Adverse maternal outcomes in women with asthma versus women without asthma

doi:10.1016/j.apnr.2009.03.004

Applied Nursing Research

Volume 23, Issue 1, February 2010, Pages e9-e13

https://doi.org/10.1016/j.apnr.2009.03.004 Get rights and content

Abstract

The purpose of this retrospective cohort study was to examine differences in adverse maternal outcomes between pregnant women with asthma and pregnant women without asthma. A total of 7,777 pregnant patients with asthma were abstracted from a national database. The comparison group was 31,108 women, randomly selected from 541,719 pregnant women without asthma. Logistic regression was used to examine the relationship of asthma to 12 maternal outcome measures. Odds ratios were used to approximate the association of how much more likely pregnant women with asthma were to have adverse maternal outcomes. Pregnant women with asthma were more likely to have adverse maternal outcomes than did the pregnant women without asthma.

Introduction

Asthma is a “common, chronic disorder of the airways that is complex and characterized by variable and recurring airflow obstruction, bronchial hyperresponsiveness, and an underlying inflammation” (National Heart, Lung, and Blood Institute [NHLBI], 2007, p. 12). The Centers for Disease Control reported that, during the 3-year period from 2001 to 2003, the estimated number of persons in the United States with self-reported asthma during the preceding 12 months increased from approximately 6.8 million (3.1%) to 14.9 million (5.6%; Moorman et al., 2007). For the pregnant population, up to 8.4% of pregnancies may be affected by asthma, making it one of the most common medical complications of pregnancy (Kwon, Triche, Belanger, & Bracken, 2006). Although well-controlled asthma poses little to no risk to the fetus or mother, uncontrolled asthma during pregnancy may result in maternal hypoxemia and has been associated with adverse outcomes, such as premature delivery, low birth weight, fetal death, pregnancy-induced hypertension, hyperbilirubinemia, and an increased rate of operative delivery (MacMullen, Tymkow, & Shen, 2006).

Section snippets

Comparison studies

There are few studies that compare adverse maternal outcomes of pregnant women with asthma with nonpregnant women with asthma. Mabie, Barton, Wasserstrum, and Sabai (1992) reviewed the medical records of pregnant women with asthma and compared them with pregnant women without asthma in the general population and found that there was no increased rate of preterm delivery or low birth weight among the women with asthma versus the comparison group. However, the authors found that intrauterine

Purpose

The purpose of this study was to examine the relationship of asthma and adverse maternal outcomes among women with asthma and women who did not have asthma during their pregnancies.

Research question

Is there a relationship between asthma and adverse maternal outcomes in pregnant women with asthma compared with pregnant women without asthma?

Design

A retrospective cohort design was used. The design examined a potential association between the independent variable and the dependent variable but did not establish a causal relationship between the variables. Data were abstracted from the National Inpatient Sample (NIS) data set available through the Healthcare Cost and Utilization Project (HCUP), maintained and disseminated by the Agency for Healthcare Research and Quality (AHRQ). The unit of the NIS data was the inpatient care episode that

Results

Of the women who delivered in 2001, 1.4% had asthma. As shown in Table 1, the average ages at delivery were as follows: Women with asthma were 27 years old, and women without asthma were 27.4 years old. The women with asthma were predominately White (61.8%) and had private insurance (55.9%), whereas the percentage of women without asthma was 55.6%. The number of women who had comorbidities was small for both the group with asthma and group without asthma. The average length of stay for women

Discussion

The results showed that women with asthma experienced greater adverse pregnancy outcomes than did women without asthma, despite controlling for insurance status, maternal age, ethnicity, income level, and comorbidities. Pregnant women with asthma experienced more preterm labor, preeclampsia, gestational diabetes, premature rupture of membranes, hypertensive conditions (transient hypertension of pregnancy and pregnancy-induced hypertension), hemorrhages (placenta previa, abruptio placenta, and

Limitations

One limitation with the research is that the design is retrospective; therefore, the data obtained may be subject to error due to faulty recall of the respondents and potential errors in documentation of information. The data on severity of asthma, medication use, hospitalizations, emergency room visits, and asthma exacerbations were unavailable from the data set. Similar concerns were detailed in a study by Enriquez et al. (2007). Therefore, the results of the study were limited to indicating

Future studies

Future studies should continue to focus on comparing pregnant women with asthma, but the type of asthma should be included in the comparison, which would enable the researchers to determine if this affects outcome, a factor which this study did not address. Ideally, future studies should be prospective.

To facilitate prospective studies, researchers, who are interested in studying asthma in pregnancy, should establish trusting relationships with health care providers and form partnerships in a

Application to practice

Because the study results cited conclude that the severity of asthma is implicated in adverse maternal outcomes, the first step for nurses who work with pregnant patients is to be aware of the relationship between asthma to adverse maternal outcomes and to be vigilant in assessing the patient for potential risk factors such as smoking, respiratory infections, and other asthma triggers that lead to hypoxic episodes from a severe attack. The nurse should do a thorough patient and family history

Conclusion

Asthma during pregnancy may have adverse outcomes for the mother or fetus. The nurse plays a crucial role in preventing these outcomes by utilizing research and applying it when working with patients and family in concert with physicians, respiratory therapists, and other members of the health care team. This provides guidance, education, and support that will help pregnant women with asthma achieve the goal of a healthy pregnancy, delivery, and postpartum trajectory. Future studies by nurse

Callouts

1.
Asthma is potentially a serious complication of the perinatal period.
2.
A sample of 7,777 pregnant patients with asthma was abstracted from a national database.
3.
Research comparing pregnant patients with asthma with pregnant patients without asthma has been sparse.
4.
Pregnant women with asthma experienced greater adverse maternal outcomes than did nonpregnant women with asthma.

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Pregnancy outcomes in asthmatic women
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Clinical observations in asthma and pregnancy
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There are more references available in the full text version of this article.

Cited by (10)

Long-Acting β<inf>2</inf>-Agonists and Risk of Hypertensive Disorders of Pregnancy: A Cohort Study
2018, Journal of Allergy and Clinical Immunology: In Practice
Maternal asthma has been found to be associated with an increased risk of hypertensive disorders of pregnancy (HDP), that is, gestational hypertension, preeclampsia, and eclampsia. There is limited data, however, regarding the relationship between the use of long-acting beta-agonists (LABAs) during pregnancy and these outcomes.
To investigate whether exposure to a LABA in addition to an inhaled corticosteroid increases the risk of HDP or preeclampsia/eclampsia, as compared with nonexposure to LABAs, in pregnant women with asthma.
A cohort of 8,936 pregnancies in women with asthma who delivered between 1998 and 2010 was reconstructed using Quebec (Canada) health administrative databases. Cox proportional hazard regression models, adjusted for potential confounders, were used for statistical analyses. The primary exposure was LABA use (yes/no) measured on the first day of the 20th week of pregnancy. HDP were identified on the basis of recorded diagnoses and on prescriptions of antihypertensive drugs filled on or after the first day of week 20 of gestation.
There were 567 (6.3%) cases of HDP and 256 (2.9%) cases of preeclampsia/eclampsia in the cohort, and the rates of both disorders were similar in women exposed or not exposed to LABAs. LABA use was not associated with increased risks of HDP (adjusted hazard ratio, 0.96; 95% CI, 0.69-1.33) or preeclampsia/eclampsia (adjusted hazard ratio, 0.89; 95% CI, 0.53-1.50).
The results of this study provide evidence suggesting the safety of LABAs for the treatment of asthma in pregnancy, in terms of the risks of HDP and preeclampsia/eclampsia.
Does maternal asthma contribute to racial/ethnic disparities in obstetrical and neonatal complications?
2015, Annals of Epidemiology
Citation Excerpt :
Our clinical data do not allow for investigation of important social factors such as poverty in our analyses. The relationship between maternal asthma and obstetrical and neonatal outcomes has been widely studied, but differences across race/ethnicity have not been examined [3,5,14,31–39]. To the best of our knowledge, our study is the first to investigate the joint effects of maternal asthma by maternal race/ethnicity on the odds of obstetrical and neonatal complications.
To examine whether maternal asthma contributes to racial/ethnic differences in obstetrical and neonatal complications.
Data on white (n = 110,603), black (n = 50,284), and Hispanic (n = 38,831) singleton deliveries came from the Consortium on Safe Labor. Multilevel logistic regression models, with an interaction term for asthma and race/ethnicity, estimated within-group adjusted odds ratios (aORs) for gestational diabetes, gestational hypertension, pre-eclampsia, placental abruption, premature rupture of membranes, preterm delivery, maternal hemorrhage, neonatal intensive care unit admissions, small for gestational age, apnea, respiratory distress syndrome, transient tachypnea of the newborn, anemia, and hyperbilirubinemia after adjustment for clinical and demographic confounders. Nonasthmatics of the same racial/ethnic group were the reference group.
Compared with nonasthmatics, white asthmatics had increased odds of pre-eclampsia (aOR, 1.28; 95% confidence interval [CI], 1.15–1.43) and maternal hemorrhage (aOR, 1.14; 95% CI, 1.04–1.23). White and Hispanic infants were more likely to have neonatal intensive care unit admissions (aOR, 1.19; 95% CI, 1.11–1.28; aOR, 1.16; 95% CI, 1.02–1.32, respectively) and be small for gestational age (aOR, 1.11; 95% CI, 1.02–1.20; aOR, 1.26; 95% CI, 1.10–1.44, respectively), and Hispanic infants were more likely to have apnea (aOR, 1.32; 95% CI, 1.02–1.69).
Maternal asthma did not affect most obstetrical and neonatal complication risks within racial/ethnic groups. Despite their increased risk for both asthma and many complications, our findings for black women were null. Asthma did not contribute to racial/ethnic disparities in complications.
Asthma during pregnancy: Effects on fetal well-being, and maternal and perinatal complications
2013, Revista da Associacao Medica Brasileira
Avaliar os efeitos da asma materna sobre a gravidez, analisando as repercussões da gravidade da doença no comprometimento do bem-estar fetal, bem como as complicações maternas e perinatais associadas.
Foi realizado estudo retrospectivo de 117 gestações complicadas pela asma materna e sem outras comorbidades, no período de janeiro de 2005 a dezembro de 2010. Os critérios de inclusão foram: gestação única; diagnóstico de asma prévio à gestação; início do pré-natal antes da 28ª semana de gravidez; parto realizado na instituição; peso do recém-nascido acima de 500 g e idade gestacional no parto acima de 22 semanas; ausência de malformações fetais ou anomalias cromossômicas; ausência de comorbidades maternas. A gravidade da asma foi classificada em intermitente, persistente leve, persistente moderada, persistente grave. Foram analisados os resultados do perfil biofísico fetal e da dopplervelocimetria de artéria umbilical realizados até 14 dias antes do parto.
Do total de 117 gestantes asmáticas analisadas: 41 (35,0%) eram intermitentes, 33 (28,2%) persistentes leves, 21 (17,9%) persistentes moderadas e 22 (18,8%) persistentes graves. Não houve diferença significativa entre os grupos quanto ao tipo de parto: a cesárea foi realizada em 65,8% dos casos, a corticoterapia materna no momento do parto em 20,5%, a idade gestacional no parto apresentou média de 38,6 semanas (DP 1,9 semanas) e o peso ao nascimento apresentou média de 3056 g (DP 581 g). O perfil biofísico fetal realizado no período anteparto (n = 90, 76,9%) apresentou resultado normal (8 ou 10) em 99% dos casos. A dopplervelocimetria de artéria umbilical foi avaliada em 23,9% (n = 28) das gestantes, e apresentou-se normal em 100% dos casos. O uso de corticoterapia sistêmica foi significativamente (p < 0,001) diferente entre os grupos intermitente (4,9%) e persistente leve (9,1%), persistente moderada (28,6%), persistente grave (45,5%). Quanto ao início do parto, houve maior proporção de cesárea eletiva no grupo com asma persistente moderada (52,5%) e persistente grave (54,6%) quando comparados aos grupos intermitente (21,9%) e persistente leve (24,2%) (p = 0,039).
A gravidade da asma materna não parece influenciar diretamente os resultados perinatais e não compromete a vitalidade fetal. A conduta ativa proporcionando melhor quadro clínico materno promove evolução favorável para a gestação complicada pela asma.
To assess the effects of maternal asthma on pregnancy, analyzing the consequences of the severity of the disease in the impairment of fetal well-being, as well as the related maternal and perinatal complications.
A retrospective study with 117 pregnancies complicated by maternal asthma and with no other comorbidities, in the period from January, 2005 to December, 2010. Inclusion criteria were as follows: singleton pregnancy; pregnant women diagnosed with asthma prior to pregnancy; initiation of prenatal care before the 28^th week of pregnancy; birth at this institution; newborn weighing over 500 g and gestational age at delivery of 22 weeks or more; absence of fetal malformations or chromosomal abnormalities; absence of maternal comorbidities. Asthma was classified as intermittent, mild persistent, moderate persistent, or severe persistent. The results of fetal biophysical profile and of Doppler velocimetry of the umbilical artery performed 14 days prior to birth were analyzed.
Of the total of 117 pregnant women with asthma, 41 (35.0%) had intermittent, 33 (28.2%) mild persistent, 21 (17.9%) moderate persistent, and 22 (18.8%) severe persistent asthma. There was no significant difference among the groups as to the type of birth: cesarean section was performed in 65.8% of the cases, maternal corticosteroid therapy was used at the moment of birth in 20.5%, the gestational age at birth averaged 38.6 weeks (SD 1.9 weeks), and birth weight averaged 3,056 g (SD 581 g). The fetal biophysical profile performed during the antepartum period (n = 90, 76.9%) showed a normal result (8 or 10) in 99% of the cases. Doppler velocimetry of the umbilical artery was assessed in 23.9% (n = 28) of the pregnant women, and delivered normal results in 100% of the cases. The use of systemic corticosteroid therapy was significantly (p < 0.001) different among the intermittent (4.9%), mild persistent (9.1%), moderate persistent (28.6%), and severe persistent (45.5%) groups. Regarding the beginning of birth, there was a higher proportion of elective cesarean section in the groups with moderate persistent asthma (52.5%) and severe persistent (54.6%) when compared to the intermittent (21.9%) and mild persistent (24.2%) groups (p = 0.039).
The severity of maternal asthma does not appear to have any direct influence on perinatal outcomes, and does not compromise fetal well-being. Active conduct to enable a better maternal clinical condition provides a favorable prognosis for pregnancy complicated by asthma.
Asthma in Pregnancy
2011, Clinics in Chest Medicine
Citation Excerpt :
However, many large studies have examined this outcome, along with others, and have concluded that there is no increased risk in women with asthma.21,23,25,38,59,66,72–74 Some studies62,65,69,76 did find an increased risk of gestational diabetes, and in one of these the increased risk occurred in oral steroid–dependent asthmatics only.76 Many studies of both prospective and retrospective design have concluded that maternal asthma is a risk factor for delivery by cesarean (C) section.4,25,61,62,64,65,69,72,74,76,81–83
Maternal asthma and the risk of hypertensive disorders of pregnancy: a systematic review and meta-analysis of cohort studies
2020, Hypertension in Pregnancy
Exacerbations of asthma during pregnancy: Impact on pregnancy complications and outcome
2016, Journal of Obstetrics and Gynaecology

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Adverse maternal outcomes in women with asthma versus women without asthma

Abstract

Introduction

Section snippets

Comparison studies

Purpose

Research question

Design

Results

Discussion

Limitations

Future studies

Application to practice

Conclusion

Callouts

Journal of Allergy and Clinical Immunology

Immunology and Allergy Clinics of North America

American Journal of Obstetrics and Gynecology

Asthma in pregnancy. ACOG practice bulletin. Clinical management guidelines for obstetrician-gynecologists

Obstetrics & Gynecology

Applied logistic regression

Pregnancy outcomes in asthmatic women

Iranian Journal of Allergy Asthma and Immunology

Clinical observations in asthma and pregnancy

Journal of Maternal Fetal Medicine