Crowe Holly Michelle, Wise Lauren Anne, Wesselink Amelia Kent, Rothman Kenneth Jay, Mikkelsen Ellen Margrethe, Sørensen Henrik Toft, Walkey Allan Jay, Hatch Elizabeth Elliott
Department of Epidemiology, Boston University School of Public Health, Boston, MA 02118, USA.
RTI International, Raleigh, NC 27709, USA.
Clin Epidemiol. 2020 Jun 8;12:579-587. doi: 10.2147/CLEP.S245040. eCollection 2020.
Asthma has been positively associated with irregular menses and infertility in some studies, but data are limited on the relation between asthma medication use and fecundability (i.e., average per-cycle probability of conception among non-contracepting couples). This study examines the extent to which a history of asthma, asthma medication use, and age at first asthma diagnosis are associated with fecundability among female pregnancy planners.
Pregnancy Study Online (PRESTO) is an ongoing, web-based preconception cohort study of couples aged 21-45 years from North America. Between July 2013 and July 2019, a total of 10,436 participants enrolled in PRESTO, and 8286 were included in the present analysis. At study enrollment, women reported whether they had ever been diagnosed with asthma and, if so, the year they were first diagnosed. Women who reported ever being diagnosed with asthma were asked about medication use, including medication type and frequency of use. Participants completed follow-up questionnaires every 8 weeks for up to 12 months or until pregnancy. Proportional probabilities regression models were used to estimate fecundability ratios (FRs) and 95% confidence intervals (CIs), adjusting for potential confounders. Fecundability ratios below 1.00 indicate reduced probability of conception.
There was little association between a history of asthma diagnosis or asthma medication use and fecundability. Compared with no history of asthma, the FR for ever-diagnosis of asthma with medication use was 1.02 (95% CI: 0.91-1.15) and for ever-diagnosis of asthma without medication use was 1.00 (95% CI: 0.91-1.09). Highest intensity asthma medication use (daily plus extra dosing for symptoms), combination inhaled corticosteroid and long-acting beta-agonist inhaler use, and a first diagnosis of asthma after age 17 years were associated with small reductions in fecundability.
The present study provides little evidence that asthma or asthma medication use is adversely associated with fecundability.
在一些研究中，哮喘与月经不规律和不孕呈正相关，但关于哮喘药物使用与受孕能力（即未采取避孕措施的夫妇每个周期受孕的平均概率）之间关系的数据有限。本研究探讨哮喘病史、哮喘药物使用情况以及首次哮喘诊断时的年龄与有怀孕计划的女性受孕能力之间的关联程度。
在线妊娠研究（PRESTO）是一项正在进行的基于网络的孕前队列研究，研究对象为来自北美的21至45岁夫妇。2013年7月至2019年7月期间，共有10436名参与者纳入PRESTO，本分析纳入了8286名。在研究入组时，女性报告她们是否曾被诊断为哮喘，如果是，首次诊断的年份。报告曾被诊断为哮喘的女性被问及药物使用情况，包括药物类型和使用频率。参与者每8周完成一次随访问卷，最长随访12个月或直至怀孕。使用比例概率回归模型估计受孕能力比率（FRs）和95%置信区间（CIs），并对潜在混杂因素进行调整。受孕能力比率低于1.00表明受孕概率降低。
哮喘诊断史或哮喘药物使用与受孕能力之间几乎没有关联。与无哮喘病史相比，使用药物的哮喘确诊者的FR为1.02（95%CI：0.91 - 1.15），未使用药物的哮喘确诊者的FR为1.00（95%CI：0.91 - 1.09）。最高强度的哮喘药物使用（每日用药加症状发作时额外用药）、联合使用吸入性糖皮质激素和长效β受体激动剂吸入器以及17岁后首次诊断为哮喘与受孕能力的小幅下降有关。
本研究几乎没有证据表明哮喘或哮喘药物使用与受孕能力存在不利关联。
