THE EFFECT OF PREGNANCY ON THE COURSE OF ASTHMA - 04/09/11

Doi : 10.1016/S0889-8561(05)70180-6

Joan C. Gluck, MD ^a, Paul A. Gluck, MD ^b

^a Florida Center for Allergy and Asthma Care and Research (JCG)

^b Department of Obstetrics and Gynecology, University of Miami School of Medicine (PAG), Miami, Florida

Résumé

Bronchial asthma is a chronic disease whose incidence and mortality has increased by more than 30% during the 1980s.^{4 Center for Disease Control and Prevention Asthma—United States 1980–1990 Morb Mortal Wkly Rep 1992 ; 41 : 733

Cliquez ici pour aller à la section Références} The course of bronchial asthma is one of exacerbation and remission caused by a cascade of events. Airway inflammation (with infiltration of inflammatory cells, such as eosinophils, lymphocytes, and mast cells) leads to increased airway responsiveness and airway obstruction. There are multiple intrinsic and extrinsic factors that can influence the course of asthma, all of which can occur concomitantly with pregnancy.

Asthma is the most common chronic pulmonary disease that complicates approximately 4% of all pregnancies.^{30 Venkataraman M.T., Shanies H.M. Pregnancy and asthma J Asthma 1997 ; 34 : 265 [cross-ref]

Cliquez ici pour aller à la section Références} This percentage is most likely an underestimate because in many mild cases, similar to the nonpregnant population, asthma is probably undiagnosed. The effect of pregnancy itself on asthma has been evaluated in many studies over the years. The general conclusion by Juniper and Newhouse,^{17 Juniper E.F., Newhouse M.T. Effect of pregnancy on asthma: A systematic review and meta-analysis New York: Marcel Dekker (1993).
401

Cliquez ici pour aller à la section Références} using meta-analysis to evaluate both retrospective and prospective studies, is that one third of women have improvement of asthma during pregnancy, one third experience no change, and one third have a worsening of their asthma. Great variations occur among the individual studies, which may be the result of the way asthma was assessed and the source of the populations studied (e.g., prenatal versus pulmonary clinics), which may influence the severity of asthma existing prepregnancy.

Historically, it is important to recall that for many years both obstetricians and their patients would stop all treatment as soon as pregnancy began. Asthma was not regarded as a high-risk condition, so it is likely that more women had severe difficulty with their asthma due to lack of treatment. In the 1966 edition of Williams Obstetrics^{6 Eastman N.J., Hellman L.M., Pritchard J.A. Williams Obstetrics New York: Appleton-Century-Crofts (1966).
767

Cliquez ici pour aller à la section Références} the entire subject of asthma and pregnancy is discussed in just two paragraphs. Relying on one retrospective study,^{24 Schaefer G., Silverman F. Pregnancy complicated by asthma Am J Obstet Gynecol 1961 ; 82 : 182

Cliquez ici pour aller à la section Références} it states that pregnancy had no effect on asthma in the majority of cases. No mention is made of any specific problems with asthma during pregnancy or any specific treatment.