Asthma exacerbations during pregnancy are associated with adverse pregnancy outcomes.
The aim of this study was to establish factors associated with asthma exacerbations during pregnancy.
Data were obtained from three cohorts of pregnant women with asthma recruited in Eastern Australia (2004-2019, n=1461). Severe exacerbations were defined as episodes of asthma requiring hospitalization, an emergency department visit, or prescription of oral corticosteroids after enrollment. Baseline information on potential risk factors included demographic characteristics, asthma characteristics (e.g. lung function, asthma triggers, asthma control, medication use), pregnancy factors (e.g. fetal sex, parity, antenatal care type), and other maternal factors (body mass index, smoking status, mental health). Backwards stepwise logistic regression and Akaike’s Information Criterion were used to determine the best fitting model.
One hundred thirty-five (9.2%) participants experienced a severe exacerbation during pregnancy. Medium/high ICS dose was most strongly associated with severe asthma exacerbations (adjusted odds ratio: 3.20, 95% confidence interval 1.85-5.53). Worse asthma control, possession of a written action plan, and a history of asthma exacerbations in the year preceding pregnancy were associated with an increased rate of exacerbations.
Asthma exacerbations before pregnancy and more severe asthma at the beginning of pregnancy were associated with an increased rate of exacerbations during pregnancy. Despite GINA step 3 and 4 treatment and optimal management including a written asthma action plan, a significant asthma burden remains present in a group of women at high risk for severe exacerbations in pregnancy.
Copyright © 2021. Published by Elsevier Inc.
Factors associated with asthma exacerbations during pregnancy.
