Prenatal Asthma Attacks Up

Complications for Mom and Baby

Veronica Hackethal, MD
December 03, 2019

  Asthma attacks during pregnancy may increase the risk for complications for
both the mother and child, according to a study published online November 26 in
the European Respiratory Journal.
The study included more than 100,000 pregnancies and found that children of
women who had asthma attacks during pregnancy were also at increased risk for
asthma and other respiratory problems in the first 5 years of life.

"Asthma is the most common chronic disease in pregnant women, affecting 8%-13% of
pregnant women worldwide," author Kawsari Abdullah, PhD, a research fellow at the
Children's Hospital of Eastern Ontario Research Institute in Ottawa, Canada, said in a
news release.

Abdullah was at the Hospital for Sick Children in Toronto when the study was being
conducted.
Almost 40% of women with asthma stop taking their asthma controller medications
during pregnancy out of concern that these medications may harm the fetus, according
to senior author Teresa To, PhD, also from The Hospital for Sick Children.

"[O]ur study indicates that severe asthma symptoms present the greater risk to mother
and baby," To said in the news release.

The researchers analyzed administrative data from the Ontario Asthma

Surveillance System and five other healthcare administrative databases. The study
included data from 103,424 singleton pregnancies in 58,524 women with asthma
between April 2003 and March 2012. Asthma exacerbations occurred in 2663 women
with asthma and a total of 4455 pregnancies.
The investigators defined asthma exacerbations as five or more physician visits,
one emergency department visit, or one hospital admission for asthma during
pregnancy. They adjusted results for mother's age, number of prior births, maternal
smoking during pregnancy, rural residence, socioeconomic status, the baby's sex, and
co morbidities.
Past studies have linked prenatal asthma attacks to serious complications in the
mother, including pregnancy-induced hypertension and preeclampsia.  If untreated, the
latter can lead to life-threatening eclampsia.
"Previous research has shown that 1 of every 3 pregnant women with asthma will suffer
severe symptoms, so we need to understand what this means for women and their
babies," Abdullah said.
Asthma attacks during pregnancy can also contribute to preterm delivery, low
birth weight in newborns, birth defects, and newborn death. Longer-term effects on
offspring may include increased risk for asthma, allergic rhinitis, and other lung or
allergic conditions.
Most of this evidence comes from small studies, however.

"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 5 years. Our results reinforce the findings of smaller studies that uncontrolled
asthma can be bad for mothers and their babies," To explained.

The study had several potential limitations. Because they lacked information on
the severity of asthma exacerbations and asthma medications, the researchers could
not evaluate their impact on mother and child. Although asthma medications such as
oral corticosteroids may contribute to adverse outcomes, the authors note that having a
severe asthma attack may pose a higher risk.

"This study does not explain why asthma attacks contribute to all these health issues,
but the likely mechanism is reduced oxygen supply for the mother and subsequently to
the baby in the
womb," Jørgen Vestbo, DrMedSci, FRCP FERS, FMedSci, said in a press release.

"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," Vestbo stressed.

The study was supported by the Institute for Clinical Evaluative Sciences, with an
annual grant from the Ontario Ministry of Health and Long-Term Care. The study
authors have disclosed no relevant financial relationships.

Eur Respir J. Published online November 26, 2019. Abstract

https://www.medscape.com/viewarticle/922084#vp_2