Effect of pregnancy in asthma on health care use and perinatal outcomes

Kim, Sujeong; Kim, Jinhee; Park, So Young; Um, Hye-Yeon; Kim, Kyoung-Joo; Kim, Yuri; Park, Yunjin; Baek, Seunghee; Yoon, Sun-Young; Kwon, Hyouk‐Soo; Cho, You Sook; Moon, Hee‐Bom; Kim, Tae‐Bum

doi:10.1016/j.jaci.2015.04.043

Cited by 47 publications

(59 citation statements)

References 38 publications

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“…In our study, hospitalisations for asthma, which accounted for a minority (∼10%) of acute care visits for asthma, peaked in the third trimester of pregnancy. This is consistent with the study by KIM et al [18] and may reflect an increased tendency toward hospitalisation among pregnant females with asthma presenting to the emergency department in the third trimester with respiratory complaints.…”

Section: Discussionsupporting

confidence: 92%

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Asthma health services utilisation before, during and after pregnancy: a population-based cohort study

Feldman

Zhu

et al. 2018

Eur Respir J

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During pregnancy, females with asthma may be at higher risk of exacerbation. The objective of this study was to determine whether females with asthma in Ontario, Canada have increased health services utilisation (HSU) during pregnancy.Rates of asthma-specific, asthma-related and non-pregnancy-related HSU were calculated in a population-based cohort of pregnant females with asthma. Poisson regression with repeated measures was used to determine adjusted rate ratios and 95% confidence intervals of HSU during and 1 year after pregnancy, compared to the year before pregnancy.The cohort consisted of 103 976 pregnant females with asthma. Compared to the year prior to pregnancy, hospitalisation rates per 100 person-months during pregnancy increased 30% for asthma (from 0.016 to 0.020), 24% for asthma-related conditions (from 0.012 to 0.015) and decreased 37% for non-pregnancy-related conditions (from 0.24 to 0.15). Emergency department visits for asthma and asthma-related conditions did not increase significantly during pregnancy. During pregnancy, physician office visits decreased 19% for asthma (from 2.20 to 1.79), 10% for asthma-related conditions (from 9.44 to 8.47) and increased 74% for non-pregnancy-related conditions (from 56.4 to 98.2).Hospitalisations for asthma and asthma-related conditions increased during pregnancy, demonstrating that the overall increase in non-pregnancy-related physician office visits may not meet the primary care needs of pregnant females with asthma.

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Section: Discussionsupporting

confidence: 92%

“…Interpretation of findings in broader context of existing literature KIM et al [18] examined asthma HSU in 3357 pregnant and 50 355 non-pregnant females using the Korean National Health Insurance claim database. They examined patterns of HSU in the year prior to pregnancy, during pregnancy and in the first and second years after delivery.…”

Section: Discussionmentioning

confidence: 99%

Asthma health services utilisation before, during and after pregnancy: a population-based cohort study

Feldman

Zhu

et al. 2018

Eur Respir J

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“…The risk of emergency caesarean was almost significantly elevated (p ¼ 0.059) in pregnancies complicated by exacerbations. The increased rate of acute caesarean section is in agreement with most previous studies [7,8,13,28,36]. Higher rate of caesarean section is also seen in other chronic conditions such as inflammatory bowel disease [17,37] and epilepsy [18].…”

Section: Number Of Visitsupporting

confidence: 91%

Low risk of adverse obstetrical and perinatal outcome in pregnancies complicated by asthma: A case control study

Ali

Nilas

Ulrik

2016

Respiratory Medicine

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“…The results of this study in a socially disadvantaged population lend support to these criticisms of the common definition of asthma exacerbations and provide an argument for the preferred use of validated tools such as the ACQ, which does not rely on self-awareness or health-seeking behaviours for assessing asthma-related outcomes during pregnancy. Many previous studies required retrospective collection of exacerbation data from medical records [10, 37, 38] and we speculate, based our current data, that while exacerbations identified from medical records may be a surrogate marker for persistently poorly controlled asthma during pregnancy, their predictive value in identifying persistently poorly controlled asthma during pregnancy could be biased by the characteristics of the population being studied. Therefore, a major strength of this study is that it provides new evidence that chronically or persistently uncontrolled asthma may be a greater driver for poor perinatal outcomes than an acute exacerbation.…”

Section: Discussionmentioning

confidence: 81%

Patterns, predictors and outcomes of asthma control and exacerbations during pregnancy: a prospective cohort study

et al. 2016

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There exists a paucity of data for socially disadvantaged populations describing patterns and predictors of asthma control status and exacerbations during pregnancy, and their relationship to adverse perinatal outcomes.Asthmatic women (n=189) were followed prospectively during pregnancy, with visits at 12, 20, 28 and 36 weeks gestation. Data on loss of control, recurrent uncontrolled asthma and moderate/severe exacerbations were collected at each visit and their relationship to perinatal outcomes examined following stratification for fetal sex.50% of asthmatic women experienced a loss of control or moderate/severe exacerbation during pregnancy, with 22% of women experiencing a moderate/severe exacerbation. Factors associated with an increased risk of women experiencing recurrent uncontrolled asthma during pregnancy included smoking (relative risk 2.92, 95% CI 1.53–5.58), inhaled corticosteroid use at the beginning of pregnancy (relative risk 2.40, 95% CI 1.25–4.60) and increasing maternal age (relative risk 1.06, 95% CI 1.01–1.11). No factors were associated with moderate/severe exacerbations. Asthma control rather than exacerbations during pregnancy appeared to be most strongly correlated with perinatal outcomes. Following stratification by fetal sex, the presence of recurrent uncontrolled asthma was associated with an increased risk of being small for gestational age in women pregnant with females (33.3% versus 9.5%; p=0.018). In contrast, there was a nonsignificant increased risk of preterm birth in women with recurrent uncontrolled asthma that were pregnant with males (25.0% versus 11.8%; p=0.201)These results suggest that the key to improving perinatal outcomes lies in improving asthma control as early as possible in pregnancy and monitoring throughout pregnancy, rather than focusing on preventing exacerbations alone.

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Effect of pregnancy in asthma on health care use and perinatal outcomes

Cited by 47 publications

References 38 publications

Asthma health services utilisation before, during and after pregnancy: a population-based cohort study

Asthma health services utilisation before, during and after pregnancy: a population-based cohort study

Low risk of adverse obstetrical and perinatal outcome in pregnancies complicated by asthma: A case control study

Patterns, predictors and outcomes of asthma control and exacerbations during pregnancy: a prospective cohort study

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