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Am J Perinatol 2023; 40(02): 172-180
DOI: 10.1055/s-0041-1727233
Original Article

Asthma Medication Regimens in Pregnancy: Longitudinal Changes in Asthma Status

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
,
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
,
Jenna Kanner
1   Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
,
Carrie Nobles
1   Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
,
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
,
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
2   The Emmes Company, Rockville, 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
,
Joseph Biggio
5   Ochsner Baptist Medical Center, New Orleans, Louisiana
6   Center for Women's Reproductive Health, The University of Alabama at Birmingham, Birmingham, Alabama
,
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
7   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 NIH Medical Research Scholars Program Fund.
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Abstract

Objective This study aimed to assess the impact of common asthma medication regimens on asthma symptoms, exacerbations, lung function, and inflammation during pregnancy.

Study Design A total of 311 women with asthma were enrolled in a prospective pregnancy cohort. Asthma medication regimen was categorized into short-acting β agonist (SABA) alone, SABA + inhaled corticosteroid (ICS), SABA + ICS + long-acting β agonist (LABA), and no asthma medications (reference). We evaluated asthma control at enrollment (< 15 weeks' gestation) and its change into trimesters 2 and 3, including per cent predicted forced expiratory volume in 1 second (%FEV1) and peak expiratory flow (%PEF), pulse oximetry, fractional exhaled nitric oxide (FeNO), asthma symptoms (asthma attacks/month, night symptoms/week), and severe exacerbations. Linear mixed models adjusted for site, age, race, annual income, gestational age, body mass index, and smoking, and propensity scores accounted for asthma control status at baseline.

Results Women taking SABA + ICS and SABA + ICS + LABA had better first trimester %PEF (83.5% [75.7–91.3] and 84.6% [76.9–92.3], respectively) compared with women taking no asthma medications (72.7% [66.0–79.3]). Women taking SABA + ICS + LABA also experienced improvements in %FEV1 (+11.1%, p < 0.01) in the third trimester and FeNO in the second (−12.3 parts per billion [ppb], p < 0.01) and third (−11.0 ppb, p < 0.01) trimesters as compared with the trajectory of women taking no medications. SABA + ICS use was associated with increased odds of severe exacerbations in the first (odds ratio [OR]: 2.22 [1.10–4.46]) and second (OR: 3.15 [1.11–8.96]) trimesters, and SABA + ICS + LABA use in the second trimester (OR: 7.89 [2.75–21.47]). Women taking SABA alone were similar to those taking no medication.

Conclusion Pregnant women taking SABA + ICS and SABA + ICS + LABA had better lung function in the first trimester. SABA + ICS + LABA was associated with improvements in lung function and inflammation across gestation. However, both the SABA + ICS and SABA + ICS + LABA groups had a higher risk of severe exacerbation during early to mid-pregnancy.

Key Points

  • Medication regimens may affect perinatal asthma control.

  • Intensive regimens improved lung function/inflammation.

  • Women on intensive regimens had more acute asthma events.

Keywords

asthma - pregnancy - medication

Supplementary Material



Publication History

Received: 18 August 2020

Accepted: 02 March 2021

Article published online:
21 April 2021

© 2021. Thieme. All rights reserved.

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