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Relationship of Circulating C5a and Complement Factor H Levels With Disease Control in Pregnant Women With Asthma

et al. 2016

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“…This was difficult to link to specific antiasthmatic drug use but the general pattern indicates a confounding by indication and that poorly controlled asthma may carry the largest risk [19]. Probably intense asthma therapy can be recommended without fear for harmful drug effects.…”

Section: Journal Of Respiratory Medicinementioning

confidence: 99%

Use of Antiasthmatic Drugs during Pregnancy after the First Trimester and Maternal and Neonatal Outcomes

Källén

Wikner

2014

Journal of Respiratory Medicine

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Background. Women with asthma using antiasthmatics during the later part of the pregnancy have an increased risk for obstetric complications and their infants of neonatal complications. Material and Methods. The study is based on a linkage between the Swedish Medical Birth Register and a register of prescribed drugs in Sweden for the years 2009-2011, identifying women who had filled prescriptions for antiasthmatics after the first trimester. Their characteristics, their obstetric history, and the neonatal conditions of their infants were compared with all other women who gave birth. Adjusted Mantel-Haenszel odds ratios were determined. Results. We found an increased risk for a number of maternal conditions but no risk increase for gestational diabetes (after adjustment for body mass index) or for premature rupture of membranes. There was an increase in preterm births for some drugs used at severe asthma and of low birth weight and small for gestational age for most drug combinations. An increased risk was seen for neonatal hypoglycemia, respiratory problems, and low Apgar score. Conclusions. There are many hazards associated with maternal asthma and use of antiasthmatic drugs. Most evidence suggests a disease effect. A careful control of the asthma during pregnancy is important.

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“…Asthma ist eine der häufigsten chronischen Begleiterkrankungen in der Schwangerschaft [7]. Der Krankheitsstatus kann sich im Verlauf einer Schwangerschaft verschlechtern.…”

Section: Asthmaanfallunclassified

Notfallmedikamente bei Schwangeren

Fink

Steinburg

2012

Med Klin Intensivmed Notfmed

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Medical emergencies in pregnant patients pose a great challenge. Due to a lack of experience many emergency care providers are uncertain about which drugs can be used and the dosage. The following article reviews the physiological changes during pregnancy, general considerations about pharmacotherapy in pregnant patients and highlights typical emergency scenarios with the corresponding recommendations for which drugs to use in pregnant patients.

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Asthma in pregnancy – Immunological changes and clinical management

Cited by 46 publications

References 37 publications

Relationship of Circulating C5a and Complement Factor H Levels With Disease Control in Pregnant Women With Asthma

Relationship of Circulating C5a and Complement Factor H Levels With Disease Control in Pregnant Women With Asthma

Use of Antiasthmatic Drugs during Pregnancy after the First Trimester and Maternal and Neonatal Outcomes

Notfallmedikamente bei Schwangeren

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