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Han X, Wu TQ, Bian Y, Chen L, Feng X. Asthma and risk of adverse pregnancy outcomes: A Mendelian randomization study. Heliyon 2024; 10:e33857. [PMID: 39044964 PMCID: PMC11263667 DOI: 10.1016/j.heliyon.2024.e33857] [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: 03/13/2024] [Revised: 06/26/2024] [Accepted: 06/27/2024] [Indexed: 07/25/2024] Open
Abstract
Background Multiple empirical investigations have indicated a connection between asthma and adverse pregnancy outcomes (APOs). Nevertheless, the effects of asthma on APOs remain uncertain. Methods We performed bi-directional Univariable Mendelian randomization (UVMR) analyses using combined information obtained from genome-wide association studies (GWAS) data that is publicly accessible. The principal approach used to analyze the causal association between asthma or age when diagnosed and APOs was the inverse variance weighted (IVW) method. The two types of data regarding exposure originate from the IEU Open GWAS project, which includes 56,167 and 47,222 European asthma patients, respectively. The data of four APOs were acquired via the GWAS dataset of the FinnGen collaboration. In addition, we implemented multivariable Mendelian randomization (MVMR), controlling for confounding factors such as smoking status, frequent drinking, body mass index (BMI), and live birth quantity. Furthermore, we executed several meticulous sensitivity studies to ascertain the reliability of our MR results. Results Following the implementation of the Bonferroni adjustment, the UVMR assessment revealed that in the IVW model, asthma was significantly linked to an elevated risk of spontaneous abortion (SA) (odds ratio [OR]: 1.115; 95 % confidence interval [CI]: 1.031-1.206; P = 0.006) and gestational diabetes mellitus (GDM) (OR: 1.125; 95 % CI: 1.037-1.220; P = 0.005). However, there was no causal correlation between asthma and preterm birth (PTB) (OR: 0.979; 95 % CI: 0.897-1.068; P = 0.629) or preeclampsia (PE) (OR: 1.059; 95 % CI: 0.951-1.179; P = 0.297). After adjusting for confounding factors, including smoking status, frequent drinking, BMI, and live birth quantity, the MVMR analysis shows a statistically significant causal relationship between asthma and SA or GDM. Furthermore, our investigation's findings did not reveal a substantial correlation between the age of asthma onset based on genetics and the likelihood of SA or GDM. The inverse MR outcomes indicate a lack of causal connection linking APOs to the incidence of asthma. The validity of these findings were verified by sensitivity analyses. Conclusions The evidence provided by this study proves that genetically determined asthma is linked to a higher likelihood of SA and GDM. Further research is required to examine potential pathways. However, no conclusive evidence has been found to support the increased risk of SA and GDM in early asthma diagnosis or the interaction between asthma and PTB or PE, indicating that confounding factors may affect the results of previous observational studies.
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Affiliation(s)
- Xinyu Han
- Department of First Clinical Medical College, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Tian qiang Wu
- Department of First Clinical Medical College, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Yuanyuan Bian
- Department of First Clinical Medical College, Heilongjiang University of Chinese Medicine, Harbin, China
| | - Lu Chen
- Department of Gynecology, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
| | - Xiaoling Feng
- Department of Gynecology, The First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
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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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Abstract
İNTRODUCTION Asthma is one of the most common chronic airway disease among reproductive period of women. Chronic inflammation in asthma, eosinophilia, high steroid treatment and uncontrolled asthma may cause infertility by affecting the reproductive organs, menstrual cycle and quality of life. Some patients with severe asthma have frequent exacerbations associated with persistent eosinophilic inflammation despite continuous treatment with high-dose inhaled glucocorticoids with or without oral glucocorticoids. Mepolizumab (anti-IL-5) is a succesful option of treatment. CASES First case; 25-year-old female patient has been diagnosed having asthma and rhinitis for 5 years. Even she had desired pregnancy for 3 years, she was unable to have a baby, and had been diagnosed having primary infertility. Second case; 36 years old female had rhinitis for 6 years and asthma for 4 years Although she used the same contraception method (withdrawal,condom) for years, she did not get pregnant until receiving the second dose of mepolizumab treatment. RESULT Two women were treated with mepolizumab for eosinophilic severe asthma and they got pregnant. CONCLUSION Unexplained infertility in people with severe eosinophilic asthma may be corrected by mepolizumab treatment. However, there is not enough data regarding the use of mepolizumab during pregnancy.
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Affiliation(s)
- Guzin Ozden
- Department of Internal Medicine and Allergy, Immunology, Adana City Education and Research Hospital, Turkey, Adana
| | - Pelin Pınar Deniz
- Department of Chest Medicine, Adana City Education and Research Hospital, Adana, Turkey
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Jia S, Guo P, Lu J, Huang X, Deng L, Jin Y, Zhao L, Fan X. Curcumol Ameliorates Lung Inflammation and Airway Remodeling via Inhibiting the Abnormal Activation of the Wnt/β-Catenin Pathway in Chronic Asthmatic Mice. DRUG DESIGN DEVELOPMENT AND THERAPY 2021; 15:2641-2651. [PMID: 34188444 PMCID: PMC8232843 DOI: 10.2147/dddt.s292642] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 05/24/2021] [Indexed: 12/14/2022]
Abstract
Background Curcumol exhibits anti-inflammatory effect, but its effect on chronic asthma lacked research. Therefore, this study explored the role of curcumol in asthma. Methods A chronic asthmatic mice model was established by ovalbumin induction. After treatment with curcumol, airway resistance in mice was detected by forced oscillation technique. The histopathological features of airway tissues, pulmonary inflammation, and inflammation cell recruitment in the bronchoalveolar lavage fluid (BALF) of mice were detected by hematoxylin-eosin staining. Collagen deposition in the airways of mice was examined by Masson staining. The secretion of ovalbumin-IgE, IL-4, IL-5, IL-13 in mouse serum and VEGFA secretion in BALF were analyzed by ELISA. Finally, the expressions of β-catenin, Wnt5a, VEGFA, TGF-β1, Fibronectin, and MMP-9 in mice lung tissues were determined by Western blot or immunohistochemical. Results Curcumol attenuated airway hyperresponsiveness, airway remodeling, and pulmonary inflammation in chronic asthmatic mice. Curcumol relieved collagen deposition in airway tissues, inflammation cell recruitment in BALF, and reduced the up-regulation of serum ovalbumin-IgE, IL-4, IL-5, and IL-13 and BALF VEGFA in chronic asthmatic mice. In addition, curcumol attenuated the up-regulated expressions of β-catenin, Wnt5a, VEGFA, TGF-β1, Fibronectin, and MMP-9 in the lung tissues of chronic asthmatic mice, but curcumol treatment did not show such effects on healthy mice. Conclusion Our findings revealed that curcumol could ameliorate lung inflammation and airway remodeling by inhibiting the abnormal activation of the Wnt/β-catenin pathway in chronic asthmatic mice, indicating that curcumol could be used as a novel anti-asthma drug for basic and clinical research.
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Affiliation(s)
- Shanshan Jia
- Department of Respiration, Hengdian Wenrong's Hospital, Dongyang, People's Republic of China
| | - Pin Guo
- Lithotriptic Section, Dongyang Red Cross Hospital, Dongyang City, People's Republic of China
| | - Junhua Lu
- Department of Respiration, Hengdian Wenrong's Hospital, Dongyang, People's Republic of China
| | - Xujun Huang
- Intensive Care Unit, Hengdian Wenrong's Hospital, Dongyang, People's Republic of China
| | - Laming Deng
- Department of Emergency, Hengdian Wenrong's Hospital, Dongyang, People's Republic of China
| | - Yan Jin
- Department of Nursing, Hengdian Wenrong's Hospital, Dongyang, People's Republic of China
| | - Lanyan Zhao
- Department of Respiration, Dongyang People's Hospital, Dongyang City, People's Republic of China
| | - Xiaofang Fan
- School of Basic Medicine, Wenzhou Medical University, Wenzhou City, People's Republic of China
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5
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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: 0.5] [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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6
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Bláfoss J, Hansen AV, Malchau Lauesgaard SS, Ali Z, Ulrik CS. Female asthma and atopy - impact on fertility: a systematic review. J Asthma Allergy 2019; 12:205-211. [PMID: 31440063 PMCID: PMC6664855 DOI: 10.2147/jaa.s203576] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/19/2019] [Indexed: 11/25/2022] Open
Abstract
Background and objective Asthma is one of the most common chronic diseases among women of reproductive age, and previous studies have suggested a link between female asthma and infertility. The aim of the present review is to provide an update on current knowledge of the association between female asthma and/or atopy and a reduction in fertility, ie, number of offspring, time to pregnancy (TTP) and need for fertility treatment. Methods Systematic review performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-guidelines. Results A total of 14 studies fulfilled the predefined criteria for inclusion in the present review. Six studies investigated the association between female asthma and/or atopy and number of offspring, of which one reported a positive, two a negative, and three no association. Three studies addressed the association between asthma and TTP and found that TTP was significantly prolonged in asthmatic women compared to non-asthmatic women. Five studies investigated subfertility and the need for fertility treatments of which two studies found a higher prevalence of infertility among women prescribed anti-asthma medication. One study found no difference in the number of fertility treatments of asthmatic women compared to non-asthmatic women, whereas three studies reported that female asthma was associated with significantly more fertility treatment compared to non-asthmatic women. Conclusion Although the available evidence is conflicting, there is a clear trend toward an association between female asthma and a reduction in fertility, and by that a larger proportion requiring fertility treatment, even though female asthma might not negatively affect total number of offspring.
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Affiliation(s)
- Joan Bláfoss
- Department of Respiratory Medicine, Hvidovre Hospital, Hvidovre, Denmark
| | - Anne Vejen Hansen
- Department of Respiratory Medicine, Hvidovre Hospital, Hvidovre, Denmark
| | | | - Zarqa Ali
- Department of Respiratory Medicine, Hvidovre Hospital, Hvidovre, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Hvidovre Hospital, Hvidovre, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Grzeskowiak LE, Smithers LG, Grieger JA, Bianco-Miotto T, Leemaqz SY, Clifton VL, Poston L, McCowan LM, Kenny LC, Myers J, Walker JJ, Norman RJ, Dekker GA, Roberts CT. Asthma treatment impacts time to pregnancy: evidence from the international SCOPE study. Eur Respir J 2018; 51:51/2/1702035. [PMID: 29444917 DOI: 10.1183/13993003.02035-2017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/06/2017] [Indexed: 11/05/2022]
Affiliation(s)
- Luke E Grzeskowiak
- Robinson Research Institute, University of Adelaide, Adelaide, Australia .,Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Lisa G Smithers
- Robinson Research Institute, University of Adelaide, Adelaide, Australia.,School of Public Health, University of Adelaide, Adelaide, Australia
| | - Jessica A Grieger
- Robinson Research Institute, University of Adelaide, Adelaide, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Tina Bianco-Miotto
- Robinson Research Institute, University of Adelaide, Adelaide, Australia.,Waite Research Institute, School of Agriculture, Food and Wine, University of Adelaide, Adelaide, Australia
| | - Shalem Y Leemaqz
- Robinson Research Institute, University of Adelaide, Adelaide, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - Vicki L Clifton
- Mater Medical Research Institute, University of Queensland, Brisbane, Australia
| | - Lucilla Poston
- Women's Health Academic Centre, King's College London and King's Health Partners, London, UK
| | - Lesley M McCowan
- Dept of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Louise C Kenny
- The Irish Centre for Fetal and Neonatal Translational Research (INFANT) and Dept of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Jenny Myers
- Maternal and Fetal Health Research Centre, University of Manchester, Manchester, UK
| | - James J Walker
- Obstetrics and Gynaecology Section, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK
| | - Robert J Norman
- Robinson Research Institute, University of Adelaide, Adelaide, Australia.,Fertility SA, Adelaide, Australia
| | - Gus A Dekker
- Robinson Research Institute, University of Adelaide, Adelaide, Australia.,Women and Children's Division, Lyell McEwin Hospital, Adelaide, Australia
| | - Claire T Roberts
- Robinson Research Institute, University of Adelaide, Adelaide, Australia.,Adelaide Medical School, University of Adelaide, Adelaide, Australia
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Turkeltaub PC, Cheon J, Friedmann E, Lockey RF. The Influence of Asthma and/or Hay Fever on Pregnancy: Data from the 1995 National Survey of Family Growth. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2017; 5:1679-1690. [PMID: 28550983 DOI: 10.1016/j.jaip.2017.03.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 03/19/2017] [Accepted: 03/31/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Asthma is associated with adverse pregnancy outcomes. At the same time there is a worldwide increase in asthma and hay fever. OBJECTIVE This study addresses whether asthma and/or hay fever adversely influence pregnancy outcomes. METHODS Data from the 1995 National Survey of Family Growth that include a history of diagnosed asthma, hay fever, and adverse pregnancy outcomes in 10,847 women representative of the US population aged 15 to 44 years were analyzed. RESULTS Women with the allergic phenotypes asthma and hay fever and hay fever only had no significant increase in adverse pregnancy outcomes (spontaneous pregnancy loss, preterm birth, infant low birth weight), whereas women with the nonatopic phenotype asthma only (without hay fever) did. The study did not evaluate endotypes. CONCLUSIONS This study provides new data that the allergic phenotypes, asthma and hay fever and hay fever only, are compatible with healthy pregnancy, whereas the nonatopic asthma phenotype, asthma only, adversely impacts pregnancy.
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Affiliation(s)
| | - Jooyoung Cheon
- Sungshin Women's University College of Nursing, Seoul, Korea
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Gade EJ, Thomsen SF, Lindenberg S, Backer V. Fertility outcomes in asthma: a clinical study of 245 women with unexplained infertility. Eur Respir J 2016; 47:1144-51. [PMID: 26869675 DOI: 10.1183/13993003.01389-2015] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 11/27/2015] [Indexed: 11/05/2022]
Abstract
Evidence is increasing of an association between asthma and aspects of female reproduction. However, current knowledge is limited and furthermore relies on questionnaire studies or small populations. In a prospective observational cohort study to investigate whether time to pregnancy, the number of fertility treatments, and the number of successful pregnancies differ significantly between women with unexplained infertility with and without asthma.245 women with unexplained infertility (aged 23-45 years) underwent questionnaires and asthma and allergy testing while undergoing fertility treatment. 96 women entering the study had either a former doctor's diagnosis of asthma or were diagnosed with asthma when included. After inclusion they were followed for a minimum of 12 months in fertility treatment, until they had a successful pregnancy, stopped treatment, or the observation ended.The likelihood of achieving pregnancy was lower in women with asthma compared with those without asthma: median total time to pregnancy was 32.3 months in non-asthmatic women versus 55.6 months in those with asthma, hazard ratio 0.50 (95% confidence interval 0.34-0.74) p<0.001.Women with asthma had fewer successful pregnancies during fertility treatment, 39.6 versus 60.4% (p=0.002). Increasing age was of negative importance for expected time to pregnancy, especially among asthmatic women (interaction between age and asthma on time to pregnancy, p=0.001). Female asthmatics had a longer time to pregnancy and less often became pregnant than non-asthmatic women. Increasing age reduced the chances of conceiving especially among asthmatic women. The causal relationship between asthma and subfertility remains unclear.
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Affiliation(s)
- Elisabeth Juul Gade
- Respiratory Research Unit, Dept of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark Copenhagen Fertility Center, Copenhagen, Denmark
| | - Simon Francis Thomsen
- Respiratory Research Unit, Dept of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark Center for Medical Research Methodology, University of Copenhagen, Copenhagen, Denmark
| | | | - Vibeke Backer
- Respiratory Research Unit, Dept of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
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