Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada; Research Centre, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada; Endowment Pharmaceutical Chair AstraZeneca in Respiratory Health, Montreal, Quebec, Canada.
Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada; Research Centre, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada.
J Allergy Clin Immunol Pract. 2018 Mar-Apr;6(2):555-561.e2. doi: 10.1016/j.jaip.2017.07.004. Epub 2017 Aug 26.
Maternal asthma has been found to be associated with an increased risk of hypertensive disorders of pregnancy (HDP), that is, gestational hypertension, preeclampsia, and eclampsia. There is limited data, however, regarding the relationship between the use of long-acting beta-agonists (LABAs) during pregnancy and these outcomes.
To investigate whether exposure to a LABA in addition to an inhaled corticosteroid increases the risk of HDP or preeclampsia/eclampsia, as compared with nonexposure to LABAs, in pregnant women with asthma.
A cohort of 8,936 pregnancies in women with asthma who delivered between 1998 and 2010 was reconstructed using Quebec (Canada) health administrative databases. Cox proportional hazard regression models, adjusted for potential confounders, were used for statistical analyses. The primary exposure was LABA use (yes/no) measured on the first day of the 20th week of pregnancy. HDP were identified on the basis of recorded diagnoses and on prescriptions of antihypertensive drugs filled on or after the first day of week 20 of gestation.
There were 567 (6.3%) cases of HDP and 256 (2.9%) cases of preeclampsia/eclampsia in the cohort, and the rates of both disorders were similar in women exposed or not exposed to LABAs. LABA use was not associated with increased risks of HDP (adjusted hazard ratio, 0.96; 95% CI, 0.69-1.33) or preeclampsia/eclampsia (adjusted hazard ratio, 0.89; 95% CI, 0.53-1.50).
The results of this study provide evidence suggesting the safety of LABAs for the treatment of asthma in pregnancy, in terms of the risks of HDP and preeclampsia/eclampsia.
研究发现，母亲哮喘与妊娠高血压疾病（HDP）风险增加有关，即妊娠期高血压、先兆子痫和子痫。然而，关于怀孕期间使用长效β-激动剂（LABA）与这些结果之间的关系的数据有限。
调查与未接触 LABA 相比，哮喘孕妇在吸入皮质类固醇的基础上加用 LABA 是否会增加 HDP 或先兆子痫/子痫的风险。
使用魁北克（加拿大）健康管理数据库重建了 1998 年至 2010 年期间分娩的 8936 例哮喘孕妇的队列。使用 Cox 比例风险回归模型，调整潜在混杂因素后进行统计分析。主要暴露是妊娠第 20 周第 1 天测量的 LABA 使用（是/否）。根据记录的诊断和妊娠第 20 周第 1 天或之后开具的降压药处方确定 HDP。
队列中有 567 例（6.3%）HDP 和 256 例（2.9%）先兆子痫/子痫病例，接触或不接触 LABA 的女性中这两种疾病的发生率相似。LABA 使用与 HDP 风险增加无关（调整后的危险比，0.96；95%CI，0.69-1.33）或先兆子痫/子痫风险增加无关（调整后的危险比，0.89；95%CI，0.53-1.50）。
这项研究的结果提供了证据，表明 LABA 治疗妊娠哮喘的安全性，在 HDP 和先兆子痫/子痫的风险方面。
