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Georgakopoulou VE, Taskou C, Spandidos DA, Diamanti A. Complex interplays: Asthma management and maternal‑fetal outcomes in pregnancy (Review). Exp Ther Med 2024; 28:454. [PMID: 39478732 PMCID: PMC11523260 DOI: 10.3892/etm.2024.12744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Accepted: 09/18/2024] [Indexed: 11/02/2024] Open
Abstract
Asthma, a common chronic respiratory condition, poses unique challenges in pregnancy, impacting both maternal and fetal health. Of note, 8-13% of pregnant women suffer from asthma, a condition that can worsen, stabilize, or improve during pregnancy. These fluctuations necessitate a nuanced management strategy to ensure the health of both the mother and fetus. Adverse outcomes, such as preeclampsia, gestational diabetes and increased cesarean delivery rates are associated with poorly controlled asthma. From a fetal perspective, the risks include preterm birth and a low birth weight. Physiological changes in pregnancy, such as an increased tidal volume and altered drug metabolism due to increased blood volume, complicate the management of asthma. The safety of asthma medications during pregnancy remains a significant concern, with ongoing research into their teratogenic effects. Recent advancements in treatment include the development of biologics and the increased use of personalized medicine, integrating pharmacogenomics and immunological profiling to tailor treatments to individual needs. Digital health tools have also emerged, enabling improved patient monitoring and management. The present review highlights the complex interplay between asthma management and pregnancy outcomes, advocating for comprehensive care approaches that consider the dynamic physiological changes during pregnancy. It underscores the need for ongoing research into the safety of medication and innovative therapeutic strategies to improve health outcomes for pregnant women with asthma and their babies.
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Affiliation(s)
| | - Chrysoula Taskou
- Department of Midwifery, Faculty of Health and Caring Sciences, University of West Attica, 12243 Athens, Greece
| | - Demetrios A. Spandidos
- Laboratory of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Athina Diamanti
- Department of Midwifery, Faculty of Health and Caring Sciences, University of West Attica, 12243 Athens, Greece
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Ueyama K, Kakinuma T, Mori K, Hayashi A, Kakinuma K, Okamoto R, Kaneko A, Yanagida K, Takeshima N, Ohwada M. Managing Vogt-Koyanagi-Harada disease during pregnancy with steroid pulse therapy: A case report. World J Clin Cases 2024; 12:6493-6499. [PMID: 39507109 PMCID: PMC11438695 DOI: 10.12998/wjcc.v12.i31.6493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 08/22/2024] [Accepted: 08/28/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND High-dose steroid administration is a common initial therapeutic approach for Vogt-Koyanagi-Harada disease (VKH). Nonetheless, administering substantial doses of steroids to pregnant women necessitates meticulous consideration due to the potential impacts on the mother and fetus. We present a case wherein steroid pulse therapy was administered to a patient who developed VKH during the late stages of pregnancy. CASE SUMMARY The patient was a 26-year-old nulliparous woman. At 33 weeks and 1 day of her pregnancy, she experienced a decline in visual acuity and noticed metamorphopsia in her left eye. Examination revealed bilateral serous retinal detachment, leading to VKH diagnosis. A collaborative effort involving the departments of ophthalmology, internal medicine, and neonatology was initiated. Steroid pulse therapy was administered at 34 weeks and 1 day of pregnancy under hospital supervision. Complications, such as threatened preterm labor and gestational diabetes, emerged, necessitating the initiation of oral ritodrine hydrochloride and insulin therapy. Then, serous retinal detachment was resolved, and visual acuity was restored. Labor pains initiated 32 days post-initiation of steroid pulse therapy (at 38 weeks and 4 days of gestation), culminating in a normal delivery. Mother and newborn experienced an uneventful puerperal course and were discharged from the hospital on the 5th day following delivery. CONCLUSION VKH management in pregnancy requires multidisciplinary coordination, emphasizing collaboration with ophthalmologists and specialists in internal medicine and neonatology.
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Affiliation(s)
- Kyouhei Ueyama
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Tochigi 329-2763, Nasushiobara, Japan
| | - Toshiyuki Kakinuma
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Tochigi 329-2763, Nasushiobara, Japan
| | - Keisuke Mori
- Department of Ophthalmology, International University of Health and Welfare Hospital, Tochigi 327-2763, Japan
| | - Ayumi Hayashi
- Department of Ophthalmology, International University of Health and Welfare Hospital, Tochigi 327-2763, Japan
| | - Kaoru Kakinuma
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Tochigi 329-2763, Nasushiobara, Japan
| | - Rora Okamoto
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Tochigi 329-2763, Nasushiobara, Japan
| | - Ayaka Kaneko
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Tochigi 329-2763, Nasushiobara, Japan
| | - Kaoru Yanagida
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Tochigi 329-2763, Nasushiobara, Japan
| | - Nobuhiro Takeshima
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Tochigi 329-2763, Nasushiobara, Japan
| | - Michitaka Ohwada
- Department of Obstetrics and Gynecology, International University of Health and Welfare Hospital, Tochigi 329-2763, Nasushiobara, Japan
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Sturm A, Atreya R, Bettenworth D, Bokemeyer B, Dignass A, Ehehalt R, Germer CT, Grunert PC, Helwig U, Horisberger K, Herrlinger K, Kienle P, Kucharzik T, Langhorst J, Maaser C, Ockenga J, Ott C, Siegmund B, Zeißig S, Stallmach A. Aktualisierte S3-Leitlinie „Diagnostik und Therapie des Morbus Crohn“ der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) (Version 4.1) – living guideline. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2024; 62:1229-1318. [PMID: 39111333 DOI: 10.1055/a-2309-6123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2024]
Affiliation(s)
- Andreas Sturm
- Klinik für Innere Medizin mit Schwerpunkt Gastroenterologie, DRK Kliniken Berlin Westend, Berlin, Deutschland
| | - Raja Atreya
- Medizinische Klinik 1, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | | | - Bernd Bokemeyer
- Gastroenterologische Gemeinschaftspraxis Minden, Minden, Deutschland
| | - Axel Dignass
- Medizinische Klinik I, Agaplesion Markus Krankenhaus, Frankfurt am Main, Deutschland
| | | | | | - P C Grunert
- Klinik für Innere Medizin IV (Gastroenterologie, Hepatologie und Infektiologie), Universitätsklinikum Jena, Deutschland
| | - Ulf Helwig
- Internistische Praxengemeinschaft, Oldenburg, Deutschland
| | - Karoline Horisberger
- Universitätsmedizin Johannes Gutenberg, Universität Klinik f. Allgemein-,Visceral- und Transplantationschirurgie, Mainz, Deutschland
| | | | - Peter Kienle
- Allgemein- und Viszeralchirurgie, Theresienkrankenhaus und Sankt Hedwig-Klinik GmbH, Mannheim, Deutschland
| | - Torsten Kucharzik
- Klinik für Allgemeine Innere Medizin und Gastroenterologie, Klinikum Lüneburg, Lüneburg, Deutschland
| | - Jost Langhorst
- Klinik für Integrative Medizin und Naturheilkunde, Klinikum am Bruderwald, Bamberg, Deutschland
| | - Christian Maaser
- Gastroenterologie, Ambulanzzentrum Lüneburg, Lüneburg, Deutschland
| | - Johann Ockenga
- Medizinische Klinik II, Klinikum Bremen Mitte - Gesundheit Nord, Bremen, Deutschland
| | - Claudia Ott
- Gastroenterologie Facharztzentrum, Regensburg, Deutschland
| | - Britta Siegmund
- Medizinische Klinik I, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Deutschland
| | - Sebastian Zeißig
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden, Deutschland
| | - Andreas Stallmach
- Klinik für Innere Medizin IV (Gastroenterologie, Hepatologie und Infektiologie), Universitätsklinikum Jena, Deutschland
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4
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Laube R, Selinger CP, Seow CH, Christensen B, Flanagan E, Kennedy D, Mountifield R, Seeho S, Shand A, Williams AJ, Leong RW. Australian inflammatory bowel disease consensus statements for preconception, pregnancy and breast feeding. Gut 2023; 72:1040-1053. [PMID: 36944479 DOI: 10.1136/gutjnl-2022-329304] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/21/2023] [Indexed: 03/23/2023]
Abstract
OBJECTIVE Because pregnancy outcomes tend to be worse in women with inflammatory bowel disease (IBD) than in those without, we aimed to update consensus statements that guide the clinical management of pregnancy in patients with IBD. DESIGN A multidisciplinary working group was established to formulate these consensus statements. A modified RAND/UCLA appropriateness method was used, consisting of a literature review, online voting, discussion meeting and a second round of voting. The overall agreement among the delegates and appropriateness of the statement are reported. RESULTS Agreement was reached for 38/39 statements which provide guidance on management of pregnancy in patients with IBD. Most medications can and should be continued throughout pregnancy, except for methotrexate, allopurinol and new small molecules, such as tofacitinib. Due to limited data, no conclusion was reached on the use of tioguanine during pregnancy. Achieving and maintaining IBD remission before conception and throughout pregnancy is crucial to optimise maternofetal outcomes. This requires a multidisciplinary approach to engage patients, allay anxieties and maximise adherence tomedication. Intestinal ultrasound can be used for disease monitoring during pregnancy, and flexible sigmoidoscopy or MRI where clinically necessary. CONCLUSION These consensus statements provide up-to-date, comprehensive recommendations for the management of pregnancy in patients with IBD. This will enable a high standard of care for patients with IBD across all clinical settings.
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Affiliation(s)
- Robyn Laube
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- Department of Gastroenterology, Macquarie University Hospital, Sydney, New South Wales, Australia
| | | | - Cynthia H Seow
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Britt Christensen
- Gastroenterology Department, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Emma Flanagan
- Department of Gastroenterology, University of Melbourne, Melbourne, Victoria, Australia
| | - Debra Kennedy
- MotherSafe, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Reme Mountifield
- Department of Gastroenterology, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Sean Seeho
- Department of Obstetrics and Gynaecology, Royal North Shore Hospital, St Leonards, New South Wales, Australia
| | - Antonia Shand
- Department of Maternal Foetal Medicine, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Astrid-Jane Williams
- Department of Gastroenterology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Rupert W Leong
- Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
- Department of Gastroenterology, Macquarie University Hospital, Sydney, New South Wales, Australia
- Gastroenterology and Liver Services, Concord Repatriation General Hospital, Concord, New South Wales, Australia
- The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
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Abstract
Asthma is one of the most common potentially serious medical problems to complicate pregnancy. Optimal management of asthma during pregnancy is thus important for both mother and baby. Treating asthmatic women requires understanding the effects of pregnancy on the course of asthma, and, conversely, the effects of asthma on pregnancy outcomes. Successful management also requires an understanding the barriers to asthma control in this population of patients. Evidence has shown that it is essential that the allergist-immunologist, obstetrician, and patient work as a team during pregnancy to achieve optimal maternal and neonatal outcomes.
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Affiliation(s)
- Jennifer A Namazy
- Department of Allergy and Immunology, Scripps Clinic, 7565 Mission Valley Road Suite 200, San Diego, CA 92108, USA.
| | - Michael Schatz
- Department of Allergy and Immunology, Kaiser Permanente, San Diego, CA, USA
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Torres J, Chaparro M, Julsgaard M, Katsanos K, Zelinkova Z, Agrawal M, Ardizzone S, Campmans-Kuijpers M, Dragoni G, Ferrante M, Fiorino G, Flanagan E, Gomes CF, Hart A, Hedin CR, Juillerat P, Mulders A, Myrelid P, O'Toole A, Rivière P, Scharl M, Selinger CP, Sonnenberg E, Toruner M, Wieringa J, Van der Woude CJ. European Crohn's and Colitis Guidelines on Sexuality, Fertility, Pregnancy, and Lactation. J Crohns Colitis 2023; 17:1-27. [PMID: 36005814 DOI: 10.1093/ecco-jcc/jjac115] [Citation(s) in RCA: 125] [Impact Index Per Article: 62.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Indexed: 02/02/2023]
Affiliation(s)
- Joana Torres
- Division of Gastroenterology, Hospital Beatriz Ângelo, Loures, Portugal
- Division of Gastroenterology, Hospital da Luz, Lisboa, Portugal
- Faculdade de Medicina, Universidade de Lisboa, Lisboa, Portugal
| | - María Chaparro
- Department of Gastroenterology, Hospital Universitario de La Princesa, IIS-Princesa, UAM, CIBEREHD, Madrid, Spain
| | - Mette Julsgaard
- Department of Hepatology & Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
- Center for Molecular Prediction of Inflammatory Bowel Disease [PREDICT], Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
| | - Konstantinos Katsanos
- Department of Gastroenterology and Hepatology, University and Medical School of Ioannina, Ioannina, Greece
| | - Zuzana Zelinkova
- Department of Internal Medicine, Svet zdravia, Nemocnica Dunajska Streda, Slovakia
- Firstst Department of Internal Medicine of University Hospital and Slovak Medical University in Bratislava, Bratislava, Slovakia
| | - Manasi Agrawal
- Dr Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Center for Molecular Prediction of Inflammatory Bowel Disease [PREDICT], Department of Clinical Medicine, Aalborg University, Copenhagen, Denmark
| | - Sandro Ardizzone
- Gastrointestinal Unit, Department of Biomedical and Clinical Sciences. University of Milan, Milan, Italy
| | - Marjo Campmans-Kuijpers
- Department of Gastroenterology and Hepatology, University Medical Centre Groningen, Groningen, The Netherlands
| | - Gabriele Dragoni
- Gastroenterology Research Unit, Department of Experimental and Clinical Biomedical Sciences 'Mario Serio', University of Florence, Florence, Italy
- Gastroenterology Department, Careggi University Hospital, Florence, Italy
| | - Marc Ferrante
- Department of Gastroenterology and Hepatology, University Hospitals Leuven, Leuven, Belgium
- Department of Chronic Diseases, Metabolism and Ageing, KU Leuven, Leuven, Belgium
| | - Gionata Fiorino
- Department of Gastroenterology and Digestive Endoscopy, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Emma Flanagan
- Department of Gastroenterology, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | | | - Ailsa Hart
- Inflammatory Bowel Diseases Unit, St Mark's Hospital, Harrow, UK
| | - Charlotte Rose Hedin
- Karolinska Institutet, Department of Medicine Solna, Stockholm, Sweden
- Karolinska University Hospital, Department of Gastroenterology, Dermatovenereology and Rheumatology, Stockholm, Sweden
| | - Pascal Juillerat
- Clinic for Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland
- Crohn's and Colitis Center, Gastroenterology Beaulieu SA, Lausanne, Switzerland
| | - Annemarie Mulders
- Department of Obstetrics and Gynaecology, Division of Obstetrics and Fetal Medicine Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Pär Myrelid
- Department of Surgery, Linköping University Hospital, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Aoibhlinn O'Toole
- Beaumont Hospital, Department of Gastroenterology, Royal College of Surgeons, Dublin, Ireland
| | - Pauline Rivière
- Gastroenterology Unit, Bordeaux University Hospital, Pessac, France
| | - Michael Scharl
- Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland
| | | | - Elena Sonnenberg
- Charité-Universitätsmedizin Berlin, Department of Gastroenterology, Infectious Diseases and Rheumatology, Germany
| | - Murat Toruner
- Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
| | - Jantien Wieringa
- Department of Paediatrics, Haaglanden Medical Center, The Hague, The Netherlands
- Department of Paediatrics, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - C Janneke Van der Woude
- Department of Gastroenterology & Hepatology, Erasmus University Medical Center, Rotterdam, The Netherlands
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7
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Lao TT, Annie Hui SY. The obstetric aspects of maternal asthma. Best Pract Res Clin Obstet Gynaecol 2022; 85:57-69. [PMID: 36210285 DOI: 10.1016/j.bpobgyn.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/26/2022] [Accepted: 08/20/2022] [Indexed: 12/14/2022]
Abstract
Asthma is the commonest chronic medical condition encountered in pregnancy. Poor asthma control and exacerbations are frequently encountered due to treatment non-adherence, pregnancy-related aggravating factors such as increased susceptibility to viral infections, and comorbidities that are commonly associated. Asthma-related inflammatory reactions and placental effects, the effect of medications, and respiratory symptoms and hypoxia are probably to interact to result in an increased adverse obstetric outcomes including miscarriage, foetal congenital anomalies, pregnancy hypertensive disorders, gestational diabetes, preterm labour and birth, antepartum haemorrhage, low birthweight and foetal growth restriction (FGR), caesarean delivery, postpartum haemorrhage (PPH), maternal intensive care admission, and even mortality, while the offspring also has increased long-term morbidity. Interdisciplinary management with frequent assessment by symptoms, spirometry, and biomarkers, together with removal of risk factors such as smoking and appropriate instigation of treatment including short courses of systemic corticosteroid, could ensure optimal and tailored treatment to control symptoms, prevent exacerbations, and ultimately enhancing maternal and perinatal outcomes.
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Affiliation(s)
- Terence T Lao
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
| | - Shuk-Yi Annie Hui
- Department of Obstetrics & Gynaecology, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
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8
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Xu X, Liang MY, Wang YL, Wang JL, Zhang XH. Lower-dose corticosteroid therapy in severe immune thrombocytopenia during pregnancy: The comparable efficacy and lower incidence of maternal complications. Front Pharmacol 2022; 13:983734. [DOI: 10.3389/fphar.2022.983734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/26/2022] [Indexed: 11/13/2022] Open
Abstract
Background: This study assessed the clinical efficacy of oral prednisone at low dose (LD) versus the previous high-dose (HD) study in patients with severe immune thrombocytopenia during pregnancy and its side effects on maternal and neonatal outcomes.Study design: Pregnant patients with ITP were enrolled in the study (platelet count <30×109/L) between January 2015 and 2019. A total of 43 patients received LD oral prednisone (0.25–0.5 mg/kg) as the initial treatment and were compared retrospectively with the 31 patients in the HD (1 mg/kg) study. The primary clinical endpoint was the response rate, and the secondary endpoint was maternal hemorrhagic events, complications, and neonatal outcomes.Results: In total, 35% of patients responded (15/43) to the LD cortico-therapy, including four patients with a complete response which was no less than HD therapy (35.5%). The bleeding symptoms of 10 (30%) patients were ameliorated after 14 days of LD prednisone treatment. Preeclampsia occurred in three cases (7% of total) of which the incidence was obviously lower than that of the previous study at HD (18%). No stillbirth or miscarriage occurred in the LD group, and neonatal outcomes had no significant differences between the two studies.Conclusion: LD prednisone therapy for severe ITP patients during pregnancy had equal efficacy to HD treatment. In addition, the decrease in dosage significantly reduced the incidence of hypertension.
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9
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Sturm A, Atreya R, Bettenworth D, Bokemeyer B, Dignaß A, Ehehalt R, Germer C, Grunert PC, Helwig U, Herrlinger K, Kienle P, Kreis ME, Kucharzik T, Langhorst J, Maaser C, Ockenga J, Ott C, Siegmund B, Zeißig S, Stallmach A. Aktualisierte S3-Leitlinie „Diagnostik und Therapie des Morbus Crohn“ der Deutschen Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS) – August 2021 – AWMF-Registernummer: 021-004. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2022; 60:332-418. [PMID: 35263784 DOI: 10.1055/a-1713-3941] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Andreas Sturm
- Klinik für Innere Medizin mit Schwerpunkt Gastroenterologie, DRK Kliniken Berlin Westend, Berlin, Deutschland
| | - Raja Atreya
- Medizinische Klinik 1, Universitätsklinikum Erlangen, Deutschland
| | | | - Bernd Bokemeyer
- Gastroenterologische Gemeinschaftspraxis Minden, Deutschland
| | - Axel Dignaß
- Medizinische Klinik I, Agaplesion Markus Krankenhaus, Frankfurt am Main, Deutschland
| | | | - Christoph Germer
- Chirurgische Klinik I, Universitätsklinikum Würzburg, Deutschland
| | - Philip C Grunert
- Klinik für Innere Medizin IV (Gastroenterologie, Hepatologie und Infektiologie), Universitätsklinikum Jena, Deutschland
| | - Ulf Helwig
- Internistische Praxengemeinschaft, Oldenburg, Deutschland
| | | | - Peter Kienle
- Allgemein- und Viszeralchirurgie, Theresienkrankenhaus und Sankt Hedwig-Klinik GmbH, Mannheim, Deutschland
| | - Martin E Kreis
- Klinik für Allgemein-, Viszeral- und Gefäßchirurgie, Charité Campus Benjamin Franklin - Universitätsmedizin Berlin, Deutschland
| | - Torsten Kucharzik
- Klinik für Allgemeine Innere Medizin und Gastroenterologie, Klinikum Lüneburg, Deutschland
| | - Jost Langhorst
- Klinik für Integrative Medizin und Naturheilkunde, Klinikum am Bruderwald, Bamberg, Deutschland
| | | | - Johann Ockenga
- Medizinische Klinik II, Klinikum Bremen Mitte - Gesundheit Nord, Bremen, Deutschland
| | - Claudia Ott
- Gastroenterologie Facharztzentrum, Regensburg, Deutschland
| | - Britta Siegmund
- Medizinische Klinik I, Charité Universitätsmedizin Berlin, Campus Benjamin Franklin, Deutschland
| | - Sebastian Zeißig
- Medizinische Klinik und Poliklinik I, Universitätsklinikum Dresden, Deutschland
| | - Andreas Stallmach
- Klinik für Innere Medizin IV (Gastroenterologie, Hepatologie und Infektiologie), Universitätsklinikum Jena, Deutschland
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10
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Pfaller B, Bendien S, Ditisheim A, Eiwegger T. Management of allergic diseases in pregnancy. Allergy 2022; 77:798-811. [PMID: 34427919 DOI: 10.1111/all.15063] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 08/21/2021] [Indexed: 12/19/2022]
Abstract
Allergic diseases like asthma, allergic rhinitis, food allergy, hymenoptera allergy, or atopic dermatitis are highly prevalent in women of childbearing age and may affect up to 30% of this age group. This review focuses on the management of allergic diseases during pregnancy. Furthermore, we discuss the challenges of counseling women with allergic diseases in the reproductive age, including considerations relevant to the ongoing SARS-CoV-2 pandemic. To create the optimal milieu for the unborn child, a multitude of immunological changes occur during pregnancy which may favor type 2 responses and aggravate disease phenotypes. In co-occurrence with suboptimal preconception disease control, this elevated Th2 responses may aggravate allergic disease manifestations during pregnancy and pose a risk for mother and child. Due to limitations in conducting clinical trials in pregnant women, safety data on anti-allergic drugs during pregnancy are limited. The lack of information and concerns among pregnant patients demands counseling on the benefits of anti-allergic drugs and the potential and known risks. This includes information on the risk for mother and child of disease aggravation in the absence of treatment. By doing so, informed decisions and shared decision-making can take place.
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Affiliation(s)
- Birgit Pfaller
- Karl Landsteiner University of Health Sciences Krems Austria
- Department of Internal Medicine 1 University Hospital St. PöltenKarl Landsteiner Institute for Nephrology St. Pölten St. Pölten Austria
| | - Sarah Bendien
- Department of Respiratory Medicine Haga Teaching Hospital The Hague The Netherlands
| | - Agnès Ditisheim
- Center for Maternal‐Fetal Medicine La Tour Hospital Meyrin Switzerland
- Faculty of Medicine University of Geneva Geneva Switzerland
| | - Thomas Eiwegger
- Karl Landsteiner University of Health Sciences Krems Austria
- Translational Medicine Program Research InstituteThe Hospital for Sick Children Toronto Canada
- Department of Immunology University of Toronto Toronto ON Canada
- Department of Pediatric and Adolescent Medicine University Hospital St. Pölten St. Pölten Austria
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11
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Couillard S, Connolly C, Borg C, Pavord I. Asthma in pregnancy: An update. Obstet Med 2021; 14:135-144. [PMID: 34646341 PMCID: PMC8504309 DOI: 10.1177/1753495x20965072] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/16/2020] [Indexed: 01/13/2023] Open
Abstract
AIM To update obstetric care providers about asthma management. SUMMARY Asthma is the most frequent comorbid chronic illness in pregnancy. Convincing evidence shows that uncontrolled asthma magnifies the risk of maternal, fetal and neonate complications. Unfortunately, one in four women take no inhaler during pregnancy, and it is likely that decreased adherence, rather than changes in pathology, explains uncontrolled maternal asthma. Patient surveys reveal a need for information and reassurance. Although some molecules are preferred in pregnancy, there is currently no basis to withhold any asthma medication - old or new. Biomarkers such as blood eosinophils and fractional exhaled nitric oxide are an effective way to assess the risk of asthma attacks and the likelihood of responding to inhaled steroids. Furthermore, practice-changing trials in mild asthma show that switching reliever-only regimens to as-needed 'controller-and-reliever' therapy is effective. We suggest that applying these changes can alleviate women's concerns and improve outcomes.
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Affiliation(s)
- Simon Couillard
- Respiratory Medicine Unit and Oxford Respiratory NIHR BRC, Nuffield Department of Medicine, University of Oxford, Oxford, UK
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Clare Connolly
- Respiratory Medicine Unit and Oxford Respiratory NIHR BRC, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Catherine Borg
- Respiratory Medicine Unit and Oxford Respiratory NIHR BRC, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Ian Pavord
- Respiratory Medicine Unit and Oxford Respiratory NIHR BRC, Nuffield Department of Medicine, University of Oxford, Oxford, UK
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12
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Namazy JA, Schatz M. Contemporary management and treatment strategies for asthma during pregnancy. Expert Rev Respir Med 2021; 15:1149-1157. [PMID: 34058955 DOI: 10.1080/17476348.2021.1935243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Asthma is one of the most common conditions that afflict pregnant women. Because uncontrolled asthma in pregnancy affects both maternal and offspring outcomes, careful attention to maintaining control of asthma symptoms throughout pregnancy is of critical importance.Areas Covered: Using a search of PUBMED/MEDLINE for 'asthma and pregnancy,' this article will review the current literature regarding epidemiology and course of asthma in pregnancy, the effects of uncontrolled asthma on both the mother and offspring, and provide an overview of the management, both non-pharmacologic and pharmacologic, of asthma in pregnancy.Expert Opinion: There is a lack of adequate safety information for most medications taken during pregnancy. Future research might allow better methods to predict which women will experience worsening during pregnancy. For now, surveillance systems like pregnancy registries or observational cohort studies can provide safety information for medications used during pregnancy.
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Affiliation(s)
- Jennifer A Namazy
- Department of Allergy and Immunology, Scripps Clinic, San Diego, CA, USA
| | - Michael Schatz
- Department of Allergy, Kaiser Permanente Medical Center, San Diego, CA, USA
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13
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Pregnancy Outcomes among Women with Intermittent Asthma: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126376. [PMID: 34204663 PMCID: PMC8296199 DOI: 10.3390/ijerph18126376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/07/2021] [Accepted: 06/10/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND It is already known that asthma strongly increases risks of poor pregnancy outcomes. We wonder whether intermittent asthma, the least severe form but accounting for the majority of cases, increases such adverse outcomes or not. Therefore, we conducted this study to compare adverse pregnancy outcomes between pregnancies with intermittent asthma and low-risk pregnancies (controls). METHODS The full medical records of pregnancies with intermittent asthma were comprehensively reviewed and low-risk pregnancies were randomly recruited as controls with a ratio of 10:1. The obstetric outcomes were compared between both groups, and the outcomes in the active subgroup of intermittent asthma (defined as at least one asthmatic attack during pregnancy) were also compared with the controls. RESULTS Of 364 study cases and 3640 controls, the rates of poor outcomes (preterm birth, preeclampsia, fetal growth restriction etc.) were not significantly different. However, cases with active disease slightly, but significantly, increased the risk of low birth weight. Moreover, mean gestational age was significantly lower in the study group. CONCLUSIONS A new insight gained from this study is that intermittent asthma is not associated with poor pregnancy outcomes, but cases with asthmatic attack during pregnancy tended to increase the risk of preterm birth and low birth weight. This information is important for counseling and the planning of antepartum management.
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Issa S, Longo C, Forget A, Blais L. Association between the timing of asthma diagnosis and medication use during pregnancy. Pharmacotherapy 2021; 41:342-349. [PMID: 33555035 DOI: 10.1002/phar.2511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 12/14/2020] [Accepted: 01/22/2021] [Indexed: 11/12/2022]
Abstract
STUDY OBJECTIVE To assess whether asthma medication use during pregnancy differs in women newly diagnosed with asthma early in pregnancy (first 19 weeks of pregnancy) compared to those newly diagnosed up to 2 years pre-pregnancy. DESIGN A retrospective population-based cohort study. DATA SOURCE To conduct this study, we used the Quebec Asthma and Pregnancy Database (QAPD) constructed by linking two administrative health databases from the province of Quebec (Canada): the Régie de l'Assurance Maladie du Québec and Maintenance et Exploitation des Données pour l'Étude de la Clientèle Hospitalière databases. PATIENTS A cohort comprising pregnant women newly diagnosed with asthma at any time in the 2 years prior to pregnancy or during the first 19 weeks of pregnancy was selected from the QAPD. MEASUREMENTS AND MAIN RESULTS We assessed the number of filled prescriptions of inhaled corticosteroids (ICS), ICS/long-acting β2 agonists (LABA), and short-acting β2 agonists (SABA), as well as the number of days' supply of oral corticosteroid (OCS) from the 20th week of pregnancy until delivery. Poisson regression was used to compare the rates of asthma medication use in women diagnosed pre-pregnancy versus early in pregnancy. The cohort included 1731 women newly diagnosed with asthma pre-pregnancy and 359 women newly diagnosed with asthma early in pregnancy. Women diagnosed early in pregnancy were more likely to use ICS (adjusted rate ratio: 1.9, 95% confidence interval (CI): 1.6-2.3) and SABA (adjusted rate ratio: 2.0, 95% CI: 1.7-2.4) from the 20th week of pregnancy until delivery than those newly diagnosed pre-pregnancy. No significant differences were observed in the use of ICS/LABA [adjusted rate ratio: 0.9, 95% CI: 0.7-1.3] and OCS [adjusted rate ratio: 0.8, 95% CI: 0.6-1.2]. CONCLUSION The higher use of ICS and SABA observed in women newly diagnosed with asthma early in pregnancy may suggest a more persistent asthma phenotype caused by pregnancy-triggered hormonal changes.
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Affiliation(s)
- Simone Issa
- Faculty of Pharmacy, Université de Montréal, Montréal, Quebec, Canada.,Research Center, Centre Intégré Universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal, Montreal, Quebec, Canada
| | - Cristina Longo
- Faculty of Pharmacy, Université de Montréal, Montréal, Quebec, Canada
| | - Amélie Forget
- Faculty of Pharmacy, Université de Montréal, Montréal, Quebec, Canada.,Research Center, Centre Intégré Universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal, Montreal, Quebec, Canada
| | - Lucie Blais
- Faculty of Pharmacy, Université de Montréal, Montréal, Quebec, Canada.,Research Center, Centre Intégré Universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal, Montreal, Quebec, Canada.,Endowment Pharmaceutical Chair AstraZeneca in Respiratory Health, Montreal, Quebec, Canada
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15
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Tidemandsen C, Juul Gade E, Ulrik CS, Nielsen HS, Oxlund-Mariegaard BS, Kristiansen K, Freiesleben NLC, Nøhr B, Udengaard H, Backer V. Treatment with the anti-IgE monoclonal antibody omalizumab in women with asthma undergoing fertility treatment: a proof-of-concept study-The PRO-ART study protocol. BMJ Open 2020; 10:e037041. [PMID: 33184076 PMCID: PMC7662444 DOI: 10.1136/bmjopen-2020-037041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Asthma is associated with prolonged time to pregnancy and a higher need for fertility treatment. However, the mechanism underlying this association remains incompletely understood. Previous research points to asthma-driven systemic inflammation also affecting the reproductive organs and thereby fertility. The aim of this study was to determine if treatment with omalizumab prior to fertility treatment will increase pregnancy rate among women with asthma by decreasing the systemic asthma-related inflammation and, by that, to provide insight into the underlying mechanisms. METHODS AND ANALYSIS This is an ongoing prospective multicentre randomised controlled trial planned to enrol 180 women with asthma recruited from fertility clinics in Denmark. The patients are randomised 1:1 to either omalizumab or placebo. The primary endpoint is the difference in pregnancy rate confirmed with ultrasound at gestational week 7 of pregnancy. The secondary endpoints are change in sputum and blood eosinophil cell count, change in biomarkers, change in microbiota, together with rate of pregnancy loss, frequency of malformations, pre-eclampsia, preterm birth, birth weight, small for gestational age and perinatal death between groups. ETHICS AND DISSEMINATION The methods used in this study are of low risk, but if successful, our findings will have a large impact on a large group of patients as infertility and asthma are the most common chronic diseases among the young population. The study has been approved by the Ethics Committee-Danish national research ethics committee (H-18016605) and the Danish Medicines Agency (EudraCT no: 2018-001137-41) and the Danish Data Protection Agency (journal number: VD-2018486 and I-Suite number 6745). The test results will be published regardless of whether they are positive, negative or inconclusive. Publication in international peer-reviewed scientific journals is planned. TRIAL REGISTRATION NUMBER NCT03727971.
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Affiliation(s)
- Casper Tidemandsen
- Department of Respiratory Diseases, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Elisabeth Juul Gade
- Department of Obstetrics and Gynecology, Roskilde Hospital, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Diseases, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Henriette Svarre Nielsen
- Department of Obstetrics and Gynaecology, The Fertility Clinic, Copenhagen University Hospital, Hvidovre Hospital, Copenhagen, Denmark
| | | | - Karsten Kristiansen
- Laboratory of Genomics and Molecular Biomedicine, Department of Biology, University of Copenhagen, Copenhagen, Denmark
| | - Nina La Cour Freiesleben
- Department of Obstetrics and Gynaecology, The Fertility Clinic, Copenhagen University Hospital, Hvidovre Hospital, Copenhagen, Denmark
| | - Bugge Nøhr
- Fertility Clinic, Herlev Hospital, Herlev, Denmark
| | | | - Vibeke Backer
- Centre for Physical Activity Research, Rigshospitalet, Kobenhavn, Denmark
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16
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Cusack RP, Gauvreau GM. Pharmacotherapeutic management of asthma in pregnancy and the effect of sex hormones. Expert Opin Pharmacother 2020; 22:339-349. [PMID: 32988248 DOI: 10.1080/14656566.2020.1828863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Asthma is a common medical condition that can frequently affect pregnancy, and thus optimal management of asthma in pregnancy is important for both mother and baby. This article reviews recent developments of asthma pharmacotherapy and provides emerging data on the safety of asthma controller medications and biological therapies in pregnancy. The authors highlight the clinical outcomes of asthma during pregnancy, and summarize emerging new data related to the influence of sex hormones and fetal sex on asthma severity. AREAS COVERED This review of asthma pharmacotherapy during pregnancy examines the recent guidelines and reports the most pertinent publications on safety data and asthma management. EXPERT OPINION Asthma management during pregnancy follows the same principles as that of non-pregnant asthma. The available data for most asthma medications are reassuring, however there is a lack of adequate safety data available because pregnant women are generally excluded from clinical trials. More clarity is needed in guidelines regarding the management of asthma in pregnancy, and high-quality randomized control trials are required to strengthen the evidence base and inform future guidelines. In particular, safety studies examining biological therapies in pregnant women with severe asthma are needed.
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Affiliation(s)
- Ruth P Cusack
- Department of Medicine, Division of Respirology, McMaster University , Hamilton, Ontario, Canada
| | - Gail M Gauvreau
- Department of Medicine, Division of Respirology, McMaster University , Hamilton, Ontario, Canada
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17
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Asthma in Pregnancy: Pathophysiology, Diagnosis, Whole-Course Management, and Medication Safety. Can Respir J 2020; 2020:9046842. [PMID: 32184907 PMCID: PMC7060439 DOI: 10.1155/2020/9046842] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 01/18/2020] [Indexed: 12/16/2022] Open
Abstract
Asthma in pregnancy is a health issue of great concern. Physiological changes and drug compliance during pregnancy can affect asthma control in varying degrees, and the control level of asthma and the side effects of asthma medications are closely related to the adverse perinatal outcomes of mother and fetus. This article provides an update on the available literature regarding the alleviating or aggravating mechanism of asthma in pregnancy, diagnosis, disease assessment, and systematic management, to provide a new guidance for physician, obstetric joint doctor, and health care practitioner.
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18
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Implications of Changes in U.S. Food and Drug Administration Prescribing Information Regarding the Safety and Use of Asthma Biologics during Pregnancy. Ann Am Thorac Soc 2019; 15:1131-1136. [PMID: 30130420 DOI: 10.1513/annalsats.201806-400pp] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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19
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Khraishi M, Millson B, Woolcott J, Jones H, Marshall L, Ruperto N. Reduction in the utilization of prednisone or methotrexate in Canadian claims data following initiation of etanercept in pediatric patients with juvenile idiopathic arthritis. Pediatr Rheumatol Online J 2019; 17:64. [PMID: 31500631 PMCID: PMC6734296 DOI: 10.1186/s12969-019-0358-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 08/07/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In adult patients with arthritis, use of the tumor necrosis factor (TNF) inhibitor etanercept (ETN) is often associated with a reduction in the utilization of co-medications, particularly steroids. Comparatively little is known about the utilization of co-medications when ETN is initiated in pediatric patients with juvenile idiopathic arthritis (JIA). METHODS This study analyzed Canadian longitudinal claims level data spanning January 2007 to April 2017. Data were collated from the IQVIA Private Drug Plan, Ontario Public Drug Plan, and the Quebec Public Drug Plan (Régie de l'assurance maladie du Québec) databases. Patients < 18 years of age were indexed when filling a prescription for ETN between January 2008 and January 2016. Those who met the inclusion and exclusion criteria were assessed for methotrexate (MTX), and prednisone (PRD) use in the 6 months prior to and 12 months following initiation of ETN. RESULTS Longitudinal claims data for 330 biologic-naive pediatric patients initiating ETN therapy were included. The majority of patients were female (67%), aged 10-17 years (64%), and with a drug history consistent with JIA (96%). Most patients were from Quebec (36%) or Ontario (33%). Dosing of ETN was weight-based with a mean dosage over the first year of 31 mg per week. ETN dosing was relatively consistent over the first year. In total, 222 (67%) patients did not use MTX and 223 (68%) did not use PRD before or after starting ETN. A total of 17% (18/103) of MTX-treated and 50% (46/92) of PRD-treated patients discontinued use of those medications upon initiation of ETN treatment. In patients continuing MTX or PRD, significant reductions in the weekly dosage from 14.3 to 6.8 mg per week for MTX and from 56 to 23 mg per week for PRD were observed (P < 0.01). CONCLUSIONS This study of Canadian claims-level data is the first large prespecified analysis of co-medication utilization following the initiation of ETN therapy in pediatric patients. A decline in both MTX and PRD use and dosage was observed and may be associated with benefits related to safety, tolerability, and overall healthcare costs.
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Affiliation(s)
- Majed Khraishi
- 0000 0000 9130 6822grid.25055.37Memorial University of Newfoundland, St. Johns, NL Canada
| | | | - John Woolcott
- 0000 0000 8800 7493grid.410513.2Global Outcomes and Evidence, Pfizer, Collegeville, PA USA
| | - Heather Jones
- 0000 0000 8800 7493grid.410513.2Global Medical Affairs, Pfizer, Collegeville, PA USA
| | - Lisa Marshall
- 0000 0000 8800 7493grid.410513.2Global Medical Affairs, Pfizer, Collegeville, PA USA
| | - Nicolino Ruperto
- IRCCS, Istituto Giannina Gaslini, Clinica Pediatrica e Reumatologia - PRINTO, Genoa, Italy.
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20
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Gudeta TA, Regassa TM. Pregnancy Induced Hypertension and Associated Factors among Women Attending Delivery Service at Mizan-Tepi University Teaching Hospital, Tepi General Hospital and Gebretsadik Shawo Hospital, Southwest, Ethiopia. Ethiop J Health Sci 2019; 29:831-840. [PMID: 30700950 PMCID: PMC6341446 DOI: 10.4314/ejhs.v29i1.4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Disorders of pregnancy induced hypertensive are a major health problem in the obstetric population as they are one of the leading causes of maternal and perinatal morbidity and mortality. The World Health Organization estimates that at least one woman dies every seven minutes from complications of hypertensive disorders of pregnancy. The objective of this study is to assess pregnancy induced hypertension and its associated factors among women attending delivery service at Mizan-Tepi University Teaching Hospital, Gebretsadikshawo Hospital and Tepi General Hospital. Methods A health facility based cross-sectional study was carried out from October 01 to November 30/2016. The total sample size (422) was proportionally allocated to the three hospitals. Systematic sampling technique was used to select study participants. Variables with p-value of less than 0.25 in binary logistic regression were entered into the multivariable logistic regression to control cofounding. Odds ratio with 95% confidence interval was used. P-value less than 0.05 was considered as statistically significant. Results The prevalence of pregnancy induced hypertension was 33(7.9%); of which 5(15.2%) were gestational hypertension, 12 (36.4%) were mild preeclampsia, 15(45.5%) were severe preeclampsia and 1 (3%) eclampsia. Positive family history of pregnancy induced hypertension [AOR5.25 (1.39-19.86)], kidney diseases (AOR 3.32(1.04-10.58)), having asthma [AOR 37.95(1.41-1021)] and gestational age (AOR 0.096(0.04-.23)) were predictors of pregnancy induced hypertension. Conclusion The prevalence of pregnancy induced hypertension among women attending delivery service was 7.9%. Having family history of pregnancy induced hypertension, chronic kidney diseases and gestational age were predictors of pregnancy induced hypertension.
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Affiliation(s)
- Tesfaye Abera Gudeta
- MizanTepi University, College of Health science, Department of Nursing, Maternal Health Nursing Unit
| | - Tilahun Mekonnen Regassa
- MizanTepi University, College of Health Science, Department of Nursing, adult Health Hursing Unit
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21
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Samoilenko M, Blais L, Boucoiran I, Lefebvre G. Using a Mixture-of-Bivariate-Regressions Model to Explore Heterogeneity of Effects of the Use of Inhaled Corticosteroids on Gestational Age and Birth Weight Among Pregnant Women With Asthma. Am J Epidemiol 2018; 187:2046-2059. [PMID: 29762633 DOI: 10.1093/aje/kwy105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 05/07/2018] [Indexed: 01/18/2023] Open
Abstract
Asthma is a heterogeneous disease, and responses to asthma medications vary noticeably among patients. A substantively oriented objective of this study was to explore the potentially heterogeneous effects of exposure to maternal inhaled corticosteroids (ICS) on gestational age (GA) at delivery and birth weight (BW) using a cohort of 6,197 pregnancies among women with asthma (Quebec, Canada, 1998-2008). A methodologically oriented objective was to comprehensively describe the application of a Bayesian 2-component mixture-of-bivariate-regressions model to address this issue and estimate the effects of ICS on GA and BW jointly. Based on the proposed model, no association between ICS and GA/BW was found for a large proportion of asthmatic pregnancies. However, a positive association between ICS exposure and GA/BW was revealed in a small subset of pregnancies comprising mainly preterm and low-birth-weight infants. A novel application of this model was also subsequently performed using BW z score instead of BW as the outcome variable. In conclusion, the studied mixture-of-bivariate-regressions model was useful for detecting heterogeneity in the effect of ICS on GA and BW in our population of women with asthma. These analyses pave the way for analogous uses of this model for general assessment of exposure effect heterogeneity for these perinatal outcomes.
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Affiliation(s)
- Mariia Samoilenko
- Département de mathématiques, Faculté des sciences, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Lucie Blais
- Faculté de pharmacie, Université de Montréal, Montréal, Québec, Canada
- Centre de recherche, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
- Centre de recherche Clinique Étienne-Le Bel, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Isabelle Boucoiran
- Département d'obstétrique-gynécologie, Centre hospitalier universitaire de Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Geneviève Lefebvre
- Département de mathématiques, Faculté des sciences, Université du Québec à Montréal, Montréal, Québec, Canada
- Faculté de pharmacie, Université de Montréal, Montréal, Québec, Canada
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Xu X, Liang MY, Dou S, Wang JL, Zhang XH. Evaluation of glucocorticoid compared with immunoglobulin therapy of severe immune thrombocytopenia during pregnancy: Response rate and complication. Am J Reprod Immunol 2018; 80:e13000. [PMID: 30010227 DOI: 10.1111/aji.13000] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 05/25/2018] [Indexed: 11/28/2022] Open
Abstract
PROBLEM Evaluate the response rate of glucocorticoid (GC) and/or immunoglobulin (IVIg) therapy in severe thrombocytopenia of immune thrombocytopenia (ITP) pregnant patients and the influence on maternal and neonatal outcomes. METHOD OF STUDY This is a prospective observational cohort study. Pregnant ITP patients with platelet count less than 30 × 109 /L and their newborn infants participated in this research. Over a 3-year period, 87 patients were allocated to 4 groups: group 1 (n = 18) were treated by oral prednisone, group 2 (n = 20) with IVIg, group 3 (n = 22) with prednisone/methlyprednisone plus IVIg, and group 4 were non-treatment controls (n = 27). Diagnosis and therapy were based on guideline from the 2011 American Society of Hematology criteria, and the initial dose of prednisone was 1 mg/kg day. Their newborns were followed up to 1 year old. RESULTS The response rate among patients who ever received prednisone therapy was 35.5% (11/31) overall, while the IVIg response rate was 55.9% (19/34). The incidence of pregnancy induced hypertension in GC therapy group was significantly higher than controls (22.2% and 13.6% vs 0%). There was no significant difference in neonatal outcomes in treatment groups in comparison with controls. The rate of Neonatal follow-up within 1 year old was 63%, and there is no evidence indicated intrauterine GC exposure influence the growth and development. CONCLUSION GC therapy of 1 mg/kg for ITP patients during pregnancy is less efficiency than non-pregnant population and increases the incidence of hypertensive disorders. The use of lower starting doses of prednisone may be suggested for use in pregnancy.
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Affiliation(s)
- Xue Xu
- Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Mei-Ying Liang
- Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Sha Dou
- Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Jian-Liu Wang
- Obstetrics and Gynecology, Peking University People's Hospital, Beijing, China
| | - Xiao-Hui Zhang
- Hematology, Peking University People's Hospital, Beijing, China
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Yousif A, Lemière C, Cartier A, Forget A, Blais L. Development of a graphical tool to measure medication adherence in asthma patients: A mixed-methods pilot study. J Asthma 2018; 56:543-552. [PMID: 29746201 DOI: 10.1080/02770903.2018.1471702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
OBJECTIVES ( 1 ) To develop Med-Resp, a graphical tool based on prescription refills to measure adherence and use of asthma medications; ( 2 ) To test the feasibility of implementing Med-Resp in a hospital outpatient asthma clinic; ( 3 ) To explore the effectiveness of Med-Resp to improve medication adherence to asthma controller medications. METHODS A sequential exploratory design was used: ( 1 ) Prototype design in collaboration with respiratory physicians and patients via focus groups; ( 2 ) Med-Resp creation based on algorithms developed and applied to prescription refills data recorded in the drug claims database reMed; ( 3 ) Feasibility assessment of the implementation of Med-Resp in the outpatient asthma clinic; and ( 4 ) Exploration of the effectiveness of Med-Resp through a pre-post design. RESULTS A total of 29 patients and six respiratory physicians participated in this pilot study. The tool was highly appreciated by the participants, while the majority believed that Med-Resp has the potential to enhance physician-patient communication and aid in treatment decisions. The feasibility of implementing Med-Resp in clinical practice was demonstrated. However, we did not observe an increase in medication adherence in the six months following its implementation. CONCLUSION In the clinical setting, the use of prescription refills data may constitute a non-invasive and objective measure of medication adherence. This study highlights the importance of providing clinicians with objective and easily interpretable measures of medication adherence and use in routine clinical practice. Med-Resp has the potential to become implemented on a larger scale if integrated in electronic medical records.
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Affiliation(s)
- Alia Yousif
- a Faculty of Pharmacy , Université de Montréal , Montreal , Quebec , Canada.,b Research Centre, Hôpital du Sacré-Cœur de Montréal , Montreal , Quebec , Canada
| | - Catherine Lemière
- b Research Centre, Hôpital du Sacré-Cœur de Montréal , Montreal , Quebec , Canada.,c Faculty of Medicine , Université de Montréal , Montreal , Quebec , Canada
| | - André Cartier
- b Research Centre, Hôpital du Sacré-Cœur de Montréal , Montreal , Quebec , Canada.,c Faculty of Medicine , Université de Montréal , Montreal , Quebec , Canada
| | - Amélie Forget
- a Faculty of Pharmacy , Université de Montréal , Montreal , Quebec , Canada.,b Research Centre, Hôpital du Sacré-Cœur de Montréal , Montreal , Quebec , Canada
| | - Lucie Blais
- a Faculty of Pharmacy , Université de Montréal , Montreal , Quebec , Canada.,b Research Centre, Hôpital du Sacré-Cœur de Montréal , Montreal , Quebec , Canada
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Zakiyah N, ter Heijne LF, Bos JH, Hak E, Postma MJ, Schuiling-Veninga CCM. Antidepressant use during pregnancy and the risk of developing gestational hypertension: a retrospective cohort study. BMC Pregnancy Childbirth 2018; 18:187. [PMID: 29843629 PMCID: PMC5975401 DOI: 10.1186/s12884-018-1825-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 05/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prior studies reported that exposure to antidepressants during pregnancy may be associated with gestational hypertension. The aim of this study is to assess the association between the use of antidepressants during pregnancy and the risk of developing gestational hypertension. METHODS A retrospective cohort study using the prescription database IADB.nl was conducted among nulliparous women with singleton pregnancies between 1994 and 2015 in the Netherlands. Logistic regression analysis was used to estimate odds ratios (OR), adjusted OR (aOR) and their corresponding 95% confidence intervals (95% CI). Gestational hypertension as main outcome measure was defined as at least one dispensed record of an antihypertensive drug (methyldopa, nifedipine, labetalol, ketanserin, nicardipine) after 20 weeks of gestation until 14 days after delivery. Sub-analyses were conducted for class of antidepressant, duration and amount of use of antidepressant (≤30, ≥30 Defined Daily Doses or DDDs), and maternal age. Sensitivity analyses to assess uncertainties were conducted. RESULTS Twenty-eight thousand twenty women were included, of which 539 (1.92%) used antidepressants. The risk of gestational hypertension was doubled for women using antidepressant (aOR 2.00 95% CI 1.28-3.13). Significant associations were also found for the subgroup selective serotonin reuptake inhibitors (SSRIs) (aOR 2.07 95% CI 1.25-3.44), ≥30 DDDs (aOR 2.50 95% CI 1.55-3.99) and maternal age of 30-34 years (aOR 2.59 95% CI 1.35-4.98). Varying the theoretical gestational age showed comparable results. CONCLUSION Prolonged use of antidepressants during the first 20 weeks of gestation appeared to be associated with an increased risk of developing gestational hypertension. When balancing the benefits and risks of using these drugs during pregnancy, this should be taken into account.
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Affiliation(s)
- Neily Zakiyah
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTEE), Department of Pharmacy, University of Groningen, A. Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Loes F. ter Heijne
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTEE), Department of Pharmacy, University of Groningen, A. Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Jens H. Bos
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTEE), Department of Pharmacy, University of Groningen, A. Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Eelko Hak
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTEE), Department of Pharmacy, University of Groningen, A. Deusinglaan 1, 9713 AV Groningen, The Netherlands
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
| | - Maarten J. Postma
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTEE), Department of Pharmacy, University of Groningen, A. Deusinglaan 1, 9713 AV Groningen, The Netherlands
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands
- Institute of Science in Healthy Aging & healthcaRE (SHARE), University Medical Center Groningen, 9713 GZ Groningen, The Netherlands
| | - Catharina C. M. Schuiling-Veninga
- Unit of PharmacoTherapy, -Epidemiology & -Economics (PTEE), Department of Pharmacy, University of Groningen, A. Deusinglaan 1, 9713 AV Groningen, The Netherlands
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Blais L, Kettani FZ, Forget A, Beauchesne MF, Lemière C, Rey E. Long-Acting β 2-Agonists and Risk of Hypertensive Disorders of Pregnancy: A Cohort Study. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 6:555-561.e2. [PMID: 28847655 DOI: 10.1016/j.jaip.2017.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 06/15/2017] [Accepted: 07/07/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Maternal asthma has been found to be associated with an increased risk of hypertensive disorders of pregnancy (HDP), that is, gestational hypertension, preeclampsia, and eclampsia. There is limited data, however, regarding the relationship between the use of long-acting beta-agonists (LABAs) during pregnancy and these outcomes. OBJECTIVE To investigate whether exposure to a LABA in addition to an inhaled corticosteroid increases the risk of HDP or preeclampsia/eclampsia, as compared with nonexposure to LABAs, in pregnant women with asthma. METHODS A cohort of 8,936 pregnancies in women with asthma who delivered between 1998 and 2010 was reconstructed using Quebec (Canada) health administrative databases. Cox proportional hazard regression models, adjusted for potential confounders, were used for statistical analyses. The primary exposure was LABA use (yes/no) measured on the first day of the 20th week of pregnancy. HDP were identified on the basis of recorded diagnoses and on prescriptions of antihypertensive drugs filled on or after the first day of week 20 of gestation. RESULTS There were 567 (6.3%) cases of HDP and 256 (2.9%) cases of preeclampsia/eclampsia in the cohort, and the rates of both disorders were similar in women exposed or not exposed to LABAs. LABA use was not associated with increased risks of HDP (adjusted hazard ratio, 0.96; 95% CI, 0.69-1.33) or preeclampsia/eclampsia (adjusted hazard ratio, 0.89; 95% CI, 0.53-1.50). CONCLUSIONS The results of this study provide evidence suggesting the safety of LABAs for the treatment of asthma in pregnancy, in terms of the risks of HDP and preeclampsia/eclampsia.
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Affiliation(s)
- Lucie Blais
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada; Research Centre, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada; Endowment Pharmaceutical Chair AstraZeneca in Respiratory Health, Montreal, Quebec, Canada.
| | - Fatima-Zohra Kettani
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada; Research Centre, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | - Amélie Forget
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada; Research Centre, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | - Marie-France Beauchesne
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada; Endowment Pharmaceutical Chair AstraZeneca in Respiratory Health, Montreal, Quebec, Canada; Pharmacy Department, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada; Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec, Canada
| | - Catherine Lemière
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada; Research Centre, Hôpital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | - Evelyne Rey
- Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada
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Namazy JA, Schatz M. Pharmacological difficulties in the treatment of asthma in pregnant women. Expert Rev Clin Pharmacol 2016; 10:285-292. [PMID: 27927045 DOI: 10.1080/17512433.2017.1268914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION This is a review of the diagnosis and management of asthma in the pregnant patient. Asthma may adversely affect both maternal quality of life and, perinatal outcomes. Optimal management of asthma is thus important for both mother and baby. Areas covered: Special attention is paid to the challenges in diagnosis and management of asthma during pregnancy. Expert commentary: This article reviews the safety of asthma medications commonly used during pregnancy.
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Affiliation(s)
- Jennifer A Namazy
- a Department of Allergy and Immunology , Scripps Clinic , San Diego , CA , USA
| | - Michael Schatz
- b Department of Allergy , Kaiser Permanente Medical Center , San Diego , CA , USA
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Lungeanu-Juravle L, Patrascu N, Deleanu OC, Cinteza M. The Role of Obstructive Sleep Apnea in Developing Gestational Hypertension and Preeclampsia. MAEDICA 2016; 11:330-333. [PMID: 28828052 PMCID: PMC5543527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Gestational hypertension and preeclampsia are the most frequent medical complications in pregnancy and major causes of maternal and fetal morbidity and mortality. It is also known that these conditions are associated with a long term increased cardiovascular global risk for these young women. Obstructive sleep apnea (OSA) seems to be not only a frequent pathology associated with pregnancy but also an independent factor for developing gestational hypertension. It is well known the relationship between gestational hypertension, preeclampsia and intrauterine growth restriction of the foetus so the outcomes of this pathologies are important for both mother and child. Increasing awareness of OSA among pregnant women with gestational hypertension and preeclampsia is important given the potential benefits of the treatment with continuous positive airway pressure (CPAP) on these patients.
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Affiliation(s)
| | - Natalia Patrascu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Mircea Cinteza
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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Rahimi R, Nikfar S, Abdollahi M. Meta-Analysis Finds Use of Inhaled Corticosteroids During Pregnancy Safe: A Systematic Meta-Analysis Review. Hum Exp Toxicol 2016; 25:447-52. [PMID: 16937916 DOI: 10.1191/0960327106het647oa] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Inhaled corticosteroids (ICs) are the drug of choice for asthmatic women during pregnancy, but the results on the effects of these medications on obstetrical and perinatal outcomes are not conclusive. Meta-analysis is the statistical analysis of a collection of analysis results from individual studies for the purpose of integrating the findings. Meta-analysis techniques are necessary because only summary statistics are available in the literature. In order to determine the risk of exposure to ICs, we pooled data from all clinical studies that evaluated the pregnancy and perinatal outcomes in women exposed to this group of drugs during pregnancy by the meta-analytic technique. PUBMED, OVID, EMBASE and SCOPUS databases were searched for studies that investigated birth outcome following exposure to ICs during pregnancy. Data were collected from 1997 to 2005 (up to 31 December). Types of outcome investigated were major malformations, pre-term delivery, low birth weight and pregnancy-induced hypertension. The criteria for inclusion of studies in this meta-analysis were exposure of women to any therapeutic dosage of any ICs (fluticasone, beclomethasone, budesonide, triamcinolone and flunisolide) during pregnancy. The results showed that ICs do not increase the risk of major malformations, preterm delivery, low birth weight and pregnancy-induced hypertension. In conclusion, ICs do not increase the rates of any obstetrical outcomes investigated in the present study and interestingly improve the symptoms and are helpful in the management of asthma and thus can be used comfortably during pregnancy.
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Affiliation(s)
- R Rahimi
- Faculty of Pharmacy, and Pharmaceutical Sciences Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Lee CH, Kim J, Jang EJ, Lee JH, Kim YJ, Choi S, Kim DK, Yim JJ, Yoon HI. Inhaled Corticosteroids Use Is Not Associated With an Increased Risk of Pregnancy-Induced Hypertension and Gestational Diabetes Mellitus: Two Nested Case-Control Studies. Medicine (Baltimore) 2016; 95:e3627. [PMID: 27258493 PMCID: PMC4900701 DOI: 10.1097/md.0000000000003627] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Revised: 04/08/2016] [Accepted: 04/08/2016] [Indexed: 12/24/2022] Open
Abstract
There have been concerns that systemic corticosteroid use is associated with pregnancy-induced hypertension (PIH) and diabetes mellitus. However, the relationship between inhaled corticosteroids (ICSs) and the risk of PIH has not been fully examined, and there was no study investigating the association between ICS use and the development of gestational diabetes mellitus (GDM). The aims of the study are to determine whether the use of ICSs during pregnancy increases the risk of PIH and GDM in women.We conducted 2 nested case-control studies utilizing the nationwide insurance claims database of the Health Insurance Review and Assessment Service (Seoul, Republic of Korea), in which 1,306,281 pregnant women who delivered between January 1, 2009 and December 31, 2011 were included. Among them, PIH cases and GDM cases were identified and matched controls were included. Conditional logistic regression analyses adjusted by other concomitant drugs use during and before pregnancy and confounding covariates including comorbidities were performed.Total 43,908 PIH cases and 219,534 controls, and 34,190 GDM cases and 170,934 control subjects were identified. When other concomitant drugs use during pregnancy was adjusted, ICS use was associated with an increased rate of PIH (adjusted odds ratio, 1.40 [95% CI, 1.05-1.87]). ICS medication possession ratios and cumulative doses were associated with an increased risk of PIH. However, the statistical significance was not found in other models. In both unadjusted and adjusted multivariable models, ICSs use was not associated with increase in the risk of GDM.ICSs use is not associated with an increased risk of PIH and GDM.
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Affiliation(s)
- Chang-Hoon Lee
- From the National Evidence-Based Healthcare Collaborating Agency (C-HL, JK, EJJ, YJK, SC, DKK, J-JY, HIY); Division of Pulmonary and Critical Care Medicine (C-HL, J-JY), Department of Internal Medicine, Seoul National University College of Medicine; Department of Obstetrics and Gynecology (J-HL), Seoul National University College of Medicine, Seoul National University Hospital; Division of Pulmonary and Critical Care Medicine (DKK), Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center; Division of Pulmonary and Critical Care Medicine (HIY), Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam-Si, Republic of Korea; and Department of Health Policy and Hospital Management, Graduate School of Public Health, Korea University (JK)
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Panchaud A, Di Paolo ER, Koutsokera A, Winterfeld U, Weisskopf E, Baud D, Sauty A, Csajka C. Safety of Drugs during Pregnancy and Breastfeeding in Cystic Fibrosis Patients. Respiration 2016; 91:333-48. [PMID: 26942733 DOI: 10.1159/000444088] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 01/13/2016] [Indexed: 11/19/2022] Open
Abstract
Health management of cystic fibrosis (CF) patients should be maximized during pregnancy and breastfeeding because of its significant impact on the maternal and newborn outcomes. Thus, numerous drugs will have to be continued during pregnancy and lactation. Most of the drugs representing CF treatment lines cross the placenta or are excreted into human milk. Research addressing the risks and benefits of drugs used in CF patients during pregnancy and lactation is often incomplete or challenged by limited methodology, which often leads to conflicting or inconclusive results. Yet, potential treatment benefits for CF pregnant patients most often outbalance potential risks for the unborn child.
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Affiliation(s)
- Alice Panchaud
- School of Pharmaceutical Sciences, University of Geneva and University of Lausanne, Geneva, Switzerland
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Namazy JA, Schatz M. Pharmacotherapy options to treat asthma during pregnancy. Expert Opin Pharmacother 2015; 16:1783-91. [PMID: 26194212 DOI: 10.1517/14656566.2015.1066332] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Pregnancy may be complicated by new onset or pre-existing asthma. This article reviews the recognition and management of asthma during pregnancy, paying close attention to the general principles of asthma medication use during pregnancy. Asthma is one of the most common potentially serious medical problems to complicate pregnancy, and asthma may adversely affect both maternal quality of life and perinatal outcomes. Therefore, optimal management of asthma during pregnancy is important for both mother and baby. This article reviews asthma pharmacotherapy during pregnancy, with an emphasis on gestational safety of commonly used medications. AREAS COVERED In this review of asthma pharmacotherapy during pregnancy, the most pertinent recent publications are reported. Electronic databases such as PubMed were searched for terms pregnan* or perinat* or obstet* and asthma or wheeze and treatment. EXPERT OPINION Although retrospective data have been reassuring, since pregnant women are generally excluded from clinical trials, there is a lack of adequate safety information for most medications taken during pregnancy. One of the most important needs for the future is the availability of further safety information for asthma medications used during pregnancy that can also account for asthma control.
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Affiliation(s)
- Jennifer A Namazy
- Scripps Clinic , 7565 Mission Valley Road, San Diego, CA 92108 , USA +1 619 245 9000 ; +1 619 245 2922 ;
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Kim S, Kim J, Park SY, Um HY, Kim K, Kim Y, Park Y, Baek S, Yoon SY, Kwon HS, Cho YS, Moon HB, Kim TB. Effect of pregnancy in asthma on health care use and perinatal outcomes. J Allergy Clin Immunol 2015; 136:1215-23.e1-6. [PMID: 26071938 DOI: 10.1016/j.jaci.2015.04.043] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 04/21/2015] [Accepted: 04/22/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND It is generally known that pregnancy in asthmatic patients increases the risk of asthma exacerbations and poor perinatal outcomes. However, the effect of pregnancy in asthmatic patients on health care use is not known well. In addition, its effect on perinatal outcomes is still controversial because of study limitations caused by ethical issues. National Health Insurance claim data are an ideal resource for studying real-world health care use patterns of asthma. OBJECTIVE We sought to evaluate the effect of pregnancy on asthma in terms of asthma-related health care use and prescription patterns in concert with the effect of asthma exacerbations on adverse pregnancy outcomes. METHODS Among all asthmatic patients in the Korean National Health Insurance claim database from January 2009 to December 2013, pregnant women who delivered in 2011 with pre-existing asthma were enrolled. Analyses included asthma-related health care use and prescription patterns compared between pregnant asthmatic women and nonpregnant female asthmatic control subjects, as well as within the pregnant subjects from before pregnancy throughout postpartum periods. In addition, the association between asthma exacerbation during pregnancy and adverse pregnancy outcomes was assessed. RESULTS A total of 3,357 pregnant asthmatic patients were compared with 50,355 nonpregnant asthmatic patients, and 10,311 pregnant patients were included to determine the effect of asthma exacerbations on adverse pregnancy outcome in the study. Pregnant asthmatic patients underwent more asthma-related hospitalizations (1.3% vs 0.8%, P = .005) but had significantly fewer outpatient visits and prescriptions for most asthma medications than nonpregnant asthmatic patients. The proportion of patients ever hospitalized gradually increased throughout pregnancy (first trimester, 0.2%; second trimester, 0.5%; and third trimester, 0.7%; P = .018). The prevalence of asthma exacerbation during pregnancy was 5.3%, and the patients who had acute exacerbation during pregnancy had significantly higher asthma-related health care use in terms of hospitalization, intensive care unit admission, and emergency department and outpatient visits within 1 year before delivery than those who had not. However, asthma exacerbation during pregnancy was not significantly related to adverse perinatal outcomes, except for cesarean section (27.1% vs 18.9%, P < .001). All exacerbations were managed with systemic corticosteroids, and the patients who ever experienced acute exacerbations maintained asthma medications, including inhaled corticosteroid-based inhalers, throughout the pregnancy period. CONCLUSION Pregnancy profoundly affects asthma-related health care use but to a different degree depending on whether the patient experienced an exacerbation. Asthma exacerbation during pregnancy is not associated with adverse pregnancy outcomes while managed appropriately with systemic corticosteroids. However, further studies are needed to clarify the effect of asthma control on perinatal outcome and delivery method.
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Affiliation(s)
- Sujeong Kim
- Department of Allergy and Clinical Immunology, Asthma Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Jinhee Kim
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea; Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea
| | - So Young Park
- Department of Allergy and Clinical Immunology, Asthma Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hye-Yeon Um
- Korea Institute of Drug Safety and Risk Management, Seoul, Korea
| | - Kyoungjoo Kim
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Yuri Kim
- National Evidence-based Healthcare Collaborating Agency, Seoul, Korea
| | - Yunjin Park
- Department of Statistics, Dongguk University, Seoul, Korea
| | - Seunghee Baek
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Korea
| | - Sun-Young Yoon
- Department of Allergy and Clinical Immunology, Asthma Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyouk-Soo Kwon
- Department of Allergy and Clinical Immunology, Asthma Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - You Sook Cho
- Department of Allergy and Clinical Immunology, Asthma Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee-Bom Moon
- Department of Allergy and Clinical Immunology, Asthma Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Bum Kim
- Department of Allergy and Clinical Immunology, Asthma Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
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van der Woude CJ, Ardizzone S, Bengtson MB, Fiorino G, Fraser G, Katsanos K, Kolacek S, Juillerat P, Mulders AGMGJ, Pedersen N, Selinger C, Sebastian S, Sturm A, Zelinkova Z, Magro F. The second European evidenced-based consensus on reproduction and pregnancy in inflammatory bowel disease. J Crohns Colitis 2015; 9:107-124. [PMID: 25602023 DOI: 10.1093/ecco-jcc/jju006] [Citation(s) in RCA: 331] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Trying to conceive and being pregnant is an emotional period for those involved. In the majority of patients suffering from inflammatory bowel disease, maintenance therapy is required during pregnancy to control the disease, and disease control might necessitate introduction of new drugs during a vulnerable period. In this updated consensus on the reproduction and pregnancy in inflammatory bowel disease reproductive issues including fertility, the safety of drugs during pregnancy and lactation are discussed.
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Namazy JA, Chambers C, Schatz M. Safety of therapeutic options for treating asthma in pregnancy. Expert Opin Drug Saf 2014; 13:1613-21. [PMID: 25382594 DOI: 10.1517/14740338.2014.975203] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Pregnancy may be complicated by new onset or preexisting asthma. Asthma is one of the most common potentially serious medical problems to complicate pregnancy, and it may adversely affect both maternal quality of life and perinatal outcomes. Optimal management of asthma during pregnancy is thus important for both mother and baby. AREAS COVERED This article reviews the recognition and management of asthma during pregnancy, paying close attention to the general principles of asthma medication use during pregnancy. Further, the article reviews the safety of asthma medications commonly used during pregnancy. In this article, the most pertinent recent publications are reported. Electronic databases, such as PUBMED, were searched for terms pregnan* or perinat* or obstet* and asthma or wheeze and treatment. EXPERT OPINION Because pregnant women are generally excluded from clinical trials, there is a lack of adequate safety information for most medications taken during pregnancy. One of the most important requirements for the future is the availability of further safety information for asthma medications used during pregnancy that can also account for asthma control.
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Affiliation(s)
- Jennifer A Namazy
- Division of Allergy and Immunology, Scripps Clinic , 7565 Mission Valley Road, San Diego, CA 92108 , USA +1 619 245 2922 ;
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Eltonsy S, Forget A, Beauchesne MF, Blais L. Risk of congenital malformations for asthmatic pregnant women using a long-acting β₂-agonist and inhaled corticosteroid combination versus higher-dose inhaled corticosteroid monotherapy. J Allergy Clin Immunol 2014; 135:123-30. [PMID: 25226849 DOI: 10.1016/j.jaci.2014.07.051] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 06/27/2014] [Accepted: 07/30/2014] [Indexed: 01/24/2023]
Abstract
BACKGROUND Current recommendations for managing persistent asthma during pregnancy when low-dose inhaled corticosteroids (ICSs) are insufficient include adding a long-acting β₂-agonist (LABA) or increasing the ICS dose. However, there are no data to help clinicians evaluate the safest regimen during pregnancy. OBJECTIVE We sought to compare the risk of major congenital malformations in asthmatic women exposed to a LABA plus ICS combination and those exposed to ICS monotherapy at higher doses during the first trimester. METHODS A cohort of asthmatic pregnant women exposed to ICSs during the first trimester who delivered between January 1990 and March 2009 was established. The primary outcome was major malformation recorded at birth or during the first year of life. Two subcohorts were established as follows: (1) users of a LABA plus low-dose ICS combination or users of a medium-dose ICS and (2) users of a LABA plus medium-dose ICS combination or users of a high-dose ICS. Generalized estimating equations were used to compare the risk of major malformations between the groups. RESULTS In one subcohort there were 643 women who used a LABA plus low-dose ICS and 305 who used a medium-dose ICS; the other subcohort included 198 users of a LABA plus medium-dose ICS and 156 users of a high-dose ICS. The prevalence of major malformations was 6.9% and 7.2%, respectively. The adjusted odds ratio for major malformations was 1.1 (95% CI, 0.6-1.9) when a LABA plus low-dose ICS was used compared with a medium-dose ICS and 1.2 (95% CI, 0.5-2.7) when a LABA plus medium-dose ICS was used compared with a high-dose ICS. CONCLUSION The risk of major malformations was similar with a LABA plus ICS combination and ICS monotherapy at higher doses, suggesting that both therapeutic options can be considered during pregnancy.
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Affiliation(s)
- Sherif Eltonsy
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada; Hopital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | - Amelie Forget
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada; Hopital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada
| | - Marie-France Beauchesne
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada; Département de Pharmacie, Centre Hospitalier Universitaire de Sherbrookes, Sherbrooke, Quebec, Canada
| | - Lucie Blais
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada; Hopital du Sacré-Cœur de Montréal, Montreal, Quebec, Canada.
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Namazy JA, Schatz M. The safety of asthma medications during pregnancy: an update for clinicians. Ther Adv Respir Dis 2014; 8:103-110. [PMID: 25034020 DOI: 10.1177/1753465814540029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Pregnancy may be complicated by new onset or preexisting asthma. This article reviews the recognition and management of asthma during pregnancy, as well as general principles of asthma medication use during pregnancy.
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Affiliation(s)
| | - Michael Schatz
- Department of Allergy, Kaiser Permanente Medical Center, San Diego, CA, USA
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Blais L, Kettani FZ, Forget A. Associations of maternal asthma severity and control with pregnancy complications. J Asthma 2014; 51:391-8. [PMID: 24404798 DOI: 10.3109/02770903.2013.879880] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To assess the associations of maternal asthma severity and control with pregnancy-induced hypertension (PIH), gestational diabetes and cesarean delivery. METHODS A cohort of 41 660 pregnancies from women with and without asthma who delivered between 1990 and 2002 was constructed by linking Québec's administrative databases. Maternal asthma was defined by at least one asthma diagnosis and one dispensed prescription for an asthma medication in the 2 years before or during pregnancy. Asthma severity and control were assessed using validated indexes during the entire pregnancy to study cesarean delivery and 1-year prior to week 20 of gestation to study PIH and gestational diabetes. Generalized Estimation Equation models were used to obtain odds ratios (OR) for PIH, gestational diabetes and cesarean in association with maternal asthma severity and control. RESULTS Almost one-third of the women had uncontrolled asthma and up to 5% had severe asthma. Severe asthma increased the risk of cesarean delivery (OR = 1.35; 95% CI: 1.11-1.63) compared with mild asthma, but no association was found between asthma severity and the other outcomes. The level of asthma control was not associated with any of the outcomes, except for a near-significant increased risk of PIH among uncontrolled women (OR = 1.18; 95% CI: 0.97-1.42). CONCLUSIONS The risk of gestational diabetes was not associated with asthma severity or control, and the risk of PIH was not associated with asthma severity. However, further studies are needed to clarify the association between asthma control and PIH. The increased risk of cesarean among women with severe asthma may be explained by the physician's and patient's concerns over the safety of normal delivery.
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Affiliation(s)
- Lucie Blais
- Faculty of Pharmacy, Université de Montréal , Montréal, Québec , Canada and
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Murphy VE, Powell H, Wark PAB, Gibson PG. A prospective study of respiratory viral infection in pregnant women with and without asthma. Chest 2014; 144:420-427. [PMID: 23493968 PMCID: PMC7107276 DOI: 10.1378/chest.12-1956] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Respiratory viral infections are common in pregnancy, but their health impact, especially in asthma, is unknown. The objective of this study was to assess the frequency, severity, and consequences of respiratory viral infection during pregnancy in women with and without asthma. METHODS In this prospective cohort study, common cold symptoms were assessed during pregnancy in 168 women with asthma and 117 women without asthma using the common cold questionnaire and by self-report. Nasal and throat swabs were collected for suspected infections and tested by polymerase chain reaction for respiratory viruses. Pregnancy and asthma outcomes were recorded. RESULTS Pregnant women with asthma had more prospective self-reported and questionnaire-detected common colds than pregnant women without asthma (incidence rate ratio, 1.77; 95% CI, 1.30-2.42; P < .0001). Retrospectively reported common colds in early pregnancy and post partum were increased in women with asthma compared with women without asthma. The severity of cold symptoms was also increased in women with asthma (total cold score median, 8; interquartile range [5, 10] in women with asthma vs 6 [5, 8] in control subjects; P = .031). Among women with asthma, having a laboratory-confirmed viral infection was associated with poorer maternal health, with 60% of infections associated with uncontrolled asthma and a higher likelihood of preeclampsia. CONCLUSIONS Pregnant women with asthma have more common colds during pregnancy than pregnant women without asthma. Colds during pregnancy were associated with adverse maternal and pregnancy outcomes. Prevention of viral infection in pregnancy may improve the health of mothers with asthma.
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Affiliation(s)
- Vanessa E Murphy
- Centre for Asthma and Respiratory Diseases, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia.
| | - Heather Powell
- Centre for Asthma and Respiratory Diseases, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia; John Hunter Hospital, Newcastle, NSW, Australia
| | - Peter A B Wark
- Centre for Asthma and Respiratory Diseases, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia; John Hunter Hospital, Newcastle, NSW, Australia
| | - Peter G Gibson
- Centre for Asthma and Respiratory Diseases, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia; John Hunter Hospital, Newcastle, NSW, Australia
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Gregersen TL, Ulrik CS. Safety of bronchodilators and corticosteroids for asthma during pregnancy: what we know and what we need to do better. J Asthma Allergy 2013; 6:117-25. [PMID: 24259987 PMCID: PMC3833838 DOI: 10.2147/jaa.s52592] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Asthma is a common medical condition complicating pregnancy with potentially serious effects on pregnancy outcome. The aim of this review is to provide an update on efficacy and safety of asthma medications, primarily bronchodilators and corticosteroids, used during pregnancy with focus on pregnancy outcome, and, furthermore, to discuss limitations of available studies and point to possible improvements in future studies. A planned series of systematic searches was conducted using the PubMed database. Use of short-acting β2-agonists has generally been established as safe, and the few studies stating otherwise appear to have, perhaps critical, methodological limitations. The safety of long-acting β2-agonists remains to be further investigated, and the few available studies have methodological limitations and, therefore, provide no definite answers, although a very recent study supports the safety of add-on long-acting β2-agonists to inhaled corticosteroids. Inhaled corticosteroids are generally found to be safe, although further research is needed to investigate both the efficacy and safety of high dose therapy with inhaled corticosteroids. Studies have reported associations between the use of systemic corticosteroids and adverse perinatal outcomes, such as preterm birth, low birth weight, and pre-eclampsia. This must, however, be weighed against the potential serious impact of severe, uncontrolled asthma itself on pregnancy outcome. The main obstacle to a valid interpretation of several of the available studies is the inadequate stratification for asthma severity and control. Overall, asthma in itself and not just poor asthma control poses a greater risk to pregnancy outcomes than asthma medication. Nonetheless, more studies focusing on disentangling the effects of asthma alone and asthma medications are needed. Increased use of stratified risk assessments, taking the concept of asthma severity into greater consideration, is much warranted in future studies.
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Abstract
Asthma is common among women of reproductive age and affects between 4% and 8% of pregnant women. Pregnancy outcomes are correlated to the degree of asthma severity and control. Approximately one-third of pregnant women with asthma remain stable, a third will have improvement of their asthma, and a third will have worsening of the disease. Pregnant women with severe asthma are at markedly increased risk of maternal and perinatal morbidity and mortality, preeclampsia, low-birth weight infants, and preterm delivery. A severe asthma exacerbation in a pregnant woman may be clinically daunting, however immediate intervention with appropriate supplemental oxygenation, medical therapy, and intubation if necessary can be life-saving. A focus on maternal well-being and pulmonary function in a pregnant asthmatic is essential to ensure optimal outcomes for both mother and her fetus. This article will provide an overview of asthma management, particularly in the acute care setting.
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Affiliation(s)
- Diana Alex Racusin
- Department of Obstetrics and Gynecology, Baylor College of Medicine, One Baylor Plaza, Mail Stop 610, Houston, TX 77030, USA
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Brien S, Kwong JC, Charland KM, Verma AD, Brownstein JS, Buckeridge DL. Neighborhood determinants of 2009 pandemic A/H1N1 influenza vaccination in Montreal, Quebec, Canada. Am J Epidemiol 2012; 176:897-908. [PMID: 23077284 DOI: 10.1093/aje/kws154] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Neighborhood-level analyses of influenza vaccination can identify the characteristics of vulnerable neighborhoods, which can inform public health strategy for future pandemics. In this study, the authors analyzed rates of 2009 pandemic A/H1N1 influenza vaccination in Montreal, Quebec, Canada, using individual-level vaccination records from a vaccination registry with census, survey, and administrative data to estimate the population at risk. The neighborhood socioeconomic and demographic determinants of vaccination were identified using Bayesian ecologic logistic regression, with random effects to account for spatial autocorrelation. A total of 918,773 (49.9%) Montreal residents were vaccinated against pandemic A/H1N1 influenza from October 22, 2009, through April 8, 2010. Coverage was greatest among females, children under age 5 years, and health-care workers. Neighborhood vaccine coverage ranged from 33.6% to 71.0%. Neighborhoods with high percentages of immigrants (per 5% increase, odds ratio = 0.90, 95% credible interval: 0.86, 0.95) and material deprivation (per 1-unit increase in deprivation score, odds ratio = 0.93, 95% credible interval: 0.88, 0.98) had lower vaccine coverage. Half of the Montreal population was vaccinated; however, considerable heterogeneity in coverage was observed between neighborhoods and subgroups. In future vaccination campaigns, neighborhoods that are materially deprived or have high percentages of immigrants may benefit from focused interventions.
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Affiliation(s)
- Stephanie Brien
- Surveillance Lab, Clinical and Health Informatics Research Group, McGill University, 1140 Pine Avenue West, Montreal, Quebec H3A 1A3, Canada
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Blais L, Firoozi F, Kettani FZ, Ducharme FM, Lemière C, Beauchesne MF, Bérard A. Relationship between changes in inhaled corticosteroid use and markers of uncontrolled asthma during pregnancy. Pharmacotherapy 2012; 32:202-9. [PMID: 22392453 DOI: 10.1002/j.1875-9114.2012.01091.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
STUDY OBJECTIVE To describe changes in inhaled corticosteroid use during pregnancy and markers of uncontrolled asthma, and to evaluate the association between them. DESIGN Population-based, cross-sectional study. DATA SOURCE Three administrative claims databases in Québec, Canada. PATIENTS A cohort of 4434 asthmatic women (4920 pregnancies) who delivered their infants between 1990 and 2002 and who used inhaled corticosteroids before their pregnancy. MEASUREMENTS AND MAIN RESULTS The average daily doses of inhaled corticosteroids during pregnancy and during the 9 months before conception were compared; the change in use was categorized as discontinuation (reduction of ≥75%), reduction (26-75% reduction), no change (±25% change), or increase (increase of ≥25%). The markers of uncontrolled asthma included at least one asthma exacerbation and the use of three or more doses/week of a short-acting β(2) -agonist during pregnancy. Generalized estimating equation models were used for statistical analyses. In nearly 50% of the pregnancies (2388 [48.5%] of 4920), the women either stopped or reduced their doses of corticosteroid during pregnancy, and these doses were already quite low before pregnancy. The proportion of women who had an asthma exacerbation during pregnancy was 8.2% among women who discontinued corticosteroids and greater than 20% in all of the other groups. All of the groups used frequent doses of short-acting β(2) -agonists. Discontinuing inhaled corticosteroid use during pregnancy was associated with a lower risk of exacerbations (odds ratio [OR] 0.42, 95% confidence interval [CI] 0.33-0.54), whereas increasing inhaled corticosteroid use was associated with a higher risk (OR 1.42, 95% CI 1.17-1.72), compared with no change in use. CONCLUSION Because of residual confounding by asthma severity, our study was not able to show that women who stopped inhaled corticosteroids during pregnancy were at increased risk of having an asthma exacerbation. However, women who stopped corticosteroids tended to have a milder form of asthma, which is reassuring and suggests that women can recognize, to a certain extent, the need to continue taking their controller agents if necessary.
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Affiliation(s)
- Lucie Blais
- University of Montréal, Montréal, Québec, Canada.
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Streck MR, Blaiss MS. Quality of care of asthma during pregnancy. Expert Rev Pharmacoecon Outcomes Res 2012; 6:67-77. [PMID: 20528540 DOI: 10.1586/14737167.6.1.67] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The goal of asthma management during pregnancy is to keep the mother symptom free and to prevent complications in the fetus. Asthma is a common chronic condition in pregnancy that, if inadequately treated, has the potential to cause adverse effects for both mother and fetus. Aggressive treatment during pregnancy can decrease costs associated with asthma now and additional costs later if the fetus has a poor outcome due to maternal asthma. A stepwise approach to the management of asthma during pregnancy has been developed and is not unlike the management of the nonpregnant patient. Although there are no double-blind, placebo-controlled studies on asthma medications in pregnant women, large cohort studies have shown the efficacy of aggressive management. With adequate control of asthma from the preconception time through delivery, studies have shown similar outcomes in asthmatic patients compared with nonasthmatics, thus obtaining the goal of a symptom-free mother and a healthy baby.
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Affiliation(s)
- Maria R Streck
- University of Tennessee Center for the Health Sciences, College of Medicine, 50 North Dunlap Street, 4th Floor, West Patient Tower, Memphis, TN 38103, USA.
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Firoozi F, Lemière C, Beauchesne MF, Perreault S, Forget A, Blais L. Impact of maternal asthma on perinatal outcomes: a two-stage sampling cohort study. Eur J Epidemiol 2012; 27:205-14. [PMID: 22286718 DOI: 10.1007/s10654-012-9654-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Accepted: 01/16/2012] [Indexed: 11/24/2022]
Abstract
There are conflicting results concerning the impact of maternal asthma during pregnancy on perinatal outcomes. The present study investigated the associations between maternal asthma during pregnancy and the risk of a small-for-gestational-age (SGA) infant, a low-birth-weight (LBW) infant, and preterm birth. A population-based cohort of 40,788 pregnancies from asthmatic and non-asthmatic women was reconstructed through the linking of three Quebec (Canada) administrative databases between 1990 and 2002. A two-stage sampling cohort design was used to collect additional information by way of a mailed questionnaire. The generalized estimation equation models were used to obtain adjusted odds ratios of SGA, LBW and preterm birth comparing asthmatic and non-asthmatic women. The cohort included 13,007 pregnancies from asthmatic and 27,781 pregnancies from non-asthmatic women. Final estimates showed that the odds of SGA (odds ratio: 1.27, 95% confidence interval: 1.14, 1.41), LBW (1.41: 1.22, 1.63) and preterm delivery (1.64: 1.46, 1.83) were significantly higher among asthmatic than non-asthmatic women. Mothers with asthma during pregnancy are more likely to have SGA, LBW, or preterm birth infants than non-asthmatic women. These results can be more easily generalized to women with lower socio-economic status since the cohort under represents women with high socio-economic status.
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Affiliation(s)
- Faranak Firoozi
- Faculty of Pharmacy, Université de Montréal, succursale Centre-ville, C.P. 6128, Montréal, QC, H3C 3J7, Canada
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Johnston S, Said J. Perinatal complications associated with maternal asthma during pregnancy. Obstet Med 2012; 5:14-8. [PMID: 27579125 DOI: 10.1258/om.2011.110062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Asthma is one of the most common medical illnesses occurring in pregnancy and its incidence amongst the obstetric population is increasing. Previous studies have suggested that asthma is not a benign illness in pregnancy, and can contribute towards increased rates of pregnancy complications. METHODS We undertook a retrospective audit of 6458 deliveries during 2008 at The Royal Women's Hospital to determine the perinatal outcomes for women with a self-reported diagnosis of asthma. RESULTS We found that 501 (7.8%) deliveries were to women who identified themselves as asthmatics. Of these, 15.6% reported exacerbations of their asthma symptoms during pregnancy, with the remainder reporting improvement or stabilization. There was an increased rate of preterm birth (12.9%) in the asthmatic population, compared to the non-asthmatic population (OR = 1.48, CI [1.12-1.95], P = 0.005). Asthma remained significantly associated with an increased risk of preterm birth after adjusting for maternal smoking status using logistic regression analysis (Adjusted OR 1.41, CI [1.07-1.86], P = 0.01). Women were also at increased risk of developing pre-eclampsia (OR 1.71, CI [1.09-2.67], P = 0.02) but not fetal growth restriction. Women identifying themselves as asthmatics were also more likely to deliver by caesarean section (OR 1.32, CI [1.09-1.6], P = 0.003). CONCLUSION These findings suggest that maternal asthma may be associated with an increased risk of preterm birth, pre-eclampsia and caesarean delivery.
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Affiliation(s)
| | - Joanne Said
- Department of Perinatal Medicine, The Royal Women's Hospital; Department of Obstetrics and Gynaecology, The University of Melbourne, Melbourne, Victoria, Australia
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Abstract
Pregnancy may be complicated by new-onset or preexisting rhinitis, or asthma. This article reviews the recognition and management of rhinitis and asthma during pregnancy, as well as general principles of medication use during pregnancy. Asthma is one of the most common potentially serious medical problems to complicate pregnancy, and chronic rhinitis is even more common in pregnant women. Both conditions may substantially affect maternal quality of life and directly or indirectly affect the pregnancy. Optimal management of asthma and rhinitis during pregnancy is thus important for both mother and baby. This article reviews the assessment and management of rhinitis and asthma in pregnant women.
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Spezielle Arzneimitteltherapie in der Schwangerschaft. ARZNEIMITTEL IN SCHWANGERSCHAFT UND STILLZEIT 2012. [PMCID: PMC7271212 DOI: 10.1016/b978-3-437-21203-1.10002-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Eltonsy S, Forget A, Blais L. Beta2-agonists use during pregnancy and the risk of congenital malformations. ACTA ACUST UNITED AC 2011; 91:937-47. [PMID: 21948561 DOI: 10.1002/bdra.22850] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 06/28/2011] [Accepted: 07/04/2011] [Indexed: 01/09/2023]
Abstract
BACKGROUND Treatment of asthma symptoms during pregnancy is crucial for maternal and fetal health. Short-acting beta2-agonists (SABA) are frequently used as rescue medications and long-acting beta2-agonists (LABA) are used as add-on controller therapy for asthma during pregnancy. OBJECTIVE The objective of this study was to investigate the association between exposure to SABA and LABA in the first trimester of pregnancy and the risk of congenital malformations among women with asthma. METHODS A cohort of pregnancies from women with asthma was formed through linkage of three administrative databases from Québec, Canada. The primary outcomes were major and any congenital malformations. The primary exposures were exposure to SABA and LABA during the first trimester, while secondary exposure was weekly SABA doses. The associations between congenital malformations (any, major, and specific) and SABA and LABA exposure were assessed with generalized estimating equations models. RESULTS From a group of 13,117 pregnancies, we identified 1242 and 762 infants with any (9.5%) and major (5.8%) congenital malformations, respectively. The adjusted odds ratios (95% confidence interval [CI]) for any malformations associated with the use of SABA and LABA were 1.04 (95% CI, 0.92-1.17) and 1.37 (95% CI, 0.92-2.17), respectively. The corresponding figures were 0.93 (95% CI, 0.80-1.08) and 1.31 (95% CI, 0.74-2.31) for major malformations. Significant increased risks of major "cardiac" and major "other and unspecified" congenital malformations were observed with LABA use. CONCLUSION Our study supports the evidence of SABA safety during pregnancy, but more research is required to assess whether the increased risk of malformations among LABA users is due to the medication, bias by asthma severity, or chance alone.
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Affiliation(s)
- Sherif Eltonsy
- Faculty of Pharmacy, Université de Montréal, Montréal, Québec, Canada
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Murphy VE, Namazy JA, Powell H, Schatz M, Chambers C, Attia J, Gibson PG. A meta-analysis of adverse perinatal outcomes in women with asthma. BJOG 2011; 118:1314-23. [PMID: 21749633 DOI: 10.1111/j.1471-0528.2011.03055.x] [Citation(s) in RCA: 235] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Asthma is a common condition during pregnancy and may be associated with adverse perinatal outcomes. OBJECTIVE This meta-analysis sought to establish if maternal asthma is associated with an increased risk of adverse perinatal outcomes, and to determine the size of these effects. SEARCH STRATEGY Electronic databases were searched for the following terms: (asthma or wheeze) and (pregnan* or perinat* or obstet*). SELECTION CRITERIA Cohort studies published between 1975 and March 2009 were considered for inclusion. Studies were included if they reported at least one perinatal outcome in pregnant women with and without asthma. DATA COLLECTION AND ANALYSIS A total of 103 articles were identified, and of these 40 publications involving 1,637,180 subjects were included. Meta-analysis was conducted with subgroup analyses by study design and active asthma management. MAIN RESULTS Maternal asthma was associated with an increased risk of low birthweight (RR 1.46, 95% CI 1.22-1.75), small for gestational age (RR 1.22, 95% CI 1.14-1.31), preterm delivery (RR 1.41, 95% CI 1.22-1.61) and pre-eclampsia (RR 1.54, 95% CI 1.32-1.81). The relative risk of preterm delivery and preterm labour were reduced to non-significant levels by active asthma management (RR 1.07, 95% CI 0.91-1.26 for preterm delivery; RR 0.96, 95% CI 0.73-1.26 for preterm labour). AUTHOR'S CONCLUSIONS Pregnant women with asthma are at increased risk of perinatal complications, including pre-eclampsia and outcomes that affect the baby's size and timing of birth. Active asthma management with a view to reducing the exacerbation rate may be clinically useful in reducing the risk of perinatal complications, particularly preterm delivery.
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Affiliation(s)
- V E Murphy
- Centre for Asthma and Respiratory Diseases, University of Newcastle and Hunter Medical Research Institute, Newcastle, NSW, Australia
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50
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Lim A, Stewart K, König K, George J. Systematic review of the safety of regular preventive asthma medications during pregnancy. Ann Pharmacother 2011; 45:931-45. [PMID: 21712513 DOI: 10.1345/aph.1p764] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To review the safety of regular preventive asthma medications during pregnancy. DATA SOURCES The following databases were searched from inception to February 2011: Ovid MEDLINE, PubMed, Cochrane Library, EMBASE and CINAHL Plus. STUDY SELECTION AND DATA EXTRACTION The search was limited to human studies published in the English language. Titles of all articles were screened for relevance. Abstracts of relevant articles were scrutinized to confirm relevance before obtaining full text. DATA SYNTHESIS Selected articles were read by 2 authors and the accuracy of the data extracted was confirmed. RESULTS Thirty-three articles were included in the final review. Small sample size, missing data, inadequate control for confounding factors, and poor documentation of dosage range were common limitations of the studies reviewed. The use of inhaled corticosteroids, cromolyns, and long-acting β(2) agonists during pregnancy was not associated with any particular adverse event, although the fluticasone/salmeterol combination has been associated with poor outcomes in postmarketing studies. Congenital malformations have been reported with leukotriene receptor antagonist exposure during pregnancy, but those women also had exposure to other medications, including oral corticosteroids. CONCLUSIONS Some negative outcomes of preventive asthma medications have been reported, although their direct link with medication use is inconclusive. Selection of preventive medications for asthma management during pregnancy should be based on an assessment of the risks and benefits of medication use versus the risks of poorly controlled asthma.
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Affiliation(s)
- Angelina Lim
- Pharmacy Department, Mercy Hospital for Women, Heidelberg, Victoria, Australia
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