The relationship of asthma medication use to perinatal outcomes

doi:10.1016/j.jaci.2004.03.017

Journal of Allergy and Clinical Immunology

Volume 113, Issue 6, June 2004, Pages 1040-1045

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https://doi.org/10.1016/j.jaci.2004.03.017 Get rights and content

Background

Maternal asthma has been reported to increase the risk of preeclampsia, preterm deliveries, and lower-birth-weight infants, but the mechanisms of this effect are not defined.

Objective

We sought to evaluate the relationship between the use of contemporary asthma medications and adverse perinatal outcomes.

Methods

Asthmatic patients were recruited from the 16 centers of the National Institute of Child Health and Human Development Maternal Fetal Medicine Units Network from December 1994 through February 2000. Gestational medication use was determined on the basis of patient history at enrollment and at monthly visits during pregnancy. Perinatal data were obtained at postpartum chart reviews. Perinatal outcome variables included gestational hypertension, preterm births, low-birth-weight infants, small-for-gestational-age infants, and major malformations.

Results

The final cohort included 2123 asthmatic participants. No significant relationships were found between the use of inhaled β-agonists (n = 1828), inhaled corticosteroids (n = 722), or theophylline (n = 273) and adverse perinatal outcomes. After adjusting for demographic and asthma severity covariates, oral corticosteroid use was significantly associated with both preterm birth at less than 37 weeks' gestation (odds ratio, 1.54; 95% CI, 1.02-2.33) and low birth weight of less than 2500 g (odds ratio, 1.80; 95% CI, 1.13-2.88).

Conclusions

Use of inhaled β-agonists, inhaled steroids, and theophylline do not appear to increase perinatal risks in pregnant asthmatic women. The mechanism of the association between maternal oral corticosteroid use and prematurity remains to be determined.

Section snippets

Methods

Patients in this report were asthmatic participants who completed either the NICHD MFMU Network asthma observational cohort study14, 15 or the NICHD MFMU Network randomized controlled trial of beclomethasone versus theophylline for moderate asthma during pregnancy.¹⁶ These studies were conducted at 16 centers of the MFMU Network of the NICHD, with recruitment from December 1994 through February 2000. Participants from both studies were drawn from the same network center populations, and both

Results

The final delivered cohort included 2123 asthmatic participants, 1739 from the observational cohort study and 384 from the randomized control trial (Table I). The participants ranged in age from 13 to 44 years (mean, 23.3 years), and more than 18% were smokers. Slightly more than half of the participants were primiparas, slightly more than half were African American, and almost one third experienced unscheduled asthma care during pregnancy.

No significant relationships were found between adverse

Discussion

Asthma has been reported to complicate 7% of pregnancies,¹ making it probably the most common potentially serious medical problem to complicate pregnancy. Data regarding the effect of maternal asthma on pregnancy outcomes have been conflicting,⁶ but the largest retrospective study has shown that pregnancies in women with asthma are significantly more likely to be complicated by preeclampsia, preterm birth, or low birth weight, but not congenital malformations, compared with pregnancies in

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: Supported by grants from the National Institute of Child Health and Human Development (HD21410, HD21414, HD21434, HD27869, HD27917, HD27905, HD27889, HD27860, HD27861, HD27915, HD27883, HD34122, HD34116, HD34208, HD34136, HD19897, HD36801) and the National Heart Lung and Blood Institute.

View full text

Asthma diagnosis and treatmentThe relationship of asthma medication use to perinatal outcomes

Background

Objective

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Obstet Gynecol

Am J Obstet Gynecol

Immunol Allergy Clin North Am

J Allergy Clin Immunol

Chest

Semin Perinatol

J Allergy Clin Immunol

Obstet Gynecol

J Allergy Clin Immunol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Asthma diagnosis and treatment
The relationship of asthma medication use to perinatal outcomes