Health care education, delivery, and qualityEffect of maternal asthma and asthma control on pregnancy and perinatal outcomes
Section snippets
Methods
We conducted a cohort study of 140,299 pregnancies among black or white women age 15 to 44 years enrolled in the Tennessee Medicaid program during the period 1995 to 2003 who had at least 180 days of continuous enrollment before their last menstrual period (LMP). These requirements captured 44% of deliveries to mothers enrolled in Medicaid and approximately 19% of all births to Tennessee residents during the 9 consecutive study years. Maternal race was available for all TennCare enrollees, and
Results
The study cohort included 83,008 (59.2%) white and 57,291 (40.8%) black pregnant women enrolled in the Tennessee Medicaid program (Table I). Black women were more likely to be unmarried and have an urban residence, and white women were more likely to be smokers. Overall, 9154 (6.5%) of women had asthma; white women (7.8%) were more likely than black women (4.6%) to be classified as having asthma. In addition, women with asthma were more likely to smoke and had more comorbidities than women
Discussion
Asthma is one of the most common conditions complicating pregnancy. In this population, 77% of women with asthma did not use asthma controller medications, 26% used excessive quantities of reliever medications (>30 days' supply during pregnancy), the ratio of reliever to controller medication dispensing events was 3.4:1, and 27% had an asthma-associated hospitalization or ED visit during pregnancy. We previously reported that there was a 23% decline in inhaled corticosteroid prescriptions in
References (33)
- et al.
Asthma prevalence among pregnant and childbearing-aged women in the United States: estimates from national health surveys
Ann Epidemiol
(2003) - et al.
Perinatal outcomes in women with asthma during pregnancy
Obstet Gynecol
(1998) - et al.
Maternal morbidity and perinatal outcomes among pregnant women with respiratory hospitalizations during influenza season
Am J Obstet Gynecol
(2003) - et al.
Maternal asthma and pregnancy outcomes: a retrospective cohort study
Am J Obstet Gynecol
(2001) - et al.
Adverse outcomes in pregnancies of asthmatic women: results from a Canadian population
Ann Epidemiol
(2001) - et al.
Asthma symptoms, severity, and drug therapy: a prospective study of effects on 2205 pregnancies
Obstet Gynecol
(2003) - et al.
Intrauterine growth is related to gestational pulmonary function in pregnant asthmatic women. Kaiser-Permanente Asthma and Pregnancy Study Group
Chest
(1990) - et al.
The relationship of asthma medication use to perinatal outcomes
J Allergy Clin Immunol
(2004) - et al.
Randomized trial of inhaled beclomethasone dipropionate versus theophylline for moderate asthma during pregnancy
Am J Obstet Gynecol
(2004) - et al.
Spirometry is related to perinatal outcomes in pregnant women with asthma
Am J Obstet Gynecol
(2006)
Cessation of asthma medication in early pregnancy
Am J Obstet Gynecol
Severity of asthma and perinatal outcome
Am J Obstet Gynecol
Risk of congenital malformations associated with treatment of asthma during early pregnancy
Lancet
Asthma education and outcomes for women of childbearing age
Case Manager
Surveillance for asthma: United States, 1960-1995
MMWR Surveill Summ
NAEPP expert panel report: managing asthma during pregnancy: recommendations for pharmacologic treatment: 2004 update
J Allergy Clin Immunol
Cited by (121)
Maternal asthma in relation to infant size and body composition
2023, Journal of Allergy and Clinical Immunology: GlobalImproving Asthma Outcomes During Pregnancy in Underserved Communities
2023, Immunology and Allergy Clinics of North AmericaCitation Excerpt :In the same data set, it was noted that maternal race did not change the relationship between maternal asthma and adverse pregnancy and perinatal outcomes. However, maternal asthma exacerbations were significantly more frequent in black women compared with white women despite lower rates of smoking in black women and similar rates of inhaled corticosteroid use.14 This higher rate of asthma exacerbation among minority women during pregnancy undoubtedly leads to more maternal and perinatal complications and is therefore critical to address.
Status Asthmaticus Gravidus: Emergency and Critical Care Management of Acute Severe Asthma During Pregnancy
2023, Immunology and Allergy Clinics of North AmericaThe obstetric aspects of maternal asthma
2022, Best Practice and Research: Clinical Obstetrics and GynaecologyDetermining the Clinical Course of Asthma in Pregnancy
2022, Journal of Allergy and Clinical Immunology: In PracticeCitation Excerpt :Two previous studies have reported that the first and last month of pregnancy are characterized by lack of exacerbations and fewer asthma symptoms.10,26 Because of differences in timing of study entry and exit, as well as increased risk of preterm birth among women with asthma and poor asthma control, the decrease in asthma symptoms observed toward the end of gestation should be interpreted with caution.27-31 Thus, we interpret our trajectories to suggest that respiratory and nighttime symptoms occur with increasing frequency across gestation, with the largest increases occurring around the start of the second trimester.
Supported in part by research grants UO1 HL 72471, MO1 RR00095, and KO8 AI01582, the Agency for Healthcare Research and Quality, Centers for Education and Research grant #U18-HS10384, GRECC Department of Veterans Affairs, and the Food and Drug Administration FD-U-000073.
Disclosure of potential conflict of interest: M. Griffin has consultant arrangements with Merck and has received research support from Pfizer and MedImmune. The rest of the authors have declared that they have no conflict of interest.