Download PDF
Am J Perinatol 2024; 41(S 01): e2089-e2097
DOI: 10.1055/a-2097-1468
Original Article

The Association of Periconception Asthma Medication Discontinuation with Adverse Obstetric Outcomes

Matthew C. H. Rohn    *
1   Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
2   Department of Obstetrics and Gynecology, George Washington University Hospital, Washington, District of Columbia
,
Danielle R. Stevens   *
1   Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
,
William A. Grobman
3   Northwestern University Feinberg School of Medicine, Chicago, Illinois
,
Rajesh Kumar
3   Northwestern University Feinberg School of Medicine, Chicago, Illinois
4   Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
,
Zhen Chen
1   Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
,
Jessy Deshane
5   The University of Alabama at Birmingham, Birmingham, Alabama
,
Joseph R. Biggio
5   The University of Alabama at Birmingham, Birmingham, Alabama
6   Ochsner Health, New Orleans, Louisiana
,
Akila Subramaniam
5   The University of Alabama at Birmingham, Birmingham, Alabama
,
Katherine L. Grantz
1   Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
,
Seth Sherman
7   The Emmes Company, Rockville, Maryland
,
Pauline Mendola
1   Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
8   Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo, Buffalo, New York
› Author Affiliations Funding This study was supported by the National Institutes of Health Intramural Research Program at the Eunice Kennedy Shriver National Institute of Child Health and Human Development (clinical site contracts HHSN275201300013C to Northwestern University, HHSN275201300014C to the University of Alabama at Birmingham, and the Emmes Company for the Data Coordinating Center HHSN275201300026I, HHSN27500001, HHSN275000017) and the National Institutes of Health Medical Research Scholars Program Fund.
› Further Information
Also available at
    Permissions and Reprints

Abstract

Objective This study aimed to investigate asthma medication reduction in the periconceptional period as it relates to asthma status and adverse outcomes in pregnancy.

Study Design In a prospective cohort study, self-reported current and past asthma medications were collected and analyzes compared measures of asthma status in women who discontinued asthma medication in the 6 months prior to enrollment (“step-down”) versus those who did not (“no change”). Evaluation of asthma was done at three study visits (one per trimester) and by daily diaries, including measures of lung function (percent predicted forced expiratory volume in 1 and 6 s [%FEV1, %FEV6], peak expiratory flow [%PEF], forced vital capacity [%FVC], FEV1 to FVC ratio [FEV1/FVC]), lung inflammation (fractional exhaled nitric oxide [FeNO], ppb), rate of asthma symptoms (activity limitation, night symptoms, rescue inhaler use, wheeze, shortness of breath, cough, chest tightness, chest pain), and rate of asthma exacerbations. Adverse pregnancy outcomes were also evaluated. Adjusted regression analyses examined whether adverse outcomes differed by periconceptional asthma medication changes.

Results Of 279 participants included in analyses, 135 (48.4%) did not change asthma medication in the periconceptional period, whereas 144 (51.6%) reported a step down in medication. Those in the step-down group were more likely to have milder disease (88 [61.1%] in the step-down vs. 74 [54.8%] in the no change group), exhibited less activity limitation (rate ratio [RR]: 0.68, 95% confidence interval [CI]: 0.47–0.98), and experienced fewer asthma attacks (RR: 0.53, 95% CI: 0.34–0.84) during pregnancy. The step-down group had a nonsignificant increase in overall odds of experiencing an adverse pregnancy outcome (odds ratio: 1.62, 95% CI: 0.97–2.72).

Conclusion Over half of women with asthma reduce asthma medication in the periconceptional period. Although these women typically have milder disease, a step down in medication may be associated with an increased risk of adverse pregnancy outcomes.

Key Points

  • Many women reduce their asthma medication in pregnancy.

  • Reduction is more common among those with mild disease.

  • Medication reduction may lead to adverse pregnancy outcomes.

Keywords

asthma - medication - reduction - pregnancy

* The authors consider that the first two authors should be regarded as joint-First Authors.


Supplementary Material



Publication History

Received: 20 March 2022

Accepted: 19 May 2023

Accepted Manuscript online:
22 May 2023

Article published online:
26 June 2023

© 2023. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Mendola P, Laughon SK, Männistö TI. et al. Obstetric complications among US women with asthma. Am J Obstet Gynecol 2013; 208 (02) 127.e1-127.e8
    CrossrefPubMedGoogle Scholar
  • 2 Spiegel E, Shoham-Vardi I, Goldbart A, Sergienko R, Sheiner E. Maternal asthma is an independent risk factor for long-term respiratory morbidity of the offspring. Am J Perinatol 2018; 35 (11) 1065-1070
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Enriquez R, Griffin MR, Carroll KN. et al. Effect of maternal asthma and asthma control on pregnancy and perinatal outcomes. J Allergy Clin Immunol 2007; 120 (03) 625-630
    CrossrefPubMedGoogle Scholar
  • 4 Bonham CA, Patterson KC, Strek ME. Asthma outcomes and management during pregnancy. Chest 2018; 153 (02) 515-527
    CrossrefPubMedGoogle Scholar
  • 5 Belanger K, Hellenbrand ME, Holford TR, Bracken M. Effect of pregnancy on maternal asthma symptoms and medication use. Obstet Gynecol 2010; 115 (03) 559-567
    CrossrefPubMedGoogle Scholar
  • 6 Murphy VE, Gibson P, Talbot PI, Clifton VL. Severe asthma exacerbations during pregnancy. Obstet Gynecol 2005; 106 (5 Pt 1): 1046-1054
    CrossrefPubMedGoogle Scholar
  • 7 Tinker SC, Broussard CS, Frey MT, Gilboa SM. Prevalence of prescription medication use among non-pregnant women of childbearing age and pregnant women in the United States: NHANES, 1999–2006. Matern Child Health J 2015; 19 (05) 1097-1106
    CrossrefPubMedGoogle Scholar
  • 8 Cohen JM, Bateman BT, Huybrechts KF. et al. Poorly controlled asthma during pregnancy remains common in the United States. J Allergy Clin Immunol Pract 2019; 7 (08) 2672-2680.e10
    CrossrefPubMedGoogle Scholar
  • 9 Enriquez R, Wu P, Griffin MR. et al. Cessation of asthma medication in early pregnancy. Am J Obstet Gynecol 2006; 195 (01) 149-153
    CrossrefPubMedGoogle Scholar
  • 10 Stevens DR, Perkins N, Chen Z. et al. Determining the clinical course of asthma in pregnancy. J Allergy Clin Immunol Pract 2022; 10 (03) 793-802.e10
    CrossrefPubMedGoogle Scholar
  • 11 Dombrowski MP, Schatz M. ACOG Committee on Practice Bulletins-Obstetrics. ACOG practice bulletin: clinical management guidelines for obstetrician-gynecologists number 90, February 2008: asthma in pregnancy. Obstet Gynecol 2008; 111 (2 Pt 1): 457-464
    PubMedGoogle Scholar
  • 12 National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program Asthma and Pregnancy Working Group. NAEPP expert panel report. Managing asthma during pregnancy: recommendations for pharmacologic treatment-2004 update. J Allergy Clin Immunol 2005; 115 (01) 34-46
    CrossrefPubMedGoogle Scholar
  • 13 Rohn MCH, Stevens DR, Kanner J. et al. Asthma medication regimens in pregnancy: longitudinal changes in asthma status. Am J Perinatol 2023; 40 (02) 172-180
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Dweik RA, Boggs PB, Erzurum SC. et al; American Thoracic Society Committee on Interpretation of Exhaled Nitric Oxide Levels (FENO) for Clinical Applications. An official ATS clinical practice guideline: interpretation of exhaled nitric oxide levels (FENO) for clinical applications. Am J Respir Crit Care Med 2011; 184 (05) 602-615
    CrossrefPubMedGoogle Scholar
  • 15 Talge NM, Mudd LM, Sikorskii A, Basso O. United States birth weight reference corrected for implausible gestational age estimates. Pediatrics 2014; 133 (05) 844-853
    CrossrefPubMedGoogle Scholar
  • 16 Shin D, Chung H, Weatherspoon L, Song WO. Validity of prepregnancy weight status estimated from self-reported height and weight. Matern Child Health J 2014; 18 (07) 1667-1674
    CrossrefPubMedGoogle Scholar
  • 17 Perkins NJ, Cole SR, Harel O. et al. Principled approaches to missing data in epidemiologic studies. Am J Epidemiol 2018; 187 (03) 568-575
    CrossrefPubMedGoogle Scholar
  • 18 Rothman KJ. No adjustments are needed for multiple comparisons. Epidemiology 1990; 1 (01) 43-46
    CrossrefPubMedGoogle Scholar
  • 19 Davies G, Jordan S, Thayer D, Tucker D, Humphreys I. Medicines prescribed for asthma, discontinuation and perinatal outcomes, including breastfeeding: a population cohort analysis. PLoS One 2020; 15 (12) e0242489
    CrossrefPubMedGoogle Scholar
  • 20 Schatz M. Interrelationships between asthma and pregnancy: a literature review. J Allergy Clin Immunol 1999; 103 (2 pt 2): S330-S336
    CrossrefPubMedGoogle Scholar
  • 21 Rogers L, Reibman J. Stepping down asthma treatment: how and when. Curr Opin Pulm Med 2012; 18 (01) 70-75
    CrossrefPubMedGoogle Scholar
  • 22 Zozus MN, Young LW, Simon AE. et al. Training as an intervention to decrease medical record abstraction errors multicenter studies. Stud Health Technol Inform 2019; 257: 526-539
    PubMedGoogle Scholar