Breton M-C, Beauchesne M-F, Lemière C, Rey E, Forget A, Blais L
Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada.
Thorax. 2009 Feb;64(2):101-6. doi: 10.1136/thx.2008.102970. Epub 2008 Nov 13.
Thirteen studies investigating the association between asthma during pregnancy and perinatal mortality reported generally no increased risk. Most of these studies should be interpreted with caution because they were limited in terms of statistical power. A study was therefore undertaken to evaluate whether maternal asthma during pregnancy increases the risk of perinatal mortality.
Through three administrative databases from Québec (Canada), a cohort of women with and without asthma who had at least one pregnancy between 1990 and 2002 was formed. Perinatal mortality was identified by diagnostic codes. The adjusted odds ratio (OR) of perinatal mortality in women with and without asthma was compared using Generalised Estimation Equation (GEE) models. The first model included all potential confounders (except small for gestational age, SGA), the second model excluded birth weight, gestational age at birth and SGA and the third model excluded birth weight, gestational age at birth but included only SGA. This analysis was also stratified for birth weight and gestational age at birth.
The cohort was formed of 13 100 and 28 042 single pregnancies in women with and without asthma. The crude OR of perinatal mortality was 1.35 (95% CI 1.08 to 1.67), which decreased to 0.93 (95% CI 0.75 to 1.17) after adjustment for birth weight and gestational age at birth. Women with asthma had a higher rate of low birthweight babies and preterm delivery than those without asthma.
The increased risk of low birthweight babies and premature delivery in women with asthma may partly explain the association between maternal asthma and the increased risk of perinatal mortality.
13项关于孕期哮喘与围产期死亡率之间关联的研究普遍报告称风险未增加。由于这些研究在统计效力方面存在局限性，因此大多数此类研究的解读应谨慎。因此开展了一项研究，以评估孕期母亲哮喘是否会增加围产期死亡风险。
通过来自加拿大魁北克的三个行政数据库，组建了一个在1990年至2002年期间至少有一次妊娠的患有和未患哮喘的女性队列。通过诊断编码确定围产期死亡率。使用广义估计方程（GEE）模型比较患有和未患哮喘女性围产期死亡的调整优势比（OR）。第一个模型纳入了所有潜在混杂因素（除小于胎龄儿，SGA），第二个模型排除了出生体重、出生时孕周和SGA，第三个模型排除了出生体重、出生时孕周，但仅纳入了SGA。该分析还按出生体重和出生时孕周进行了分层。
该队列由13100例患有哮喘的女性单胎妊娠和28042例未患哮喘的女性单胎妊娠组成。围产期死亡的粗OR为1.35（95%CI 1.08至1.67），在对出生体重和出生时孕周进行调整后降至0.93（95%CI 0.75至1.17）。患有哮喘的女性低体重儿和早产的发生率高于未患哮喘的女性。
哮喘女性低体重儿和早产风险增加可能部分解释了母亲哮喘与围产期死亡风险增加之间的关联。
