Clinical analysis of disease control and pregnancy outcome in asthmatic patients during pregnancy_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

 YU Bing , MA Yanliang , ZHANG Tong , GAO Zhancheng , HE Quanying

Department of Respiratory and Critial Care Medicine, Peking University People’s Hospital, Beijing 100044, P. R. China;

Corresponding author：

YU Bing, Email: yubing_660@.com

Keywords：

Pregnancy asthma; gain weight; eosinophil level; pregnancy outcome

DOI：

10.7507/1671-6205.202201053

Video：

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Objective To explored the influence of disease changes, weight gain, eosinophil levels and other factor in pregnancy women with asthma. Methods Case records of gestational asthma patients produced in the obstetrics department of Peking University People's Hospital from October 2010 to October 2020 were collected, and refer to electronic medical records of clinics (pre-pregnancy and pregnancy). According to the disease control (asthma related unplanned respiratory clinics, emergency or hospitalization), patients were divided into pregnancy stable group and pregnancy fluctuation group. The basic characteristics, pre-pregnancy asthma control, weight gain during pregnancy and peripheral blood eosinophil level before labor were retrospectively analyzed. The cause of asthma attacks, clinical characteristics and distribution of gestational time in pregnancy fluctuations were described. Peripheral blood eosinophil levels in different period during pregnancy in the stable group were analyzed. Results Totally 124 cases of natural pregnancy singleton were enrolled in the study. The age was (32.3±3.9) years old. There were 71 patients in stable group and 53 patients in fluctuation group. The proportion of pre-pregnancy instability in the fluctuating pregnancy group was higher than that in the stable pregnancy group (P<0.05). The proportion of intermittent medication before pregnancy was higher in the fluctuating pregnancy group than in the stable pregnancy group (P<0.05). Peripheral blood eosinophil count before labor and the number of cases with eosinophil count≥0.15×10⁹/L before labor were higher in the fluctuation group (all P<0.05). The proportion of hypertentive diseases in pregnancy and fetal distress in uterus were higher in the fluctuation group (all P<0.05). The common cold was the common trigger factor (38.2%) and asthma recurrences occur between 13 and 36 weeks of gestation (65.8%) in fluctuation group. In further analysis of subgroup (the stable group), peripheral blood eosinophil count in early pregnancy (P<0.05) and pregnant metaphase (P<0.05) were higher than before delivery. The number of cases with eosinophil count>0.15×10⁹/L in pregnant metaphase (P<0.05) was higher than before delivery. Conclusions Asthma fluctuates during pregnancy is associated with adverse maternal and fetal outcomes. It is very important and critical that asthma control before pregnancy, weight gain management and eosinophil level monitoring of patients with asthma during pregnancy. The whole management is imperative in women with asthma during pregnancy.

Citation： YU Bing, MA Yanliang, ZHANG Tong, GAO Zhancheng, HE Quanying. Clinical analysis of disease control and pregnancy outcome in asthmatic patients during pregnancy. Chinese Journal of Respiratory and Critical Care Medicine, 2022, 21(3): 178-184. doi: 10.7507/1671-6205.202201053 Copy

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10.	Ali Z, Nilas L, Ulrik CS. Excessive gestational weight gain in first trimester is a risk factor for exacerbation of asthma during pregnancy: a prospective study of 1283 pregnancies. J Allergy Clin Immunol, 2018, 141(2): 761-767.
11.	Ali Z. Asthma and pregnancy: possible to prevent complications?- With Special reference to the impact of obesity and type of airway inflammation. Dan Med J, 2017, 64(12): B5428.
12.	Zhang XY, Simpson JL, Powell H, et al. Full blood count parameters for the detection of asthma inflammatory phenotypes. Clin Exp Allergy, 2014, 44(9): 1137-1145.
13.	Liang Z, Zhao H, Lv Y, et al. Moderate accuracy of peripheral eosinophil count for predicting eosinophilic phenotype in steroid-naive non-atopic adult asthmatics. Intern Med, 2012, 51(7): 717-722.
14.	Murphy VE, Powell H, Wark PA, et al. A prospective study of respiratory viral infection in pregnant women with and without asthma. Chest, 2013, 144: 420-427.
15.	Norjavaara E, de Verdier MG. Normal pregnancy outcomes in a population-based study including 2968 pregnant women exposed to budesonide. J Allergy Clin Immunol, 2003, 111: 736-742.
16.	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(8): 2672-2680.e10.

1. National Heart, Lung, and Blood Institute; National Asthma Education and Prevention Program Asthma and Pregnancy Working Group. Managing asthma during pregnancy: recommendations for pharmacologic treatment-2004 update NAEPP expert panel report. J Allergy Clin Immunol, 2005, 115(1): 34-46.
2. Källén B, Rydhstroem H, Aberg A. Asthma during pregnancy-a population based study. Eur J Epidemiol, 2000, 16(2): 167-171.
3. Murphy VE, Schatz M. Asthma in pregnancy: a hit for two. Eur Respir Rev, 2014, 23(131): 64-68.
4. Getahun D, Ananth CV, Peltier MR, et al. Acute and chronic respiratory diseases in pregnancy: associations with placental abruption. Am J Obstet Gynecol, 2006, 195(4): 1180-1184.
5. Lim A, Stewart K, Konig K, et al. Systematic review of the safety of regular preventive asthma medications during pregnancy. Ann Pharmacother, 2011, 45: 931-945.
6. Murphy VE, Gibson PG. Asthma in pregnancy. Clin Chest Med, 2011, 32: 93-110.
7. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention[EB/OL]. (2020-04-06) [2020-09-12]. Available at: www.ginasthma.org.
8. 中华医学会呼吸病学分会哮喘学组. 支气管哮喘防治指南(2020 年版). 中华结核和呼吸杂志, 2020, 43(12): 1023-1048.
9. Hendler I, Schatz M, Momirova V, et al. Association of obesity with pulmonary and nonpulmonary complications of pregnancy in asthmatic women. Obstet Gynecol, 2006, 108: 77-82.
10. Ali Z, Nilas L, Ulrik CS. Excessive gestational weight gain in first trimester is a risk factor for exacerbation of asthma during pregnancy: a prospective study of 1283 pregnancies. J Allergy Clin Immunol, 2018, 141(2): 761-767.
11. Ali Z. Asthma and pregnancy: possible to prevent complications?- With Special reference to the impact of obesity and type of airway inflammation. Dan Med J, 2017, 64(12): B5428.
12. Zhang XY, Simpson JL, Powell H, et al. Full blood count parameters for the detection of asthma inflammatory phenotypes. Clin Exp Allergy, 2014, 44(9): 1137-1145.
13. Liang Z, Zhao H, Lv Y, et al. Moderate accuracy of peripheral eosinophil count for predicting eosinophilic phenotype in steroid-naive non-atopic adult asthmatics. Intern Med, 2012, 51(7): 717-722.
14. Murphy VE, Powell H, Wark PA, et al. A prospective study of respiratory viral infection in pregnant women with and without asthma. Chest, 2013, 144: 420-427.
15. Norjavaara E, de Verdier MG. Normal pregnancy outcomes in a population-based study including 2968 pregnant women exposed to budesonide. J Allergy Clin Immunol, 2003, 111: 736-742.
16. 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(8): 2672-2680.e10.

Chinese Journal of Respiratory and Critical Care Medicine

Clinical analysis of disease control and pregnancy outcome in asthmatic patients during pregnancy

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