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

Clin Experimental Allergy

2017

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.

Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Determinants of low risk of asthma exacerbation during pregnancy

Ali

Nilas

Clin Experimental Allergy

2017

“…Scheduled follow-up visits were planned every 4 weeks during pregnancy with adjustment, if necessary, of asthma medication based on symptoms, level of fractional exhaled nitric oxide (F E NO), and spirometry in accordance with the algorithm subsequently described by Powell et al17 The MAP study has been described in detail previously 18–21…”

Section: Methodsmentioning

confidence: 99%

Postpartum airway responsiveness and exacerbation of asthma during pregnancy – a pilot study

Ali¹,

Nilas

2017

JAA

Self Cite

BackgroundAirway responsiveness and inflammation are associated with the clinical manifestations of asthma and the response to pharmacological therapy.ObjectiveTo investigate if airway responsiveness and inflammatory characteristics are related to asthma exacerbations during pregnancy.Materials and methodsIn women with asthma who were prescribed controller medication and monitored closely during pregnancy, the risk of exacerbations was analyzed in relation to postpartum measures of fractional exhaled nitric oxide (FENO), skin prick test reactivity, static and dynamic lung volumes, diffusing capacity for carbon monoxide, bronchial responsiveness to inhaled mannitol, and inflammatory characteristics in induced sputum. Obtained data were analyzed in relation to exacerbation status during pregnancy. The PD15 is defined as the cumulative administered dose causing a 15% decline in forced expiratory volume in the first second (FEV1).ResultsFifty women (mean age ± standard deviation of 32±5 years) were enrolled over an 11-month period and examined on average 4 months postpartum. During pregnancy, 13 women had a total of 16 exacerbations (8 mild and 8 severe). Women with asthma exacerbation during pregnancy had more pronounced airway responsiveness to inhaled mannitol (geometric mean PD15 82 vs 171 mg, p=0.04) and were less likely to be atopic (62% vs 86%, respectively; p=0.04) than the non-exacerbators. No statistically significant difference was found between the 2 groups of women with regard to type of airway inflammation in sputum and fractional exhaled nitric oxide (FENO).ConclusionMore pronounced airway hyperresponsiveness together with nonatopic status appears to characterize women at high risk of exacerbation of asthma during pregnancy.

Associations between maternal and environmental exposures on atopic disease in the offspring of mothers with asthma

Ali

Jemec

Immunity Inflam & Disease

2021

Self Cite

Background and Objective Available data on the impact of perinatal and environmental factors on atopic diseases in the offspring are sparse and conflicting. We, therefore, investigated the impact of these factors on the risk of atopic diseases in the offspring of women with asthma. Methods Pregnant women referred to give birth at Copenhagen University Hospital‐Hvidovre, Denmark, have since 2007 been invited to participate in the Management of Asthma during Pregnancy program. Women with diagnosed asthma, currently prescribed asthma medication, first visit to the respiratory out‐patient clinic within the first 18 weeks of pregnancy that completed an online questionnaire about atopic diseases in their child were included in the current study. Results Five hundred and seventy‐one pregnancies were included. Among the off‐spring, 113 children (21%) had doctor‐diagnosed asthma, 178 (31%) atopic dermatitis (AD), and 55 (32%) both AD and doctor‐diagnosed asthma. AD in the offspring was associated with having a dog at home (odds ratio [OR], 2.56; 95% confidence interval [CI], [1.40–4.67], p = .002), whereas having a cat at home was associated with a higher risk of asthma in the offspring (OR, 2.16; 95% CI, [1.14–4.11], p = .02). The associations remained significant after adjusting for maternal age, smoking status, allergy, treatment with inhaled corticosteroids, forced expiratory volume in 1 s less than 80% predicted, uncontrolled asthma, and history of pre‐pregnancy asthma exacerbations. No association was found between gestational weight gain (GWG) in first trimester and total GWG and atopic disease in the offspring. Conclusion Having pets at home is associated with AD and asthma in the offspring of mothers with asthma.