Date Published: April 17, 2018
Publisher: BioMed Central
Author(s): A. Grosso, F. Locatelli, E. Gini, F. Albicini, C. Tirelli, I. Cerveri, A. G. Corsico.
Over the years it has been widely stated that approximately one-third of asthmatic women experience worsening of the disease during pregnancy. However, the literature has not been reviewed systematically and the meta-analytic reviews include old studies. This study aimed to examine whether the prevalence of worsening asthma during pregnancy is still consistent with prior estimate or it has been reduced.
A detailed Clinical Questionnaire on respiratory symptoms, medical history, medication, use of services, occupation, social status, home environment and lifestyle was administered to random samples of the Italian population in the frame of the Gene Environment Interactions in Respiratory Diseases (GEIRD) study. Only clinical data belong to 2.606 subjects that completed the clinical stage of the GEIRD study, were used for the present study.
Out of 1.351 women, 284 self-reported asthma and 92 of them had at least one pregnancy. When we considered the asthma course during pregnancy, we found that 16 women worsened, 31 remained unchanged, 25 improved. Seven women had not the same course in the different pregnancies and 13 did not know. The starting age of ICS use almost overlaps with that of asthma onset in women with worsening asthma during pregnancy (19 years ± 1.4), unlike the other women who started to use ICS much later (30.3 years ± 12). In addition, the worsening of asthma was more frequent in women with an older age of onset of asthma (18 years ± 9 vs 13 years ± 10). Among women who completed the ACT during the clinical interview, the 50% of women who experienced worsening asthma during pregnancy (6/12) had an ACT score below 20.
Asthma was observed to worsen during pregnancy in a percentage much lower to that generally reported in all the previous studies. There is still room in clinical practice to further reduce worsening of asthma during pregnancy by improving asthma control, with a more structured approach to asthma education and management prepregnancy.
Asthma is the most common respiratory disorder complicating pregnancy and it is associated with a range of adverse maternal and perinatal outcomes. Its prevalence among pregnant women varies among studies from 4 to 8% and appears to have increased over recent decades. Several studies have demonstrated that the use of inhaled corticosteroid (ICS) for the treatment of asthma does not affect fetal growth, and that maternal uncontrolled asthma has a greater impact on the fetus and placenta [1–3]. Even though asthma is a potentially serious medical condition and despite known risks of poorly controlled asthma during pregnancy, a large proportion of women still have a sub-optimal asthma control, principally due to concerns about surrounding risks of pharmacological agents, particularly ICS, and uncertainties regarding the effectiveness and the safety of different management strategies.
Out of 1351 women, 284 (mean age 44.4 ± 9) self-reported asthma and 92 of them had at least one pregnancy.
The main finding in the present analysis is that asthma was observed to worsen during pregnancy in a percentage much lower that the one generally reported in all the previous studies, 18.8% (16/85) versus 30%. A meta-analytic review of 14 studies, conducted before 1990, assessing changes in the course of asthma throughout pregnancy suggested that approximately one-third of pregnant asthmatic women experience a symptomatic improvement, one-third experience a worsening, and one-third remain the same . In our knowledge, at present, there are only few published data recently collected and the use of heterogeneous methods, such as the subjective nature and different definitions of asthma symptoms and control, makes the comparison with the older studies difficult.
The most interesting findings of this study are that: (1) the prevalence of asthma worsening during pregnancy is actually reduced compared to the past and (2) the worsening is significantly related to the severity of the disease, as indicated by the more regular use of ICS and by the presence of an ACT score below 20. There is still room in clinical practice to further reduce worsening of asthma during pregnancy by improving asthma control, with a more structured approach to asthma education and management pre-pregnancy.