Grzeskowiak Luke E, Smith Brian, Roy Anil, Dekker Gustaaf A, Clifton Vicki L
Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia.
Respiratory Medicine Unit, The Queen Elizabeth Hospital, Adelaide, Australia.
ERJ Open Res. 2016 Feb 18;2(1). doi: 10.1183/23120541.00054-2015. eCollection 2016 Jan.
There exists a paucity of data for socially disadvantaged populations describing patterns and predictors of asthma control status and exacerbations during pregnancy, and their relationship to adverse perinatal outcomes. Asthmatic women (n=189) were followed prospectively during pregnancy, with visits at 12, 20, 28 and 36 weeks gestation. Data on loss of control, recurrent uncontrolled asthma and moderate/severe exacerbations were collected at each visit and their relationship to perinatal outcomes examined following stratification for fetal sex. 50% of asthmatic women experienced a loss of control or moderate/severe exacerbation during pregnancy, with 22% of women experiencing a moderate/severe exacerbation. Factors associated with an increased risk of women experiencing recurrent uncontrolled asthma during pregnancy included smoking (relative risk 2.92, 95% CI 1.53-5.58), inhaled corticosteroid use at the beginning of pregnancy (relative risk 2.40, 95% CI 1.25-4.60) and increasing maternal age (relative risk 1.06, 95% CI 1.01-1.11). No factors were associated with moderate/severe exacerbations. Asthma control rather than exacerbations during pregnancy appeared to be most strongly correlated with perinatal outcomes. Following stratification by fetal sex, the presence of recurrent uncontrolled asthma was associated with an increased risk of being small for gestational age in women pregnant with females (33.3% 9.5%; p=0.018). In contrast, there was a nonsignificant increased risk of preterm birth in women with recurrent uncontrolled asthma that were pregnant with males (25.0% 11.8%; p=0.201) These results suggest that the key to improving perinatal outcomes lies in improving asthma control as early as possible in pregnancy and monitoring throughout pregnancy, rather than focusing on preventing exacerbations alone.
关于社会弱势群体在孕期哮喘控制状况、病情加重的模式及预测因素，以及它们与不良围产期结局的关系，目前的数据匮乏。对189名哮喘女性在孕期进行前瞻性随访，分别在妊娠12周、20周、28周和36周进行访视。每次访视时收集哮喘控制不佳、复发性未控制哮喘及中度/重度病情加重的数据，并在按胎儿性别分层后检查它们与围产期结局的关系。50%的哮喘女性在孕期经历了哮喘控制不佳或中度/重度病情加重，其中22%的女性经历了中度/重度病情加重。与孕期女性复发性未控制哮喘风险增加相关的因素包括吸烟（相对风险2.92，95%置信区间1.53 - 5.58）、妊娠开始时使用吸入性糖皮质激素（相对风险2.40，95%置信区间1.25 - 4.60）以及产妇年龄增加（相对风险1.06，95%置信区间1.01 - 1.11）。没有因素与中度/重度病情加重相关。孕期哮喘控制而非病情加重似乎与围产期结局关联最为密切。按胎儿性别分层后，复发性未控制哮喘与怀女胎女性胎儿生长受限风险增加相关（33.3%对9.5%；p = 0.018）。相比之下，怀男胎且有复发性未控制哮喘的女性早产风险虽有增加但无统计学意义（25.0%对11.8%；p = 0.201）。这些结果表明，改善围产期结局的关键在于在孕期尽早改善哮喘控制并在整个孕期进行监测，而非仅专注于预防病情加重。
