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      Asthma during Pregnancy in a Population-Based Study - Pregnancy Complications and Adverse Perinatal Outcomes

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          Abstract

          Background

          Asthma is one of the most common chronic diseases, and prevalence, severity and medication may have an effect on pregnancy. We examined maternal asthma, asthma severity and control in relation to pregnancy complications, labour characteristics and perinatal outcomes.

          Methods

          We retrieved data on all singleton births from July 1, 2006 to December 31, 2009, and prescribed drugs and physician-diagnosed asthma on the same women from multiple Swedish registers. The associations were estimated with logistic regression.

          Results

          In total, 266 045 women gave birth to 284 214 singletons during the study period. Maternal asthma was noted in 26 586 (9.4%) pregnancies. There was an association between maternal asthma and increased risks of pregnancy complications including preeclampsia or eclampsia (adjusted OR 1.15; 95% CI 1.06–1.24) and premature contractions (adj OR 1.52; 95% CI 1.29–1.80). There was also a significant association between maternal asthma and emergency caesarean section (adj OR 1.29; 95% CI 1.23–1.34), low birth weight, and small for gestational age (adj OR 1.23; 95% CI 1.13–1.33). The risk of adverse outcomes such as low birth weight increased with increasing asthma severity. For women with uncontrolled compared to those with controlled asthma the results for adverse outcomes were inconsistent displaying both increased and decreased OR for some outcomes.

          Conclusion

          Maternal asthma is associated with a number of serious pregnancy complications and adverse perinatal outcomes. Some complications are even more likely with increased asthma severity. With greater awareness and proper management, outcomes would most likely improve.

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          Most cited references33

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          Intrauterine growth curves based on ultrasonically estimated foetal weights.

          H Lilja, Louise J. P. Persson, A Selbing … (1996)
          Available standard intrauterine growth curves based on birthweights underestimate foetal growth in preterm period. New growth curves are presented based on data from four Scandinavian centres for 759 ultrasonically estimated foetal weights in 86 uncomplicated pregnancies. Mean weight of boys exceeded that of girls by 2-3%. A uniform SD value of 12% of the mean weight was adopted for the standard curves as the true SD varied non-systematically between 9.1 and 12.4%. Applied to an unselected population of 8663 singleton births, before 210 days of gestation, 32% of birthweights were classified as small-for-gestational age (SGA; i.e. below mean - 2 SD); the corresponding figures were 11.1% for gestational ages between 210 and 258 days, and 2.6% for ages of 259 days or longer. The new growth curves reveal better the true distribution of SGA foetuses and neonates, and are suggested for use in perinatological practice.
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            A meta-analysis of adverse perinatal outcomes in women with asthma.

            V. Murphy, J Namazy, H. Powell … (2011)
            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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              Drug use during pregnancy in Sweden – assessed by the Prescribed Drug Register and the Medical Birth Register

              Olof Stephansson, Fredrik Granath, Tobias Svensson … (2011)
              Purpose: The purpose of this research is to study drug use during pregnancy in Sweden and agreement between use according to antenatal medical records and dispensed drugs from a pharmacy database. Patients and methods: From the Swedish Medical Birth Register (MBR), we established a population-based cohort of 102,995 women who gave birth in 2007. Using the unique personal registration number, information on dispensed drugs from the Prescribed Drug Register (PDR) was obtained prior to, during, and after the pregnancies and compared with MBR information on drug use from standardized antenatal medical records. Results: According to the PDR, 57.6% of the 102,995 women filled a prescription with at least one drug during pregnancy and 50.9% during the lactating period (until 3 months after delivery). The most dispensed drugs during pregnancy were B-lactam antibacterials and penicillins. Agreement between drugs recorded in antenatal medical records and dispensed drugs was highest for drugs used for chronic conditions. The agreement was particularly high for thyroid therapy (85.3%), anti-intestinal inflammatory drugs (80.3%), antiepileptics (69.2%), immunosuppressants (67.4%), and insulin (63.8%). Agreement for drugs used for occasional use was generally lower, ranging between 42.5% for antihistamines and 0.8% for gynecological anti-infectives. Conclusions: A large proportion of women filled a prescription during pregnancy or the lactating period. Agreement between drug use in medical antenatal records and register information from a national pharmacy database was high for drugs used for chronic conditions but low for occasional use. For occasionally used drugs, medical record and register-based data may provide incomplete exposure information because of nonreporting or noncompliance.
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                Author and article information

                Contributors
                Katariina Laine: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, USA )
                ISSN (Electronic): 1932-6203
                Publication date Collection: 2014
                Publication date (Electronic): 20 August 2014
                Volume: 9
                Issue: 8
                Electronic Location Identifier: e104755
                Affiliations
                [1 ]Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
                [2 ]Obstetrics and Gynaecology Unit, Södersjukhuset, Stockholm, Sweden
                [3 ]Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
                [4 ]Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
                [5 ]Obstetrics and Gynaecology Unit, Karolinska University Hospital, Stockholm, Sweden
                [6 ]Astrid Lindgren Children's Hospital, Lung and Allergy Unit, Karolinska University Hospital, Stockholm, Sweden
                Oslo University Hospital, Ullevål, Norway
                Author notes

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

                Conceived and designed the experiments: GR CL CA. Performed the experiments: GR. Analyzed the data: GR. Contributed to the writing of the manuscript: GR CL KL TG SS CA. Assisted in the statistical analyses: CL.

                Article
                Publisher ID: PONE-D-14-16267
                DOI: 10.1371/journal.pone.0104755
                PMC ID: 4139314
                PubMed ID: 25141021
                SO-VID: a05d52b2-c5c5-4a9b-84ee-8bcfcaa69c3a
                Copyright statement: Copyright @ 2014
                License:

                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
                Date received : 12 April 2014
                Date accepted : 16 July 2014
                Page count
                Pages: 9
                Funding
                This work was supported by the regional agreement on medical training and clinical research (ALF) between Stockholm County Council and Karolinska Institutet ( http://www.forskningsstod.sll.se), the Swedish Research Council ( http://www.vr.se/) [grant number 2011–3060] and through the Swedish Initiative for Research on Microdata in the Social And Medical Sciences (SIMSAM) framework ( http://simsam.nu/) [grant number 340-2013-5867], the Swedish Heart-Lung Foundation ( http://www.hjart-lungfonden.se/HLF/Om-Hjart-lungfonden/About-HLF/), and the Strategic Research Program in Epidemiology at Karolinska Institutet ( http://ki.se/en/research/the-strategic-research-programme-in-epidemiology-sfoepi). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Subject: Research Article
                Subject: Medicine and Health Sciences
                Subject: Epidemiology
                Subject: Clinical Epidemiology
                Subject: Pediatrics
                Subject: Neonatology
                Subject: Pulmonology
                Subject: Asthma
                Subject: Women's Health
                Subject: Maternal Health
                Subject: Pregnancy
                Subject: Pregnancy Complications
                Subject: Birth
                Subject: Obstetrics and Gynecology
                Custom metadata
                Data Availability The authors confirm that, for approved reasons, some access restrictions apply to the data underlying the findings. Data is available from third party; the Swedish National Board of Health and Welfare and Statistics Sweden. According to Swedish law, the authors are not able to share the register data used in this study with other researchers. Any researcher interested in obtaining the data used can do so by formally applying to the Swedish National Board of Health and Welfare and Statistics Sweden after obtaining an ethical permission from a Regional Ethical Review board in Sweden.

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