Asthma attack during pregnancy may foretell adverse outcomes for maternal and child health

Children of women who had asthma exacerbations during pregnancy were more likely have respiratory disorders such as asthma and pneumonia than those whose mothers did not — suggesting that the effects of asthma exacerbations during pregnancy may transcend generations, a study finds. This was in addition to having an increased risk of adverse pregnancy and perinatal outcomes.

“[Previous] evidence has found that one in three women with asthma suffer from exacerbation during pregnancy,” said the researchers. “Considering the high incidence of asthma exacerbation during pregnancy and the tendency of women to stop taking asthma medication during pregnancy, it is important to examine the possible short and long-term impact of this dangerous health condition.”

The longitudinal population-based cohort study involved 103,424 women with asthma who had singleton pregnancies in the OASIS* health database. Women who fulfilled at least one of the following criteria during pregnancy was considered to have asthma exacerbations: ≥5 physician visits, or one emergency department visit, or one hospital admission for asthma. [Eur Respir J 2019;doi:10.1183/13993003.01335-2019]

Compared with women who did not have asthma exacerbations during pregnancy, those who did were 30 percent more likely to have preeclampsia (5.32 percent vs 3.84 percent; odds ratio [OR], 1.30; p<0.001) and 14 percent more likely to have pregnancy-induced hypertension (PIH; 7 percent vs 5.37 percent; OR, 1.14; p<0.001).

In terms of perinatal outcomes, infants born to mothers who had asthma exacerbations during pregnancy had 14 percent higher risk of being low birth weight (OR, 1.14, 95 percent confidence interval [CI], 1.00–1.31) and preterm (OR, 1.14, 95 percent CI, 1.01–1.29), compared with infants whose mothers did not have asthma exacerbations during pregnancy. Asthma exacerbations during pregnancy was also associated with a 21 percent increased risk of the infants having congenital malformations (OR, 1.21, 95 percent CI, 1.05–1.39).

In the longer-term follow-up of up to 5 years, children of mothers with asthma exacerbations during pregnancy had 23 percent greater risk of having asthma (OR, 1.23, 95 percent CI, 1.13–1.33) and 12 percent increased risk of having pneumonia (OR, 1.12, 95 percent CI, 1.03–1.22) than those whose mothers did not.

“Our study is the first to show the intergenerational impact of asthma exacerbations during pregnancy by following babies born to women with asthma up to their 5 years of age and evaluating the impact of asthma exacerbations during pregnancy on early childhood respiratory health,” said the researchers.

“Targeting women with asthma during pregnancy and ensuring appropriate asthma management and postpartum follow-up may help to reduce the risk of pregnancy complications, adverse perinatal outcomes and early childhood respiratory disorders,” they added.

According to the authors, the results were consistent with previous findings from systematic review which included mostly studies with small cohorts.

Unlike previous studies, the current analysis compared those who had exacerbations vs those who did not during pregnancy among women with asthma, and thus, “denote the impact of asthma exacerbations during pregnancy, as opposed to the impact of asthma”.

“The key priority in asthma management during pregnancy is maintenance of optimal asthma control,” the researcher stated.