OUTCOMES OF PREGNANCY IN ASTHMATIC WOMEN - 04/09/11

Doi : 10.1016/S0889-8561(05)70179-X

Michael Schatz, MD ^a, Mitchell Dombrowski, MD ^b

^a Department of Allergy, Kaiser Permanente Medical Center, San Diego, California (MS)

^b Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan (MD)

Résumé

Studies reporting the outcomes of pregnancy in asthmatic women have been conflicting. Some studies have reported increases in pre-eclampsia, preterm births, and low birth weight infants^{2 Bahna S.L., Bjerkedal T. The course and outcome of pregnancy in women with bronchial asthma Acta Allergol 1972 ; 27 : 397-406 [cross-ref]

Cliquez ici pour aller à la section Références, 7 Demissie K., Breckenridge M.B., Rhoads G.G. Infant and maternal outcomes in the pregnancies of asthmatic women Am J Resp Crit Care Med 1998 ; 158 : 109-195

Cliquez ici pour aller à la section Références, 32 Perlow J.H., Montgomery D., Morgan M.A. , et al. Severity of asthma and perinatal outcome Am J Obstet Gynecol 1992 ; 167 : 963-967

Cliquez ici pour aller à la section Références} whereas others have not reported increases in some^{14 Gordon M., Niswander K.R., Berendes H. , et al. Fetal morbidity following potentially anoxigenic obstetric conditions. VII: Bronchial asthma Am J Obstet Gynecol 1970 ; 106 : 421-429

Cliquez ici pour aller à la section Références, 23 Lao T.T., Huengsburg M. Labour and delivery in mothers with asthma Eur J Obstet Gynecol Reprod Biol 1990 ; 35 : 183-190 [cross-ref]

Cliquez ici pour aller à la section Références, 43 Stenius-Aarniala R., Piirila P., Teramo K. Asthma and pregnancy: A prospective study of 198 pregnancies Thorax 1988 ; 43 : 12 [cross-ref]

Cliquez ici pour aller à la section Références} or any^{1 Alexander S., Dodds L., Armson B.A. Perinatal outcomes in women with asthma during pregnancy Obstet Gynecol 1998 ; 92 : 435-440 [cross-ref]

Cliquez ici pour aller à la section Références, 39 Schatz M., Zeiger R.S., Hoffman C.P. , et al. Perinatal outcomes in the pregnancies of asthmatic women: A prospective controlled analysis Am J Respir Crit Care Med 1995 ; 151 : 1170

Cliquez ici pour aller à la section Références} of these outcomes. Variations in study results may be because of differences between studies regarding sample size, control for confounders, medications used, asthma severity, or adequacy of control of asthma. Mechanisms postulated to explain the possible increased perinatal risks have included (1) hypoxia and other physiologic consequences of poorly controlled asthma, (2) asthma medications, and (3) demographic or pathogenic factors associated with asthma but not directly caused by the disease or its treatment.^{41 Schatz M. Interrelationships between asthma and pregnancy: A review J Allergy Clin Immunol 1999 ; 103 (suppl) : 330-336

Cliquez ici pour aller à la section Références}

Table 1 summarizes studies that have evaluated the outcomes of pregnancy in asthmatic women compared with a concurrently followed control group.^{41 Schatz M. Interrelationships between asthma and pregnancy: A review J Allergy Clin Immunol 1999 ; 103 (suppl) : 330-336

Cliquez ici pour aller à la section Références} This article explores in detail the most commonly reported pregnancy outcomes in asthmatic women. For each adverse outcome, general information is presented regarding its definition, normal frequency, major risk factors, and clinical significance regarding subsequent infant morbidity and mortality. The specific observations that have been made regarding the outcome in asthmatic versus control women are reviewed. Finally, for each outcome, proposed mechanisms and the data supporting them are described.

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Plan

Address reprint requests to Michael Schatz, MD, Department of Allergy, Kaiser Permanente Medical Center, 7060 Clairemont Mesa Boulevard, San Diego, CA 92111, e-mail: michael.x.schatz@kp.org