Zhang Peng, Lappen Justin R, Attaway Amy, Erzurum Serpil, Love Thomas E, Zein Joe, Tsuang Wayne
Respiratory Institute, Cleveland Clinic, Cleveland, Ohio.
Maternal Fetal Medicine, Cleveland Clinic, Cleveland, Ohio.
J Allergy Clin Immunol Pract. 2025 Mar;13(3):576-582.e3. doi: 10.1016/j.jaip.2024.12.013. Epub 2024 Dec 19.
Asthma, affecting approximately 13% of pregnancies worldwide, and gestational diabetes mellitus (GDM), present in approximately 14%, are both associated with adverse maternal and perinatal outcomes. This study aims to address a lack of current knowledge about how GDM affects asthma during pregnancy.
To determine whether GDM is associated with an increased risk of asthma exacerbations during pregnancy and the first year postpartum.
This retrospective cohort study analyzed electronic health records of pregnant patients with asthma from 2010 to 2023, excluding those with pre-existing diabetes mellitus or concurrent chronic lung diseases. Asthma exacerbations were defined by the need for an oral corticosteroid prescription. Multivariable logistic regression and zero-inflated Poisson regression were used to adjust for age, race, body mass index (BMI), prepregnancy asthma exacerbation history, and insurance status.
Among 10,985 individuals, 1492 had GDM. Patients with GDM were older with higher BMIs. GDM was associated with increased asthma exacerbation risk during pregnancy (adjusted odds ratio [OR] = 1.36, 95% confidence interval [CI]: 1.10-1.67), but not postpartum. Stratified analyses of 4331 individuals with gestational blood glucose measurement showed that each doubling of blood glucose levels doubled the risk of asthma exacerbations during pregnancy (adjusted OR = 2.02, 95% CI: 1.45-2.81). Other factors associated with asthma exacerbation included prepregnancy asthma exacerbations, older age, and Medicaid coverage.
The association between GDM and increased risk of asthma exacerbations underscores the need for early, universal screening and effective interventions to improve blood glucose control in pregnant individuals with pre-existing asthma.
哮喘影响着全球约13%的孕妇，而妊娠期糖尿病（GDM）的发生率约为14%，二者均与不良的孕产妇和围产期结局相关。本研究旨在解决目前关于妊娠期糖尿病如何影响哮喘这一知识空白。
确定妊娠期糖尿病是否与孕期及产后第一年哮喘发作风险增加有关。
这项回顾性队列研究分析了2010年至2023年患有哮喘的孕妇的电子健康记录，排除了既往患有糖尿病或并发慢性肺部疾病的患者。哮喘发作定义为需要口服糖皮质激素处方。采用多变量逻辑回归和零膨胀泊松回归来调整年龄、种族、体重指数（BMI）、孕前哮喘发作史和保险状况。
在10985名个体中，有1492人患有妊娠期糖尿病。患有妊娠期糖尿病的患者年龄较大，BMI较高。妊娠期糖尿病与孕期哮喘发作风险增加相关（调整后的优势比[OR]=1.36，95%置信区间[CI]：1.10-1.67），但产后无此关联。对4331名进行了妊娠期血糖测量的个体进行分层分析显示，血糖水平每翻倍，孕期哮喘发作风险就翻倍（调整后的OR=2.02，95%CI：1.45-2.81）。与哮喘发作相关的其他因素包括孕前哮喘发作、年龄较大和医疗补助覆盖。
妊娠期糖尿病与哮喘发作风险增加之间的关联强调了对患有哮喘的孕妇进行早期、普遍筛查和有效干预以改善血糖控制的必要性。
