Effect of Bronchial Asthma on the Course of Pregnancy, Labour and Perinatal Outcome

Abstract

The course of pregnancy and labour, and perinatal outcome of 182 pregnancies complicated by bronchial asthma, over a 10-year period were studied. Antiasthmatic medications included oral and/or parenteral beta 2-agonists, theophylline, aminophylline, corticosteroids, and inhaled salbutamol and beclomethasone. A control group of 364 nonasthmatic gravidas was matched for age and parity. In asthmatic gravidas, antenatal complications mean duration of pregnancy (38.5 weeks), mode of delivery, incidence of prematurity (13.2%) and low birth weight (LBW, 19.6%) and perinatal mortality (0.5%) were not significantly different compared to the controls (p > 0.05). However, uncontrolled severe asthma in 15 gravidas who required hospitalization, was associated with significant decrease in mean birth weight (2469 +/- 571 g vs 2842 +/- 494 g; p < 0.05) and a high incidence of LBW neonates (53.3% vs 20.5%; p < 0.01) at mean gestation of 38 weeks. Bronchial asthma during pregnancy, when optimally controlled does not affect the course or pregnancy and labour, and perinatal outcome. However, uncontrolled severe asthma leads to fetal growth retardation.

Asthma during pregnancy: mechanisms and treatment implications

“…Administration of oxygen to mothers in labour resulted in increased umbilical cord O 2 values at delivery, suggesting that there is a relationship between maternal and foetal oxygen [76]. However, maternal hypoxia during asthmatic pregnancies has never been directly investigated in relation to foetal outcome and while it is unlikely to explain the finding of reduced female foetal growth in females with mild asthma [49], it may contribute to reduced growth in subjects who have been hospitalised with an exacerbation of asthma during pregnancy [26,56].…”

“…No significant increase in the rate of pre-term labour, low birth weight, caesarean section, perinatal mortality, haemorrhage or foetal distress was found in the asthmatic group compared with the control group. However, 15 of the asthmatics had a severe asthma attack during pregnancy, which required hospitalisation, and in these females there was a significant reduction in birth weight [26], suggesting that poorly controlled asthma may contribute to reduced foetal growth.…”

“…Asthma requiring hospitalisation [26] and lack of ICS use in females with mild asthma [30] emerge as risks for low birth weight in prospective cohort studies (table 2). Historical cohort studies (table 1) conducted prior to ICS use [10], or where subjects were either not on any preventer treatment [11] or reduced their use of ICS during pregnancy [18], also support the conclusion that ICS medication may protect against low birth weight in pregnant females with asthma.…”

“…JANA et al [26] examined 182 asthmatic pregnancies in India in 1983-1992 and compared outcomes to 364 nonasthmatic pregnancies. Most females had well controlled asthma (91%) and were using medications including oral or inhaled b 2 -agonists, theophylline, oral steroids or inhaled beclomethasone.…”

Mode of Delivery and Asthma – Is There a Connection?

“…In the register study, no significant difference between social classes was observed in the caesarean section rate or in the cumulative incidence of asthma. Low birth weight has been associated with an increasing risk of asthma (40). Based on our data, this may be due to an association with the mode of delivery, as caesarean section carried a greater risk of asthma than birth weight per se; after adjusting with birth weight, only one-fifth reduction in the risk of asthma was seen.…”