Asthma medication use in pregnancy and fetal growth

doi:10.1016/j.jaci.2005.05.027

Journal of Allergy and Clinical Immunology

Volume 116, Issue 3, September 2005, Pages 503-509

https://doi.org/10.1016/j.jaci.2005.05.027 Get rights and content

Background

Given the high prevalence of asthma in pregnancy, it is important to understand the relationship between asthma medications and fetal growth in the context of appropriate treatment.

Objective

This study examines the effect of inhaled corticosteroids, systemic corticosteroids, and β₂-agonists on fetal growth in 654 infants born to women with asthma compared with 303 infants born to controls without asthma.

Methods

Subjects for this prospective study were enrolled throughout North America between 1998 and 2003 and followed up by the Organization of Teratology Information Services. Incidence of small for gestational age (SGA) infants and mean birth size measures were compared among groups.

Results

Mean birth weight of full-term infants born to mothers who used systemic corticosteroids (3373 g) was lower than in the β₂-agonist group (3552 g) and controls without asthma (3540 g; P < .05) after adjustment for other risk factors. However, no differences in the incidence of SGA for weight were observed among groups. Adjusted mean birth length was slightly shorter in the systemic steroid group compared with controls (P = .02). Incidence of SGA for length and head circumference and mean head circumference did not vary among groups (P > .05).

Conclusion

The treatment of asthma with systemic corticosteroids resulted in a deficit of about 200 g in birth weight compared with controls and exclusive β₂-agonist users and no increased incidence of SGA. These results suggest that asthma management with β₂-agonists and/or inhaled corticosteroids during pregnancy does not impair fetal growth, whereas systemic corticosteroids have a minimal effect which should be weighed against the necessity to control severe asthma.

Section snippets

Study population

Subjects were participants in a prospective multicenter controlled cohort study of asthma medication use in pregnancy conducted between 1998 and 2003 by the Organization of Teratology Information Services (OTIS). The methodology of the OTIS Asthma Medications in Pregnancy Project has been described elsewhere.²² Briefly, pregnant women across North America with a current diagnosis of asthma, regardless of medications used or frequency of treatment, were eligible to enroll. Pregnant women who did

Results

In the β₂-agonist group, 96.1% of women used albuterol, 10.7% salmeterol, 4.9% terbutaline, 1.0% pirbuterol, 1.0% formoterol, and 1.0% fenoterol. In the ICS group, 53.2% of women used fluticasone, 29.9% beclomethasone, 21.9% budesonide, 13.0% triamcinolone acetonide, and 3.0% flunisolide. The majority of women in the systemic corticosteroid group used prednisone (92.9%), 6.2% methylprednisolone, and 0.9% dexamethasone. Most women in the ICS and systemic corticosteroid groups (94.7%) also used β₂

Discussion

Results of this study demonstrate that use of β₂-agonists or ICSs for treatment of asthma during pregnancy does not impair any parameters of fetal growth compared with controls without asthma. A small decrease of approximately 200 g in birth weight was observed among infants born to women who used systemic corticosteroids any time during pregnancy relative to exclusive β₂-agonist users and to controls without asthma. Mean birth length of full-term infants in the systemic corticosteroid group

References (42)

H.L. Kwon et al.
Asthma prevalence among pregnant and childbearing-aged women in the United States: estimates from national health surveys
Ann Epidemiol
(2003)
J.H. Perlow et al.
Severity of asthma and perinatal outcome
Am J Obstet Gynecol
(1992)
K.S. Tan et al.
Asthma in pregnancy
Am J Med
(2000)
M. Schatz
The efficacy and safety of asthma medications during pregnancy
Semin Perinatol
(2001)
S. Liu et al.
Maternal asthma and pregnancy outcomes: a retrospective cohort study
Am J Obstet Gynecol
(2001)
T.K. Sorensen et al.
Maternal asthma and risk of preterm delivery
Ann Epidemiol
(2003)
A.T. Luskin
An overview of the recommendations of the Working Group on Asthma and Pregnancy. National Asthma Education and Prevention Program
J Allergy Clin Immunol
(1999)
M. Schatz et al.
Intrauterine growth is related to gestational pulmonary function in pregnant asthmatic women. Kaiser-Permanente Asthma and Pregnancy Study Group
Chest
(1990)
M. Schatz et al.
The safety of inhaled beta-agonist bronchodilators during pregnancy
J Allergy Clin Immunol
(1988)
M. Schatz et al.
The safety of asthma and allergy medications during pregnancy
J Allergy Clin Immunol
(1997)

M. Schatz

Asthma during pregnancy: interrelationships and management

Ann Allergy

(1992)

Cited by (112)

Chronic Management of Asthma During Pregnancy
2023, Immunology and Allergy Clinics of North America
Use of Asthma Medication During Gestation and Risk of Specific Congenital Anomalies
2023, Immunology and Allergy Clinics of North America
The obstetric aspects of maternal asthma
2022, Best Practice and Research: Clinical Obstetrics and Gynaecology
Asthma is the commonest chronic medical condition encountered in pregnancy. Poor asthma control and exacerbations are frequently encountered due to treatment non-adherence, pregnancy-related aggravating factors such as increased susceptibility to viral infections, and comorbidities that are commonly associated. Asthma-related inflammatory reactions and placental effects, the effect of medications, and respiratory symptoms and hypoxia are probably to interact to result in an increased adverse obstetric outcomes including miscarriage, foetal congenital anomalies, pregnancy hypertensive disorders, gestational diabetes, preterm labour and birth, antepartum haemorrhage, low birthweight and foetal growth restriction (FGR), caesarean delivery, postpartum haemorrhage (PPH), maternal intensive care admission, and even mortality, while the offspring also has increased long-term morbidity. Interdisciplinary management with frequent assessment by symptoms, spirometry, and biomarkers, together with removal of risk factors such as smoking and appropriate instigation of treatment including short courses of systemic corticosteroid, could ensure optimal and tailored treatment to control symptoms, prevent exacerbations, and ultimately enhancing maternal and perinatal outcomes.
Women with Rheumatoid Arthritis have similar rates of postpartum maternal outcomes compared to women without autoimmune disease
2022, Seminars in Arthritis and Rheumatism
Limited data exist on the effect of rheumatoid arthritis (RA) on maternal postpartum outcomes. Using a real-world, electronic health record (EHR) cohort, we assessed maternal postpartum outcomes in RA.
In a large, de-identified EHR, we identified possible RA deliveries using ≥1 delivery ICD-9 or ICD-10-CM codes and a validated RA algorithm. RA cases were required to be diagnosed by a rheumatologist on chart review. Maternal postpartum outcomes included rates of blood transfusion, rates of infection up to 6 weeks postpartum defined by a clinician, and length of hospital stay. We also identified deliveries to women without autoimmune diseases.
We identified 202 deliveries occurring after RA diagnosis and 596 deliveries to controls without autoimmune diseases. Postpartum infection rates were similar among RA patients and controls (8% vs. 4%, p = 0.10), as were red blood cell transfusion rates (2% vs. 2%, p = 1.00). RA case status was not significantly associated with postpartum infection (OR = 2.10, 95% CI 0.88 – 4.98, p = 0.09) but was significantly associated with preterm birth (OR = 2.11, 95% CI 1.38 – 3.23, p = 0.001). Corticosteroid use during pregnancy was common at 41%, while tumor necrosis factor inhibitor use was 13%. After adjusting for age at delivery and race, corticosteroid use at delivery was not associated with postpartum maternal infections but was associated with a significantly lower birthweight in RA cases.
Women with RA have an increased risk of adverse pregnancy outcomes, particularly preterm birth. Our study highlights, however, that maternal postpartum outcomes such as postpartum infection and blood transfusion are not significantly increased in RA patients.
The management of asthma during pregnancy
2021, Clinical Pharmacology During Pregnancy
Asthma is one of the most common potentially serious medical problems to complicate pregnancy, and may adversely affect both maternal quality of life and perinatal outcomes. Optimal management of asthma during pregnancy is thus important for both mother and baby. While the management of asthma in pregnancy relies on guidelines that were based on studies of nonpregnant populations, special considerations regarding the safety of medications are required.
Oral Corticosteroids and Risk of Preterm Birth in the California Medicaid Program
2021, Journal of Allergy and Clinical Immunology: In Practice
There is limited information regarding the impact of dose and gestational timing of oral corticosteroid (OCS) use on preterm birth (PTB), especially among women with asthma.
To evaluate OCS dose and timing on PTB for asthma and, as a comparison, systemic lupus erythematosus (SLE).
We used health care data from California Medicaid enrollees linked to birth certificates (2007-2013), identifying women with asthma (n = 22,084) and SLE (n = 1174). We estimated risk ratios (RR) for OCS cumulative dose trajectories and other disease-related medications before gestational day 140 and hazard ratios (HR) for time-varying exposures after day 139.
For asthma, PTB risk was 14.0% for no OCS exposure and 14.3%, 16.8%, 20.5%, and 32.7% in low, medium, medium-high, and high cumulative dose trajectory groups, respectively, during the first 139 days. The high-dose group remained associated with PTB after adjustment (adjusted RR [aRR]: 1.46; 95% confidence interval [CI]: 1.00, 2.15). OCS dose after day 139 was not clearly associated with PTB, nor were controller medications. For SLE, PTB risk for no OCS exposure was 24.9%, and it was 39.1% in low- and 61.2% in high-dose trajectory groups. aRR were 1.80 (95% CI: 1.34, 2.40) for high and 1.24 (95% CI: 0.97, 1.58) for low groups. Only prednisone equivalent dose >20 mg/day after day 139 was associated with increased PTB (adjusted HR: 2.54; 95% CI: 1.60, 4.03).
For asthma, higher OCS doses early in pregnancy, but not later, were associated with increased PTB. For SLE, higher doses early and later in pregnancy were associated with PTB.

View all citing articles on Scopus

: Disclosure of potential conflict of interest: L. Bakhireva, none disclosed; K. L. Jones, none disclosed; M. Schatz received grants/research support from GlaxoSmithKline and serves on the speakers' bureau for AstraZeneca and Merck; D. Johnson, none disclosed; C. Chambers, none disclosed.

View full text

Asthma diagnosis and treatmentAsthma medication use in pregnancy and fetal growth

Background

Objective

Methods

Results

Conclusion

Section snippets

Study population

Results

Discussion

Ann Epidemiol

Am J Obstet Gynecol

Am J Med

Semin Perinatol

Am J Obstet Gynecol

Ann Epidemiol

J Allergy Clin Immunol

Chest

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Obstet Gynecol

J Allergy Clin Immunol

Semin Neonatol

J Allergy Clin Immunol

Chest

J Allergy Clin Immunol

Infant and maternal outcomes in the pregnancies of asthmatic women

Am J Respir Crit Care Med

Asthma during pregnancy: interrelationships and management

Ann Allergy

Asthma diagnosis and treatment
Asthma medication use in pregnancy and fetal growth