By Carolyn Crist
(Reuters Health) - 10/7/2019
Asthma is often not well controlled during pregnancy, especially among publicly-insured women, according to a U.S. study.
Among pregnant women in the U.S. with asthma, one in five had severe asthma and more than one in four with public insurance did not have their asthma controlled, researchers reported June 28 online in the Journal of Allergy and Clinical Immunology: In Practice.
That may be in part because some 40% of women with uncontrolled asthma did not fill any prescriptions for long-term asthma-controlling medications during their pregnancies, the authors note.
"Because asthma is relatively common, a large number of women who are pregnant or considering a pregnancy might be wondering what will happen to them, both how pregnancy can affect their asthma and how asthma can affect their pregnancy," said senior study author Dr. Sonia Hernandez-Diaz of the Harvard T.H. Chan School of Public Health in Boston.
"Overall, evidence suggests that the benefits of appropriate asthma therapies during pregnancy outweigh potential risks," she told Reuters Health by email.
Uncontrolled asthma has been associated with an increased risk for maternal and newborn complications such as preeclampsia and pre-term birth.
The American College of Obstetricians and Gynecologists recommends continued use of prescribed asthma medications during pregnancy, and the National Asthma Education and Prevention Program recommends using low-dose inhaled corticosteroids when symptoms can't be controlled with inhaled short-acting beta-agonists.
Hernandez-Diaz and her colleagues analyzed medical information on more than 2.6 million women in two claims databases. One covered privately-insured patients during 2011-2015; the other covered recipients of Medicaid, the state-run insurance programs for the poor, during 2000-2013.
They found that more than 140,000 women had asthma, 19% of them with severe cases. Women with asthma used about twice as many different prescription medications during pregnancy, including opioid drugs, as women without asthma. They were also twice as likely to smoke, to be obese and to have anxiety, depression, hypertension or diabetes.
About 17% of privately-insured women and 28% of those with Medicaid had poorly-controlled asthma, meaning they had one or more asthma-related hospitalizations, emergency room visits, courses of oral corticosteroids, or five or more filled prescriptions for short-acting beta-agonists during the pregnancy.
Women with poorly controlled asthma were also more likely to be smokers, obese and use other non-asthma-related medications.
However, 40% of the women with uncontrolled asthma didn't fill a prescription for a long-acting control medication during pregnancy. About half of women with asthma discontinued their controller therapy early in pregnancy, likely because they thought it would have adverse effects on their baby, the study authors note.
"Adherence to asthma guidelines and asthma control medication is poor, especially in a lower socioeconomic population that is more at risk from the start," said Dr. Gustaf Rejno of the Karolinska Institute in Stockholm, who wasn't involved in the study.
"If you have asthma, you should treat it in the same way whether you're pregnant or not," Rejno said in an email. "Optimal asthma treatment can improve outcomes for both mother and child."
J Allergy Clin Immunol in Pract 2019.