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Asthma exacerbations during pregnancy: incidence and association with adverse pregnancy outcomes

¹ Department of Respiratory and Sleep Medicine, John Hunter Hospital and Hunter Medical Research Institute, University of Newcastle, NSW 2310, Australia
² Mothers and Babies Research Centre, Hunter Medical Research Institute, University of Newcastle, NSW 2310, Australia

Correspondence to:
Correspondence to:
Professor P G Gibson
Department of Respiratory and Sleep Medicine, John Hunter Hospital, Locked Bag 1, Hunter Region Mail Centre, Newcastle, New South Wales, 2310, Australia; peter.gibson{at}hnehealth.nsw.gov.au

Exacerbations of asthma during pregnancy represent a significant clinical problem and may be related to poor pregnancy outcomes. A systematic review of the literature was conducted for publications related to exacerbations during pregnancy. Four studies with a control group (no asthma) and two groups of women with asthma (exacerbation, no exacerbation) were included in meta-analyses using fixed effects models. During pregnancy, exacerbations of asthma which require medical intervention occur in about 20% of women, with approximately 6% of women being admitted to hospital. Exacerbations during pregnancy occur primarily in the late second trimester; the major triggers are viral infection and non-adherence to inhaled corticosteroid medication. Women who have a severe exacerbation during pregnancy are at a significantly increased risk of having a low birth weight baby compared with women without asthma. No significant associations between exacerbations during pregnancy and preterm delivery or pre-eclampsia were identified. Inhaled corticosteroid use may reduce the risk of exacerbations during pregnancy. Pregnant women may be less likely to receive oral steroids for the emergency management of asthma. The effective management and prevention of asthma exacerbations during pregnancy is important for the health of both the mother and fetus.

Keywords: pregnancy; exacerbation; loss of asthma control; inhaled corticosteroids; fetus

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