Yland Jennifer J, Bateman Brian T, Huybrechts Krista F, Brill Gregory, Schatz Michael X, Wurst Keele E, Hernández-Díaz Sonia
Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass.
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass; Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Mass.
J Allergy Clin Immunol Pract. 2020 Jun;8(6):1928-1937.e3. doi: 10.1016/j.jaip.2020.01.016. Epub 2020 Jan 22.
Estimates of the effects of maternal asthma on pregnancy outcomes are inconsistent across studies, possibly because of differences in exposure definition.
To evaluate the risk of adverse perinatal outcomes associated with maternal asthma diagnosis, severity, and control in a large, nationally representative cohort.
This study was conducted within the IBM Health MarketScan Commercial Claims and Encounters Database (2011-2015) and the Medicaid Analytic eXtract database (2000-2014). Asthma was identified by diagnosis and treatment codes, severity was based on medications dispensed, and control was based on short-acting β-agonist dispensations and exacerbations. We estimated the relative risks (RRs) of stillbirth, spontaneous abortion, preterm birth, small for gestational age (SGA), neonatal intensive care unit (NICU) admission, and congenital malformations, comparing pregnancies with differing asthma disease status.
We identified 29,882 pregnancies complicated by asthma in the MarketScan database and 160,638 in the Medicaid Analytic eXtract database. We observed no consistent associations between asthma diagnosis, severity, or control, and stillbirth, abortions, or malformations. However, we observed increased risks of prematurity, SGA, and NICU admission among women with asthma compared with those without asthma. Compared with women with well-controlled asthma, women with poor control late in pregnancy had an increased risk of preterm birth (relative risk, 1.39; 95% CI, 1.32-1.46) and NICU admission (relative risk, 1.26; 95% CI, 1.17-1.35). More severe asthma was associated with SGA (relative risk, 1.18; 95% CI, 1.07-1.30).
We did not observe an increased risk of pregnancy losses or malformations among women with asthma. However, we found an association between asthma severity and SGA, and between exacerbations late in pregnancy and preterm delivery and NICU admission.
关于母亲哮喘对妊娠结局影响的估计在各项研究中并不一致，这可能是由于暴露定义的差异所致。
在一个具有全国代表性的大型队列中，评估与母亲哮喘诊断、严重程度及控制情况相关的不良围产期结局风险。
本研究在IBM医疗市场扫描商业索赔与病历数据库（2011 - 2015年）和医疗补助分析提取物数据库（2000 - 2014年）中进行。通过诊断和治疗代码识别哮喘，严重程度基于所配发的药物，控制情况基于短效β受体激动剂的配发和病情加重情况。我们比较了不同哮喘疾病状态的妊娠情况，估计了死产、自然流产、早产、小于胎龄儿（SGA）、新生儿重症监护病房（NICU）入院以及先天性畸形的相对风险（RRs）。
我们在医疗市场扫描数据库中识别出29,882例合并哮喘的妊娠，在医疗补助分析提取物数据库中识别出160,638例。我们未观察到哮喘诊断、严重程度或控制情况与死产、流产或畸形之间存在一致的关联。然而，我们观察到与无哮喘的女性相比，患有哮喘的女性早产、SGA及NICU入院的风险增加。与哮喘控制良好的女性相比，妊娠晚期控制不佳的女性早产风险增加（相对风险，1.39；95%置信区间，1.32 - 1.46），NICU入院风险增加（相对风险，1.26；95%置信区间，1.17 - 1.35）。更严重的哮喘与SGA相关（相对风险，1.18；95%置信区间，1.07 - 1.30）。
我们未观察到哮喘女性妊娠丢失或畸形风险增加。然而，我们发现哮喘严重程度与SGA之间存在关联，妊娠晚期病情加重与早产及NICU入院之间存在关联。
