Murphy Vanessa E, Jensen Megan E, Robijn Annelies L, Wright Thomas K, Mattes Joerg, Collison Adam, Gibson Peter G
Priority Research Centre GrowUpWell(TM) and Hunter Medical Research Institute, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.
Priority Research Centre GrowUpWell(TM) and Hunter Medical Research Institute, Faculty of Health and Medicine, The University of Newcastle, Callaghan, NSW, Australia.
J Allergy Clin Immunol Pract. 2020 Jan;8(1):219-228.e3. doi: 10.1016/j.jaip.2019.06.033. Epub 2019 Jul 10.
Maternal asthma is associated with perinatal complications and respiratory illness in offspring. Obesity increases asthma exacerbation risk in pregnancy and risk of wheeze in offspring.
In this secondary analysis of a randomized controlled trial, we investigated the influence of maternal body mass index, gestational weight gain (GWG), and fractional exhaled nitric oxide (FNO)-based management on asthma exacerbations in pregnancy and offspring wheeze.
A total of 220 women were randomized to asthma treatment adjustment according to symptoms (control group), or FNO and symptoms (FNO group). Exacerbations were recorded prospectively. Height and weight were measured at baseline, and in late pregnancy. GWG was categorized according to Institute of Medicine guidelines. A validated parent-completed questionnaire assessed infant wheeze-related outcomes.
FNO-based management was associated with a significantly lower incidence rate ratio for maternal exacerbations in nonobese mothers (0.52, 95% confidence interval [CI], 0.31-0.88, P = .015, n = 129), and women with GWG within recommendations (0.35, 95% CI, 0.12-0.96, P = .042, n = 43), but not for obese mothers (0.59, 95% CI, 0.32-1.08, P = .089, n = 88), or women with excess GWG (0.58, 95% CI, 0.32-1.04, P = .07, n = 104). Recurrent bronchiolitis occurred in 5.3% (n = 1) of infants born to non-overweight mothers, 16.7% (n = 3) of infants of overweight mothers, and 21.7% (n = 5) of infants of obese mothers in the control group. In the FNO group, 2 infants of obese mothers had recurrent bronchiolitis (7.1%, P = .031).
The benefits of FNO-based management are attenuated among obese mothers and those with excess GWG, indicating the importance of weight management in contributing to improved asthma management in pregnancy.
母亲患哮喘与围产期并发症及子代呼吸系统疾病相关。肥胖会增加孕期哮喘加重风险以及子代喘息风险。
在这项随机对照试验的二次分析中，我们研究了母亲体重指数、孕期体重增加（GWG）以及基于呼出一氧化氮分数（FNO）的管理对孕期哮喘加重和子代喘息的影响。
总共220名女性被随机分为根据症状调整哮喘治疗组（对照组），或根据FNO和症状调整治疗组（FNO组）。前瞻性记录哮喘加重情况。在基线期和妊娠晚期测量身高和体重。GWG根据医学研究所指南进行分类。通过一份经验证的由家长完成的问卷评估婴儿喘息相关结局。
在非肥胖母亲中（0.52，95%置信区间[CI]，0.31 - 0.88，P = 0.015，n = 129）以及GWG在推荐范围内的女性中（0.35，95% CI，0.12 - 0.96，P = 0.042，n = 43），基于FNO的管理与母亲哮喘加重的发病率比显著降低相关，但在肥胖母亲中（0.59，95% CI，0.32 - 1.08，P = 0.089，n = 88）以及GWG超标的女性中（0.58，95% CI，0.32 - 1.04，P = 0.07，n = 104）并非如此。在对照组中，非超重母亲所生婴儿中有5.3%（n = 1）发生复发性细支气管炎，超重母亲所生婴儿中有16.7%（n = 3）发生，肥胖母亲所生婴儿中有21.7%（n = 5）发生。在FNO组中，肥胖母亲所生的2名婴儿发生了复发性细支气管炎（7.1%，P = 0.031）。
在肥胖母亲和GWG超标的女性中，基于FNO的管理的益处减弱，这表明体重管理对于改善孕期哮喘管理具有重要意义。
