Pregnancy, asthma and exacerbations: a population-based cohort.

IF 21 1区 医学 Q1 RESPIRATORY SYSTEM
Bohee Lee, Ernie Wong, Tricia Tan, Hitasha Rupani, Chloe I Bloom
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Abstract

Background: Asthma exacerbations during pregnancy are associated with adverse maternal and perinatal outcomes. Identifying modifiable risk factors are essential for improving health outcomes. We aimed to describe exacerbation patterns during pregnancy and identify exacerbation risk factors, particularly modifiable risk factors such as inhaled corticosteroid (ICS) use.

Methods: A cohort study using UK primary care and hospital data (2004-2020) to identify pregnant women with asthma. Exacerbations were defined as a short course of oral corticosteroids, emergency department visit, or unscheduled hospital admission. Multivariable logistic regression was used to assess associations between maternal characteristics and exacerbations (primary outcome) and ICS use (secondary outcome).

Results: Among 40 196 pregnant women with asthma, total exacerbations declined by ∼30% during pregnancy. However, exacerbations associated with hospital admission increased by 30-45% during the second and third trimesters, declining abruptly after delivery. ICS prescriptions were reduced in 31% of women during pregnancy. Decreased ICS use was associated with suboptimal asthma control pre-pregnancy, age, ethnicity and smoking. The strongest exacerbation risk factors were a history of exacerbations (adjusted-OR, 95% CI: 4.09, 3.81-4.39), reduced ICS during pregnancy (2.29, 2.12-2.47) and ≥4 prescriptions/year for ICS+another-preventer before pregnancy (2.11, 1.87-2.37). Additional risk factors included blood eosinophilia, smoking and obesity.

Conclusions: Despite fewer total exacerbations, exacerbations associated with a hospital admission increased during pregnancy. One-third of women reduced ICS use during pregnancy, yet this was the second largest exacerbation risk factor, and completely modifiable. Other major risk factors were type-2 inflammation and another modifiable risk factor, suboptimal asthma control pre-pregnancy.

妊娠、哮喘和加重:一个基于人群的队列。
背景:妊娠期哮喘加重与不良的孕产妇和围产期结局相关。确定可改变的风险因素对于改善健康结果至关重要。我们的目的是描述怀孕期间的恶化模式,并确定恶化的危险因素,特别是可改变的危险因素,如吸入皮质类固醇(ICS)的使用。方法:使用英国初级保健和医院数据(2004-2020)进行队列研究,以确定患有哮喘的孕妇。急性加重被定义为短期口服皮质类固醇、急诊就诊或计划外住院。采用多变量logistic回归评估产妇特征与病情加重(主要结局)和ICS使用(次要结局)之间的关联。结果:在40196名哮喘孕妇中,妊娠期总加重率下降了~ 30%。然而,与住院有关的病情恶化在妊娠中期和晚期增加了30-45%,在分娩后突然下降。31%的怀孕妇女减少了ICS处方。减少ICS使用与孕前、年龄、种族和吸烟的次优哮喘控制有关。最强的加重危险因素是加重史(校正or, 95% CI: 4.09, 3.81-4.39)、妊娠期间ICS减少(2.29,2.12-2.47)和妊娠前ICS+另一种预防剂≥4张/年处方(2.11,1.87-2.37)。其他危险因素包括嗜酸性粒细胞增多、吸烟和肥胖。结论:尽管总加重次数较少,但与住院相关的加重次数在妊娠期间增加。三分之一的妇女在怀孕期间减少了ICS的使用,但这是第二大加重风险因素,并且完全可以改变。其他主要的危险因素是2型炎症和另一个可改变的危险因素,即孕前哮喘控制不佳。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
European Respiratory Journal
European Respiratory Journal 医学-呼吸系统
CiteScore
27.50
自引率
3.30%
发文量
345
审稿时长
2-4 weeks
期刊介绍: The European Respiratory Journal (ERJ) is the flagship journal of the European Respiratory Society. It has a current impact factor of 24.9. The journal covers various aspects of adult and paediatric respiratory medicine, including cell biology, epidemiology, immunology, oncology, pathophysiology, imaging, occupational medicine, intensive care, sleep medicine, and thoracic surgery. In addition to original research material, the ERJ publishes editorial commentaries, reviews, short research letters, and correspondence to the editor. The articles are published continuously and collected into 12 monthly issues in two volumes per year.
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