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Double trouble: gestational diabetes and asthma exacerbations in pregnancy

Published online December 19, 2024

Asthma and gestational diabetes mellitus (GDM) are two common conditions that can complicate pregnancy and lead to serious health challenges for both mother and baby. Asthma affects up to 13% of all pregnancies, and GDM impacts nearly 14%. Research in non-pregnant individuals has raised the possibility that insulin resistance could worsen asthma outcomes. However, how GDM – characterized by insulin resistance - influences asthma exacerbations remains poorly understood.

In a large retrospective cohort study recently published in The Journal of Allergy and Clinical Immunology: In Practice, authors Dr. Zhang et al. analyzed electronic health records from over 10,000 pregnant individuals with pre-existing asthma, covering the years 2010 to 2023. The research team focused on GDM diagnoses, maternal blood glucose levels, and other key factors such as maternal age, pre-pregnancy BMI, and insurance status at delivery. Asthma exacerbations were defined by short-course oral corticosteroid prescriptions. By comparing rates of asthma exacerbations among those with and without GDM, the investigators aimed to clarify the potential relationship between GDM and asthma flare-ups.

The investigators found that individuals diagnosed with GDM were more likely to experience asthma exacerbations during pregnancy than those without GDM diagnosis. A subgroup analysis showed that higher random blood glucose levels were also associated with an increased risk of exacerbations during pregnancy. After giving birth, and when GDM generally resolves, this association was no longer observed. Additionally, older maternal age, higher BMI before pregnancy, Medicaid insurance status, and a history of poorly controlled asthma before pregnancy were all related to an increased risk of asthma flare-ups both during and after pregnancy. These findings highlight the importance of early GDM screenings alongside careful asthma management to support better health outcomes for this population.

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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