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Ailes EC, Werler MM, Howley MM, Jenkins MM, Reefhuis J. Real-world data are not always big data: the case for primary data collection on medication use in pregnancy in the context of birth defects research. Am J Epidemiol 2024; 193:1211-1214. [PMID: 38751306 PMCID: PMC11372710 DOI: 10.1093/aje/kwae060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 04/25/2024] [Accepted: 05/10/2024] [Indexed: 09/04/2024] Open
Abstract
Many examples of the use of real-world data in the area of pharmacoepidemiology include "big data," such as insurance claims, medical records, or hospital discharge databases. However, "big" is not always better, particularly when studying outcomes with narrow windows of etiologic relevance. Birth defects are such an outcome, for which specificity of exposure timing is critical. Studies with primary data collection can be designed to query details about the timing of medication use, as well as type, dose, frequency, duration, and indication, that can better characterize the "real world." Because birth defects are rare, etiologic studies are typically case‑control in design, like the National Birth Defects Prevention Study, Birth Defects Study to Evaluate Pregnancy Exposures, and Slone Birth Defects Study. Recall bias can be a concern, but the ability to collect detailed information about both prescription and over-the-counter medication use and other exposures such as diet, family history, and sociodemographic factors is a distinct advantage over claims and medical record data sources. Case‑control studies with primary data collection are essential to advancing the pharmacoepidemiology of birth defects. This article is part of a Special Collection on Pharmacoepidemiology.
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Affiliation(s)
- Elizabeth C Ailes
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Martha M Werler
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Meredith M Howley
- Birth Defects Registry, New York State Department of Health, Albany, New York, USA
| | - Mary M Jenkins
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennita Reefhuis
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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2
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Rey A, Chełmińska M, Damps-Konstańska I. Non-allergic factors that influence asthma control in pregnancy. Eur J Midwifery 2024; 8:EJM-8-47. [PMID: 39206325 PMCID: PMC11350979 DOI: 10.18332/ejm/191295] [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: 05/15/2024] [Revised: 07/15/2024] [Accepted: 07/16/2024] [Indexed: 09/04/2024] Open
Abstract
INTRODUCTION Numerous factors may influence the asthma course during pregnancy, potentially elevating the risk of specific pregnancy complications. This study aimed to evaluate non-allergic factors influencing asthma and to assess perinatal outcomes between asthmatic and non-asthmatic pregnancies in the population of the Pomeranian Voivodeship region of Poland. METHODS The mixed cohort study was performed with 83 pregnant asthmatic patients aged 18-38 years. The control group consisted of 83 patients without asthma diagnosis or symptoms. A specially designed questionnaire was used to evaluate asthma course and perinatal outcomes. An Asthma Control Test (ACT) adapted for pregnancy was performed on enrollment. Asthma severity was assessed according to GINA guidelines. RESULTS In 19 cases (22.80%), patients quit their regular treatment after pregnancy was confirmed. Respiratory tract infection occurred in 23 patients (27.71%) and had been statistically significantly more frequent among patients with partially and uncontrolled asthma (χ2=8.504, p<0.05). No statistically significant difference was found between infection episodes and perinatal complications. The incidence of cesarean section was significantly higher among patients with asthma (χ2=16.37, p<0.01), particularly in patients with severe asthma (χ2=7.07, p<0.05) and uncontrolled asthma (χ2=6.7, p<0.05). Apgar score was statistically significantly lower in patients with severe asthma (χ2=20.37, p<0.05). CONCLUSIONS Respiratory tract infections and adequate asthma treatment are the most important modifiable factors in preventing perinatal complications associated with asthma.
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Affiliation(s)
- Agnieszka Rey
- Department of Pulmonology and Allergology, Medical University of Gdańsk, Gdańsk, Poland
| | - Marta Chełmińska
- Department of Pulmonology and Allergology, Medical University of Gdańsk, Gdańsk, Poland
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3
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Howell I, Howell A, Pavord I. Navigating uncertainty: asthma biologics during pregnancy. THE LANCET. RESPIRATORY MEDICINE 2024:S2213-2600(24)00248-0. [PMID: 39216498 DOI: 10.1016/s2213-2600(24)00248-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2024] [Accepted: 08/01/2024] [Indexed: 09/04/2024]
Affiliation(s)
- Imran Howell
- Respiratory Medicine Unit and Oxford Respiratory NIHR BRC, Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Aleksandra Howell
- Respiratory Medicine Unit and Oxford Respiratory NIHR BRC, Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - Ian Pavord
- Respiratory Medicine Unit and Oxford Respiratory NIHR BRC, Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK.
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4
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Joshi E, Gibson PG, McDonald VM, Murphy VE. Treatable traits in asthma during pregnancy: a call for a shift towards a precision-based management approach. Eur Respir Rev 2023; 32:230105. [PMID: 38123232 PMCID: PMC10731471 DOI: 10.1183/16000617.0105-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 10/16/2023] [Indexed: 12/23/2023] Open
Abstract
Asthma is the most common chronic medical condition in pregnancy. Asthma exacerbations in pregnancy are unpredictable, and are associated with adverse maternal and fetal perinatal outcomes such as preterm birth and low birthweight. Goals of asthma management in pregnancy are to establish effective asthma control and prevent exacerbations. Optimising the management of asthma in pregnancy is an important goal of practice and future research.Treatable traits is a precision medicine paradigm proposed for the management of airways diseases, which holistically addresses the complexity and heterogeneity of airways disease. It is an individualised treatment approach that aims to improve outcomes. This makes treatable traits well suited for pregnant women with asthma, who have a high prevalence of obesity, mental health conditions, poor symptom perception and suboptimal asthma management skills including low treatment adherence. These traits are measurable and treatable. In this review, we explore current knowledge on the burden of asthma, maternal and perinatal consequences of asthma during pregnancy, the treatable traits paradigm, the prevalence of treatable traits in pregnant women with asthma, and consider how the treatable traits paradigm can be integrated into the management of asthma in pregnancy.
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Affiliation(s)
- Esha Joshi
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
- Asthma and Breathing Program, Hunter Medical Research Institute, Newcastle, Australia
| | - Peter G Gibson
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
- Asthma and Breathing Program, Hunter Medical Research Institute, Newcastle, Australia
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia
| | - Vanessa M McDonald
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
- Asthma and Breathing Program, Hunter Medical Research Institute, Newcastle, Australia
- School of Nursing and Midwifery, University of Newcastle, Newcastle, Australia
| | - Vanessa E Murphy
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
- Asthma and Breathing Program, Hunter Medical Research Institute, Newcastle, Australia
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5
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Kazma JM, Van Den Anker J, Ahmadzia HK. Pharmacoethics and pregnancy: Overcoming the therapeutic orphan stigma. Br J Clin Pharmacol 2023; 89:483-490. [PMID: 34904271 DOI: 10.1111/bcp.15173] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 11/07/2021] [Accepted: 11/24/2021] [Indexed: 01/18/2023] Open
Abstract
There is paucity of evidence to support clinical decision making and counselling related to medication use in pregnancy. Despite multiple efforts from legislative bodies and advocacy groups, the inclusion of pregnant women in clinical drug trials assessing efficacy and safety remains scarce. Pregnancy can be complicated by multiple comorbidities that require pharmacological intervention; these interventions primarily target the pregnant woman but also sometimes have secondary effects for the foetus. The US Food and Drug Administration has issued multiple guidance documents on incorporating pregnant women in clinical trials to aid pharmaceutical companies in designing a protocol to ensure safety and adherence to ethical standards. Advances in paediatric pharmacology studies provide lessons for researchers on the best practice of designing clinical trials with inclusion of patients from special populations. In this review, we present the status of pregnant women in clinical trials, highlighting the ethical stigma and possible future directives.
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Affiliation(s)
- Jamil M Kazma
- Department of Obstetrics & Gynecology, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA
| | - John Van Den Anker
- Division of Clinical Pharmacology, Children's National Hospital, Washington D.C., USA.,Division of Pediatric Pharmacology and Pharmacometrics, University Children's Hospital Basel, University of Basel, Switzerland
| | - Homa K Ahmadzia
- Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, The George Washington University School of Medicine and Health Sciences, Washington D.C., USA
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6
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Abstract
Background: Asthma is a frequent and potentially life-threatening disease that complicates many pregnancies. There are extensive data with regard to the diagnosis and treatment of asthma during pregnancy. Medical providers require an up-to-date summary of the critical aspects of asthma management during pregnancy. Objective: This review aimed to summarize the available data from clinical trials, cohort studies, expert opinions, and guideline recommendations with regard to asthma in pregnancy. Methods: A search through PubMed was conducted by using keywords previously mentioned and MeSH (Medical Subject Headings) terminology. Clinical trials, observational studies, expert opinions, guidelines, and other reviews were included. The quality of the studies was assessed, and data were extracted and summarized. Results: Asthma worsens in ∼40% of pregnant women, which can be associated with maternal and fetal complications. Physiologic changes in the respiratory, cardiovascular, and immune systems during pregnancy play a critical role in the manifestations of asthma. The diagnosis and the treatment of asthma are similar to that of patients who are not pregnant. Nonetheless, concern for fetal malformations, preterm birth, and low birth weight must be considered when managing pregnant patients with asthma. Importantly, cornerstones of the pharmacotherapy of asthma seem to be safe during pregnancy. Conclusion: Asthma in pregnancy is associated with adverse outcomes. Roadblocks to management include associated comorbidities, medication nonadherence, atopy, lack of education, and smoking habits. These need to be acknowledged and addressed for successful asthma management during pregnancy.
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Successful and safe treatment of severe steroid depended eosinophilic asthma with mepolizumab in a woman during pregnancy. Respir Med Case Rep 2022; 41:101785. [DOI: 10.1016/j.rmcr.2022.101785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/20/2022] [Accepted: 11/20/2022] [Indexed: 11/29/2022] Open
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8
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Sodhi A, Pisani M, Glassberg MK, Bourjeily G, D'Ambrosio C. Sex and Gender in Lung Disease and Sleep Disorders: A State-of-the-Art Review. Chest 2022; 162:647-658. [PMID: 35300976 PMCID: PMC9808608 DOI: 10.1016/j.chest.2022.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 03/08/2022] [Accepted: 03/08/2022] [Indexed: 01/13/2023] Open
Abstract
The terms sex and gender often are used interchangeably, but have specific meaning when it comes to their effects on lung disease. Ample evidence is now available that sex and gender affect the incidence, susceptibility, presentation, diagnosis, and severity of many lung diseases. Some conditions are more prevalent in women, such as asthma. Other conditions are seen almost exclusively in women, like lymphangioleiomyomatosis. Some life stages-such as pregnancy-are unique to women and can affect the onset and course of lung disease. Clinical presentation may differ as well, such as higher number of exacerbations experienced by women with COPD and greater cardiovascular morbidity in women with sleep-disordered breathing. In addition, response to therapy and medication safety may also differ by sex, and yet, pharmacogenomic factors often are not addressed adequately in clinical trials. Various aspects of lung and sleep biology and pathobiology are impacted by female sex and female reproductive transitions. Differential gene expression or organ development can be impacted by these biological differences. Understanding these differences is the first step in moving toward precision medicine for women. This article is a state-of-the-art review of specific effects of sex and gender focused on epidemiology, disease presentation, risk factors, and management of lung diseases. Pathobiological mechanisms explaining sex differences in these diseases are beyond the scope of this article. We review the literature and focus on recent guidelines about using sex and gender in research. We also review sex and gender differences in lung diseases.
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Affiliation(s)
- Amik Sodhi
- Division of Allergy, Pulmonary and Critical Care Medicine, University of Wisconsin, Madison, WI
| | - Margaret Pisani
- Division of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT
| | - Marilyn K Glassberg
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Arizona College of Medicine Phoenix, Phoenix, AR
| | - Ghada Bourjeily
- Division of Pulmonary, Critical Care and Sleep Medicine, Brown University, Providence, RI
| | - Carolyn D'Ambrosio
- Division of Pulmonary, Critical Care and Sleep Medicine, Yale University School of Medicine, New Haven, CT.
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Gade EJ, Tidemandsen C, Hansen AV, Ulrik CS, Backer V. Challenges in the successful management of asthma during conception, pregnancy and delivery. Breathe (Sheff) 2022; 18:220013. [DOI: 10.1183/20734735.0013-2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 06/22/2022] [Indexed: 11/05/2022] Open
Abstract
Asthma and infertility are the most common disorders among women of reproductive age. Time to pregnancy is prolonged in women with asthma, and importantly, age seems to be a more important risk factor regarding fertility in women with asthma compared to women without asthma. Some data have shown a higher frequency of miscarriages in women with asthma, although the data are conflicting on this issue as studies have observed no association between asthma and pregnancy loss. Furthermore, studies have shown no negative effect of asthma on the total number of offspring. Pregnancy may, thus, have a significant impact on women with asthma, as well as on their offspring.The age of the women has an important impact on ability to conceive, but also for the pregnancy itself, with higher risk of uncontrolled asthma as well as asthma exacerbations with increasing age. Well-controlled asthma decreases the risk of maternal and fetal complications, while poorly controlled and undertreated asthma is associated with a range of risks for both mother and fetus. Asthma treatment should follow the general guidelines for asthma therapy, irrespective of pregnancy status, including treatment with inhaled corticosteroids, β2-agonists and muscarinic antagonists. Targeted treatment with biologics for severe asthma seems to be without important adverse effects. The use of systemic corticosteroids may be associated with adverse events during the first trimester; however, an exacerbation with the associated risk of hypoxaemia is worse for the fetus. Best possible asthma control may be achieved using repeated measurements of fractional exhaled nitric oxide (FENO), as the use of FENO compared with symptoms registration only has been shown to reduce exacerbation rate.In conclusion, women with asthma should be encouraged to conceive at an early age, might experience miscarriages, but the number of offspring are the same as in women without asthma. Well treated asthma is important for the well-being of both the mother and the unborn fetus.
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10
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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: 8] [Impact Index Per Article: 2.7] [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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11
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DaVeiga SP. "The Dilemma of the American Conscience": The Delivery of Health Care for Asthma in Pregnancy Based on Health Insurance Status in the United Status: A Call to Action. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 7:2681-2682. [PMID: 31706491 DOI: 10.1016/j.jaip.2019.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 06/20/2019] [Indexed: 11/24/2022]
Affiliation(s)
- Sigrid Payne DaVeiga
- Pulmonology Allergy Problematic Asthma (PAPA) Clinic, The Children's Hospital of Philadelphia, Division of Allergy and Immunology, Philadelphia, Pa.
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12
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Novotna B, Jarkovsky J, Beneso K. Adverse Pregnancy Outcomes in Asthmatic Women According to Steps of Treatment: A Population-Based Study. EUROPEAN MEDICAL JOURNAL 2019. [DOI: 10.33590/emj/10310084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Bronchial asthma is the most common chronic disease in pregnancy associated with adverse pregnancy, obstetric, and perinatal outcomes. The aim of this study was to determine the influence of the steps of asthma treatment during pregnancy on adverse pregnancy, obstetric, and perinatal outcomes. The data of all women with singleton delivery in 2011–2017, including the diagnosis of asthma and its treatment for the same woman, were obtained from the National Registry of Reimbursed Health Services (NRRHS) of the Czech Republic. Relation of asthma and the steps of treatment to pregnancy, labour, and perinatal outcomes taken from the National Register of Reproduction Health (NRRH) for the period 2011–2015 were analysed using logistic regression and described by odds ratios, 95% confidence interval, and statistical significance. Of the total number of 752,000 women with singleton delivery, asthma and/or its treatment were found in 6.27% of deliveries. Data from 460,324 births, in which the combination of data sources was available, showed the association between asthma and pre-eclampsia, caesarean section, and birth weight ≤2,500 g, only for the fifth step of treatment (p<0.001). Caesarean section was more frequent in all evaluated groups of treatment compared with women without asthma (p<0.001). Gestational age of <37 weeks was found in children of mothers with asthma diagnosis and no treatment and for women at the fifth step of treatment (p=0.003). The incidence of birth defects and Apgar scores of <7 in 5 minutes were without statistical significance in all evaluated women. The authors concluded that pregnant women with asthma are at risk from adverse pregnancy, obstetric, and perinatal outcomes, especially upon the fifth stage of treatment.
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Affiliation(s)
- Bronislava Novotna
- Allergology Outpatient Department, Internal Gastroenterology Clinic University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistic and Analysis, Faculty of Medicine, Masaryk University, Brno, Czech Republic; Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Klara Beneso
- Institute of Biostatistic and Analysis, Faculty of Medicine, Masaryk University, Brno, Czech Republic; Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
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13
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Robijn AL, Jensen ME, McLaughlin K, Gibson PG, Murphy VE. Inhaled corticosteroid use during pregnancy among women with asthma: A systematic review and meta-analysis. Clin Exp Allergy 2019; 49:1403-1417. [PMID: 31357230 DOI: 10.1111/cea.13474] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/16/2019] [Accepted: 08/24/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Studies demonstrate the prescription rate for inhaled corticosteroids (ICS) decreases in early pregnancy, possibly increasing exacerbation risk. This could be related to non-adherence to prescribed asthma medication or medication cessation by the patient or doctor. ICS use during pregnancy has not previously been summarized in a systematic review. OBJECTIVE The aim of this systematic review and meta-analysis was to evaluate the use of ICS during pregnancy among asthmatic women, specifically: (1) the prevalence of use, (2) changes of use during pregnancy compared with pre-pregnancy and (3) medication adherence among ICS users. METHODS We systematically searched literature in Embase, MEDLINE, CINAL and Cochrane, using terms related to asthma, pregnancy and medication use. All English articles reporting ICS among pregnant women with asthma were included. Prevalence, changes in ICS use during pregnancy and ICS adherence were pooled using STATA (version 15.0, StataCorp USA). RESULTS A total of 4237 references were retrieved in the initial search. Screening and review led to the inclusion of 52 articles for one or more aims (Aim 1: N = 45; Aim 2, N = 13; and Aim 3, N = 5). The pooled prevalence of ICS use during pregnancy was 41% (95%CI 36%-45%); 49% (95%CI 44%-55%) in Europe, 39% (95%CI 32%-47%) in Australia and 34% (95%CI 27%-41%) in North America. In eight prescription databases, ICS prescription rates lowered in the first trimester of pregnancy, compared with pre-pregnancy, increased in the second trimester and decreased in the third trimester. Five studies reported ICS adherence among pregnant women, using four measures of self-reported non-adherence. In two comparable studies, pooled ICS non-adherence was 40% (95%CI 36%-44%). CONCLUSIONS The prevalence of ICS use among pregnant women with asthma is 41% and varies widely between countries and continents, and prescription rates for ICS change throughout pregnancy. More studies are needed to investigate ICS adherence during pregnancy in women with asthma.
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Affiliation(s)
- Annelies L Robijn
- Priority Research Centre Grow Up Well, School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, Australia
| | - Megan E Jensen
- Priority Research Centre Grow Up Well, School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, Australia
| | - Karen McLaughlin
- Priority Research Centre Grow Up Well, School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, Australia
| | - Peter G Gibson
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, Australia.,Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | - Vanessa E Murphy
- Priority Research Centre Grow Up Well, School of Medicine and Public Health, Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, Australia
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14
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Cohen JM, Bateman BT, Huybrechts KF, Mogun H, Yland J, Schatz M, Wurst KE, Hernandez-Diaz S. Poorly Controlled Asthma During Pregnancy Remains Common in the United States. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2019; 7:2672-2680.e10. [PMID: 31257187 DOI: 10.1016/j.jaip.2019.05.043] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/15/2019] [Accepted: 05/15/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Asthma is among the most common preexisting medical conditions in pregnancy. Uncontrolled asthma may increase the risk of adverse pregnancy outcomes. OBJECTIVES To describe the prevalence, severity, and control of asthma during pregnancy in the United States. METHODS We identified 2 cohorts of pregnancies ending in a live birth within 2 large US health care claims databases: the Truven Health MarketScan Commercial Claims and Encounters Database (MarketScan, private insurance) for the period 2011 to 2015 and the nationwide Medicaid Analytic eXtract (MAX, public insurance) for the period 2000 to 2013. We defined asthma prevalence, severity, and control on the basis of International Classification of Diseases, 9th Revision diagnoses and asthma-related treatments. Severe asthma was defined as dispensing of 1 or more medium/high-dose inhaled corticosteroid plus additional therapy within the 12 months preceding delivery. Poor control was defined as having at least 1 of the following: 1 or more exacerbation (asthma-related hospitalization or emergency room visit, or a course of oral corticosteroids) or 5 or more filled prescriptions for short-acting β-agonists between the last menstrual period and delivery. RESULTS Among 604,420 pregnant women in MarketScan and 2,071,359 in MAX, 20,104 (3.3%) and 120,745 (5.8%) had asthma, respectively. Among pregnant women with asthma, 19.0% and 18.8% had severe asthma and 16.5% and 28.0% had poorly controlled asthma in MarketScan and MAX, respectively. Many women with poorly controlled asthma during pregnancy were not dispensed a long-term controller (38.4% in MarketScan and 43.3% in MAX). Within both cohorts, women with poor control were more often smokers and obese, had more comorbidities, and used more concomitant nonasthma medications. CONCLUSIONS Poorly controlled asthma is more frequent among publicly versus privately insured pregnancies in the United States. Dispensing of long-term controller medications during pregnancy remains low, even for symptomatic patients.
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Affiliation(s)
- Jacqueline M Cohen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Brian T Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass; Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Mass
| | - Krista F Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Helen Mogun
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass
| | - Jennifer Yland
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Michael Schatz
- Department of Allergy, Kaiser Permanente Medical Center, San Diego, Calif
| | - Keele E Wurst
- Department of Epidemiology and Real-World Evidence, GSK, Collegeville, Pa
| | - Sonia Hernandez-Diaz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass.
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15
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Effect of Pregnancy on Quantitative Medication Use and Relation to Exacerbations in Asthma. BIOMED RESEARCH INTERNATIONAL 2017; 2017:8276190. [PMID: 28808663 PMCID: PMC5541804 DOI: 10.1155/2017/8276190] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 05/23/2017] [Accepted: 06/12/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND The quantification of asthma medication reduction and its relation to an aggravation of asthma during pregnancy at an individual level are unclear. METHODS We conducted a nationwide retrospective cohort study of asthmatic pregnant women in South Korea. All of the asthma medications were ranked from 1 to 4 according to the guideline-based stepwise approach. We assessed the daily sums of the ranks of the asthma medications and their association with exacerbations during three phases based on the individual's delivery date: before, during, and after pregnancy. RESULTS The study cohort included 115,169 asthmatic pregnant women who gave birth between 2011 and 2013. The subjects were clustered into four groups according to the daily rank sums of their asthma medication. Asthma medications were rapidly reduced at the beginning of the pregnancy and then slowly increased after delivery. Exacerbations were more frequent in the group with higher rank-sum values than in the group with lower values. Overall exacerbations were reduced during pregnancy compared to before or after delivery. CONCLUSIONS Asthmatic pregnant women tended to reduce their asthma medication use during pregnancy. This led to a greater number of exacerbations in a small part of the study population.
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Cavero-Carbonell C, Vinkel-Hansen A, Rabanque-Hernández MJ, Martos C, Garne E. Fetal Exposure to Montelukast and Congenital Anomalies: A Population Based Study in Denmark. Birth Defects Res 2017; 109:452-459. [PMID: 28398707 DOI: 10.1002/bdra.23621] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The objective was to study pregnancy outcomes between groups of Danish women, with pregnancy ending between 1998 and 2009, according to their exposure to montelukast. METHODS Cross-sectional observational study in Danish women, selecting live births and stillbirths (Birth Registry) and spontaneous abortions and induced terminations (Patient Registry). Montelukast exposure was obtained from the Prescription Registry (ATC code R03DC03). Exposure period was from 3 months before the last menstrual period until the end of the first trimester. Four groups were studied: (1) women with prescription for montelukast, (2) women with prescription for montelukast and other anti-asthmatic medications, (3) women with prescription for other anti-asthmatic medications, (4) women without prescription for any anti-asthmatic medications. RESULTS A total of 754,300 singleton pregnancies (> 12 weeks) were identified: 401 pregnancies in group 1, 426 pregnancies in group 2, 24878 in group 3 and 728,595 in group 4. Risk of preterm birth, maternal preeclampsia and gestational diabetes was increased for pregnancies exposed to montelukast. No significant differences were found for the risk of major congenital anomalies (CA). Adjusted odds ratio for CA was 1.4 (95% CI 0.9-2.3) for the group 1 and 1.0 (95% CI 0.6-1.8) for group 2. CONCLUSION Pregnant women with prescriptions for montelukast had a higher risk of preterm birth and maternal complications. These risks are known to be associated with maternal asthma, no increased risk of CA was found. Further analysis including more exposed pregnancies will be needed to determine the risk of specific CA. Birth Defects Research 109:452-459, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Clara Cavero-Carbonell
- Rare Diseases Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, Valencia, Spain
| | - Anne Vinkel-Hansen
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Carmen Martos
- Rare Diseases Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, Valencia, Spain
| | - Ester Garne
- Paediatric Department, Hospital Lillebaelt-Kolding, Kolding, Denmark
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Tran YH, Groen H, Bergman JEH, Hak E, Wilffert B. Exposure to reactive intermediate-inducing drugs during pregnancy and the incident use of psychotropic medications among children. Pharmacoepidemiol Drug Saf 2017; 26:265-273. [PMID: 28097730 DOI: 10.1002/pds.4161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 12/07/2016] [Accepted: 12/11/2016] [Indexed: 11/11/2022]
Abstract
PURPOSE Our study aimed to investigate the association between prenatal exposure to reactive intermediate (RI)-inducing drugs and the initiation of psychotropic medications among children. METHODS We designed a cohort study using a pharmacy prescription database. Pregnant women were considered exposed when they received a prescription of RI-inducing drugs. These drugs could be either used alone (RI+/FAA-) or combined with drugs exhibiting folic acid antagonism (FAA, RI+/FAA+). The reference group included pregnant women who did not receive any RI-inducing drugs or FAA drugs. RESULTS We analyzed 4116 exposed and 30 422 reference pregnancies. The hazard ratio (HR) with 95% confidence interval (CI) was 1.27 (95%CI 1.15-1.41) for pregnancies exposed to RI-inducing drugs as a whole. Considering subgroups of RI-inducing drugs, prenatal exposure to both RI+/FAA+ and RI+/FAA- was associated with the children's initiation of psychotropic medications, HRs being 1.35 (95%CI 1.10-1.66) and 1.26 (1.13-1.41), respectively. The HRs were increased with prolonged exposure to RI-inducing drugs, especially in the first and second trimesters. In a detailed examination of the psychotropics, the incidences of receiving antimigraine preparations and psychostimulants were significantly increased for the exposed children, compared with the reference children. The incidences of receiving antipsychotics and hypnotics were also higher for the exposed children; however, the HRs did not reach significance after adjustment. CONCLUSIONS We found a significantly increased incident use of psychotropic medications among children prenatally exposed to RI-inducing drugs, especially during the first and second trimesters. This suggests a detrimental effect during critical periods of brain development. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Yen-Hao Tran
- Groningen Research Institute of Pharmacy, Unit of Pharmacotherapy, Epidemiology and Economics, University of Groningen, Groningen, The Netherlands
| | - Henk Groen
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jorieke E H Bergman
- Eurocat Registration Northern Netherlands, Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Eelko Hak
- Groningen Research Institute of Pharmacy, Unit of Pharmacotherapy, Epidemiology and Economics, University of Groningen, Groningen, The Netherlands
| | - Bob Wilffert
- Groningen Research Institute of Pharmacy, Unit of Pharmacotherapy, Epidemiology and Economics, University of Groningen, Groningen, The Netherlands.,Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Beau AB, Didier A, Hurault-Delarue C, Montastruc JL, Lacroix I, Damase-Michel C. Prescription of asthma medications before and during pregnancy in France: An observational drug study using the EFEMERIS database. J Asthma 2016; 54:258-264. [PMID: 27657554 DOI: 10.1080/02770903.2016.1214731] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Asthma affects between 3% to 8% of pregnant women. Previous studies have suggested that women's prescriptions for asthma medications change during pregnancy. The aim was to describe the prescription of asthma medications before and during pregnancy in France. METHODS Women from the EFEMERIS, a French database assessing the drugs prescribed, dispensed and reimbursed during pregnancy, delivering between July 2004 and December 2012, were included. Women, who were dispensed asthma medications on at least two dates from 3 months prior to pregnancy through delivery, were considered. RESULTS 2,977 women out of 69,205 (4%) were selected. They were prescribed 2.4 ± 1.2 different anti-asthmatic drugs with 3.5 ± 2.7 different dispensing dates. Almost 62% of the women were dispensed at least one prescription for short-acting β2-agonist (SABA), 63% at least one inhaled corticosteroid (IC), 42% a fixed-combination of an IC and a long-acting β2-agonist (LABA) and 8% a LABA. An increase in SABA and IC prescriptions and a decrease in fixed-combination prescriptions were observed during pregnancy compared to pre-pregnancy period. A rapid drop in prescriptions for montelukast was observed. Among the 1,507 women who were prescribed asthma medication before pregnancy, one third had a drop in dispensed asthma medications from the beginning of pregnancy. CONCLUSIONS The prevalence of dispensed asthma medications varies during pregnancy. There is a decrease in the prescriptions of fixed-combinations during pregnancy and an increase in the prescriptions of ICs. It appears important to study the potential impact of such changes on fetuses and newborns.
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Affiliation(s)
- Anna-Belle Beau
- a Service de Pharmacologie Médicale et Clinique, CHU Toulouse, Pharmacopôle Midi-Pyrénées, Faculté de Médecine, INSERM , Toulouse , France
| | - Alain Didier
- b Service de Pneumologie, Pôle des Voies Respiratoires, Hôpital Larrey, CHU Toulouse , France
| | - Caroline Hurault-Delarue
- a Service de Pharmacologie Médicale et Clinique, CHU Toulouse, Pharmacopôle Midi-Pyrénées, Faculté de Médecine, INSERM , Toulouse , France
| | - Jean-Louis Montastruc
- a Service de Pharmacologie Médicale et Clinique, CHU Toulouse, Pharmacopôle Midi-Pyrénées, Faculté de Médecine, INSERM , Toulouse , France
| | - Isabelle Lacroix
- a Service de Pharmacologie Médicale et Clinique, CHU Toulouse, Pharmacopôle Midi-Pyrénées, Faculté de Médecine, INSERM , Toulouse , France
| | - Christine Damase-Michel
- a Service de Pharmacologie Médicale et Clinique, CHU Toulouse, Pharmacopôle Midi-Pyrénées, Faculté de Médecine, INSERM , Toulouse , France
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20
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Charlton RA, Pierini A, Klungsøyr K, Neville AJ, Jordan S, de Jong-van den Berg LTW, Thayer D, Bos HJ, Puccini A, Hansen AV, Gini R, Engeland A, Nybo Andersen AM, Dolk H, Garne E. Asthma medication prescribing before, during and after pregnancy: a study in seven European regions. BMJ Open 2016; 6:e009237. [PMID: 26787250 PMCID: PMC4735125 DOI: 10.1136/bmjopen-2015-009237] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To explore utilisation patterns of asthma medication before, during and after pregnancy as recorded in seven European population-based databases. DESIGN A descriptive drug utilisation study. SETTING 7 electronic healthcare databases in Denmark, Norway, the Netherlands, Italy (Emilia Romagna and Tuscany), Wales, and the Clinical Practice Research Datalink representing the rest of the UK. PARTICIPANTS All women with a pregnancy ending in a delivery that started and ended between 2004 and 2010, who had been present in the database for the year before, throughout and the year following pregnancy. MAIN OUTCOME MEASURES The percentage of deliveries where the woman received an asthma medicine prescription, based on prescriptions issued (UK) or dispensed (non-UK), during the year before, throughout or during the year following pregnancy. Asthma medicine prescribing patterns were described for 3-month time periods and the choice of asthma medicine and changes in prescribing over the study period were evaluated in each database. RESULTS In total, 1,165,435 deliveries were identified. The prevalence of asthma medication prescribing during pregnancy was highest in the UK and Wales databases (9.4% (CI95 9.3% to 9.6%) and 9.4% (CI95 9.1% to 9.6%), respectively) and lowest in the Norwegian database (3.7% (CI95 3.7% to 3.8%)). In the year before pregnancy, the prevalence of asthma medication prescribing remained constant in all regions. Prescribing levels peaked during the second trimester of pregnancy and were at their lowest during the 3-month period following delivery. A decline was observed, in all regions except the UK, in the prescribing of long-acting β-2-agonists during pregnancy. During the 7-year study period, there were only small changes in prescribing patterns. CONCLUSIONS Differences were found in the prevalence of prescribing of asthma medications during and surrounding pregnancy in Europe. Inhaled β-2 agonists and inhaled corticosteroids were, however, the most popular therapeutic regimens in all databases.
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Affiliation(s)
- Rachel A Charlton
- Department of Pharmacy and Pharmacology, University of Bath, Bath, UK
| | - Anna Pierini
- Institute of Clinical Psychology, National Research Council (IFC-CNR), Pisa, Italy
| | - Kari Klungsøyr
- Medical Birth Registry of Norway, The Norwegian Institute of Public Health, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen,Norway
| | - Amanda J Neville
- Emilia Romagna Birth Registry, Centre for Clinical and Epidemiological Research, University of Ferrara, Ferrara, Italy
| | - Susan Jordan
- Department of Nursing, College of Human and Health Sciences, Swansea University, Swansea, UK
| | | | - Daniel Thayer
- Centre for Health Information, Research and Evaluation, Swansea University, Swansea, UK
| | - H Jens Bos
- Pharmacoepidemiology and Pharmacoeconomics Unit, University of Groningen, Groningen, The Netherlands
| | - Aurora Puccini
- Drug Policy Service, Emilia Romagna Region Health Authority, Bologna, Italy
| | - Anne V Hansen
- Paediatric Department, Hospital Lillebaelt, Copenhagen, Denmark
| | - Rosa Gini
- The Regional Agency for Public Health of Tuscany, Florence, Italy
| | - Anders Engeland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen,Norway
- Department of Pharmacoepidemiology, The Norwegian Institute of Public Health, Bergen, Norway
| | | | - Helen Dolk
- Institute of Nursing, University of Ulster, Newtownabbey, UK
| | - Ester Garne
- Paediatric Department, Hospital Lillebaelt, Copenhagen, Denmark
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Kelly W, Massoumi A, Lazarus A. Asthma in pregnancy: Physiology, diagnosis, and management. Postgrad Med 2015; 127:349-58. [PMID: 25702799 DOI: 10.1080/00325481.2015.1016386] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Asthma is a common, potentially serious, medical condition that affects an estimated 8% of pregnant patients, with 4% of all pregnant patients experiencing an exacerbation in the past year. Practitioners must be able to diagnose, educate, and treat such patients as they undergo significant physiological and immunologic change. But staying current can be challenging given over 3000 citations for "asthma and pregnancy" in a recent PubMed search, with 750 described as review articles. Patients have even more difficulty navigating information, with 29 million Google search results for this same query and 1.2 million alone for the question whether asthma medications are safe during pregnancy. This review provides brief answers to important management questions followed by supporting background literature.
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22
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Gent JF, Kezik JM, Hill ME, McKay LA, Holford TR, Leaderer BP, Bracken MB. Asthma medication use during pregnancy, wheeze and estimated exposure to ambient nitrogen dioxide. Eur Respir J 2015; 45:538-40. [PMID: 25537555 PMCID: PMC4331059 DOI: 10.1183/09031936.00161514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Risk of wheeze associated with ambient NO2 exposure is higher for pregnant asthmatics who have reduced their medication.
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Affiliation(s)
- Janneane F Gent
- Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Julie M Kezik
- Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Melissa E Hill
- Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Lisa A McKay
- Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Theodore R Holford
- Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Brian P Leaderer
- Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Michael B Bracken
- Center for Perinatal, Pediatric and Environmental Epidemiology, Yale School of Public Health, New Haven, CT, USA
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23
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Szefler SJ. Advances in pediatric asthma in 2013: coordinating asthma care. J Allergy Clin Immunol 2014; 133:654-61. [PMID: 24581430 DOI: 10.1016/j.jaci.2014.01.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Revised: 01/22/2014] [Accepted: 01/24/2014] [Indexed: 01/06/2023]
Abstract
Last year's "Advances in pediatric asthma: moving toward asthma prevention" concluded that "We are well on our way to creating a pathway around wellness in asthma care and also to utilize new tools to predict the risk for asthma and take steps to not only prevent asthma exacerbations but also to prevent the early manifestations of the disease and thus prevent its evolution to severe asthma." This year's summary will focus on recent advances in pediatric asthma on prenatal and postnatal factors altering the natural history of asthma, assessment of asthma control, and new insights regarding potential therapeutic targets for altering the course of asthma in children, as indicated in Journal of Allergy and Clinical Immunology publications in 2013 and early 2014. Recent reports continue to shed light on methods to understand factors that influence the course of asthma, methods to assess and communicate levels of control, and new targets for intervention, as well as new immunomodulators. It will now be important to carefully assess risk factors for the development of asthma, as well as the risk for asthma exacerbations, and to improve the way we communicate this information in the health care system. This will allow parents, primary care physicians, specialists, and provider systems to more effectively intervene in altering the course of asthma and to further reduce asthma morbidity and mortality.
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Affiliation(s)
- Stanley J Szefler
- Pediatric Asthma Research Program, Section of Pediatric Pulmonary Medicine, Breathing Institute, Department of Pediatrics, Children's Hospital Colorado, and the Department of Pediatrics, University of Colorado Denver School of Medicine, Aurora, Colo.
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Omalizumab in pregnant women treated due to severe asthma: two case reports of good outcomes of pregnancies. Postepy Dermatol Alergol 2014; 31:104-7. [PMID: 25097476 PMCID: PMC4112254 DOI: 10.5114/pdia.2014.40975] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 01/09/2014] [Accepted: 01/14/2014] [Indexed: 11/17/2022] Open
Abstract
The article presents case reports of 2 women who became pregnant during therapy with omalizumab. Both subjects suffered from very severe asthma and were treated chronically with all available medications including systemic steroids (first - 20 mg prednisolone/day, second - 40 mg prednisolone/day). Both were enrolled into treatment with omalizumab and started regular therapy in 2007. The course of asthma significantly improved in both cases (withdrawal of oral steroids or significant reduction of their dose, better asthma control). The first woman, 32-year-old, became pregnant in 2010 and gave birth in Oct 2010 - it was her 3(rd) pregnancy, and 3(rd) labor. The second woman, 31-year-old, also became pregnant in 2010 and gave birth in Jan 2011 - it was her 5(th) pregnancy and 2(nd) labor. Both had severe asthma exacerbations during previous pregnancies and labors, and decided to continue therapy with omalizumab. The first woman, besides omalizumab, was treated with high doses of inhaled corticosteroids (ICS) and long-acting β agonists (LABA) while the second one was treated with high doses of ICS, LABA and 2.5 mg to 5 mg prednisone/day. The pregnancies proceeded without asthma exacerbations. The first woman delivered a healthy girl (Apgar 9, weight 3200 g, length 56 cm) in the 40(th) week of pregnancy by caesarean section due to the narrow pelvis. The second one delivered a healthy boy (Apgar 9, weight 3800 g, length 56 cm) in week 40 by caesarean section due to the aggravating obstetrical history. In both cases, treatment with omalizumab did not affect pregnancies and newborns.
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Apter AJ. Advances in adult asthma diagnosis and treatment in 2013. J Allergy Clin Immunol 2014; 133:49-56. [PMID: 24369799 DOI: 10.1016/j.jaci.2013.11.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 11/11/2013] [Indexed: 10/25/2022]
Abstract
In 2013, several themes emerged: (1) a dedicated search for new therapies using new mechanisms; (2) the importance of the plasticity of the immune system (eg, that molecules that mediate inflammation in one setting can promote its resolution and return to homeostasis in other circumstances); (3) the complex role of viruses in asthma exacerbations; (4) the similarities and differences among asthma, asthma in smokers, and chronic obstructive pulmonary disease; and (5) the importance of understanding asthma phenotypes and their stability over time. Once new therapeutics pass the initial clinical trials, patient-oriented and real-world research will be needed.
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Affiliation(s)
- Andrea J Apter
- Division of Pulmonary, Allergy, & Critical Care Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, Pa.
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Mendola P, Männistö TI, Leishear K, Reddy UM, Chen Z, Laughon SK. Neonatal health of infants born to mothers with asthma. J Allergy Clin Immunol 2014; 133:85-90.e1-4. [PMID: 23916153 PMCID: PMC3874245 DOI: 10.1016/j.jaci.2013.06.012] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 06/13/2013] [Accepted: 06/17/2013] [Indexed: 12/20/2022]
Abstract
BACKGROUND Maternal asthma is associated with serious pregnancy complications, but newborn morbidity is understudied. OBJECTIVE We wanted to determine whether infants of asthmatic mothers have more neonatal complications. METHODS The Consortium on Safe Labor (2002-2008), a retrospective cohort, included 223,512 singleton deliveries at ≥ 23 weeks' gestation. Newborns of mothers with asthma (n = 17,044) were compared with newborns of women without asthma by using logistic regression models with generalized estimating equations to calculate adjusted odds ratios (ORs) and 95% CIs. Electronic medical record data included gestational week at delivery, birth weight, resuscitation, neonatal intensive care unit (NICU) admission, NICU length of stay, hyperbilirubinemia, respiratory distress syndrome, apnea, sepsis, anemia, transient tachypnea of the newborn, infective pneumonia, asphyxia, intracerebral hemorrhage, seizure, cardiomyopathy, periventricular or intraventricular hemorrhage, necrotizing enterocolitis, aspiration, retinopathy of prematurity, and perinatal mortality. RESULTS Preterm delivery was associated with maternal asthma for each week after 33 completed weeks of gestation and not earlier. Maternal asthma also increased the adjusted odds of small for gestational age (OR = 1.10; 95% CI, 1.05-1.16), NICU admission (OR = 1.12; 95% CI, 1.07-1.17), hyperbilirubinemia (OR = 1.09; 95% CI, 1.04-1.14), respiratory distress syndrome (OR = 1.09; 95% CI, 1.01-1.19), transient tachypnea of the newborn (OR = 1.10; 95% CI, 1.02-1.19), and asphyxia (OR = 1.34; 95% CI, 1.03-1.75). Findings persisted for term infants (≥ 37 weeks) who had additional increased odds of intracerebral hemorrhage (OR = 1.84; 95% CI, 1.11-3.03) and anemia (OR = 1.30; 95% CI, 1.04-1.62). CONCLUSIONS Maternal asthma was associated with prematurity and small for gestational age. Adverse neonatal outcomes, including respiratory complications, hyperbilirubinemia, and NICU admission, were increased in association with maternal asthma even among term deliveries.
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Affiliation(s)
- Pauline Mendola
- Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Rockville, Md.
| | - Tuija I Männistö
- Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Rockville, Md
| | - Kira Leishear
- Division of Epidemiology, Statistics, and Prevention Research (DESPR), Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Rockville, Md
| | - Uma M Reddy
- Pregnancy and Perinatology Branch, NICHD, Rockville, Md
| | - Zhen Chen
- Bioinformatics and Biostatistics Branch, DESPR, NICHD, Rockville, Md
| | - S Katherine Laughon
- Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Rockville, Md
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