Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada.
Thorax. 2013 Aug;68(8):724-30. doi: 10.1136/thoraxjnl-2012-203122. Epub 2013 Apr 13.
BACKGROUND: Asthma during pregnancy usually requires treatment with controller medications about which more safety information is needed. The objectives are to assess the impact of the use of long-acting β2-agonists (LABAs) and the dose of inhaled corticosteroids (ICSs) during pregnancy on the prevalence of low birth weight (LBW), preterm birth (PB) and small for gestational age (SGA). METHODS: A cohort of women with asthma giving birth from 1998 to 2008 was constructed from Québec (Canada) administrative databases. LBW was defined as weight <2500 g, PB as delivery before 37 weeks' gestation and SGA as a birth weight below the 10th percentile. The impact of the use of LABAs and the dose of ICSs during pregnancy on the outcomes was determined with generalised-estimating-equation models. RESULTS: The cohort included 7376 pregnancies: 8.8% exposed to LABAs and 56.9% exposed to ICSs. All LABA users also received ICSs. The prevalence of LBW, PB and SGA was 7.7%, 9.5% and 13.5%, respectively. LABA use was not found to be associated with increased prevalence of LBW (OR 0.81; 95% CI 0.58 to 1.12), PB (OR 0.84; 95% CI 0.61 to 1.15) or SGA (OR 0.92; 95% CI 0.70 to 1.20). Mean ICSs doses >125 μg/day (fluticasone-equivalent) were associated with a non-significant trend of increased LBW, PB and SGA. CONCLUSIONS: Despite the possibility of residual confounding due to uncontrolled or more severe asthma or smoking status, the use of LABA and low to moderate doses of ICSs were not associated with increased prevalence of perinatal outcomes. Additional research on higher ICSs doses is required to better evaluate their safety during pregnancy.
背景:妊娠期间的哮喘通常需要使用控制药物进行治疗,而这些药物需要更多的安全性信息。本研究旨在评估妊娠期间使用长效β2-激动剂(LABA)和吸入皮质类固醇(ICS)的剂量对低出生体重(LBW)、早产(PB)和小于胎龄儿(SGA)的发生率的影响。
方法:从加拿大魁北克省的行政数据库中构建了一个 1998 年至 2008 年间分娩的哮喘女性队列。LBW 定义为体重<2500g,PB 定义为妊娠 37 周前分娩,SGA 定义为出生体重低于第 10 百分位数。使用广义估计方程模型确定妊娠期间使用 LABA 和 ICS 剂量对结局的影响。
结果:该队列包括 7376 例妊娠:8.8%的孕妇暴露于 LABA,56.9%的孕妇暴露于 ICS。所有 LABA 使用者均同时接受 ICS 治疗。LBW、PB 和 SGA 的发生率分别为 7.7%、9.5%和 13.5%。LABA 的使用与 LBW(比值比 0.81;95%置信区间 0.58 至 1.12)、PB(比值比 0.84;95%置信区间 0.61 至 1.15)或 SGA(比值比 0.92;95%置信区间 0.70 至 1.20)发生率的增加无关。ICS 剂量>125μg/天(氟替卡松等效剂量)与 LBW、PB 和 SGA 的发生率呈非显著上升趋势相关。
结论:尽管存在因未控制或更严重的哮喘或吸烟状况而导致的残余混杂因素的可能性,但 LABA 的使用和低至中等剂量的 ICS 与围产期结局发生率的增加无关。需要进一步研究更高剂量的 ICS 以更好地评估其在妊娠期间的安全性。
Ann Allergy Asthma Immunol. 2014-3-19
J Allergy Clin Immunol. 2010-10
Birth Defects Res A Clin Mol Teratol. 2011-11
Respir Med. 2010-4-15
J Allergy Clin Immunol. 2004-6
Exp Ther Med. 2024-10-11
Respiration. 2024
Asthma Res Pract. 2018-12-27
PLoS One. 2018-5-18
Chest. 2017-9-1