Asthma During Pregnancy Remains Poorly Controlled in the United States
June 25, 2019
A study from The Journal of Allergy and Clinical Immunology: In Practice demonstrates that poorly controlled asthma is more common for publicly insured pregnancies than privately insured ones.
MILWAUKEE, WI – Uncontrolled asthma during pregnancy may come with an elevated risk for adverse maternal and neonatal outcomes, and is estimated to complicate between 3% and 10% of pregnancies. A new study from The Journal of Allergy and Clinical Immunology: In Practice (JACI: In Practice) shows that poorly controlled asthma during pregnancy continues to be common in the United States.
Furthermore, the study points out that pregnant women utilizing public insurance are more likely to have poorly controlled asthma than pregnant women with private insurance. Among all patients, the dispensing of long-term controller medications during pregnancy was low, even for women consistently displaying symptoms.
“Adhering to recommended asthma treatments is extremely important, and what we’re seeing is that many pregnant women with poorly-controlled asthma aren’t filling prescriptions for long-term asthma care,” said first author Jacqueline M. Cohen, PhD. “Getting asthma symptoms under control could improve health outcomes for both the mothers and their children.”
It’s estimated that about one third of women may choose to discontinue asthma controller medications early due to fears of fetal toxicity, or simply due to overall uncertainty about the medications. Medication non-adherence is a major trigger for asthma exacerbations, which can be dangerous for both the mother and the baby.
Two cohorts of pregnancies ending in a live birth were identified using two large, nationwide U.S. healthcare claims databases. The Truven Health MarketScan® Commercial Claims and Encounters Database (MarketScan, private insurance) was examined from 2011-2015 and the Medicaid Analytic eXtract (MAX, public insurance) was examined from 2000-2013 for the study.
Among pregnant women with asthma on private insurance (MarketScan), 19.0% had severe asthma and 16.5% had poorly-controlled asthma. Of those with poorly-controlled asthma, 38.4% of women were not dispensed a long-term medication. Among asthmatic pregnant women using public insurance (MAX), 18.8% had severe asthma and an alarming 28% had poorly-controlled asthma. Of those with poorly-controlled asthma, 43.3% were not dispensed a long-term medication. No matter the type of insurance, women with poor control were more likely to be obese, smoke, have more comorbidities and used more concomitant non-asthma medications. They were also more likely to be hospitalized before and during pregnancy. During their pregnancy, 1.6% of women in MarketScan and 5.1% in MAX required hospitalization due to asthma.
The study was funded by GSK as part of the Vaccines and Medications in Pregnancy Surveillance System (VAMPSS) collaboration. In 2010, VAMPSS, which is coordinated by the AAAAI, started to look at the safety of both long-acting and short-acting beta agonists in pregnancy, and more recently, added surveillance for the new biologics used to treat severe asthma.
“While it’s understandable that mothers are concerned about the safety of their children and the effect medications may have during pregnancy, current asthma guidelines recommend that women continue their asthma treatment plan throughout the entire pregnancy because the risks of uncontrolled asthma appear to be greater than the risk of recommended asthma medications,” said Michael Schatz, MD, MS, FAAAAI, also an author of the study and Principal Investigator for VAMPSS. “There is an urgent need to provide additional evidence on the risks and benefits of asthma medications during pregnancy to improve asthma control and reduce anxiety regarding medication safety in our patients. Our hope is that the information gleaned through VAMPSS will contribute to more complete risk and safety information on pharmaceutical labels for pregnant and lactating women.”
You can learn more about VAMPSS and asthma at the American Academy of Allergy, Asthma & Immunology website, aaaai.org.
The American Academy of Allergy, Asthma & Immunology (AAAAI) represents allergists, asthma specialists, clinical immunologists, allied health professionals and others with a special interest in the research and treatment of allergic and immunologic diseases. Established in 1943, the AAAAI has nearly 7,000 members in the United States, Canada and 72 other countries. The AAAAI’s Find an Allergist/Immunologist service is a trusted resource to help you find a specialist close to home.