Determinants of low risk of asthma exacerbation during pregnancy

Abstract

Summary Background Assessment of asthma control every 4‐6 weeks during pregnancy is recommended to reduce risk of exacerbation, and by that improve outcome. Objective To identify determinants of pregnancies with low risk of asthma exacerbation. Methods All pregnant women enrolled into the Management of Asthma during Pregnancy (MAP) programme at Hvidovre Hospital since 2007. Assessment of asthma control, adjustment of treatment, spirometry and measurement of exhaled nitric oxide (FENO) were performed, and baseline characteristics and exacerbation history were collected at enrolment. Determinants of low‐exacerbation risk pregnancies were identified by logistic regression analysis (stepwise backward elimination). Results In 1283 pregnancies, 107 exacerbations were observed. Multiple regression analysis revealed that no history of pre‐pregnancy exacerbations (P < .001), no prescribed controller medication (P < .001), and clinically stable asthma at enrolment (P = .002) were significantly associated with low risk of exacerbation during pregnancy; with these combined characteristics, only two of 385 pregnancies were complicated by an exacerbation (OR 0.04, 95% CI 0.01‐0.18, P < .001). Conclusion and clinical relevance Clinically stable asthma at enrolment, together with no history of previous exacerbations and no prescribed controller medication, is a determinant of low risk of an asthma exacerbation during pregnancy, which may guide clinicians in individualizing surveillance of asthma during pregnancy.

Inhaled corticosteroid use during pregnancy among women with asthma: A systematic review and meta‐analysis

“…Data from previous studies suggest that women with asthma may be undertreated during pregnancy. In the study of Ali et al, 41% of pregnant women with asthma were using controller medication pre‐enrolment, and after asthma assessment (including symptoms and lung inflammation measurement) at enrolment, the proportion of women with prescribed controller medication increased to 63%. In agreement, another study found similar increases in ICS prescription rates, with asthma review and management during pregnancy (41% at enrolment, and 69% at end of study) .…”

Fertility treatment among women with asthma: a case–control study of 3689 women with live births

“…Women with asthma were included in the MAP cohort provided they fulfilled the following criteria: 1) they possessed a diagnosis of asthma as defined according to the GINA-guidelines [10]; 2) they were receiving current prescribed treatment with at least a rescue bronchodilator; and 3) they had their first visit to the respiratory outpatient clinic within the first 18 weeks of pregnancy. A more detailed description of the MAP cohort has been published previously [11][12][13]. Only women from the MAP cohort with a live birth were included in the present study.…”

Asthma in Pregnancy: Pathophysiology, Diagnosis, Whole-Course Management, and Medication Safety

“…Attack of asthma during pregnancy is connected with increased risk of adverse pregnancy and perinatal outcomes. Current studies have shown that acute attack increases the risk of LBW; however, the relationship between acute attack and other adverse outcomes is still controversial, such as PB, SGA, congenital malformations, neonatal death, and hospitalizations, as well as a range of maternal and placental complications, preeclampsia, gestational diabetes, placenta previa, and caesarean section [66,67].…”