NHMRC Centre for Research Excellence on Women and Non-communicable Diseases (CRE-WaND), School of Public Health, University of Queensland, Brisbane, QLD, Australia.
Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, QLD, Australia.
BJOG. 2022 Feb;129(3):367-377. doi: 10.1111/1471-0528.16968. Epub 2021 Oct 28.
BACKGROUND: Large-scale studies exploring the associations of asthma severity, exacerbations and medication use with adverse perinatal outcomes have been published in recent years. OBJECTIVES: To update evidence on the associations of asthma severity, exacerbations and medication use with the adverse perinatal outcomes of preterm delivery (PD), low birthweight (LBW) and small-for-gestational-age (SGA). SEARCH STRATEGY: PubMed, Embase, Wanfang, and China National Knowledge Infrastructure (CNKI) from inception to 1 January 2021. SELECTION CRITERIA: Cohort studies comparing the likelihood of adverse perinatal outcomes in groups of asthmatic women stratified by asthma severity, asthma exacerbations or medication use, or comparing the likelihood of adverse perinatal outcomes between non-asthmatic women and asthmatics of various levels of severity and exacerbation. DATA COLLECTION AND ANALYSIS: Two authors independently extracted data and assessed risk of bias. Random-effects models were used to meta-analyse the results. MAIN RESULTS: Twenty studies met the inclusion criteria. The odds of delivering SGA babies increased with maternal asthma severity. Pregnant women with an asthma exacerbation had higher odds of delivering LBW babies and SGA babies, compared with pregnant women with asthma but without an exacerbation (pooled adjusted odds ratio [OR] 1.15, 95% CI 1.02-1.29 for LBW; number of studies with adjusted OR 3; I = 0%) (pooled adjusted OR 1.13, 95% CI 1.04-1.23 for SGA; number of studies with adjusted OR 4; I = 0%) and compared to pregnant women without asthma. Oral corticosteroids use during pregnancy was associated with increased odds of LBW, but not PD. CONCLUSIONS: The available data suggest that maternal asthma severity and exacerbations are associated with increased odds of LBW and SGA babies. TWEETABLE ABSTRACT: A systematic review and meta-analysis found that maternal asthma severity and exacerbations are associated with increased odds of delivering low birthweight and small-for-gestational-age babies.
背景：近年来，已经有大量研究探讨了哮喘严重程度、加重和药物使用与不良围产期结局之间的关联。
目的：更新关于哮喘严重程度、加重和药物使用与早产（PD）、低出生体重（LBW）和小于胎龄儿（SGA）等不良围产期结局之间关联的证据。
检索策略：从建库至 2021 年 1 月 1 日，检索 PubMed、Embase、万方和中国知网（CNKI）。
选择标准：比较哮喘女性按哮喘严重程度、哮喘加重或药物使用分层的不良围产期结局发生可能性的队列研究，或比较无哮喘的女性和不同严重程度和加重程度的哮喘女性的不良围产期结局发生可能性的研究。
数据收集和分析：两位作者独立提取数据并评估偏倚风险。使用随机效应模型对结果进行荟萃分析。
主要结果：有 20 项研究符合纳入标准。母亲哮喘严重程度与 SGA 婴儿的分娩几率增加相关。与哮喘但无加重的孕妇相比，有哮喘加重的孕妇分娩 LBW 婴儿和 SGA 婴儿的几率更高（汇总校正比值比 [OR] 1.15，95%CI 1.02-1.29 用于 LBW；调整后的 OR 有 3 项研究；I ² = 0%）（汇总校正 OR 1.13，95%CI 1.04-1.23 用于 SGA；调整后的 OR 有 4 项研究；I ² = 0%），且与无哮喘的孕妇相比。孕期使用口服皮质类固醇与 LBW 几率增加相关，但与 PD 无关。
结论：现有数据表明，母亲哮喘严重程度和加重与 LBW 和 SGA 婴儿的几率增加相关。
研究结果表明，母亲哮喘的严重程度和加重与低出生体重和小于胎龄儿的风险增加相关。
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