Perlow J H, Montgomery D, Morgan M A, Towers C V, Porto M
Department of Obstetrics and Gynecology, Long Beach Memorial Medical Center Women's Hospital, California.
Am J Obstet Gynecol. 1992 Oct;167(4 Pt 1):963-7. doi: 10.1016/s0002-9378(12)80020-2.
Our objective was to determine the impact of asthma and its severity, as determined by medication requirements, on perinatal outcome.
A case-controlled study was conducted. Among 30,940 live births at Long Beach Memorial Medical Center Women's Hospital, 183 deliveries occurred between Jan. 1, 1985, and Dec. 31, 1990, that were coded for the diagnosis of asthma. Eighty-one that required the chronic use of medications to control their disease were identified. Thirty-one patients were steroid dependent and 50 were non-steroid-medication dependent. A control group was randomly selected (excluding maternal transports), and selected perinatal variables were compared between groups.
When compared with controls, steroid-dependent asthmatics were at significantly increased risk for gestational (1.5% vs 12.9%) and insulin-requiring diabetes (0% vs 9.7%). Preterm delivery and preterm premature ruptured membranes occurred significantly more often in both asthmatic groups. Overall cesarean section rate was significantly increased in the non-steroid-medication-dependent asthmatic group when compared with controls (56.0% vs 30.0%). Delivery by primary cesarean section was significantly more common in the steroid-dependent group (38.7% vs 19.2%), and a strong trend was noted among the non-steroid-medication-dependent patients (34.0% vs 19.2%). Cesarean delivery for fetal distress was also more common in these two asthmatic groups. Neonates born to both groups of asthmatic pregnant women were significantly more likely to be of birth weight < 2500 gm but did not have an increased frequency of intrauterine growth restriction. No significant differences in low 5-minute Apgar scores were found; however, neonates born to both steroid-dependent and non-steroid-medication-dependent asthmatics were significantly more likely to be admitted to the neonatal intensive care unit (39.0% and 22.0% vs 7.7%). Preterm delivery and low birth weight were complications observed significantly more often in the steroid-dependent asthma group when compared with the non-steroid-medication-dependent group (54.8% vs 14.0% and 45.2% vs 14.0%).
Perinatal outcome is compromised in the pregnancy complicated by chronic medication-dependent asthma. The extent is variable and is associated with disease severity, as measured by medication requirements.
我们的目的是确定哮喘及其严重程度（由药物需求决定）对围产期结局的影响。
进行了一项病例对照研究。在长滩纪念医学中心妇女医院的30940例活产中，1985年1月1日至1990年12月31日期间有183例分娩被编码为哮喘诊断。确定了81例需要长期使用药物来控制疾病的患者。31例患者依赖类固醇，50例依赖非类固醇药物。随机选择一个对照组（不包括产妇转运情况），并比较两组之间选定的围产期变量。
与对照组相比，依赖类固醇的哮喘患者患妊娠期糖尿病（1.5%对12.9%）和需胰岛素治疗的糖尿病（0%对9.7%）的风险显著增加。两组哮喘患者早产和胎膜早破的发生率均显著更高。与对照组相比，依赖非类固醇药物的哮喘组总体剖宫产率显著增加（56.0%对30.0%）。在依赖类固醇的组中，首次剖宫产分娩显著更常见（38.7%对19.2%），在依赖非类固醇药物的患者中也有明显趋势（34.0%对19.2%）。这两组哮喘患者因胎儿窘迫进行剖宫产也更常见。两组哮喘孕妇所生新生儿出生体重<2500克的可能性显著更高，但宫内生长受限的发生率没有增加。在5分钟Apgar评分低方面未发现显著差异；然而，依赖类固醇和依赖非类固醇药物的哮喘患者所生新生儿入住新生儿重症监护病房的可能性显著更高（分别为39.0%和22.0%对7.7%）。与依赖非类固醇药物的哮喘组相比，依赖类固醇的哮喘组早产和低出生体重等并发症的发生率显著更高（分别为54.8%对14.0%和45.2%对14.0%）。
妊娠期合并慢性药物依赖性哮喘会损害围产期结局。其程度各不相同，且与疾病严重程度相关，疾病严重程度由药物需求衡量。
