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Asthma: Interrelationships with Pregnancy

  • Vanessa E. MurphyEmail author
  • Megan E. Jensen
  • Linda E. Campbell
  • Peter G. Gibson
Chapter

Abstract

Asthma affects pregnancy, and pregnancy affects asthma. These interrelationships affect the health of both mother and baby and have influences over the future health of the offspring.

Asthma is the most common chronic medical condition to impact on pregnancy, with global prevalence increasing. Pregnancy has been long understood to be associated with variable changes in asthma symptoms, which for some results in an improvement and others a deterioration. Ventilatory function is not thought to change with pregnancy, although large longitudinal studies are lacking. Exacerbations are common in pregnancy, requiring medical intervention in at least one third of pregnant women with asthma. Women with asthma also have a high prevalence of co-morbidities and behavioural issues which may impact their disease and increase the risk of adverse perinatal outcomes. These include rhinitis, gastro-oesophageal reflux disease, tobacco smoking, mental health concerns, obesity, poor nutrition and excess gestational weight gain. Infertility has recently been shown to be increased amongst women with asthma, and women with asthma are at increased risk of a range of adverse perinatal outcomes, including low birth weight, preterm birth, pre-eclampsia, gestational diabetes, neonatal death and neonatal intensive care admission at birth. The relationship between maternal asthma and offspring outcomes doesn’t finish at birth, however, with evidence for associations between poorly controlled asthma and asthma in childhood, and some studies suggesting a link between maternal asthma and poor cognitive and behavioural outcomes in childhood. The importance of good asthma management in pregnancy cannot be overstated, given the unpredictable changes in asthma during pregnancy, the association with poor outcomes for the baby, both at birth and into early life, and the complex relationships with co-morbidities which affect disease and pregnancy outcomes.

Keywords

Asthma Asthma control Exacerbation Perinatal outcomes Infertility Exhaled nitric oxide 

References

  1. 1.
    Sawicki E, Stewart K, Wong S, Leung L, Paul E, George J. Medication use for chronic health conditions by pregnant women attending an Australian maternity hospital. Aust N Z J Obstet Gynaecol. 2011;51(4):333–8.CrossRefGoogle Scholar
  2. 2.
    Kwon HL, Belanger K, Bracken MB. Asthma prevalence among pregnant and childbearing-aged women in the United States: estimates from national health surveys. Ann Epidemiol. 2003;13(5):317–24.CrossRefGoogle Scholar
  3. 3.
    Hansen C, Joski P, Freiman HC, Andrade S, Toh S, Dublin S, et al. Medication exposure in pregnancy risk evaluation program: the prevalence of asthma medication use during pregnancy. Matern Child Health J. 2013;17(9):1611–21.CrossRefGoogle Scholar
  4. 4.
    Rejno G, Lundholm C, Gong T, Larsson K, Saltvedt S, Almqvist C. Asthma during pregnancy in a population-based study – pregnancy complications and adverse perinatal outcomes. PLoS One. 2014;9(8):e104755.CrossRefGoogle Scholar
  5. 5.
    Baghlaf H, Spence AR, Czuzoj-Shulman N, Abenhaim HA. Pregnancy outcomes among women with asthma. J Matern Fetal Neonatal Med. 2017.  https://doi.org/10.1080/14767058.2017.1404982. [Epub ahead of print]
  6. 6.
    Jolving LR, Nielsen J, Kesmodel US, Nielsen RG, Beck-Nielsen SS, Norgard BM. Prevalence of maternal chronic diseases during pregnancy – a nationwide population based study from 1989 to 2013. Acta Obstet Gynecol Scand. 2016;95:1295–304.CrossRefGoogle Scholar
  7. 7.
    Schatz M, Harden K, Forsythe A, Chilingar L, Hoffman C, Sperling W, et al. The course of asthma during pregnancy, postpartum, and with successive pregnancies: a prospective analysis. J Allergy Clin Immunol. 1988;81(3):509–17.CrossRefGoogle Scholar
  8. 8.
    Zairina E, Abramson MJ, McDonald CF, Rochford P, Nolan G, Stewart K, et al. A prospective cohort study of pulmonary function during pregnancy in women with and without asthma. J Asthma. 2016;53(2):155–63.CrossRefGoogle Scholar
  9. 9.
    Phatak MS, Kurhade GA. A longitudinal study of antenatal changes in lung function tests and importance of postpartum exercises in their recovery. Indian J Physiol Pharmacol. 2003;47(3):352–6.PubMedGoogle Scholar
  10. 10.
    de Araujo GV, Leite DFB, Rizzo JA, Sarinho ESC. Asthma in pregnancy: association between the asthma control test and the global initiative for asthma classification and comparisons with spirometry. Eur J Obstet Gynecol Reprod Biol. 2016;203:25–9.CrossRefGoogle Scholar
  11. 11.
    Grarup PA, Janner JH, Ulrik CS. Passive smoking is associated with poor asthma control during pregnancy: a prospective study of 500 pregnancies. PLoS One. 2014;9(11):e112435.CrossRefGoogle Scholar
  12. 12.
    Grzeskowiak LE, Smith B, Roy A, Dekker G, Clifton VL. Patterns, predictors and outcomes of asthma control and exacerbations during pregnancy: a prospective cohort study. ERJ Open Res. 2016;2(1):00054–2015.CrossRefGoogle Scholar
  13. 13.
    Amaral L, Martins C, Coimbra A. Use of the control of allergic rhinitis and asthma test and pulmonary function tests to assess asthma control in pregnancy. Aust N Z J Obstet Gynaecol. 2017;58(1):86–90.CrossRefGoogle Scholar
  14. 14.
    Juniper EF, Daniel EE, Roberts RS, Kline PA, Hargreave FE, Newhouse MT. Effect of pregnancy on airway responsiveness and asthma severity. Relationship to serum progesterone. Am Rev Respir Dis. 1991;143(3 Pt 2):S78.CrossRefGoogle Scholar
  15. 15.
    Murphy VE, Gibson PG, Giles WB, Zakar T, Smith R, Bisits AM, et al. Maternal asthma is associated with reduced female fetal growth. Am J Respir Crit Care Med. 2003;168(11):1317–23.CrossRefGoogle Scholar
  16. 16.
    Firoozi F, Ducharme FM, Lemiere C, Beauchesne MF, Perreault S, Forget A, et al. Effect of fetal gender on maternal asthma exacerbations in pregnant asthmatic women. Respir Med. 2009;103(1):144–51.CrossRefGoogle Scholar
  17. 17.
    Bakhireva LN, SChatz M, Jones KL, Tucker CM, Slymen DJ, Klonoff-Cohen HS, et al. Fetal sex and maternal asthma control in pregnancy. J Asthma. 2008;45(5):403–7.CrossRefGoogle Scholar
  18. 18.
    Tan KS, McFarlane LC, Lipworth BJ. Paradoxical down-regulation and desensitization of beta2-adrenoceptors by exogenous progesterone in female asthmatics. Chest. 1997;111(4):847–51.CrossRefGoogle Scholar
  19. 19.
    Murphy VE, Gibson PG, Smith R, Clifton VL. Asthma during pregnancy: mechanisms and treatment implications. Eur Respir J. 2005;25(4):731–50.CrossRefGoogle Scholar
  20. 20.
    Forbes RL, Gibson PG, Murphy VE, Wark PA. Impaired type I and III interferon response to rhinovirus infection during pregnancy and asthma. Thorax. 2012;67(3):209–14.CrossRefGoogle Scholar
  21. 21.
    Forbes RL, Wark PA, Murphy VE, Gibson PG. Pregnant women have attenuated innate interferon responses to the 2009 pandemic influenza A virus subtype H1N1. J Infect Dis. 2012;206:646–53.CrossRefGoogle Scholar
  22. 22.
    Murphy VE, Gibson P, Talbot PI, Clifton VL. Severe asthma exacerbations during pregnancy. Obstet Gynecol. 2005;106(5):1046–54.CrossRefGoogle Scholar
  23. 23.
    Murphy VE, Clifton VL, Gibson PG. The effect of cigarette smoking on asthma control during exacerbations in pregnant women. Thorax. 2010;65(8):739–44.CrossRefGoogle Scholar
  24. 24.
    Schatz M, Dombrowski MP, Wise R, Thom EA, Landon M, Mabie W, et al. Asthma morbidity during pregnancy can be predicted by severity classification. J Allergy Clin Immunol. 2003;112(2):283–8.CrossRefGoogle Scholar
  25. 25.
    Cunningham SD, Magriples U, Thomas JL, Kozhimannil KB, Herrera C, Barrette E, et al. Association between maternal comorbidities and emergency department use among a national sample of commercially insured pregnant women. Acad Emerg Med. 2017;24:940–7.CrossRefGoogle Scholar
  26. 26.
    Powell H, McCaffery K, Murphy VE, Hensley MJ, Clifton VL, Giles W, et al. Psychosocial variables are related to future exacerbation risk and perinatal outcomes in pregnant women with asthma. J Asthma. 2013;50(4):383–9.CrossRefGoogle Scholar
  27. 27.
    Murphy VE, Jensen ME, Powell H, Gibson PG. Influence of maternal BMI and macrophage activation on asthma exacerbations in pregnancy. J Allergy Clin Immunol Pract. 2017;5(4):981–7.CrossRefGoogle Scholar
  28. 28.
    Hendler I, Schatz M, Momirova V, Wise R, Landon M, Mabie W, et al. Association of obesity with pulmonary and nonpulmonary complications of pregnancy in asthmatic women. Obstet Gynecol. 2006;108:77–82.CrossRefGoogle Scholar
  29. 29.
    Ali Z, Nilas L, Ulrik CS. Excessive gestational weight gain in first trimester is a risk factor for exacerbation of asthma during pregnancy: a prospective study of 1283 pregnancies. J Allergy Clin Immunol. 2018;141(2):761–7.CrossRefGoogle Scholar
  30. 30.
    Ali Z, Nilas L, Ulrik CS. Determinants of low risk of asthma exacerbation during pregnancy. Clin Exp Allergy. 2018;48(1):23–8.CrossRefGoogle Scholar
  31. 31.
    Ali Z, Nilas L, Ulrik CS. Postpartum airway responsiveness and exacerbation of asthma during pregnancy – a pilot study. J Asthma Allergy. 2017;10:261–7.CrossRefGoogle Scholar
  32. 32.
    Stenius-Aarniala B, Piirila P, Teramo K. Asthma and pregnancy: a prospective study of 198 pregnancies. Thorax. 1988;43(1):12–8.CrossRefGoogle Scholar
  33. 33.
    Juniper EF, Daniel EE, Roberts RS, Kline PA, Hargreave FE, Newhouse MT. Improvement in airway responsiveness and asthma severity during pregnancy. A prospective study. Am Rev Respir Dis. 1989;140(4):924–31.CrossRefGoogle Scholar
  34. 34.
    Shaked E, Wainstock T, Sheiner E, Walfisch A. Maternal asthma: pregnancy course and outcome. J Matern Fetal Neonatal Med. 2017.  https://doi.org/10.1080/14767058.2017.1372414. [Epub ahead of print].CrossRefGoogle Scholar
  35. 35.
    Bidad K, Heidarnazhad H, Pourpak Z, Shayestefar G, Moayeri H, Zendehdel N. Gastroesophageal reflux disease and asthma in pregnant women with dyspnea. Iran J Allergy Asthma Immunol. 2014;13(2):104–9.PubMedGoogle Scholar
  36. 36.
    Body C, Christie JA. Gastrointestinal diseases in pregnancy: nausea, vomiting, hyperemesis gravidarum, gastroesophageal reflux disease, constipation and diarrhea. Gastroenterol Clin N Am. 2016;45:267–83.CrossRefGoogle Scholar
  37. 37.
    Hodyl NA, Stark MJ, Scheil W, Grzeskowiak LE, Clifton VL. Perinatal outcomes following maternal asthma and cigarette smoking during pregnancy. Eur Respir J. 2014;43(3):704–16.CrossRefGoogle Scholar
  38. 38.
    Murphy VE, Powell H, Wark PA, Gibson PG. A prospective study of respiratory viral infection in pregnant women with and without asthma. Chest. 2013;144(2):420–7.CrossRefGoogle Scholar
  39. 39.
    Ali Z, Nilas L, Ulrik CS. Low risk of adverse obstetrical and perinatal outcome in pregnancies complicated by asthma: a case control study. Respir Med. 2016;120:124–30.CrossRefGoogle Scholar
  40. 40.
    Grzeskowiak LE, Smith B, Roy A, Schubert KO, Baune BT, Dekker GA, et al. Impact of a history of maternal depression and anxiety on asthma control during pregnancy. J Asthma. 2017;54(7):706–13.CrossRefGoogle Scholar
  41. 41.
    Zairina E, Abramson MJ, McDonald CF, Li J, Dharmasiri T, Stewart K, et al. Telehealth to improve asthma control in pregnancy: a randomized controlled trial. Respirology. 2016;21(5):867–74.CrossRefGoogle Scholar
  42. 42.
    Powell H, McCaffery K, Murphy VE, Hensley MJ, Clifton VL, Giles W, et al. Psychosocial outcomes are related to asthma control and quality of life in pregnant women with asthma. J Asthma. 2011;48(10):1032–40.CrossRefGoogle Scholar
  43. 43.
    Schatz M, Dombrowski MP, Wise R, Lai Y, Landon M, Newman RB, et al. The relationship of asthma-specific quality of life during pregnancy to subsequent asthma and perinatal morbidity. J Asthma. 2010;47(1):46–50.CrossRefGoogle Scholar
  44. 44.
    Brunst KJ, Rosa MJ, Jara C, Lipton LR, Lee A, Coull BA, et al. Impact of maternal lifetime interpersonal trauma on children’s asthma: mediation through maternal active asthma during pregnancy. Psychosom Med. 2017;79(1):91–100.CrossRefGoogle Scholar
  45. 45.
    Charlton RA, Snowball JM, Nightingale AL, Davis KJ. Safety of fluticasone propionate prescribed for asthma during pregnancy: a UK population-based cohort study. J Allergy Clin Immunol Pract. 2015;2015(3):772–9.CrossRefGoogle Scholar
  46. 46.
    Jensen ME, Murphy VE, Gibson PG, Mattes J, Camargo CA. Vitamin D status in pregnant women with asthma and its association with adverse respiratory outcomes during infancy. J Matern Fetal Neonatal Med. 2018.  https://doi.org/10.1080/14767058.2017.1419176. [Epub ahead of print].
  47. 47.
    Thuot M, Coursol MA, Nguyen S, Lacasse-Guay V, Beauchesne MF, Fillion A, et al. Impact of obesity on perinatal outcomes among asthmatic women. Can Respir J. 2013;20(5):345–50.CrossRefGoogle Scholar
  48. 48.
    Powell H, Murphy VE, Taylor DR, Hensley MJ, McCaffery K, Giles W, et al. Management of asthma in pregnancy guided by measurement of fraction of exhaled nitric oxide: a double-blind, randomised controlled trial. Lancet. 2011;378(9795):983–90.CrossRefGoogle Scholar
  49. 49.
    Mirzakhani H, O’Connor G, Bacharier LB, Zeiger RS, Schatz MX, Weiss ST, et al. Asthma control status in pregnancy, body mass index, and maternal vitamin D levels. J Allergy Clin Immunol. 2017;140(5):1453–6.e7.CrossRefGoogle Scholar
  50. 50.
    Goldstein RF, Abell SK, Ranasinha S, et al. Association of gestational weight gain with maternal and infant outcomes: a systematic review and meta-analysis. JAMA. 2017;317(21):2207–25.CrossRefGoogle Scholar
  51. 51.
    Gade EJ, Thomsen SF, Lindenberg S, Kyvik KO, Lieberoth S, Backer V. Asthma affects time to pregnancy and fertility: a register-based twin study. Eur Respir J. 2014;43(4):1077–85.CrossRefGoogle Scholar
  52. 52.
    Gade EJ, Thomsen SF, Lindenberg S, Backer V. Fertility outcomes in asthma: a clinical study of 245 women with unexplained infertility. Eur Respir J. 2016;47(4):1144–51.CrossRefGoogle Scholar
  53. 53.
    Grzeskowiak LE, Smithers LG, Grieger JA, Bianco-Miotto T, Leemaqz SY, Clifton VL, et al. Asthma treatment impacts time to pregnancy: evidence from the international SCOPE study. Eur Respir J. 2018;51(2):1702035.CrossRefGoogle Scholar
  54. 54.
    Sarkar M, Koren G, Kalra S, Ying A, Smorlesi C, De Santis M, et al. Montelukast use during pregnancy: a multicentre, prospective, comparative study of infant outcomes. Eur J Clin Pharmacol. 2009;65(12):1259–64.CrossRefGoogle Scholar
  55. 55.
    Tata LJ, Lewis SA, McKeever TM, Smith CJ, Doyle P, Smeeth L, et al. A comprehensive analysis of adverse obstetric and pediatric complications in women with asthma. Am J Respir Crit Care Med. 2007;175(10):991–7.CrossRefGoogle Scholar
  56. 56.
    Blais L, Kettani FZ, Forget A. Relationship between maternal asthma, its severity and control and abortion. Hum Reprod. 2013;28(4):908–15.CrossRefGoogle Scholar
  57. 57.
    Sobande AA, Archibong EI, Akinola SE. Pregnancy outcome in asthmatic patients from high altitudes. Int J Gynaecol Obstet. 2002;77(2):117–21.CrossRefGoogle Scholar
  58. 58.
    Syed RZ, Zubairi AB, Zafar MA, Qureshi R. Perinatal outcomes in pregnancy with asthma. JPMA J Pak Med Assoc. 2008;58(9):525–7.PubMedGoogle Scholar
  59. 59.
    Gade EJ, Thomsen SF, Lindenberg S, Macklon NS, Backer V. Lower values of VEGF in endometrial secretion are a possible cause of subfertility in non-atopic asthmatic patients. J Asthma. 2015;52(4):336–42.CrossRefGoogle Scholar
  60. 60.
    Murphy VE, Namazy JA, Powell H, Schatz M, Chambers C, Attia J, et al. A meta-analysis of adverse perinatal outcomes in women with asthma. BJOG. 2011;118(11):1314–23.CrossRefGoogle Scholar
  61. 61.
    Murphy VE, Wang G, Namazy JA, Powell H, Gibson PG, Chambers C, et al. The risk of congenital malformations, perinatal mortality and neonatal hospitalisation among pregnant women with asthma: a systematic review and meta-analysis. BJOG. 2013;120(7):812–22.CrossRefGoogle Scholar
  62. 62.
    Wang G, Murphy VE, Namazy J, Powell H, Schatz M, Chambers C, et al. The risk of maternal and placental complications in pregnant women with asthma: a systematic review and meta-analysis. J Matern Fetal Neonatal Med. 2014;27(9):934–42.CrossRefGoogle Scholar
  63. 63.
    Namazy JA, Murphy VE, Powell H, Gibson PG, Chambers C, Schatz M. Effects of asthma severity, exacerbations and oral corticosteroids on perinatal outcomes. Eur Respir J. 2013;41(5):1082–90.CrossRefGoogle Scholar
  64. 64.
    Rejno G, Lundholm C, Larsson K, Larsson H, Lichtenstein P, D'Onofrio BM, et al. Adverse pregnancy outcomes in asthmatic women: a population-based family design study. J Allergy Clin Immunol Pract. 2017.  https://doi.org/10.1016/j.jaip.2017.07.036. [Epub ahead of print].PubMedGoogle Scholar
  65. 65.
    Martel MJ, Beauchesne MF, Malo JL, Rey E, Perreault S, Forget A, et al. Maternal asthma, its control and severity in pregnancy, and the incidence of atopic dermatitis and allergic rhinitis in the offspring. J Pediatr. 2009;155(5):707–13 e1.CrossRefGoogle Scholar
  66. 66.
    Sheriff A, Peters TJ, Henderson J, Strachan D, Team AS. Risk factor associations with wheezing patterns in children followed longitudinally from birth to 3 1/2 years. Int J Epidemiol. 2001;30:1473–84.CrossRefGoogle Scholar
  67. 67.
    Litonjua AA, Carey VJ, Burge HA, Weiss ST, Gold DR. Parental history and the risk for childhood asthma. Does mother confer more risk than father? Am J Respir Crit Care Med. 1998;158(1):176–81.CrossRefGoogle Scholar
  68. 68.
    Martel MJ, Rey E, Beauchesne MF, Malo JL, Perreault S, Forget A, et al. Control and severity of asthma during pregnancy are associated with asthma incidence in offspring: two-stage case-control study. Eur Respir J. 2009;34(3):579–87.CrossRefGoogle Scholar
  69. 69.
    Whalen O, Karayanidis F, Murphy VE, Lane AE, Mallise C, Campbell LE. The effects of maternal asthma during pregnancy on child cognitive and behavioural development: a systematic review. J Asthma. 2018.  https://doi.org/10.1080/02770903.2018.1437174. [Epub ahead of print].
  70. 70.
    Gordon M, Niswander KR, Berendes H, Kantor AG. Fetal morbidity following potentially anoxigenic obstetric conditions. VII. Bronchial asthma. Am J Obstet Gynecol. 1970;106(3):421–9.CrossRefGoogle Scholar
  71. 71.
    Leonard H, De Klerk N, Bourke J, Bower C. Maternal health in pregnancy and intellectual disability in the offspring: a population-based study. Ann Epidemiol. 2005;16(6):448–54.CrossRefGoogle Scholar
  72. 72.
    Langridge AT, Glasson EJ, Nassar N, Jacoby PA, Pennell C, Hagan R, et al. Maternal conditions and perinatal characteristics associated with autism spectrum disorder and intellectual disability. PLoS One. 2013;8(1):e50963.CrossRefGoogle Scholar
  73. 73.
    Schatz M, Harden K, Kagnoff M, Zeiger RS, Chilingar L. Developmental follow-up in 15-month-old infants of asthmatic vs. control mothers. Pediatr Allergy Immunol. 2001;12(3):149–53.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Vanessa E. Murphy
    • 1
    Email author
  • Megan E. Jensen
    • 1
  • Linda E. Campbell
    • 1
  • Peter G. Gibson
    • 2
    • 3
  1. 1.Priority Research Centre Grow Up WellUniversity of NewcastleNewcastleAustralia
  2. 2.Priority Research Centre for Healthy LungsUniversity of Newcastle and Hunter Medical Research InstituteNewcastleAustralia
  3. 3.Department of Respiratory and Sleep MedicineJohn Hunter HospitalNewcastleAustralia

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