Elsevier

Obstetrics & Gynecology

Volume 102, Issue 4, October 2003, Pages 739-752
Obstetrics & Gynecology

Original research
Asthma symptoms, severity, and drug therapy: a prospective study of effects on 2205 pregnancies

https://doi.org/10.1016/S0029-7844(03)00621-5Get rights and content

Abstract

Objective

To prospectively examine in pregnant women whether asthma or asthma therapy influenced preterm delivery, intrauterine grown restriction (IUGR), or birthweight.

Methods

We enrolled 873 pregnant women with a history of asthma, of whom 778 experienced asthma symptoms or took medication, and 1333 women with no asthma history, including 884 women with neither asthma diagnosis nor symptoms and 449 with symptoms but no diagnosis. Asthma symptoms, medication, and severity were classified according to 2002 Global Initiative for Asthma guidelines.

Results

Preterm delivery was not associated with asthma diagnosis, severity, or symptoms but was associated with use of controller medications, independent of symptoms, specifically oral steroids and theophylline. Gestation was reduced by 2.22 weeks in women using oral steroids daily (P = .001) and 1.11 weeks after theophylline (P = .002). We observed a 24% (5–47%) increased risk for IUGR with each increased symptom step, which increased further in symptomatic women with no asthma diagnosis (31%, 4–65%) compared with women with neither asthma nor symptoms.

Conclusion

We found no effect of asthma symptoms or severity on preterm delivery but observed increased risks associated with use of oral steroid and theophylline. Intrauterine growth restriction was associated with asthma severity, which possibly reflects a hypoxic fetal effect. Women with asthma symptoms but no diagnosis were at particular risk of undermedication and delivering IUGR infants. These observations support guidelines that advocate active management of pregnant patients with mild or moderate asthma with β2 agonists, with oral steroids added only if severity increases. Symptomatic patients without an asthma diagnosis might need to be equally managed.

Section snippets

Materials and methods

Pregnant women were recruited from 56 obstetric practices and 15 clinics associated with six hospitals in Connecticut and Massachusetts. Exclusion criteria included being more than 24 weeks pregnant at interview, having insulin-dependent diabetes mellitus, not speaking English or Spanish, and intending to terminate the pregnancy.

Between April 1997 and June 2000, 11,484 women were screened for eligibility; all women with a history of physician-diagnosed asthma (n = 1343) and a simple random

Results

The distribution of study population characteristics by asthma status is shown in Table 1. rate than expected in the general pregnant population. The largest proportion of women had no asthma symptoms or treatment during their pregnancy (44.4%), one third (32.2%) had intermittent asthma, and almost a quarter of women (23.4%) were in higher-severity groups. Having an asthma diagnosis and having more severe asthma symptoms and treatment during pregnancy seems related to younger age, not being

Discussion

This study examines the independent associations of asthma diagnosis, severity, symptoms, treatment, and medication type with two different perinatal outcomes (preterm delivery and fetal growth assessed by IUGR). We found a modest increased risk of preterm delivery in women with an asthma diagnosis, but this was not distinguishable from chance when other risk factors were considered. No evidence of a relationship between preterm delivery and asthma symptoms or severity was observed.

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    This work was supported by grants AI41040 and DA05484 from the National Institutes of Health.

    The authors thank the following for providing patient access to this study: Baystate Health System, Massachusetts: R. Burkman, MD, K. Troczynski, RN, P. O'Grady, MD; Bridgeport Hospital, Connecticut: E. Luchansky, MD, I. San Pietro, J. Collins, R. Torres, C. Presnick; Danbury Hospital, Connecticut: L. Silberman, MD; Hartford Hospital, Connecticut: S. Curry, MD, C. Mellon, MS; St. Raphael Hospital, Connecticut: W. Reguero, MD, B. McDowell, MD; Yale-New Haven Hospital, Connecticut: J. Coppel, MD, A. Somsel, S. Updegrove, MD, as well as many others in labor and delivery and neonatology in these hospitals. We also recognize the assistance of numerous staff at 56 private obstetric practices affiliated with the hospitals.

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