Asthma remains poorly controlled in pregnancy

Published online: June 27, 2019

Asthma complicates over 5% of pregnancies in the United States. Uncontrolled asthma during pregnancy may increase the risk for adverse maternal and neonatal outcomes including severe hypertension, preterm birth, and low birth weight. Proper asthma treatment can avoid asthma exacerbations during pregnancy and may therefore improve pregnancy outcomes for the mother and the infant.

In this study by Cohen et al. in The Journal of Allergy and Clinical Immunology: In Practice, the authors identified pregnancies within two large US healthcare administrative databases to describe the prevalence, severity, and control of asthma during pregnancy. The identification of asthma symptoms and treatments was based on coded diagnoses in claims and pharmacy dispensing of medications, respectively. Severe asthma was defined as dispensing of medium/high-dose inhaled corticosteroids plus additional asthma therapy (e.g., theophylline, tiotropium, anti-IgE) in the 12 months before delivery. Poor control during pregnancy was defined as having at least one of the following: ≥ 1 exacerbation (asthma-related hospitalization or emergency room visit, or a course of oral corticosteroids) or ≥ 5 filled prescriptions for short-acting β-agonists (rescue medication) between the last menstrual period and delivery.

Among the over 2.5 million pregnancies included in the study, 140,849 (5.3%) had asthma. Among pregnant women with asthma, 19% had severe asthma. The frequency of poor control was 17% in commercially insured and 28% in publicly insured (Medicaid). Women with poor control were more often smokers and obese. The proportion of women with asthma with at least one pharmacy dispensing for short-acting β-agonists during pregnancy declined between 2000 and 2015 from 85% to around 70%, while the proportion with inhaled corticosteroid remained relatively constant and under 50%. About 40% of women with uncontrolled asthma were not dispensed long-acting control medications during pregnancy. Moreover, of those on inhaled corticosteroids at conception, about half discontinued filling prescriptions for them after the first trimester of pregnancy.

In summary, the authors identified a high prevalence of poorly controlled asthma among pregnant women in the US, particularly in the Medicaid population. Dispensing of controller therapy remains low, even for symptomatic patients, suggesting that asthma in pregnancy may be inadequately treated. Since appropriate therapeutic management during pregnancy could improve the health of both mothers and children, there is a need to provide additional evidence on the risks and benefits of asthma medications in pregnancy.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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