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Developmental Biology - Asthma

Uncontrolled Asthma In Pregnancy

Uncontrolled asthma attacks during pregnancy increase health risks for mother and baby...

Women with asthma who suffer severe symptoms while they are pregnant face higher risks of health problems both for themselves and their babies compared to women with well-controlled asthma, according to research published in the European Respiratory Journal.

The study, which included data on more than 100,000 pregnancies, showed that women with asthma who experienced severe symptoms were more likely to suffer with high blood pressure (known as pregnancy-induced hypertension) and a potentially serious condition called pre-eclampsia.
Babies born to women who suffered asthma attacks were at greater risk of having a low birth weight, being born prematurely or with a congenital abnormality, such as a heart defect or cleft lip. The children's risk of having asthma and pneumonia was also higher in the first five years of life.

Researchers believe these findings are important as a large proportion of women with asthma are known to decrease or stop taking asthma medication during pregnancy.

The research was led by Kawsari Abdullah PhD, currently a research fellow at the Children's Hospital of Eastern Ontario, Research Institute in Ottawa, Canada. While conducting the study, Dr Abdullah was working at The Hospital for Sick Children (SickKids) in the Child Health Evaluative Sciences (CHES) Program, in Toronto, Canada.
"Asthma is the most common chronic disease in pregnant women, affecting 8-13% of pregnant women worldwide. If asthma is poorly controlled, patients can suffer with severe symptoms such as wheezing, coughing, or feeling breathless or tight-chested.

Previous research has shown that one out of every three pregnant women with asthma will suffer severe symptoms, so we need to understand what this means for women and their babies."

Kawsari Abdullah PhD, Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Canada Emergency Medicine, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Canada.

Abdullah and her colleagues studied 103,424 pregnancies in 58,524 women with asthma living in the province of Ontario in Canada between April 2003 and March 2012. This included 4,455 pregnancies in 2,663 women who experienced severe symptoms while pregnant. This means the women either visited their doctor at least five times because of their asthma symptoms, or went to the emergency department or were admitted to hospital at least once for asthma during pregnancy.

Researchers took account of other factors that can influence the health of the mother and baby, including the mother's age, whether she had been pregnant before, whether she smoked and her socioeconomic status. Comparing pregnant women with asthma who had experienced severe symptoms to pregnant women whose asthma was well-controlled, researchers found those who had asthma attacks were around 30% more likely to suffer with pre-eclampsia and around 17% more likely to suffer with high blood pressure during pregnancy.

Their results showed that babies born to mothers who had asthma attacks while pregnant were around 14% more likely to have a low birth weight, also around 14% more likely to be born prematurely, and around 21% more likely to have a congenital abnormality.
Children's risk of asthma up to the age of five years was 23% higher if their mother had experienced severe asthma symptoms in pregnancy, and their risk of pneumonia was around 12% higher.

According to Teresa To, senior researcher on the study and senior scientist at SickKids: "This is the biggest study looking at the risks associated with severe asthma symptoms in pregnancy and it's also the first to show the longer-term impacts on children up to the age of five years. Our results reinforce the findings of smaller studies that uncontrolled asthma can be bad for mothers and their babies.

"Nearly 40% of pregnant women decrease or stop taking asthma medication because they are worried that it could be harmful to their unborn babies. However, our study indicates that severe asthma symptoms present the greater risk to mother and baby. Although this study does not explain why asthma attacks contribute to all these health issues, the likely mechanism is reduced oxygen supply for the mother and subsequently to the baby in the womb."
"This large and important study suggests that asthma that is not well controlled may have serious effects on pregnant women and their children. This highlights the importance of carefully maintaining asthma control and managing asthma symptoms during pregnancy. Pregnant women who have asthma need regular antenatal care to discuss their symptoms and ensure their medication is effective."s

Professor Jørgen Vestbo PhD, Chair, European Respiratory Society's Advocacy Council, University of Manchester. Prof Vestbo was not involved in the study.

The association between asthma exacerbation (AE) during pregnancy and adverse maternal and child health outcomes have not been appropriately investigated. Our objective was to determine the short- and long-term intergenerational effect of AE in pregnant women with asthma.

A population cohort study was conducted using data from the Ontario asthma surveillance system and population-level health administrative data. AE in pregnant women with asthma was defined as at least one of the following criteria: >=5 physician visits, or 1 emergency department visit, or 1 hospital admission for asthma during pregnancy. Pregnancy complications, adverse perinatal outcomes, and early childhood respiratory disorders were identified using ICD codes 9th and 10th Revisions.

The cohort consisted of 103?424 singleton pregnancies in women with asthma. AE in pregnant women with asthma was associated with higher odds of preeclampsia (OR 1.30; 95% CI 1.12, 1.51), and pregnancy induced hypertension (OR 1.17; 95% CI 1.02, 1.33); babies had higher odds of low birth weight (OR 1.14; 95% CI 1.00, 1.31), being pre-term (OR 1.14; 95% CI 1.01, 1.29), and congenital malformations (OR 1.21; 95% CI 1.05, 1.39). Children born to women with AE during pregnancy had elevated risk of asthma (OR 1.23; 95% CI 1.13, 1.33) and pneumonia (OR 1.12; 95% CI 1.03, 1.22) during first 5 years of life.

AE during pregnancy in women with asthma showed increased risk of pregnancy complications, adverse perinatal outcomes and early childhood respiratory disorders in their children, indicating appropriate asthma management may reduce the risk of adverse health outcomes.

Kawsari Abdullah, Jingqin Zhu, Andrea Gershon, Sharon Dell and Teresa To.

This research was funded through the Biosphere Evolution, Transitions and Resilience (BETR) programme, which is co-funded by the Natural Environment Research Council (NERC) and Natural Science Foundation of China (NSFC).

Author Contributions
M.B.F. and F.C.-H. designed experiments. F.C.-H. performed experiments and data analysis.

Declaration of Interests
The authors declare no competing interest.

The research was supported by the National Institutes of Health (NIH F31EY028022-03, RO1EY019498, RO1EY013528, P30EY003176).

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Dec 5 2019   Fetal Timeline   Maternal Timeline   News 

Asthma is one of the most common medical problems that occurs during pregnancy. It can be potentially serious. Some studies have suggested that asthma complicates up to 7% of all pregnancies. CREDIT Asthma and Allergy Foundation of America.

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