Outcome of pregnancy in women requiring corticosteroids for severe asthma

doi:10.1016/S0091-6749(86)80088-4

Journal of Allergy and Clinical Immunology

Volume 78, Issue 2, August 1986, Pages 349-353

https://doi.org/10.1016/S0091-6749(86)80088-4 Get rights and content

We report on the outcome of 56 pregnancies in 51 women with severe asthma requiring prednisone and/or beclomethasone dipropionate. There were no malformations, neonatal deaths, or maternal deaths. The overall incidence of premature (<37 weeks gestational age) and low birth-weight infants (≤2500 gr) was slightly higher than would be expected in the general population. These findings appeared attributable in part to infants of gravidas whose asthma was complicated by emergency room visits or status asthmaticus. There was a statistically increased incidence of low birth weight and small size for gestational age infants in the eight infants born to women who experienced status asthmaticus when these infants were compared to the 41 infants born to women who did not require emergency room therapy or develop status asthmaticus. Our data confirm that prednisone and beclomethasone dipropionate are appropriate therapy for pregnant women with severe asthma and suggest that the prevention of status asthmaticus may result in a favorable outcome for the fetus. The current study confirms previous evaluations of pregnant women with severe asthma conducted by Northwestern University Allergy Service and extends the series to 171 pregnancies.

References (20)

GordonM et al.
Fetal morbidity following potentially anoxigeric obstetric conditions. VII. Bronchial Asthma
Am J Obstet Gynecol
(1970)
MoyaF et al.
Influence of maternal hyperventilation on the new born infant
Am J Obstet Gynecol
(1965)
RolfBB
Corticosteroids and pregnancy
Am J Obstet Gynecol
(1966)
YackelDB et al.
Adrenocorticosteroid therapy in pregnancy
Am J Obstet Gynecol
(1966)
WulfKH et al.
Clinical aspects of placental gas exchange
BhanaSL et al.
The course and outcome of pregnancy in women with bronchial asthma
Acta Allergol
(1972)
SchatzM et al.
Corticosteroid therapy for the pregnant asthmatic patient
JAMA
(1975)
GreenbergerPA et al.
Beclomethasone dipropionate for severe asthma during pregnancy
Ann Intern Med
(1983)
LoevyH et al.
Induced cleft palate development in mice: comparison between the effect of epinephrine and cortisone
Anat Rec
(1968)
MisenheimerHR et al.
Effects of vasoconstrictive drugs on the placental circulation of the rhesus monkey
Invest Radiol
(1972)

There are more references available in the full text version of this article.

Cited by (140)

Inhaled beclomethasone in pregnant asthmatic women - A systematic review
2014, Allergologia et Immunopathologia
Citation Excerpt :
Most articles discuss about the efficacy and safety of inhaled corticosteroids in general, which is a recurrent subject of research in this area.11,13–17 The first publications from the 1980s sought to evaluate the drug efficacy and safety in a period in which it had never been used in pregnant women.17,18 As a result, several case series studies emerged, which were important to suggest safety of using corticosteroids and to stimulate the emergence of new studies in the 1990s, at this time, more capable to evaluate risks and efficacy.14–16
The aim of this study was to systematically review the safety and efficacy of inhaled beclomethasone for asthma treatment in pregnant women. We performed a systematic review in Medline, LILACS and SciELO electronic databases in December 2012. A total of 3433 articles were found by using the keywords asthma, pregnancy and beclomethasone. Among these, 1666 were from Medline, via PubMed, and 1767 were from LILACS and SciELO. Nine of these articles were selected. Only one paper suggested an increased foetal risk for congenital malformations, and one other for offspring endocrine and metabolic disturbances. Data are mostly reassuring, supporting the use of glucocorticoid inhalants during pregnancy, and we found no evidence of inferiority in relation to efficacy and safety of beclomethasone compared to other drugs used in pregnant asthmatic women.
Adrenal disorders in pregnancy
2011, Endocrinology and Metabolism Clinics of North America
Asthma and pregnancy. Review of the current literature and management according to the GINA 2006-2007 guidelines
2011, Revue Francaise d'Allergologie
De nombreuses femmes enceintes sont asthmatiques et l’asthme maternel n’est pas sans susciter des questions ni provoquer des complications autant en ce qui concerne le deroulement de la grossesse elle-meme que l’impact sur le foetus. Le controle de l’asthme maternel est dans cette situation plus qu’indispensable d’autant plus que l’asthme peut s’aggraver pendant la grossesse, les exacerbations y sont possibles, favorisees par les baisses voire arrets de traitement par crainte de teratogenicite.
Meme si les medicaments utilises ne sont parfois pas denues de toxicite en cours de grossesse, leur utilisation raisonnee est validee par diverses etudes et recommandations. Nous proposons, afin d’aider les cliniciens confrontes a cette prise en charge delicate, une revue des complications engendrees par l’asthme maternel et les medicaments et ensuite des guides de prise en charge par paliers a la lumiere des recommandations les plus recentes.
Il convient d’expliquer les risques et les benefices des traitements de l’asthme dans le cadre d’un veritable partenariat, impliquant particulierement la patiente et ses medecins traitants et specialistes (obstetriciens et pneumologues, allergologues). Un bon controle de l’asthme est necessaire pour reduire le plus possible le taux des complications tant maternelles que foetales et les glucocorticoides inhales restent le traitement d’entretien de choix des asthmes partiellement ou non controles de la femme enceinte.
Many pregnant women are asthmatics and maternal asthma is a source of questions and complications concerning both the progress of the pregnancy itself and the impact on the foetus. In this situation good asthma control is essential as the disease can deteriorate with acute exacerbations, possibly precipitated by reduction or even withdrawal of treatment on account of fear of teratogenicity.
Even though asthma treatments are not totally harmless during pregnancy, their use has been validated by several studies and guidelines. To help clinicians, we undertake here a review of the complications induced by maternal asthma and its medications, and then suggest management guidelines according to the most recent publications.
The risks and benefits of asthma treatments should be explained in a real partnership between the patient and her general practitioner and specialists (obstetrician, chest physician or allergist). In order to reduce complications to both mother and child, perfect control of asthma is required and inhaled steroids remain the treatment of choice for partially or uncontrolled asthma in the pregnant woman.
Sex-specific differences in placental global gene expression in pregnancies complicated by asthma
2011, Placenta
Chronic maternal asthma is associated with reduced growth of the female fetus and normal growth of the male fetus. The mechanisms that control the differential effects of maternal asthma on the fetus have not been fully elucidated but alterations in placental function may play a role. In the current study we have used microarray platform to examine fetal sex-specific global changes in placental gene expression in pregnancies complicated by asthma as compared to non-asthmatic subjects.
Placental RNA was extracted from 11 control subjects and 38 asthmatic subjects. Labeled cDNA was hybridized to an oligonucleotide chip with 1700 double spotted well-characterized human genes. Global gene expression data analysis and visualization were performed using the Binary Tree-Structured Vector Quantization (BTSVQ) software. Functional relationships of differentially expressed genes were assessed using protein–protein interaction database I2D, network analysis and visualization software NAViGaTOR and Ingenuity Pathway Analysis software.
Overall, 65 genes were found to be altered in placentae of pregnancies complicated by asthma. Of these, only 6 genes were altered in male placentae. There were 59 gene changes in female placentae of asthmatic mothers relative to control placentae. Some of the sex-specific genes were associated with growth, inflammation and immune pathways.
There are sex-specific alterations in placental gene expression in the presence of maternal asthma. Given that many of the identified genes in the female placentae were associated with or involved in cellular growth and tissue development, these may contribute to the sexually dimorphic difference in fetal growth in response to maternal asthma.
Risk of perinatal mortality associated with inhaled corticosteroid use for the treatment of asthma during pregnancy
2010, Journal of Allergy and Clinical Immunology
Four studies investigating the association between inhaled corticosteroid (ICS) use during pregnancy and perinatal mortality reported no significantly increased risk. These studies must be interpreted with caution because they have insufficient statistical power and a lack of adjustment for potential confounders.
We sought to evaluate whether asthmatic women exposed to ICSs during pregnancy are more at risk of perinatal mortality than asthmatic women not exposed. We also sought to estimate the risk of perinatal mortality as a function of the daily ICS dose taken during pregnancy.
From the linkage of 3 administrative databases from Quebec, a cohort including 13,004 single pregnancies from asthmatic women was constructed. We used a 2-stage sampling cohort design to obtain information on cigarette smoking from the medical charts of 487 mothers. The final estimates of the odds ratios (ORs) of perinatal mortality were estimated with a logistic regression model.
The cohort was formed of 4,140 women who used greater than 0 to 250 μg/d ICS, 1,140 women who used greater than 250 μg/d ICS, and 7,724 nonusers of ICSs during pregnancy. Women exposed to ICSs (any dose) had a nonsignificant increased risk of perinatal mortality (OR, 1.07; 95% CI, 0.70-1.61). The use of greater than 250 μg/d ICS was associated with a nonsignificant 52% increased risk of perinatal mortality (OR, 1.52; 95% CI, 0.62-3.76).
The risk of perinatal mortality was not found to be significantly associated with ICS use during pregnancy. The result associated with higher doses of ICSs is limited due to a lack of statistical power and a possibility of residual confounding by asthma severity and control.
Effect of maternal moderate to severe asthma on perinatal outcomes
2010, Respiratory Medicine
Citation Excerpt :
Also, Jana et al. found a significantly higher incidence of LBW among infants of 15 mothers requiring as compared to 167 mothers not requiring emergency admission (53.3% vs. 20.5%; p < 0.01).18 Greenberg et al. and Fitzsimmons et al. have found a significant decrease in mean birth weight (ranging from 300 to 500 g) among women who were hospitalized for asthma during pregnancy.19,43 However, the lack of adjustment for any confounding variables including maternal smoking and also the use of a much stricter definition of severe asthma could explain the discrepancies between these studies and our study.
It has been reported that adverse fetal outcomes are more prevalent in pregnant women with asthma than they are in women without asthma. In our study, we investigated the effect that the severity of asthma during pregnancy has on the risk of a small for gestational age (SGA) infant, low birth weight (LBW), and preterm birth.
A population-based cohort of 13,007 pregnancies from asthmatic women was reconstructed through the linking of three of Quebec's (Canada) administrative databases covering the period between 1990 and 2002. A two-stage sampling cohort design was used to collect additional information on the selected women's life-style habits via a mailed questionnaire. Asthma severity during pregnancy was measured with a validated database index. A logistic regression model was used to obtain the adjusted odds ratios of SGA, LBW and preterm birth as a function of the level of asthma severity.
The proportions of women with mild, moderate and severe asthma were 82.5%, 12.5% and 5.0%, respectively. We sent 3,168 questionnaires to selected women, with a 40.2% (n = 1274) response rate. Final estimates showed that the risk of SGA was significantly higher among severe (OR:1.48, 95%CI: 1.15–1.91) and moderate asthmatic women (OR: 1.30, 95%CI:1.10–1.55) than mild asthmatic women. No significant associations were found between asthma severity, preterm birth and LBW.
Mothers with severe and moderate asthma during pregnancy have a higher risk of SGA babies than those with mild asthma.

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^*: Supported by United States Public Health Service Grant AI 11403 and the Ernest S. Bazley grant.

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Outcome of pregnancy in women requiring corticosteroids for severe asthma*

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Am J Obstet Gynecol

Clinical aspects of placental gas exchange

The course and outcome of pregnancy in women with bronchial asthma

Acta Allergol

Corticosteroid therapy for the pregnant asthmatic patient

JAMA

Beclomethasone dipropionate for severe asthma during pregnancy

Ann Intern Med

Induced cleft palate development in mice: comparison between the effect of epinephrine and cortisone

Anat Rec

Effects of vasoconstrictive drugs on the placental circulation of the rhesus monkey

Invest Radiol