孕期哮喘女性使用吸入性皮质类固醇：系统评价和荟萃分析。
Inhaled corticosteroid use during pregnancy among women with asthma: A systematic review and meta-analysis.
机构信息
Priority Research Centre Grow Up Well, School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, Australia.
Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, Australia.
出版信息
Clin Exp Allergy. 2019 Nov;49(11):1403-1417. doi: 10.1111/cea.13474. Epub 2019 Sep 9.
BACKGROUND
Studies demonstrate the prescription rate for inhaled corticosteroids (ICS) decreases in early pregnancy, possibly increasing exacerbation risk. This could be related to non-adherence to prescribed asthma medication or medication cessation by the patient or doctor. ICS use during pregnancy has not previously been summarized in a systematic review.
OBJECTIVE
The aim of this systematic review and meta-analysis was to evaluate the use of ICS during pregnancy among asthmatic women, specifically: (1) the prevalence of use, (2) changes of use during pregnancy compared with pre-pregnancy and (3) medication adherence among ICS users.
METHODS
We systematically searched literature in Embase, MEDLINE, CINAL and Cochrane, using terms related to asthma, pregnancy and medication use. All English articles reporting ICS among pregnant women with asthma were included. Prevalence, changes in ICS use during pregnancy and ICS adherence were pooled using STATA (version 15.0, StataCorp USA).
RESULTS
A total of 4237 references were retrieved in the initial search. Screening and review led to the inclusion of 52 articles for one or more aims (Aim 1: N = 45; Aim 2, N = 13; and Aim 3, N = 5). The pooled prevalence of ICS use during pregnancy was 41% (95%CI 36%-45%); 49% (95%CI 44%-55%) in Europe, 39% (95%CI 32%-47%) in Australia and 34% (95%CI 27%-41%) in North America. In eight prescription databases, ICS prescription rates lowered in the first trimester of pregnancy, compared with pre-pregnancy, increased in the second trimester and decreased in the third trimester. Five studies reported ICS adherence among pregnant women, using four measures of self-reported non-adherence. In two comparable studies, pooled ICS non-adherence was 40% (95%CI 36%-44%).
CONCLUSIONS
The prevalence of ICS use among pregnant women with asthma is 41% and varies widely between countries and continents, and prescription rates for ICS change throughout pregnancy. More studies are needed to investigate ICS adherence during pregnancy in women with asthma.
背景
研究表明，吸入性皮质类固醇（ICS）在早孕时的处方率下降，可能会增加恶化的风险。这可能与患者或医生不遵守规定的哮喘药物或停止药物治疗有关。ICS 在怀孕期间的使用以前并未在系统评价中进行总结。
目的
本系统评价和荟萃分析的目的是评估哮喘女性怀孕期间使用 ICS 的情况，具体包括：（1）使用的流行率，（2）与妊娠前相比妊娠期间使用情况的变化，以及（3）ICS 使用者的药物依从性。
方法
我们系统地检索了 Embase、MEDLINE、CINAL 和 Cochrane 中的文献，使用了与哮喘、妊娠和药物使用相关的术语。所有报告哮喘孕妇使用 ICS 的英文文章均被纳入。使用 STATA（版本 15.0，StataCorp USA）汇总了 ICS 的流行率、妊娠期间 ICS 使用情况的变化以及 ICS 依从性。
结果
初步搜索共检索到 4237 条参考文献。经过筛选和审查，纳入了 52 篇文章，这些文章涉及一个或多个目的（目的 1：N=45；目的 2，N=13；目的 3，N=5）。怀孕期间使用 ICS 的总体流行率为 41%（95%CI 36%-45%）；欧洲为 49%（95%CI 44%-55%），澳大利亚为 39%（95%CI 32%-47%），北美为 34%（95%CI 27%-41%）。在 8 个处方数据库中，与妊娠前相比，ICS 的处方率在妊娠早期下降，在妊娠中期增加，在妊娠晚期下降。五项研究报告了孕妇的 ICS 依从性，使用了四种自我报告的不依从性措施。在两项可比的研究中，汇总的 ICS 不依从率为 40%（95%CI 36%-44%）。
结论
哮喘孕妇使用 ICS 的流行率为 41%，在国家和地区之间差异很大，ICS 的处方率在整个妊娠期间发生变化。需要进一步研究来调查哮喘孕妇怀孕期间的 ICS 依从性。
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