This systematic review and meta-analysis demonstrated an increase in the risk of asthma exacerbation associated with obesity, smoking, depression and anxiety, parity, moderate or severe asthma, Black ethnicity, and maternal age.
Asthma is a prevalent health condition in pregnancy. Approximately 8-12% of pregnant women have asthma across the globe. Among these women, approximately 45% experience asthma exacerbations, which require medical interventions to alleviate symptoms. Uncontrolled asthma and asthma exacerbations are related to an increased risk for adverse perinatal outcomes. The outcomes may include poor offspring respiratory health that includes the onset of asthma. Patient-related risk factors associated with asthma exacerbations in pregnancy include smoking, obesity, and maternal age. Disease-related risk factors associated with asthma exacerbations in pregnancy include lung function and increasing asthma severity. It is imperative to recognize the modifiable risk factors in order to facilitate early identification and monitoring of pregnant women.
This systematic review and meta-analysis, published in the journal European Respiratory Review, aimed to determine the risk factors associated with asthma exacerbations in pregnancy, as well as to quantify these associations. Articles published from 2000 to August 24, 2021 were searched. This systematic review and meta-analysis included case-control studies, randomized controlled trials, and retrospective and prospective cohort studies that contained data about pregnant women who had physician-diagnosed asthma. Exposures included asthma characteristics, demographic features, and other pregnancy and health-related characteristics. The outcome was asthma exacerbations that required medical interventions in pregnancy. These interventions included hospitalizations, oral corticosteroid courses, emergency department visits, and unscheduled physician visits.
This study included 35 articles with a total of 429,583 pregnant women. The percentage of women who experienced asthma exacerbations during pregnancy ranged from 2.5 to 36.3%. The meta-analysis revealed a 27% increase in the risk for asthma exacerbations when the maternal age was more than 35 years. It also showed that the risk of asthma exacerbations increased by 25% in obese women and 35% in women who were smoking during pregnancy. Asthma factors associated with asthma exacerbations in pregnancy included moderate or severe asthma, prior pre-pregnancy exacerbations, utilization of inhaled corticosteroids, lung inflammation, higher Asthma Quality of Life Questionnaire scores, strategies related to antenatal asthma management, self-reported triggers of asthma exacerbations, and self-management skills of the pregnant women. Pregnancy-related factors associated with asthma exacerbations included multiparous status and twin or triplet pregnancy.
In summary, this study recognized several risk factors associated with asthma exacerbations during pregnancy. Increased risk for asthma exacerbations was observed in women suffering from moderate or severe asthma, twin or triplet pregnancy, Black ethnicity, women suffering from depression and anxiety, current smokers, multiparous women, obese women, and women older than 35 years of age.
Reference
Robijn AL, Bokern MP, Jensen ME, Barker D, Baines KJ, Murphy VE. Risk factors for asthma exacerbations during pregnancy: a systematic review and meta-analysis. Eur Respir Rev. Jun 30 2022;31(164). https://doi.org/10.1183/16000617.0039-2022
