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      Maternal asthma is associated with increased risk of perinatal mortality

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          Abstract

          Background

          Asthma is the most common chronic disease during pregnancy and it may have influence on pregnancy outcome.

          Objectives

          Our goal was to assess the association between maternal asthma and the perinatal risks as well as possible effects of asthma medication.

          Methods

          The study was based on a nationwide Finnish register-based cohort between the years 1996 and 2012 in the Drug and Pregnancy Database. The register data comprised 962 405 singleton live and stillbirths, 898 333 (93.3%) pregnancies in mothers with neither confirmed asthma nor use of asthma medication (controls), and 26 674 (2.8%) pregnancies with confirmed maternal asthma. 71% of mothers with asthma used asthma medication. The diagnosis of asthma was based on the mothers’ right for subsidised medication which is carefully evaluated by strict criteria including pulmonary function testing. Odds ratio was used in comparison. Premature birth (PB), low birth weight, small for gestational age (SGA), neonatal death were the main outcome measures.

          Results

          Maternal asthma was associated with adjusted odds ratios (aORs) for perinatal mortality 1.24 (95% CI 1.05 to 1.46), preterm birth 1.18 (1.11 to 1.25), low birth weight 1.29 (1.21 to 1.37), fetal growth restriction (SGA) 1.32, (1.24 to 1.40), and asphyxia 1.09 (1.02 to 1.17). Asthma treatment reduced the increased risk of preterm birth aOR 0.85 (95% CI 0.76 to 0.96) but mothers with treated asthma had higher risks of fetal growth restriction (SGA) aOR 1.26 (1.10 to 1.45), and asphyxia aOR 1.37 (1.17 to 1.61) than mothers with untreated asthma.

          Conclusion

          Asthma is associated with increased risks of perinatal mortality, preterm birth, low birth weight, fetal growth restriction (SGA), and asphyxia. Asthma treatment reduces the risk of preterm delivery, but it does not seem to reduce other complications such as perinatal mortality.

          Related collections

          Most cited references29

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          New population-based references for birth weight, length, and head circumference in singletons and twins from 23 to 43 gestation weeks.

          Birth size curves are needed for clinical and epidemiological purposes. We constructed birth weight (BW), length (BL), and head circumference (BHC) references, assessed effects of twinness and parity, and defined cut-off points for small, appropriate, and large for gestational age. Birth register data of all 753,036 infants born in 1996-2008 in Finland were cleaned to create references reflecting optimal intrauterine growth. The final data included 533,666 singletons and 15,033 twins (median gestation weeks (gws) 40.0 and 37.1, respectively, 41.6% primiparous). Sex-specific BW, BL, and BHC references were constructed from 23 to 43 gws separately for singletons and twins born to primiparous or multiparous mothers. GAMLSS method was used for modelling. In singletons from 36 gws onwards, increased BW and BL were observed in comparison to previous reference from 1979-1983. Twins diverged from singletons from 30 gws onwards. At 37.0 gws, mean BW was 400 g lower and mean BL 1.2 cm shorter than in singletons. From 30 gws onwards, birth size was larger in infants of multiparous than primiparous mothers. Population-based birth size references are available for the evaluation of birth size. Accounting for plurality and parity improves the accuracy of birth size evaluation.
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            Contemporary cesarean delivery practice in the United States.

            To describe contemporary cesarean delivery practice in the United States. Consortium on Safe Labor collected detailed labor and delivery information from 228,668 electronic medical records from 19 hospitals across the United States, 2002-2008. The overall cesarean delivery rate was 30.5%. The 31.2% of nulliparous women were delivered by cesarean section. Prelabor repeat cesarean delivery due to a previous uterine scar contributed 30.9% of all cesarean sections. The 28.8% of women with a uterine scar had a trial of labor and the success rate was 57.1%. The 43.8% women attempting vaginal delivery had induction. Half of cesarean for dystocia in induced labor were performed before 6 cm of cervical dilation. To decrease cesarean delivery rate in the United States, reducing primary cesarean delivery is the key. Increasing vaginal birth after previous cesarean rate is urgently needed. Cesarean section for dystocia should be avoided before the active phase is established, particularly in nulliparous women and in induced labor. Published by Mosby, Inc.
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              A meta-analysis of adverse perinatal outcomes in women with asthma.

              Asthma is a common condition during pregnancy and may be associated with adverse perinatal outcomes. This meta-analysis sought to establish if maternal asthma is associated with an increased risk of adverse perinatal outcomes, and to determine the size of these effects. Electronic databases were searched for the following terms: (asthma or wheeze) and (pregnan* or perinat* or obstet*). Cohort studies published between 1975 and March 2009 were considered for inclusion. Studies were included if they reported at least one perinatal outcome in pregnant women with and without asthma. A total of 103 articles were identified, and of these 40 publications involving 1,637,180 subjects were included. Meta-analysis was conducted with subgroup analyses by study design and active asthma management. Maternal asthma was associated with an increased risk of low birthweight (RR 1.46, 95% CI 1.22-1.75), small for gestational age (RR 1.22, 95% CI 1.14-1.31), preterm delivery (RR 1.41, 95% CI 1.22-1.61) and pre-eclampsia (RR 1.54, 95% CI 1.32-1.81). The relative risk of preterm delivery and preterm labour were reduced to non-significant levels by active asthma management (RR 1.07, 95% CI 0.91-1.26 for preterm delivery; RR 0.96, 95% CI 0.73-1.26 for preterm labour). Pregnant women with asthma are at increased risk of perinatal complications, including pre-eclampsia and outcomes that affect the baby's size and timing of birth. Active asthma management with a view to reducing the exacerbation rate may be clinically useful in reducing the risk of perinatal complications, particularly preterm delivery. © 2011 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2011 RCOG.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: InvestigationRole: SoftwareRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SupervisionRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: MethodologyRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: InvestigationRole: SupervisionRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                18 May 2018
                2018
                : 13
                : 5
                : e0197593
                Affiliations
                [1 ] Department of Paediatrics, Children’s Hospital Helsinki University Hospital, Helsinki, Finland
                [2 ] National Institute for Health and Welfare, Information Services Department, Unit of Statistics and Registers, Helsinki, Finland
                [3 ] Helsinki University, Respiratory Medicine and Allergology, Helsinki, Finland
                [4 ] Helsinki University Central Hospital, Skin and Allergy Hospital, Helsinki, Finland
                [5 ] Nordic Casemix Center, Helsinki, Finland
                [6 ] Unit of Nutrition, National Institute for Health and Welfare, Helsinki, Finland
                [7 ] Health Sciences Center, University of Tampere, Center for Child Health Research, University of Tampere, Tampere, Finland
                [8 ] Tampere University Hospital, and the Science Center of Pirkanmaa Hospital District, Tampere, Finland
                [9 ] Regional State Administrative Agencies, Tampere, Finland
                [10 ] Karolinska Institute, Department of Neurobiology, Care Sciences and Society, Division of Family Medicine, Stockholm, Sweden
                University of Torino, ITALY
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-5680-7394
                Article
                PONE-D-17-41301
                10.1371/journal.pone.0197593
                5959067
                29775476
                4c8fc1ab-f130-4021-87a4-3a9df7d1fc25
                © 2018 Kemppainen et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 22 November 2017
                : 4 May 2018
                Page count
                Figures: 1, Tables: 3, Pages: 10
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100002327, Kela;
                Drugs and Pregnancy database is a collaboration by THL National Institute for Health and Welfare, Kela Social Insurance Institution and Fimea Finnish Medicines Agency (main funder). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. The author(s) received no specific funding for this work.
                Categories
                Research Article
                Medicine and Health Sciences
                Pulmonology
                Asthma
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Pregnancy
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Pregnancy
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Birth
                Preterm Birth
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Birth
                Preterm Birth
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Pregnancy
                Pregnancy Complications
                Preterm Birth
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Pregnancy
                Pregnancy Complications
                Preterm Birth
                Medicine and Health Sciences
                Pulmonology
                Biology and Life Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Birth Weight
                Medicine and Health Sciences
                Physiology
                Physiological Parameters
                Body Weight
                Birth Weight
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Stillbirths
                Medicine and Health Sciences
                Pediatrics
                Child Development
                Child Growth
                Growth Restriction
                Medicine and Health Sciences
                Diagnostic Medicine
                Signs and Symptoms
                Asphyxia
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Signs and Symptoms
                Asphyxia
                Custom metadata
                Because of the national legal restrictions, authors cannot make de-identified dataset available. Data contains confidential patient information for which access is strongly prohibited. An authorisation from the National Institute of Health and Welfare (THL) and Social Insurance Institution (KELA) is necessary for any use of similar confidential data for research purposes. The contact information for a data access committee in THL is kirjaamo@ 123456thl.fi and in KELA tietopyynnot@ 123456kela.fi .

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