University of Montréal, Montréal, Québec, Canada.
Pharmacotherapy. 2012 Mar;32(3):202-9. doi: 10.1002/j.1875-9114.2012.01091.x.
To describe changes in inhaled corticosteroid use during pregnancy and markers of uncontrolled asthma, and to evaluate the association between them.
Population-based, cross-sectional study.
Three administrative claims databases in Québec, Canada.
A cohort of 4434 asthmatic women (4920 pregnancies) who delivered their infants between 1990 and 2002 and who used inhaled corticosteroids before their pregnancy.
The average daily doses of inhaled corticosteroids during pregnancy and during the 9 months before conception were compared; the change in use was categorized as discontinuation (reduction of ≥75%), reduction (26-75% reduction), no change (±25% change), or increase (increase of ≥25%). The markers of uncontrolled asthma included at least one asthma exacerbation and the use of three or more doses/week of a short-acting β(2) -agonist during pregnancy. Generalized estimating equation models were used for statistical analyses. In nearly 50% of the pregnancies (2388 [48.5%] of 4920), the women either stopped or reduced their doses of corticosteroid during pregnancy, and these doses were already quite low before pregnancy. The proportion of women who had an asthma exacerbation during pregnancy was 8.2% among women who discontinued corticosteroids and greater than 20% in all of the other groups. All of the groups used frequent doses of short-acting β(2) -agonists. Discontinuing inhaled corticosteroid use during pregnancy was associated with a lower risk of exacerbations (odds ratio [OR] 0.42, 95% confidence interval [CI] 0.33-0.54), whereas increasing inhaled corticosteroid use was associated with a higher risk (OR 1.42, 95% CI 1.17-1.72), compared with no change in use.
Because of residual confounding by asthma severity, our study was not able to show that women who stopped inhaled corticosteroids during pregnancy were at increased risk of having an asthma exacerbation. However, women who stopped corticosteroids tended to have a milder form of asthma, which is reassuring and suggests that women can recognize, to a certain extent, the need to continue taking their controller agents if necessary.
描述怀孕期间吸入性皮质类固醇的使用变化和未控制哮喘的指标，并评估两者之间的关系。
基于人群的横断面研究。
加拿大魁北克的三个行政索赔数据库。
1990 年至 2002 年间分娩的 4434 名哮喘女性（4920 例妊娠）队列，她们在怀孕前使用过吸入性皮质类固醇。
比较了怀孕期间和怀孕前 9 个月的平均日剂量吸入皮质类固醇；使用情况的变化分为停药（减少≥75%）、减少（减少 26-75%）、不变（变化±25%）或增加（增加≥25%）。未控制哮喘的指标包括至少一次哮喘加重和怀孕期间每周使用 3 次或更多次短效β（2）-激动剂。使用广义估计方程模型进行统计分析。在近 50%的妊娠中（4920 例中的 2388 例[48.5%]），女性在怀孕期间停止或减少皮质类固醇剂量，而且这些剂量在怀孕前已经相当低。怀孕期间哮喘加重的女性比例在停药组为 8.2%，在所有其他组均大于 20%。所有组都使用了频繁剂量的短效β（2）-激动剂。与使用无变化相比，怀孕期间停止吸入皮质类固醇的使用与哮喘加重的风险降低相关（比值比[OR]0.42，95%置信区间[CI]0.33-0.54），而增加吸入皮质类固醇的使用与风险增加相关（OR 1.42，95%CI 1.17-1.72）。
由于哮喘严重程度的残余混杂，我们的研究未能表明怀孕期间停止吸入皮质类固醇的女性发生哮喘加重的风险增加。然而，停止皮质类固醇的女性往往患有较轻的哮喘，这令人欣慰，表明女性在某种程度上可以认识到，如果需要，需要继续服用她们的控制剂。
