RT Journal Article
SR Electronic
T1 Effect of Maternal Asthma Exacerbations on Perinatal Outcomes: A Population-based Study
JF ERJ Open Research
JO erjor
FD European Respiratory Society
SP 00295-2020
DO 10.1183/23120541.00295-2020
A1 Annelies L. Robijn
A1 Bronwyn K. Brew
A1 Megan E. Jensen
A1 Gustaf Rejnö
A1 Cecilia Lundholm
A1 Vanessa E. Murphy
A1 Catarina Almqvist
YR 2020
UL http://openres.ersjournals.com/content/early/2020/09/17/23120541.00295-2020.abstract
AB Background Although there is a growing body of literature about the impact of asthma exacerbations during pregnancy on adverse perinatal outcomes, it is still unclear whether asthma exacerbations themselves or asthma severity are the driving factor for negative outcomes. This study aimed to estimate the associations between maternal asthma exacerbations and perinatal outcomes; and whether this differed by asthma treatment regime as a proxy for severity.Methods We included births of women with asthma in Sweden from July 2006-November 2013 (N=33 829). Asthma exacerbations were defined as unplanned emergency visits/hospitalisations, or a short course of oral corticosteroids. Adjusted odds ratios (aOR) were estimated for the associations between exacerbations during pregnancy and perinatal outcomes (small for gestational age (SGA), preterm birth, birth weight and mode of delivery), stratified by pre-conception treatment regime.Results Exacerbations occurred in 1430 (4.2%) pregnancies. Exacerbations were associated with reduced birth weight (aOR 1.45, 95%CI 1.24–1.70), and elective (aOR 1.50, 95%CI 1.25–1.79) and emergency caesarean section (aOR 1.35, 95%CI 1.13–1.61). Multiple exacerbations were associated with a 2.6-fold increased odds of SGA (95%CI 1.38–4.82). Amongst women treated pre-pregnancy with combination therapy (proxy for moderate-severe asthma), exacerbators were at increased odds of elective (aOR 1.69, 95%CI 1.30–2.2) and emergency (aOR 1.62, 95%CI 1.26–2.08) caesarean section; and SGA (aOR 1.74, 95%CI 1.18–2.57) versus non-exacerbators.Conclusion Maternal asthma exacerbations increase the risk of SGA and caesarean sections, particularly in women with multiple exacerbations or moderate-severe asthma. Adequate antenatal asthma care is needed to reduce exacerbations and reduce risks of poor outcomes.FootnotesThis manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.Conflict of interest: A.L. Robijn reports a Short-Term Research Fellowship from the European Respiratory Society during the conduct of the study.Conflict of interest: Dr. Brew has nothing to disclose.Conflict of interest: Dr. Jensen has nothing to disclose.Conflict of interest: Dr. Rejnö has nothing to disclose.Conflict of interest: Dr. Lundholm has nothing to disclose.Conflict of interest: Dr. Murphy has nothing to disclose.Conflict of interest: Dr. Almqvist reports grants from Swedish Research Council, from Swedish Heart-Lung Foundation, from Swedish Research Council for Health, Working Life and Welfare (FORTE), during the conduct of the study.