Asthma is the in the greatest degre...

Asthma is the in the greatest degree common chronic condition associated with complications during pregnancy and carries an increased risk of poor consequences for the fetus. Studies have indicated that at least common in five women with asthma experience a plain exacerbation during pregnancy, rising to more than undivided half in women with strict asthma. The relationship between severity of asthma during pregnancy and perinatal issues is unclear. Some studies have shown an association between hospitalization for asthma during pregnancy and gentle birth weight of the neonate, whereas in others there was no correlation between birth weight and acute asthmatic attacks during pregnancy. Murphy and colleagues evaluated asthma exacerbations in 146 Australian women enlisted in a prospective cohort studious mood of asthma to establish the rate of stern exacerbations during pregnancy and investigate the relationship between exacerbation rate and perinatal fetal outcomes

The participants included all consenting women who were pregnant and had asthma and who made sum of two units or more antenatal visits to a university clinic. An intake assessment was performed, with a detailed history, pulmonary function testing, physical examination, and laboratory investigations. Prepregnancy asthma was classified as mild, moderate, or methodical using national guidelines based forward history, symptom severity and oftenness medication use, and pulmonary testing (eg forced expiratory tome and peak expiratory flow). The asthma history was repeated at each clinic visit, and the participants were monitored for exacerbations. A mild exacerbation, or los of command was defined as an episode managed at the patient and characterized according to an increase in symptoms or medication use, or a period of decreased peak stream on home monitoring. An exacerbation was defined as accurate if it required hospital admission, crisis department treatment, an unscheduled physician appointment, or a course of oral steroid therapy. The main issue measured was the frequency and severity of exacerbations during pregnancy; fetal results principally birth weight, also were examined.

Overall, 55 percent of participants had an exacerbation of asthma during pregnancy. rigid exacerbations occurred in 53 women (36 percent) at a mean gestation of 25 weeks. Mild exacerbations were documented in 34 women (23 percent) at a median gestation of 285 weeks. Seven women reported mild and strict exacerbations. Eight percent of women with mild asthma before pregnancy experienced stern exacerbations during pregnancy compared with 47 percent of those with moderate background asthma and 65 percent of those with censorious background asthma. Nineteen of 49 women (39 percent) who had bitter asthma before pregnancy required oral steroids during pregnancy, and nine women (18 percent) required hospital admission. The differences between the simple and mild groups were statistically significant.

No statistically significant differences were ground in overall pregnancy outcomes between women who experienced a strict exacerbation of asthma during pregnancy and those who did not, although there was a tend toward lower neonate birth weight in women who had a exact exacerbation. Subgroup analysis showed a significantly decreased birth weight in male neonates whose mothers had a rigid exacerbation. Women who had a austere exacerbation gained less weight nevertheless did not differ from other participants in any other significant variable. Factors associated with exacerbations included the winter season (43 percent of exacerbations), possible viral infection (34 percent) smoking (28 percent) and nonadherence to inhaled corticosteroid medication (29 percent)

The authors finish that women with asthma experience an increased rate of exacerbations during pregnancy and require substantial medical interventions. The rate of censorious exacerbations is highest in mothers with the in the greatest degree severe prepregnancy asthma. Viral infections and nonadherence to medications appear to be everyday causes. The study was too small to establish significant relationships between exacerbations of asthma and poor pregnancy issues but it showed significantly reduc birth weight in male infants.

ANNE D WALLING, MD

Murphy VE et al. rigorous asthma exacerbations during pregnancy. Obstet Gynecol November 2005;106:1046-54

COPYRIGHT 2006 American Academy of Family Physicians

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