Risk factors for asthma exacerbations during pregnancy: a systematic review and meta-analysis

Robijn, Annelies L.; Bokern, Marleen; Jensen, Megan E.; Barker, Daniel; Baines, Katherine J.; Murphy, Vanessa E.

doi:10.1183/16000617.0039-2022

Cited by 19 publications

(9 citation statements)

References 73 publications

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“…A recent meta-analysis of 35 publications involving 429 583 pregnant women identified several important risk factors for asthma exacerbations during pregnancy [14 ▪▪ ]. The authors found that increased maternal age (mean difference 0.62, 95% CI 0.11–1.13), obesity (relative risk 1.25, 95% CI 1.15–1.37), smoking (relative risk 1.35, 95% CI 1.04–1.75), black ethnicity (relative risk 1.62, 95% CI 1.52–1.73), multiparity (relative risk 1.31, 95% CI 1.01–1.68), depression/anxiety (relative risk 1.42, 95% CI 1.27–1.59), moderate–severe asthma (relative risk 3.44, 95% CI 2.03–5.83, versus mild) and severe asthma (relative risk 2.70, 95% CI 1.85–3.95) were associated with an increased risk of asthma exacerbations during pregnancy.…”

Section: Risk Factors During Pregnancymentioning

confidence: 99%

Asthma in pregnancy: a review of recent literature

Colas,

Namazy

2024

Current Opinion in Pulmonary Medicine

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Purpose of review Asthma remains the most common respiratory disease in pregnancy. Identifying risk factors for asthma exacerbations during pregnancy is critical, as uncontrolled asthma can have detrimental effects for both mother and baby. In this review, we discuss recent literature exploring risk factors, fetal and maternal effects, and treatment options for asthma during pregnancy. Recent findings Recent literature suggests that optimizing asthma during pregnancy improves outcomes for both mother and baby, as well as later in childhood. Current research affirms that the benefit of asthma medication use outweighs any potential risks related to the medications themselves. Limited information is available regarding the use of newer therapies such as biologics during pregnancy. Summary Identifying risk factors for asthma exacerbations during pregnancy is critical to prevent adverse outcomes for both mother and baby. Recent evidence continues to affirm the safety of asthma medication use; more studies are needed regarding the use of new therapies during pregnancy.

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Section: Risk Factors During Pregnancymentioning

confidence: 99%

Asthma in pregnancy: a review of recent literature

Colas,

Namazy

2024

Current Opinion in Pulmonary Medicine

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“…Pregnant women with asthma and obesity are at greater risk of stillbirth, neonatal mortality and preterm birth compared to asthmatic pregnant women with a normal BMI [133]. Maternal obesity increases the risk of asthma exacerbations [28,126,134,135]. Excessive gestational weight gain during the first trimester of pregnancy, particularly of more than 5 kg is associated with an increased risk of asthma exacerbations [136].…”

Section: Obesitymentioning

confidence: 99%

“…In non-pregnant women with asthma, OSA may contribute to poor disease control, and increase the risk for exacerbations [26,151]. Maternal obesity is an independent risk factor for maternal complications, such as exacerbations during pregnancy, but also a major risk factor for OSA [28]. Also, patients with CRS have an increased risk for OSA [152,153].…”

Section: Obstructive Sleep Apneamentioning

confidence: 99%

“…Existing studies in asthma show that identification and appropriate management of comorbidities can improve outcomes [26,27]. Although not as extensively studied as outside pregnancy, additional studies evaluating the impact of these comorbidities during pregnancy, also suggest an association between certain comorbidities and uncontrolled asthma during pregnancy [28][29][30]. Thus, management of asthma during pregnancy should also include systematic evaluation and treatment of comorbidities.…”

Section: Introductionmentioning

confidence: 99%

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Treatable Traits in Pregnant Women with Asthma

Ramlal,

Van der Meer,

Bendien

2024

Respiration

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Background: Asthma is the most common chronic respiratory disease in pregnancy, affecting approximately 8–10% of pregnant women. Uncontrolled asthma is associated with adverse perinatal outcomes, including low birth weight, preterm birth, and maternal complications such as pre-eclampsia. Summary: A current approach to the management of chronic airway diseases is based on targeting treatable traits. The aim of this review was to define treatable traits in pregnant women with asthma based on recent literature and to determine personalized treatment options according to these traits. Traits addressed in this review that may improve asthma control and pregnancy outcomes are fractional exhaled nitric oxide-based asthma monitoring and treatment, medication adherence and inhalation technique, impaired lung function, smoking cessation and comorbidity including psychological conditions (depression and anxiety), obesity, rhinitis, gastroesophageal reflux disease, chronic rhinosinusitis with or without nasal polyps, and sleep apnea. Key Messages: All the treatable traits discussed have the potential to improve asthma control and pregnancy outcomes in pregnant women with asthma. Further research is needed to determine which management approaches are best to improve asthma control during pregnancy, to identify other relevant treatable traits, and to determine whether the treatable trait approach is feasible and beneficial in pregnant women with asthma.

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“…Asthma exacerbation during pregnancy mostly occurs in the second trimester ( 85 ). A recent meta-analysis has shown that old gestational age, obesity, smoking, multipara, anxiety and depression, and moderate to severe asthma increase the risk of asthma exacerbation during pregnancy ( 86 ). Other risk factors for asthma exacerbation during pregnancy include poor compliance to medication, respiratory viral infection, and rapid weight gain during pregnancy ( 85 , 87 ).…”

Section: Incidence and Management Of Asthma In Different Age Groups A...mentioning

confidence: 99%

Chinese expert consensus on the diagnosis, treatment, and management of asthma in women across life

Hu,

Chen,

et al. 2024

J Thorac Dis

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Background The epidemiology and severity of asthma vary by sex and age. The diagnosis, treatment, and management of asthma in female patients are quite challenging. However, there is hitherto no comprehensive and standardized guidance for female patients with asthma. Methods Corresponding search strategies were determined based on clinical concerns regarding female asthma. Search terms included “sex hormones and lung development”, “sex hormone changes and asthma”, “hormones and asthma immune response”, “women, asthma”, “children, asthma”, “puberty, asthma”, “menstruation, asthma”, “pregnancy, asthma”, “lactation, asthma”, “menopause, asthma”, “obesity, asthma”, and “women, refractory, severe asthma”. Literature was retrieved from PubMed/Medline, Embase, Cochrane Library, China Biology Medicine disc, China National Knowledge Infrastructure, Wanfang Data with the search date of July 30, 2022 as the last day. This consensus used the Grading of Recommendations Assessment, Development, and Evaluation to evaluate the strength of recommendation and quality of evidence. Results We collected basic research results and clinical evidence-based medical data and reviewed the effects of sex hormones, classical genetics, and epigenetics on the clinical presentation and treatment response of female patients with asthma under different environmental effects. Based on that, we formulated this expert consensus on the management of female asthma throughout the life cycle. Conclusions This expert consensus on the management of asthma in women throughout the life cycle provides diagnosis, treatment, and research reference for clinical and basic medical practitioners.

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Risk factors for asthma exacerbations during pregnancy: a systematic review and meta-analysis

Cited by 19 publications

References 73 publications

Asthma in pregnancy: a review of recent literature

Asthma in pregnancy: a review of recent literature

Treatable Traits in Pregnant Women with Asthma

Chinese expert consensus on the diagnosis, treatment, and management of asthma in women across life

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