Call for improved antenatal asthma management
medwireNews: The results of a study in South Australia show that maternal asthma significantly and independently increases the risk for perinatal complications, such as premature birth, gestational diabetes, and small for gestational age (SGA) birthweight.
“These results clearly indicate that asthma, independent of maternal smoking during pregnancy, low SES [socioeconomic status] or pre-existing conditions, adversely affects both maternal and neonatal pregnancy outcomes,” say Vicki Clifton and team from the University of Adelaide.
“This data has important clinical implications, suggesting that the appropriate antenatal management (and control) of asthma during pregnancy has the potential to reduce rates of adverse pregnancy outcomes.”
They assessed data on 172,305 singleton births in the state between 1999 and 2008. Maternal asthma was reported for 11,512 (6.7%) of all births and, consistent with previous findings, one-quarter of these pregnancies were associated with maternal smoking compared with 17% of non-asthmatic pregnancies.
The team, writing in the European Respiratory Journal, found that asthma was independently associated with a number of poor maternal outcomes. Patients with asthma, whether or not they smoked during pregnancy, had an increased odds for gestational diabetes, antepartum hemorrhage, emergency cesarean section, polyhydramnios, and premature rupture of membranes.
But smoking also had a dose-dependent effect on complication risk in both patients with and without asthma and compounded the risk for preterm birth and urinary tract infections in women with asthma.
For example, the risk for preterm birth in those with asthma who smoked was 2.10-fold higher than that for non-asthmatic non-smokers, compared with 1.78- and 1.04-fold increased risks among non-asthmatic smokers and asthmatic non-smokers, respectively.
The authors also note that both smoking and asthma were independently associated with the risks for poor neonatal outcomes, with smoking linked to complications such as SGA birthweight and congenital malformations, while asthma was linked to very preterm birth, intrauterine growth restriction, and neonatal intensive care admission.
“Some debate exists regarding whether the adverse maternal and neonatal outcomes that are associated with asthma are due to the presence of this disease or to underlying common risk factors related to poor health, including cigarette smoking or low socioeconomic state,” explain Clifton and team.
They say that their results provide support for interventions to decrease the risk for preterm birth in asthmatic women, in particular smoking cessation during pregnancy and improved antenatal asthma management “could significantly improve maternal and perinatal outcomes in this at-risk population,” they conclude.
medwireNews (www.medwirenews.com) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2013
By Kirsty Oswald, medwireNews Reporter