Robijn Annelies L, Brew Bronwyn K, Jensen Megan E, Rejnö Gustaf, Lundholm Cecilia, Murphy Vanessa E, Almqvist Catarina
Priority Research Centre Grow Up Well, School of Medicine and Public Health, University of Newcastle, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia.
Dept of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
ERJ Open Res. 2020 Dec 21;6(4). doi: 10.1183/23120541.00295-2020. eCollection 2020 Oct.
Although there is a growing body of literature about the impact of asthma exacerbations during pregnancy on adverse perinatal outcomes, it is still unclear whether asthma exacerbations themselves or asthma severity are the driving factor for negative outcomes. This study aimed to estimate the associations between maternal asthma exacerbations and perinatal outcomes, and whether this differed by asthma treatment regime as a proxy for severity.
We included births of women with asthma in Sweden from July 2006 to November 2013 (n=33 829). Asthma exacerbations were defined as unplanned emergency visits/hospitalisations or a short course of oral corticosteroids. Adjusted odds ratios (aOR) were estimated for the associations between exacerbations during pregnancy and perinatal outcomes (small for gestational age (SGA), preterm birth, birthweight and mode of delivery), stratified by preconception treatment regime.
Exacerbations occurred in 1430 (4.2%) pregnancies. Exacerbations were associated with reduced birthweight (aOR 1.45, 95% CI 1.24-1.70), and elective (aOR 1.50, 95% CI 1.25-1.79) and emergency caesarean section (aOR 1.35, 95% CI 1.13-1.61). Multiple exacerbations were associated with a 2.6-fold increased odds of SGA (95% CI 1.38-4.82). Amongst women treated prepregnancy with combination therapy (proxy for moderate-severe asthma), exacerbators were at increased odds of elective (aOR 1.69, 95% CI 1.30-2.2) and emergency (aOR 1.62, 95% CI 1.26-2.08) caesarean section, and SGA (aOR 1.74, 95% CI 1.18-2.57) non-exacerbators.
Maternal asthma exacerbations increase the risk of SGA and caesarean sections, particularly in women with multiple exacerbations or moderate-severe asthma. Adequate antenatal asthma care is needed to reduce exacerbations and reduce risks of poor outcomes.
尽管关于孕期哮喘发作对不良围产期结局的影响的文献越来越多，但哮喘发作本身还是哮喘严重程度是导致不良结局的驱动因素仍不清楚。本研究旨在评估孕产妇哮喘发作与围产期结局之间的关联，以及这种关联是否因作为严重程度替代指标的哮喘治疗方案而异。
我们纳入了2006年7月至2013年11月在瑞典患有哮喘的女性的分娩病例（n = 33829）。哮喘发作定义为计划外的急诊就诊/住院或短期口服糖皮质激素治疗。根据孕前治疗方案分层，估计孕期发作与围产期结局（小于胎龄儿（SGA）、早产、出生体重和分娩方式）之间关联的调整优势比（aOR）。
1430例（4.2%）妊娠发生了哮喘发作。发作与出生体重降低（aOR 1.45，95%CI 1.24 - 1.70）、择期剖宫产（aOR 1.50，95%CI 1.25 - 1.79）和急诊剖宫产（aOR 1.35，95%CI 1.13 - 1.61）相关。多次发作与SGA几率增加2.6倍相关（95%CI 1.38 - 4.82）。在孕前接受联合治疗（中度至重度哮喘的替代指标）的女性中，发作患者择期剖宫产（aOR 1.69，95%CI 1.30 - 2.2）和急诊剖宫产（aOR 1.62，95%CI 1.26 - 2.08）以及SGA（aOR 1.74，95%CI 1.18 - 2.57）的几率高于未发作患者。
孕产妇哮喘发作会增加SGA和剖宫产的风险，尤其是在多次发作或患有中度至重度哮喘的女性中。需要进行充分的产前哮喘护理以减少发作并降低不良结局的风险。
