Bracken Michael B, Triche Elizabeth W, Belanger Kathleen, Saftlas Audrey, Beckett William S, Leaderer Brian P
Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut 06520, USA.
Obstet Gynecol. 2003 Oct;102(4):739-52. doi: 10.1016/s0029-7844(03)00621-5.
To prospectively examine in pregnant women whether asthma or asthma therapy influenced preterm delivery, intrauterine grown restriction (IUGR), or birthweight.
We enrolled 873 pregnant women with a history of asthma, of whom 778 experienced asthma symptoms or took medication, and 1333 women with no asthma history, including 884 women with neither asthma diagnosis nor symptoms and 449 with symptoms but no diagnosis. Asthma symptoms, medication, and severity were classified according to 2002 Global Initiative for Asthma guidelines.
Preterm delivery was not associated with asthma diagnosis, severity, or symptoms but was associated with use of controller medications, independent of symptoms, specifically oral steroids and theophylline. Gestation was reduced by 2.22 weeks in women using oral steroids daily (P =.001) and 1.11 weeks after theophylline (P =.002). We observed a 24% (5-47%) increased risk for IUGR with each increased symptom step, which increased further in symptomatic women with no asthma diagnosis (31%, 4-65%) compared with women with neither asthma nor symptoms.
We found no effect of asthma symptoms or severity on preterm delivery but observed increased risks associated with use of oral steroid and theophylline. Intrauterine growth restriction was associated with asthma severity, which possibly reflects a hypoxic fetal effect. Women with asthma symptoms but no diagnosis were at particular risk of undermedication and delivering IUGR infants. These observations support guidelines that advocate active management of pregnant patients with mild or moderate asthma with beta(2) agonists, with oral steroids added only if severity increases. Symptomatic patients without an asthma diagnosis might need to be equally managed.
前瞻性研究孕妇哮喘或哮喘治疗是否会影响早产、宫内生长受限（IUGR）或出生体重。
我们纳入了873例有哮喘病史的孕妇，其中778例有哮喘症状或正在接受药物治疗，以及1333例无哮喘病史的孕妇，包括884例既无哮喘诊断也无哮喘症状的孕妇和449例有症状但未确诊的孕妇。根据2002年全球哮喘防治创议指南对哮喘症状、药物治疗及严重程度进行分类。
早产与哮喘诊断、严重程度或症状无关，但与使用控制药物有关，与症状无关，尤其是口服类固醇和茶碱。每日使用口服类固醇的孕妇妊娠时间缩短2.22周（P = 0.001），使用茶碱后缩短1.11周（P = 0.002）。我们观察到，随着症状严重程度每增加一级，IUGR风险增加24%（5%-47%），与既无哮喘也无症状的孕妇相比，有症状但未确诊哮喘的孕妇IUGR风险进一步增加（31%，4%-65%）。
我们发现哮喘症状或严重程度对早产无影响，但观察到使用口服类固醇和茶碱会增加风险。宫内生长受限与哮喘严重程度有关，这可能反映了胎儿缺氧的影响。有哮喘症状但未确诊的孕妇用药不足及分娩IUGR婴儿的风险尤其高。这些观察结果支持以下指南，即提倡对轻度或中度哮喘孕妇使用β2激动剂进行积极管理，仅在严重程度增加时添加口服类固醇。对有症状但未确诊哮喘的患者可能也需要同样的管理。
