A real-world asthma management during pregnancy: Is it safe?

Published June 10, 2015

Asthma is one of the most common respiratory disorders complicating pregnancy. Uncontrolled maternal asthma is associated with a range of adverse perinatal outcomes including low birth weight, preterm delivery, preeclampsia, and perinatal fetal death. However, a large proportion of pregnant women with asthma and some physicians remain apprehensive of using asthma medications because of concern for the fetus. Moreover, the effect of asthma-related health care use patterns during pregnancy on perinatal outcomes is not well known.

In an original article recently published in The Journal of Allergy & Clinical Immunology (JACI), Kim et al. used National Health Insurance claims data, which covers almost the entire Korean population, to investigate health care use and prescription patterns associated with asthma in pregnant patients compared to those of nonpregnant patients with asthma. A total of 3,357 pregnant asthmatic patients were compared with 50,355 nonpregnant patients with asthma, and 10,311 pregnant patients were included to determine the effect of asthma exacerbations on adverse pregnancy outcome in this study.

The authors found that pregnant patients with asthma had more asthma-related hospitalization than nonpregnant patients with asthma, which could have resulted from prominent reduction of outpatient visits or prescribed asthma medications after pregnancy. It was observed that patients who have experienced more asthma exacerbations one year before pregnancy had more asthma deterioration during pregnancy, even though their anti-asthma prescriptions remained stable during pregnancy. However, the analysis showed that asthma exacerbation during pregnancy did not increase the risk of poor perinatal outcomes, except for cesarean delivery, probably because it was managed appropriately with systemic corticosteroids.

Pregnancy profoundly affects asthma-related healthcare use, but to a different degree depending on whether the patient experienced exacerbations or not. Appropriate guidelines for pregnant patients with asthma should be implemented to physicians in order to prevent asthma exacerbations. In addition, further studies are needed to clarify the impact of asthma control on perinatal outcomes.

The Journal of Allergy and Clinical Immunology (JACI) is the official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.

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