Maternal asthma, asthma medication use, and the risk of congenital heart defects

Lin, Shao; Herdt-Losavio, Michele L.; Gensburg, Lenore; Marshall, Elizabeth G.; Druschel, Charlotte M.

doi:10.1002/bdra.20523

Cited by 70 publications

(48 citation statements)

References 17 publications

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“…Our results are in line with previous human studies on short-term reproductive failures after asthma during pregnancy, which have shown associations of asthma during pregnancy with adverse obstetric outcomes and congenital malformation, [4][5][6] and extend knowledge to an overview of potential long-term consequences. Indeed, previous studies on long-term consequences of asthma during pregnancy with regard to selected child diseases also demonstrated an increased risk of asthma, bronchiolitis, atopic dermatitis, and autism spectrum disorder, in offspring of mothers with asthma.…”

Section: Figuresupporting

confidence: 91%

“…5 Maternal asthma during pregnancy was also shown to play a role in cardiac malformations in the offspring. 6 However, the focus of these previous studies was on short-term adverse outcomes in the offspring, whereas long-term effects of maternal asthma on child health remain largely unknown. First studies on a narrow range of selected diseases suggest that maternal asthma during pregnancy is associated with an increased risk of asthma, 7,8 bronchiolitis, 9 atopic dermatitis, 10 and autism spectrum disorder 11 in the offspring during childhood, which is in line with animal models documenting intrauterine susceptibility to hypoxia-induced damage.…”

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confidence: 99%

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Asthma During Pregnancy and Clinical Outcomes in Offspring: A National Cohort Study

Tegethoff¹,

Olsen

Schaffner

et al. 2013

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT: Asthma is a common medical complication during pregnancy that is associated with an increased risk of adverse obstetric outcomes. WHAT THIS STUDY ADDS:This study adds knowledge on potential long-term consequences of maternal asthma during pregnancy for offspring health, demonstrating that maternal asthma during pregnancy is linked to a wide spectrum of offspring diseases during childhood. abstract BACKGROUND AND OBJECTIVE: Maternal asthma is a common pregnancy complication, with adverse short-term effects for the offspring. The objective was to determine whether asthma during pregnancy is a risk factor of offspring diseases. METHODS:We studied pregnant women from the Danish National Birth Cohort (births: 1996Cohort (births: -2002; prospective data) giving birth to live singletons (n = 66 712 mother-child pairs), with 4145 (6.2%) women suffering from asthma during pregnancy. We estimated the associations between asthma during pregnancy and offspring diseases (International Classification of Diseases, 10th Revision diagnoses from national registries), controlling for potential confounders and validating findings by secondary analyses. RESULTS:Offspring median age at end of follow-up was 6.2 (3.6-8.9) years. Asthma was associated with an increased offspring risk of infectious and parasitic diseases (hazard ratio [HR] 1.34; 95% confidence interval [CI] 1.23-1.46), diseases of the nervous system (HR 1.43; CI 1.18-1.73), ear (HR 1.33; CI 1.19-1.48), respiratory system (HR 1.43; CI 1.34-1.52), and skin (HR 1.39; CI 1.20-1.60), and potentially (not confirmed in secondary analyses) of endocrine and metabolic disorders (HR 1.26; CI 1.02-1.55), diseases of the digestive system (HR 1.17; CI 1.04-1.32), and malformations (odds ratio 1.13; CI 1.01-1.26), but not of neoplasms, mental disorders, or diseases of the blood and immune system, circulatory system, musculoskeletal system, and genitourinary system. CONCLUSIONS:To the best of our knowledge, this is the first comprehensive study of the associations between asthma during pregnancy and a wide spectrum of offspring diseases. In line with previous data on selected outcomes, asthma during pregnancy may be a risk factor for numerous offspring diseases, suggesting that careful monitoring of women with asthma during pregnancy and their offspring is important. Dr Tegethoff conceptualized and designed the study, carried out the statistical analyses, interpreted data, drafted the initial manuscript, critically reviewed the manuscript, and obtained funding; Dr Olsen acquired data, interpreted data, critically reviewed the manuscript, and obtained funding; Mr Schaffner carried out the statistical analyses, interpreted data, and critically reviewed the manuscript; Dr Meinlschmidt conceptualized and designed the study, carried out the statistical analyses, interpreted data, critically reviewed the manuscript, and obtained funding; and all authors approved the final manuscript as submitted. Asthma is a frequently occurring medical condition in pregnancy, ...

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Section: Figuresupporting

confidence: 91%

mentioning

confidence: 99%

Asthma During Pregnancy and Clinical Outcomes in Offspring: A National Cohort Study

Tegethoff¹,

Olsen

Schaffner

et al. 2013

Pediatrics

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“…Among the nine cohort studies that examined the association between maternal asthma and the risk of any congenital malformation (Alexander et al, 1998;Demissie et al, 1998;Dombrowski et al, 2004;Enriquez et al, 2007;Liu et al, 2001;Perlow et al, 1992;Schatz et al, 1995;Sobande et al, 2002;SteniusAarniala et al, 1996), only one reported a significantly greater risk among women with asthma (Demissie et al, 1998). The remaining case-control studies evaluated defects related to specific organ systems and even though they were limited in power, all of them reported a significantly greater risk for at least one specific congenital malformation among women with asthma (Lin et al, 2009;Tamasi et al, 2006;Tata et al, 2008). However, these three studies were impeded by other methodological weaknesses, such as the use of multiple testing without adjustment, recall bias, and earlier study periods resulting in a limited use of newer asthma controller therapies such inhaled corticosteroids (ICS) and long-acting inhaled beta 2 -agonists which are implicated in the current management of asthma (Lin et al, 2009;Tamasi et al, 2006;Tata et al, 2008).…”

Section: Introductionmentioning

confidence: 93%

“…The remaining case-control studies evaluated defects related to specific organ systems and even though they were limited in power, all of them reported a significantly greater risk for at least one specific congenital malformation among women with asthma (Lin et al, 2009;Tamasi et al, 2006;Tata et al, 2008). However, these three studies were impeded by other methodological weaknesses, such as the use of multiple testing without adjustment, recall bias, and earlier study periods resulting in a limited use of newer asthma controller therapies such inhaled corticosteroids (ICS) and long-acting inhaled beta 2 -agonists which are implicated in the current management of asthma (Lin et al, 2009;Tamasi et al, 2006;Tata et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

Effect of maternal asthma on the risk of specific congenital malformations: A population‐based cohort study

Blais

Kettani

Elftouh

et al. 2010

Birth Defects Research

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“…A meta-analysis in the latter article found a weighted total odds ratio for a major malformation from four relatively large cohort studies of 1.18 (95% CI 1.00-1.36). Other studies used case-control approaches [4][5][6] and found statistically significant associations between maternal use of antiasthmatics and specific congenital malformations. As pointed out by many authors [2], a major problem in the interpretation of these results is the question of confounding by indication, that the underlying asthma and not the use of drugs caused the malformations.…”

Section: Introductionmentioning

confidence: 99%

Maternal Asthma and Use of Antiasthmatic Drugs in Early Pregnancy and Congenital Malformations in the Offspring

Källén¹

2014

J Pulm Respir Med

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Objectives: To investigate the risk of congenital malformations in infants born of women who had used antiasthmatic drugs in early pregnancy.Methods: Data were obtained from the Swedish Medical Birth Register for 1996-2011. Information on drug use was based on midwife interviews towards the end of the first trimester. Presence of congenital malformations was ascertained from three national health registers. Risk estimates were made with Mantel-Haenszel odds ratios after adjustment for delivery year, maternal age, parity, smoking, and body mass index. Consideration was taken to concomitantly used drugs.Results: Among more than 1.5 million women who gave birth, 2.9% reported the use of antiasthmatics. These women had characteristics which distinguished them from other women who gave birth and they more often than these used other drugs than antiasthmatics. These differences seemed to affect malformation risk only little. The risk for a major malformation was slightly but significantly increased (odds ratio=1.09, 95% confidence interval 1.03-1.12), specifically this was seen for cardiovascular defects, median cleft palate, and pyloric stenosis. There was no specific association with specific drugs or drug groups, the highest risk estimate was seen for women who used only one drug and notably a short-acting adrenergic or used three or more antiasthmatic drug groups. Conclusion:The absolute risk for a congenital malformation in infants born of women using antiasthmatics is low and some evidence indicates that it is due to underlying asthma. A good control of asthma seems important and scare of teratogenicity of the common antiasthmatic drugs should not prevent adequate use.

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Maternal asthma, asthma medication use, and the risk of congenital heart defects

Abstract: These results suggest that both maternal asthma status (controlled vs. uncontrolled; severe vs. mild) and asthma medication use, particularly bronchodilators, may play a role in cardiac malformations in offspring.

Cited by 70 publications

References 17 publications

Asthma During Pregnancy and Clinical Outcomes in Offspring: A National Cohort Study

Asthma During Pregnancy and Clinical Outcomes in Offspring: A National Cohort Study

Effect of maternal asthma on the risk of specific congenital malformations: A population‐based cohort study

Maternal Asthma and Use of Antiasthmatic Drugs in Early Pregnancy and Congenital Malformations in the Offspring

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