The incidence of asthma is higher in pregnancy, and poorly controlled asthma during pregnancy can seriously affect maternal and fetal outcomes.The effective management and reasonable treatment of asthma during pregnancy is critical.We reviewed the latest high quality test researches about asthma during pregnancy, and we overviewed the effects of cardiovascular and respiratory physiology changes on asthma.At the same time, we systematically expounded the comprehensive treatment, management and the treatment of asthma related complications.It was hoped to provide professional guidance for medication in patients with asthma during pregnancy.
妊娠期妇女心血管系统会发生一系列变化以满足胎儿、胎盘和孕妇的代谢需求,并为分娩做准备,包括心排血量增加和心率加快等[2]。妊娠期女性的分钟通气量增加会导致呼吸性碱中毒,这主要是由于潮气量增加而非呼吸频率加快。妊娠晚期胸壁顺应性降低及功能残气量下降导致呼吸困难加重,但是吸气容量增加能使总肺活量保持在正常范围内。健康孕妇第一秒用力呼气容积(forced expiratory volume in one second,FEV1)没有变化,用力肺活量(forced vital capacity,FVC)在14~16周孕龄后也仅有轻度变化,整个妊娠期间一秒率(FEV1/FVC)亦没有明显变化[3]。因此,伴有支气管哮喘的孕妇如果出现以上肺活量参数的下降,应对其进行密切监测。
有效控制妊娠期哮喘能减少早产的发生率,且定期随访能改善妊娠期哮喘患者的自我管理和症状。有研究将60例妊娠期哮喘患者分为药师指导治疗组和常规治疗组,并对其进行随访。结果证明,药师的指导能有效降低患者哮喘控制问卷(asthma control questionnaire,ACQ)评分,明显降低患者住院率和就诊率[6]。
妊娠期哮喘与非妊娠期哮喘治疗原则相同。慢性持续期需要借助哮喘控制测试(asthma control test,ACT)、ACQ等工具反复评估患者症状以调整吸入药物的剂量。在调整哮喘治疗方案前应仔细评估和纠正患者吸入器运用是否正确。高达三分之一的患者在使用干粉吸入器时存在吸气力度不足,四分之一的患者在吸入器药物未安装到位前就开始吸入药物,PRICE等[10]研究证实这些错误与哮喘控制不良有关。轻度妊娠期哮喘急性发作的患者可以考虑在有密切随访的情况下进行门诊或急诊治疗,中-重度患者建议住院治疗。
JOLVING LR,NIELSENJ,KESMODEL US,et al.Prevalence of maternal chronic diseases during pregnancy-a nationwide population based study from 1989 to 2013[J].Acta Obstet Gynecol Scand,2016,95(11):1295-1304.
There is substantial evidence of a negative impact of maternal chronic disease during pregnancy on reproductive outcomes. Knowledge of the prevalence of chronic diseases during pregnancy is limited, but essential for a focused preventive effort regarding optimal disease control during pregnancy. We aimed to analyze the prevalence of chronic diseases during pregnancy. This register-based cohort study included all women giving birth in Denmark between 1989 and 2013 based on data from Danish health registers. Maternal chronic diseases included 23 disease categories of both physical and mental health conditions recorded within a period of 10 years before childbirth. We included 1 362 200 childbirths during the study period. The overall prevalence of maternal chronic disease increased from 3.71% in 1989 to 15.76% in 2013. The most frequently registered chronic diseases were chronic lung diseases/asthma (1.73%), thyroid disorders (1.50%) and anxiety and personality disorders (1.33%). Taking increasing maternal age at birth into account, the relative risk for women to have a chronic disease from 2009 to 2013 was 4.14 (95% CI 4.05-4.22), compared with mothers giving birth from 1989 to 1993. We found an increasing prevalence of maternal chronic disease during pregnancy and more than a four-fold increased risk of maternal chronic disease during pregnancy for childbirths in the period 2009 through 2013, compared with 1989 through 1993. The main limitation of our study is related to a potentially greater awareness and hence more careful registration of maternal chronic disease over time and thereby an increased tendency to register diseases.
PETERSEN JW,LIUJ,CHI YY,et al.Comparison of multiple non-invasive methods of measuring cardiac output during pregnancy reveals marked heterogeneity in the magnitude of cardiac output change between women[J].Physiol Rep,2017,5(8):e13223.
Phase contrast MRI (PC-MRI) is a useful tool for evaluating valvular pathology. In addition, PC-MRI can provide a noninvasive assessment of blood flow in an arbitrary cross section. However, the blood flow measurement with breath-hold or free breath PC-MRI may be different from each other because of intrathoracic pressure changing and variable image position. The aim of this study was to find... [Show full abstract]
GRINDHEIMG,TOSKAK,ESTENSEN ME,et al.Changes in pulmonary function during pregnancy: a longitudinal cohort study[J].BJOG,2012,119(1):94-101.
Please cite this paper as: Grindheim G, Toska K, Estensen M, Rosseland L. Changes in pulmonary function during pregnancy: a longitudinal cohort study. BJOG 2012;119:94–101. Objective68 To record any physiological changes in lung function during healthy pregnancies, and evaluate the influence of parity, pregestational overweight, and excessive weight gain. Design68 Longitudinal cohort study. Setting68 Antenatal clinic at Oslo University Hospital. Population68 One hundred healthy white women with singleton pregnancies. Methods68 The women were studied with repeated measures of lung function using spirometry at a gestational age of 14–16, 22–24, 30–32, and 3602weeks, and at 602months postpartum. Main outcome measures68 Forced vital capacity (FVC), forced expiratory volume in 102second (FEV1), and peak expiratory flow (PEF), also expressed as a percentage of predicted values according to age and height: i.e. FVC%, FEV1%, and PEF%. Results68 Both FVC and FVC% increased significantly after 14–1602weeks of gestation ( P02 =020.001), as was the case for both PEF and PEF% ( P02 <020.001). FVC, FVC%, PEF, and PEF% in early and mid-pregnancy were significantly lower compared with the postpartum value (all P02 <020.05). Nulliparous women had an overall 4.4% lower value of FVC% than parous women ( P02 =020.039). There were no differences in FVC, FEV1, or PEF dependent upon pregestational overweight or excessive weight gain. Conclusions68 Forced vital capacity (FVC) increases significantly after 14–1602weeks of gestation. The FVC% is significantly higher in parous compared with primigravida women, suggesting that the changes in FVC occurring during pregnancy persist postpartum. PEF increases significantly during healthy pregnancies, and should be interpreted cautiously in pregnant women with impaired lung function.
LONGO LD.Respiratory gas exchange in the placenta[J].Comprehensive Physiology,2011,164(2):521-529.
ABSTRACT Plant breeding for organic agriculture (OA) was stimulated when it came under the European Organic Agriculture Regulation (2092/91) in 2004. In Brittany, the need for specific varieties for organic farming arose early for the Brassica species because of the unsuitability of most of the modern varieties to the principles of OA. Moreover, the private sector of plant breeding finds it economically difficult to satisfy the demands of OA. The aim of the present study is to provide varieties and seed for organic farmers for two vegetable Brassica crops, and to show how genetic resources can contribute to this purpose in the framework of a Participatory Plant Breeding (PPB) programme. The emergence of PPB in Brittany is the result of several concomitant and favourable circumstances: the will of the professionals (represented by IBB, Inter Bio Bretagne), their organization (an experimental station, the PAIS, Plateforme Agrobiologique Suscinio), the research initiative in INRA and the availability of genetic resources. From genetic resource observations, our experience showed several breeding situations: reviving a traditional activity (Roscoff cauliflower and local cabbages), extending tradition (autumn cauliflower), diversifying production by new introductions (coloured cauliflowers), and creating new forms of population varieties (broccoli and coloured cauliflowers). Farmers have taken charge of population breeding by mass selection and the PAIS, with INRA scientific support, has taken up innovative selection and the improvement of varieties completing the farmers initiatives. The PAIS remained the central point for information and for providing the seed for trials. Seed production will be managed in a collective way. Until now, the exchange of seed remained an experimental dimension of PPB. French seed legislation represents a limitation on the development of seed exchange by PPB.
SOMA-PILLAYP,NELSON-PIERCYC,TOLPPANENH,et al.Physiological changes in pregnancy[J].Cardiovasc J Afr,2016,27(2):89-94.
[本文引用:1]
[6]
LIM AS,STEWARTK,ABRAMSON MJ,et al.Multidisciplinary Approach to Management of Maternal Asthma (MAMMA): a randomized controlled trial[J].Chest,2014,145(5):1046-1054.
Background: Uncontrolled asthma during pregnancy is associated with maternal and perinatal hazards. A pharmacist-led intervention directed at improving maternal asthma control, involving multidisciplinary care, education, and regular monitoring to help reduce these risks, was developed and evaluated.<br/>Methods: A randomized controlled trial was carried out in the antenatal clinics of two major Australian maternity hospitals. Sixty pregnant women, 20 weeks gestation who had used asthma medications in the previous year were recruited. Participants were randomized to either an intervention or a usual care group and followed prospectively throughout pregnancy. The primary outcome was Asthma Control Questionnaire (ACQ) score. Mean changes in ACQ scores from baseline were compared between groups at 3 and 6 months to evaluate intervention efficacy.<br/>Results: The ACQ score in the intervention group (n = 29) decreased by a mean +/- SD of 0.46 +/- 1.05 at 3 months and 0.89 +/- 0.98 at 6 months. The control group (n = 29) had a mean decrease of 0.15 +/- 0.63 at 3 months and 0.18 +/- 0.73 at 6 months. The difference between groups, adjusting for baseline, was 2 0.22 (95% CI, 2 0.54 to 0.10) at 3 months and 2 0.60 (95% CI, 2 0.85 to 2 0.36) at 6 months. The difference at 6 months was statistically significant (P<.001) and clinically signifi cant (> 0.5). No asthma-related oral corticosteroid use, hospital admissions, emergency visits, or days off from work were reported during the trial.<br/>Conclusions: A multidisciplinary model of care for asthma management involving education and regular monitoring could potentially improve maternal asthma outcomes and be widely implemented in clinical practice.
TINKER SC,BROUSSARD CS,FREY MT,et al.Prevalence of prescription medication use among non-pregnant women of childbearing age and pregnant women in the United States: NHANES,1999-2006[J].Matern Child Health J,2015,19(5):1097-1106.
[本文引用:1]
[8]
POWELLH,MCCAFFERYK,MURPHY VE,et al.Psychosocial outcomes are related to asthma control and quality of life in pregnant women with asthma[J].J Asthma,2011,48(10):1032-1040.
Background. Little is known about the psychosocial impact and perceived teratogenic (fetal harm due to medication) risks of asthma treatment (inhaled/oral corticosteroids and 0205-agonist) during pregnancy. Aims. To assess the perception of asthma control, quality of life (QoL), and perceived risks of therapy in pregnant women with asthma. Methods. Pregnant women with asthma (n = 125) were recruited between 12 and 20 weeks gestation. QoL (generic: Short Form-12 Health Survey v1, and asthma specific: Asthma Quality of Life Questionnaire-Marks (AQLQ-M)) and psychological variables were assessed using the Perceived Control of Asthma Questionnaire (PCAQ), the Brief Illness Perception Questionnaire, and the Six-Item Short-Form State Trait Anxiety Inventory (STAI-6). Women090005s perceptions of the teratogenic risks of asthma therapy were also assessed and analyzed for adherence to maintenance inhaled corticosteroids (ICSs), poor asthma control, and QoL. Results. Women reported good QoL (median AQLQ-M total score/maximum score = 0.88/10), moderate ability to deal with asthma symptoms (mean PCAQ score = 42.6/55), positive beliefs about their asthma and low anxiety (median STAI score = 26.7/80). Perceived teratogenic risks for asthma drugs were excessive and class dependent. Women perceived there was a 42% teratogenic risk for oral corticosteroid, a 12% risk for ICSs, and a 5% risk with short-acting 0205-agonist. Illness beliefs, emotional response to illness (p = .030), age 090906 30 years (p = .046), and maintenance ICS use (p = .045) were significantly associated with uncontrolled asthma, while maintenance ICS use (p = .023), illness beliefs, consequences (p = .044), timeline (p = .016), and emotional response (p = .015) and anxiety (p 0909¤ .0001) were significantly associated with reduced QoL. Conclusions. In pregnancy, women with asthma experience good QoL but overestimate teratogenic risks of asthma medication. Maintenance ICS use, illness beliefs, and anxiety are associated with impaired QoL and asthma control.
BLAISL,KETTANI FZ,FORGETA,et al.Asthma exacerbations during the first trimester of pregnancy and congenital malformations: revisiting the association in a large representative cohort[J].Thorax,2015,70(7):647-652.
PRICE DB,ROMAN-RODRIGUEZM,MCQUEEN RB,et al.Inhaler Errors in the CRITIKAL study: type,frequency,and association with asthma outcomes[J].J Allergy Clin Immunol Pract,2017,5(4):1071-1081.
Abstract BACKGROUND: Poor inhaler technique has been linked to poor asthma outcomes. Training can reduce the number of inhaler errors, but it is unknown which errors have the greatest impact on asthma outcomes. OBJECTIVE: The CRITical Inhaler mistaKes and Asthma controL study investigated the association between specific inhaler errors and asthma outcomes. METHODS: This analysis used data from the iHARP asthma review service-a multicenter cross-sectional study of adults with asthma. The review took place between 2011 and 2014 and captured data from more than 5000 patients on demographic characteristics, asthma symptoms, and inhaler errors observed by purposefully trained health care professionals. People with asthma receiving a fixed-dose combination treatment with inhaled corticosteroids and long-acting beta agonist were categorized by the controller inhaler device they used-dry-powder inhalers or metered-dose inhalers: inhaler errors were analyzed within device cohorts. Error frequency, asthma symptom control, and exacerbation rate were analyzed to identify critical errors. RESULTS: This report contains data from 3660 patients. Insufficient inspiratory effort was common (made by 32%-38% of dry-powder inhaler users) and was associated with uncontrolled asthma (adjusted odds ratios [95% CI], 1.30 [1.08-1.57] and 1.56 [1.17-2.07] in those using Turbohaler and Diskus devices, respectively) and increased exacerbation rate. In metered-dose inhaler users, actuation before inhalation (24.9% of patients) was associated with uncontrolled asthma (1.55 [1.11-2.16]). Several more generic and device-specific errors were also identified as critical. CONCLUSIONS: Specific inhaler errors have been identified as critical errors, evidenced by frequency and association with asthma outcomes. Asthma management should target inhaler training to reduce key critical errors. Copyright 2017 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
BRETON MC,BEAUCHESNE MF,LEMIEREC,et al.Risk of perinatal mortality associated with inhaled corticosteroid use for the treatment of asthma during pregnancy[J].J Allergy Clin Immunol,2010,126(4):772-777.
Four studies investigating the association between inhaled corticosteroid (ICS) use during pregnancy and perinatal mortality reported no significantly increased risk. These studies must be interpreted with caution because they have insufficient statistical power and a lack of adjustment for potential confounders. We sought to evaluate whether asthmatic women exposed to ICSs during pregnancy are more at risk of perinatal mortality than asthmatic women not exposed. We also sought to estimate the risk of perinatal mortality as a function of the daily ICS dose taken during pregnancy. From the linkage of 3 administrative databases from Quebec, a cohort including 13,004 single pregnancies from asthmatic women was constructed. We used a 2-stage sampling cohort design to obtain information on cigarette smoking from the medical charts of 487 mothers. The final estimates of the odds ratios (ORs) of perinatal mortality were estimated with a logistic regression model. The cohort was formed of 4,140 women who used greater than 0 to 250 g/d ICS, 1,140 women who used greater than 250 g/d ICS, and 7,724 nonusers of ICSs during pregnancy. Women exposed to ICSs (any dose) had a nonsignificant increased risk of perinatal mortality (OR, 1.07; 95% CI, 0.70-1.61). The use of greater than 250 g/d ICS was associated with a nonsignificant 52% increased risk of perinatal mortality (OR, 1.52; 95% CI, 0.62-3.76). The risk of perinatal mortality was not found to be significantly associated with ICS use during pregnancy. The result associated with higher doses of ICSs is limited due to a lack of statistical power and a possibility of residual confounding by asthma severity and control.
MURPHY VE,WANGG,NAMAZY JA,et al.The risk of congenital malformations,perinatal mortality and neonatal hospitalisation among pregnant women with asthma: a systematic review and meta-analysis[J].BJOG,2013,120(7):812-822.
[本文引用:2]
[13]
CHARLTON RA,SNOWBALL JM,NIGHTINGALE AL,et al.Safety of fluticasone propionate prescribed for asthma during pregnancy: a UK population-based cohort study[J].J Allergy Clin Immunol Pract,2015,3(5):772-779.
Asthma is commonly treated during pregnancy, yet data on the safety of asthma medicines used during pregnancy are sparse. The objective of this study was to evaluate the safety of the inhaled corticosteroid (ICS) fluticasone propionate (FP), alone and in fixed-dose combination with salmeterol (FSC) in terms of the risk of all major congenital malformations (MCMs), compared with all other non-FP ICS. Women with asthma who had a pregnancy between January 1, 2000, and December 31, 2010, were identified in the United Kingdom's Clinical Practice Research Datalink. Exposure to asthma medicines during the first trimester of pregnancy was based on issued prescriptions. The mothers' and infants' medical records were linked where possible, and pregnancy outcomes with an MCM diagnosed by age 1 year were identified based on medical codes in the mother's and infant's medical records, including those MCMs prenatally diagnosed that ended in an induced pregnancy termination. The absolute and relative risks of an MCM after different ICS exposures, stratified by the asthma treatment intensity level, were calculated. A total of 14,654 mother-infant pairs were identified, of which 6,174 received an ICS prescription during the first trimester, in addition to 13 first trimester ICS exposed pregnancies that ended in an induced termination after a prenatal MCM diagnosis. In total, 5,362 pregnancies were eligible for the primary analysis at age 1 year. The absolute risk of an MCM after any first trimester FP exposure was 2.4% (CI95 0.8-4.1) and022.7% (CI95 1.8-3.6) for the “moderate” and “considerable/severe” asthma treatment intensity levels, respectively. The adjusted odds ratios when compared with non-FP ICS were 1.1 (CI95 0.5-2.3) and 1.2 (CI95 0.7-2.0) for the “moderate” and “considerable/severe” intensity levels; risks for any FP and for FSC did not differ substantially. No increase in the overall risk of MCMs was identified after first trimester FP exposure compared with non-FP ICS.
NAMAZYJ,MURPHYV,POWELLH,et al.Effects of asthma severity,exacerbations and oral corticosteroids on perinatal outcomes[J].Eur Respir J,2013,41(5):1082-1090.
This systematic review and meta-analysis sought to investigate whether asthma exacerbations, oral corticosteroid use or asthma severity are associated with prematurity and intrauterine growth restriction.Cohort studies published between 1975 and March 11, 2012 were considered for inclusion. 138 publications were identified for possible inclusion, and nine papers met the inclusion criteria, by reporting perinatal outcomes of interest (low birth weight, Maternal asthma exacerbations and oral corticosteroid use had a significant effect on outcomes, including low birth weight (RR 3.02, 95% CI 1.87-4.89 and RR 1.41, 95% CI 1.04-1.93, respectively) and pre-term delivery (RR 1.54, 95% CI 0.89-2.69 and RR 1.51, 95% CI 1.15-1.98, respectively). Moderate-to-severe asthma during pregnancy was associated with an increased risk of small for gestational age (RR 1.24, 95% CI 1.15-1.35) and low birth weight (RR 1.15, 95% CI 1.05-1.26) infants.These data suggest that asthma exacerbations, oral corticosteroid use or asthma severity defined as moderate-to-severe may be associated with pre-term delivery, low birth weight, and small for gestational age infants. Further studies on the effect of maternal asthma control on perinatal outcomes are warranted.
PARK-WYLLIE L MP,PASTUSZAKA.Birth defects after maternal exposure to corticosteroids: prospective cohort study and meta-analysis of epidemiologic studies[J].Teratology,2000,62(6):385-392.
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HYIIDA,MOLGAARD-NIELESEND.Corticosteroid use during pregnancy and the risk of orofacial clefts[J].CMAJ,2011,183(7):796-804.
The association between the risk of orofacial clefts in infants and the use of corticosteroids during pregnancy is unclear from the available evidence. We conducted a nationwide cohort study of all live births in Denmark over a 12-year period.We collected data on all live births in Denmark from Jan. 1, 1996, to Sept. 30, 2008. We included live births for which information was available from nationwide health registries on the use of corticosteroids during pregnancy, the diagnosis of an orofacial cleft and possible confounders.There were 832,636 live births during the study period. Exposure to corticosteroids during the first trimester occurred in 51,973 of the pregnancies. A total of 1232 isolated orofacial clefts (i.e., cleft lip, cleft palate, or cleft lip and cleft palate) were diagnosed within the first year of life, including 84 instances in which the infant had been exposed to corticosteroids during the first trimester of pregnancy. We did not identify any statistically significant increased risk of orofacial clefts associated with the use of corticosteroids: cleft lip with or without cleft palate, prevalence odds ratio (OR) 1.05 (95% confidence interval [CI] 0.80-1.38]; cleft palate alone, prevalence OR 1.23 (95% CI 0.83-1.82). Odds ratios for risk of orofacial clefts by method of delivery (i.e., oral, inhalant, nasal spray, or dermatologic and other topicals) were consistent with the overall results of the study and did not display significant heterogeneity, although the OR for cleft lip with or without cleft palate associated with the use of dermatologic corticosteroids was 1.45 (95% CI 1.03-2.05).Our results add to the safety information on a class of drugs commonly used during pregnancy. Our study did not show an increased risk of orofacial clefts with the use of corticosteroids during pregnancy. Indepth investigation of the pattern of association between orofacial clefts and the use of dermatologic corticosteroids during pregnancy indicated that this result did not signify a causal connection and likely arose from multiple statistical comparisons.
MURPHY VE,CLIFTON VL,GIBSON PG.Asthma exacerbations during pregnancy: incidence and association with adverse pregnancy outcomes[J].Thorax,2006,61(2):169-176.
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[18]
SCHATZM,DOMBROWSKI MP,WISER,et al.The relationship of asthma medication use to perinatal outcomes[J].J Allergy Clin Immunol,2004,113(6):1040-1045.
Maternal asthma has been reported to increase the risk of preeclampsia, preterm deliveries, and lower-birth-weight infants, but the mechanisms of this effect are not defined. We sought to evaluate the relationship between the use of contemporary asthma medications and adverse perinatal outcomes. Asthmatic patients were recruited from the 16 centers of the National Institute of Child Health and Human Development Maternal Fetal Medicine Units Network from December 1994 through February 2000. Gestational medication use was determined on the basis of patient history at enrollment and at monthly visits during pregnancy. Perinatal data were obtained at postpartum chart reviews. Perinatal outcome variables included gestational hypertension, preterm births, low-birth-weight infants, small-for-gestational-age infants, and major malformations. The final cohort included 2123 asthmatic participants. No significant relationships were found between the use of inhaled -agonists (n = 1828), inhaled corticosteroids (n = 722), or theophylline (n = 273) and adverse perinatal outcomes. After adjusting for demographic and asthma severity covariates, oral corticosteroid use was significantly associated with both preterm birth at less than 37 weeks' gestation (odds ratio, 1.54; 95% CI, 1.02-2.33) and low birth weight of less than 2500 g (odds ratio, 1.80; 95% CI, 1.13-2.88). Use of inhaled -agonists, inhaled steroids, and theophylline do not appear to increase perinatal risks in pregnant asthmatic women. The mechanism of the association between maternal oral corticosteroid use and prematurity remains to be determined.
LINS,MUNSIE J P W,HERDT-LOSAVIO M L,et al.Maternal asthma medication use and the risk of selected birth defects[J].Pediatrics,2012,129(2):e317-e324.
OBJECTIVES:Approximately 4% to 12% of pregnant women have asthma; few studies have examined the effects of maternal asthma medication use on birth defects. We examined whether maternal asthma medication use during early pregnancy increased the risk of selected birth defects.METHODS:National Birth Defects Prevention Study data for 2853 infants with 1 or more selected birth defects (diaphragmatic hernia, esophageal atresia, small intestinal atresia, anorectal atresia, neural tube defects, omphalocele, or limb deficiencies) and 6726 unaffected control infants delivered from October 1997 through December 2005 were analyzed. Mothers of cases and controls provided telephone interviews of medication use and additional potential risk factors. Exposure was defined as maternal periconceptional (1 month prior through the third month of pregnancy) asthma medication use (bronchodilator or anti-inflammatory). Associations between maternal periconceptional asthma medication use and individual major birth defects were estimated by using adjusted odds ratios (aOR) and 95% confidence intervals (95%CI).RESULTS:No statistically significant associations were observed for maternal periconceptional asthma medication use and most defects studied; however, positive associations were observed between maternal asthma medication use and isolated esophageal atresia (bronchodilator use: aOR = 2.39, 95%CI = 1.23, 4.66), isolated anorectal atresia (anti-inflammatory use: aOR = 2.12, 95%CI = 1.09, 4.12), and omphalocele (bronchodilator and anti-inflammatory use: aOR = 4.13, 95%CI = 1.43, 11.95).CONCLUSIONS:Positive associations were observed for anorectal atresia, esophageal atresia, and omphalocele and maternal periconceptional asthma medication use, but not for other defects studied. It is possible that observed associations may be chance findings or may be a result of maternal asthma severity and related hypoxia rather than medication use.
COSSETTEB,BEAUCHESNE MF,FORGETA,et al.Relative perinatal safety of salmeterol vs formoterol and fluticasone vs budesonide use during pregnancy[J].Ann Allergy Asthma Immunol,2014,112(5):459-464.
Background: Recent asthma guidelines endorse the safety of long-acting beta(2)-agonists (LABAs) and of mild and moderate doses of inhaled corticosteroids (ICSs) when required to control asthma during pregnancy, yet do not state a preferred medication within each class. Objective: To estimate the relative perinatal safety with the use of salmeterol and formoterol (LABAs) and that of fluticasone and budesonide (ICSs) during pregnancy. Methods: A subcohort of pregnancies from asthmatic women was selected from health care administrative databases of Quebec, Canada. Low birth weight (LBW) was defined as weight less than 2,500 g, preterm birth (PB) as delivery before 37 weeks of gestation, and small for gestational age (SGA) as a birth weight below the 10th percentile. The effect of treatment with salmeterol vs formoterol and fluticasone vs budesonide on the outcomes was determined with generalized estimating equation models. Results: The LABA and ICS subcohorts were composed of 547 (385 salmeterol and 162 formoterol users) and 3,798 (3,190 fluticasone and 608 budesonide users) pregnancies, respectively. No statistically significant differences were observed for LBW (odds ratio [OR], 0.91; 95% confidence interval [CI], 0.44-1.88), PB (OR, 1.11; 95% CI, 0.56-2.23), and SGA (OR, 1.16; 95% CI, 0.67-2.02) newborns between women exposed to salmeterol vs formoterol or between women exposed to fluticasone vs budesonide (LBW: OR, 1.08; 95% CI, 0.76-1.52; PB: OR, 1.07; 95% CI, 0.78-1.49; and SGA, OR: 1.10; 95% CI, 0.85-1.44). Conclusion: This study does not provide evidence of greater perinatal safety for one LABA or one ICS over the other. (C) 2014 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.
SARKARM,KORENG,KALRAS,et al.Montelukast use during pregnancy; a multicentre,prospective,comparative study of infant outcomes[J].Eur J Clin Pharmacol,2009,65(12):1259-1264.
Montelukast (Singulair) is a selective leukotriene receptor antagonist (LTRA) indicated for the maintenance treatment of asthma. Currently, there are limited prospective, comparative studies in the literature examining the safety of montelukast use in pregnancy.The primary objective of this study was to determine whether exposure to montelukast during pregnancy increases the rate of major malformations above the 1–3% baseline risk or the rate of other adverse effects.Pregnant women taking montelukast were enrolled in the study from six teratogen information services around the world. These women were compared to two other groups of women: (1) disease-matched, who used inhalers for a similar indication and (2) women not diagnosed with asthma and not exposed to any known teratogens. The primary outcome was major malformations and secondary endpoints included spontaneous abortion, fetal distress, gestational age at birth and birth weight.Out of 180 montelukast-exposed pregnancies, there were 160 live births including three sets of twins, 20 spontaneous abortions, 2 elective abortions and 1 major malformation reported. The mean birth weight was lower (3,21465±65685 g) compared to controls [3,35665±65657 (disease-matched) and 3,42465±65551 (exposed to non-teratogens), P65=650.038] and the gestational age was shorter [37.865±653.1 weeks (montelukast) and 37.665±654.4 (disease-matched) versus 39.365±652.4 weeks (exposed to non-teratogens), P65=650.045]. About 25% of the newborns had fetal distress, a higher rate than controls (P65=650.007). However, upon sub-analysis of women who continued the drug until delivery, only birth-weight difference (304 g) remained significant.Montelukast does not appear to increase the baseline rate of major malformations. The lower birth weight in both asthma groups is most likely associated with the severity of the maternal condition.
NELSEN LM,SHIELDS KE,CUNNINGHAM ML,et al.Congenital malformations among infants born to women receiving montelukast,inhaled corticosteroids,and other asthma medications[J].J Allergy Clin Immunol,2012,129(1):251-256.
Background: The role of exposure to air pollution in the development of allergic sensitization remains unclear. Objective: We sought to assess the development of sensitization until school age related to longitudinal exposure to air pollution from road traffic. Methods: More than 2500 children in the birth cohort BAMSE (Children, Allergy, Milieu, Stockholm, Epidemiological Survey) from Stockholm, Sweden, were followed with repeated questionnaires and blood sampling until 8 years of age. Outdoor concentrations of nitrogen oxides, as a marker of exhaust particles, and particles with an aerodynamic diameter of less than 10 mu m (PM(10)), mainly representing road dust, were assigned to residential, day care, and school addresses by using dispersion models. Time-weighted average exposures were linked to levels of IgE against common inhalant and food allergens at 4 and 8 years of age. Results: Air pollution exposure during the first year of life was associated with an increased risk of pollen sensitization at 4 years of age (odds ratio, 1.83; 95% confidence interval, 1.02-3.28) for a 5th to 95th difference in exposure to nitrogen oxides. At 8 years, there was no general increase in the risk of sensitization; however, the risk of food sensitization was increased, particularly among children free of sensitization at 4 years of age (odds ratio, 2.30; 95% confidence interval, 1.10-4.82). Results were similar by using PM(10). No associations between air pollution exposure after the first year of life and sensitization were seen. Conclusion: Traffic-related air pollution exposure does not seem to increase the overall risk of sensitization to common inhalant and food allergens up to school age, but sensitization to certain allergens might be related to exposure during infancy. (J Allergy Clin Immunol 2012;129:240-6.)
DOMBROWSKI MP,SCHATZM,WISER,et al.Randomized trial of inhaled beclomethasone dipropionate versus theophylline for moderate asthma during pregnancy[J].Am J Obstet Gynecol,2004,190(3):737-744.
This study was undertaken to compare the efficacy of inhaled beclomethasone dipropionate to oral theophylline for the prevention of asthma exacerbation(s) requiring medical intervention. A prospective, double-blind, double placebo-controlled randomized clinical trial of pregnant women with moderate asthma was performed. There was no significant difference ( P = .554) in the proportion of asthma exacerbations among the 194 women in the beclomethasone cohort (18.0%) versus the 191 in the theophylline cohort (20.4%; risk ratio [RR] = 0.9, 95% CI = 0.6-1.3). The beclomethasone cohort had significantly lower incidences of discontinuing study medications caused by side effects (RR = 0.3, 95% CI = 0.1-0.9; P = .016), and proportion of study visits with forced expiratory volume expired in 1 second (FEV1) less than 80% predicted (0.284卤0.331 vs 0.284卤0.221, P = .039). There were no significant differences in treatment failure, compliance, or proportion of peak expiratory flow rate less than 80% predicted. There were no significant differences in maternal or perinatal outcomes. The treatment of moderate asthma with inhaled beclomethasone versus oral theophylline resulted in similar rates of asthma exacerbations and similar obstetric and perinatal outcomes. These results favor the use of inhaled corticosteroids for moderate asthma during pregnancy because of the improved FEV1 and because theophylline had more side effects and requires serum monitoring.
NATIONAL HEARTL,BLOODI,NATIONAL ASTHMAE,et al.NAEPP expert panel report.Managing asthma during pregnancy: recommendations for pharmacologic treatment-2004 update[J].J Allergy Clin Immunol,2005,115(1):34-46.
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NAMAZYJ,CABANA MD,SCHEUERLE AE,et al.The Xolair Pregnancy Registry (EXPECT): the safety of omalizumab use during pregnancy[J].J Allergy Clin Immunol,2015,135(2):407-412.
For many asthma medications, pregnancy safety data remains insufficient. The omalizumab pregnancy registry, EXPECT, evaluates maternal, pregnancy, and infant outcomes after exposure to omalizumab, including incidence of congenital anomalies. EXPECT is a prospective, observational study of pregnant women exposed to 1 dose of omalizumab within 8 weeks prior to conception or at any time during pregnancy. Primary outcome measures include rates of live births, elective terminations, stillbirths, and congenital anomalies. Data were collected at enrollment, each trimester, birth, and every 6 months up to 18 months post-delivery. As of November 2012, 188 of 191 pregnant women were exposed to omalizumab during their first trimester. Of 169 pregnancies with known outcomes (median exposure during pregnancy, 8.8 months), there were 156 live births of 160 infants (4 twin pairs), 1 fetal death/stillbirth, 11 spontaneous abortions, and 1 elective termination. Among 152 singleton infants, 22 (14.5%) were born prematurely. Of 147 singleton infants with weight data, 16 (10.9%) were small for gestational age. Among 125 singleton full-term infants, 4 (3.2%) had low birth weights. Overall, 20 infants had congenital anomalies confirmed, 7 (4.4%) of whom had 1 major defect. No pattern of anomalies was observed. To date, proportions of major congenital anomalies, prematurity, low birth weight, and small size for gestational age observed in the EXPECT registry are not inconsistent with findings from other studies in this asthma population. Recognizing the small sample size available, no apparent increased birth prevalence of major anomalies or patterns of major anomalies has been observed.
OYKHMANP,KIM HL,ELLIS AK.Allergen immunotherapy in pregnancy[J].Allergy Asthma Clin Immunol,2015,11(1):31.
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[27]
SHAIKH WA,SHAIKH SW.A prospective study on the safety of sublingual immunotherapy in pregnancy[J].Allergy,2012,67(6):741-743.
BackgroundThe aim of this study was to determine the safety of sublingual immunotherapy in pregnancy, which has not yet been reported.MethodsOne hundred and fifty-five patients received sublingual immunotherapy with either house dust mite (D. farinae) or a mixture of up to five allergens during 185 pregnancies. Twenty-four patients received sublingual immunotherapy for the first time during pregnancy. Follow-up data were analysed with regard to abortion, perinatal mortality, prematurity, toxaemia and congenital malformation. Two control groups did not receive immunotherapy; group A (85 patients) received budesonide 400 g twice daily and group B (40 patients) received rescue salbutamol inhalation. All three groups were on appropriate avoidance measures.ResultsSix-year follow-up data for the sublingual immunotherapy group revealed an incidence of complications less than that in the general population and a higher incidence of complications in both control groups.ConclusionsThis study concludes that sublingual immunotherapy is safe during pregnancy and is also safe when initiated for the first time in a pregnant patient.
PITSIOSC,DEMOLYP,BILO MB,et al.Clinical contraindications to allergen immunotherapy: an EAACI position paper[J].Allergy,2015,70(8):897-909.
Abstract Clinical indications for allergen immunotherapy (AIT) in respiratory and Hymenoptera venom allergy are well established; however, clinical contraindications to AIT are not always well documented. There are some discrepancies when classifying clinical contraindications for different forms of AIT as ‘absolute’ or ‘relative’. EAACI Task Force on ‘Contraindications to AIT’ was created to evaluate and review current literature on clinical contraindications, and to update recommendations for both sublingual and subcutaneous AIT for respiratory and venom immunotherapy. An extensive review of the literature was performed on the use of AIT in asthma, autoimmune disorders, malignant neoplasias, cardiovascular diseases, acquired immunodeficiencies and other chronic diseases (including mental disorders), in patients treated with β-blockers, ACE inhibitors or monoamine oxidase inhibitors, in children under 502years of age, during pregnancy and in patients with poor compliance. Each topic was addressed by the following three questions: (1) Are there any negative effects of AIT on this concomitant condition/disease? (2) Are more frequent or more severe AIT-related side-effects expected? and (3) Is AIT expected to be less efficacious? The evidence, for the evaluation of these clinical conditions as contraindications, was limited, and most of the conclusions were based on case reports. Based on an extended literature research, recommendations for each medical condition assessed are provided. The final decision on the administration of AIT should be based on individual evaluation of any medical condition and a risk/benefit assessment for each patient.
POWELLH,MURPHY VE,HENSLEY MJ,et al.Rhinitis in pregnant women with asthma is associated with poorer asthma control and quality of life[J].J Asthma,2015,52(10):1023-1030.
Objective: To describe the pattern and severity of rhinitis in pregnancy and the impact rhinitis has on asthma control and quality of life (QoL) in pregnant women with asthma. Methods: Two hundred and eighteen non-smoking pregnant women with asthma were participants in a randomised controlled trial of exhaled nitric oxide guided treatment adjustment. Rhinitis was assessed using a visual analogue scale (VAS) scored from 0 to 10 and classified as current (VAS > 2.5), moderate/severe versus mild (VAS > 6 vs <5), atopic versus non-atopic and pregnancy rhinitis. At baseline, women completed the 20-Item Sino-Nasal Outcome Test (SNOT20), asthma-specific (AQLQ-M) QoL questionnaires and the Six-Item Short-Form State Trait Anxiety Inventory (STAI-6). Asthma control was assessed using the asthma control questionnaire (ACQ). Perinatal outcomes were collected after delivery. Results: Current rhinitis was present in 142 (65%) women including 45 (20%) women who developed pregnancy rhinitis. Women with current rhinitis had higher scores for ACQ (p = 0.004), SNOT20 (p < 0.0001) and AQLQ-M (p < 0.0001) compared to women with no rhinitis. Current rhinitis was associated with increased anxiety symptoms (p = 0.002), rhinitis severity was associated with higher ACQ score (p = 0.004) and atopic rhinitis was associated with poorer lung function (p = 0.037). Rhinitis symptom severity improved significantly during gestation (p < 0.0001). There was no impact on perinatal outcomes. Improved asthma control was associated with improvement in rhinitis. Conclusion: Rhinitis in pregnant women with asthma is common and associated with poorer asthma control, sino-nasal and asthma-specific QoL impairment and anxiety. In the context of active asthma management there was significant improvement in rhinitis symptoms and severity as pregnancy progressed.
Pregnancy rhinitis is a common condition with longstanding nasal congestion; troublesome for the mother, possibly also affecting the fetus. There is need for a safe, effective treatment. Nasal corticosteroids, indisputable in other types of rhinitis, have not been evaluated in pregnancy rhinitis. In this placebo-controlled, randomized, double-blind study with parallel groups, we evaluated the effect of 8 weeks of treatment with fluticasone propionate aqueous nasal spray in 53 women with pregnancy rhinitis. Daily symptom scores and nasal peak expiratory flow, as well as acoustic rhinometry before and after treatment, did not show any difference between the groups. Placebo resulted in 6/27 responders, compared with 5/26 for active treatment. There was no detectable influence on maternal cortisol as measured by morning S-cortisol and overnight 12-h-U-cortisol, or any difference in ultrasound measures of fetal growth or pregnancy outcome. Altogether, our study indicates no significant effects of the treatment described here.
KALLENB.Use of antihistamine drugs in early pregnancy and delivery outcome[J].J Matern Fetal Neonatal Med,2002,11(3):146-152.
Objective: To study the impact of antihistamine use in early pregnancy on delivery outcome. Methods: Using prospectively collected information on drug use in early pregnancy, delivery outcome was studied among 17 266 women with 17 776 deliveries and 18 197 infants. The analysis was performed according to the main reason for antihistamine use: nausea and vomiting in pregnancy and allergy. Results: In the nausea and vomiting in pregnancy group, we found a significant increase in twin births and a significant reduction in preterm births, low birth weight and being small-for-gestational age among singletons. The perinatal death rate was reduced and the rate of congenital malformations was normal. A reduction was seen in the occurrence of congenital cardiovascular defects after the use of antihistamines. The odds ratio for specified cardiac defects, with the exception of ventricular and atrium septal defects, after the use of antihistamines for nausea and vomiting in pregnancy (0.54) was significantly lower than that for non-cardiovascular congenital malformations (0.95). No statistically significant effects on delivery outcome were seen after the use of antihistamine drugs for allergy. However, there was a non-significant tendency for a reduced risk for cardiovascular defects (odds ratio 0.71). Conclusions: The beneficial effects on delivery outcome observed are most probably related to the underlying nausea and vomiting in pregnancy. There is no clear teratogenic effect of the antihistamines studied.
WERLER MM.Teratogen update:pseudoephedrine[J].Birth Defects Res A Clin Mol Teratol,2006,76(6):445-452.
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[33]
BIDADK,HEIDARNAZHADH,POURPAKZ,et al.Gastroesophagial reflux disease and asthma in pregnant women with dyspnea[J].Iran J Allergy Asthma Immunol,2014,13(2):104-109.
Asthma and gastroesophageal reflux disease (GERD) are two common problems in pregnancy and they affect pregnancy in several ways. In this study, we aimed to evaluate GERD and asthma in pregnant women who referred for prenatal care visits. One-hundred and seventy three pregnant women with a complaint of dyspnea were included in the study. A questionnaire was filled and lung function tests were performed. All patients were visited by a respiratory specialist and questionnaires were evaluated by a gastroenterologist. Out of the total number of women studied, 37% were diagnosed to have asthma and 36.4% were non-asthmatics. Twenty six percent of the pregnant women who had symptoms and signs of asthma with normal spirometry were classified as probable to have asthma. GERD was diagnosed in 80.9% of the pregnant women, but it was not significantly higher in asthmatic or probable asthmatic women compared to non-asthmatic ones. However, severity of GERD was significantly higher in asthmatic pregnant women compared to the others. In conclusion, the prevalence of GERD was quite high in pregnant women, irrespective of the fact that they were asthmatic or non-asthmatic. Further studies evaluating women throughout pregnancy will inform us more about this relationship.
VAN DER WOUDE C J,METSELAAR HJ,DANESES.Management of gastrointestinal and liver diseasesduring pregnancy[J].Gut,2014,63(6):1014-1023.
Abstract In the majority of patients with chronic gastrointestinal and liver diseases, maintenance therapy is required during pregnancy to control the disease, and disease follow-up or disease control might necessitate endoscopy. Evidence on the safety of drugs and imaging techniques during pregnancy is scarce and sometimes difficult to interpret. In this review we summarise existing literature with the aim of optimising counselling of patients with common chronic gastrointestinal and liver diseases who want to conceive.
Comparison of multiple non-invasive methods of measuring cardiac output during pregnancy reveals marked heterogeneity in the magnitude of cardiac output change between women
1
2017
... 妊娠期妇女心血管系统会发生一系列变化以满足胎儿、胎盘和孕妇的代谢需求,并为分娩做准备,包括心排血量增加和心率加快等[2].妊娠期女性的分钟通气量增加会导致呼吸性碱中毒,这主要是由于潮气量增加而非呼吸频率加快.妊娠晚期胸壁顺应性降低及功能残气量下降导致呼吸困难加重,但是吸气容量增加能使总肺活量保持在正常范围内.健康孕妇第一秒用力呼气容积(forced expiratory volume in one second,FEV1)没有变化,用力肺活量(forced vital capacity,FVC)在14~16周孕龄后也仅有轻度变化,整个妊娠期间一秒率(FEV1/FVC)亦没有明显变化[3].因此,伴有支气管哮喘的孕妇如果出现以上肺活量参数的下降,应对其进行密切监测. ...
Changes in pulmonary function during pregnancy: a longitudinal cohort study
1
2012
... 妊娠期妇女心血管系统会发生一系列变化以满足胎儿、胎盘和孕妇的代谢需求,并为分娩做准备,包括心排血量增加和心率加快等[2].妊娠期女性的分钟通气量增加会导致呼吸性碱中毒,这主要是由于潮气量增加而非呼吸频率加快.妊娠晚期胸壁顺应性降低及功能残气量下降导致呼吸困难加重,但是吸气容量增加能使总肺活量保持在正常范围内.健康孕妇第一秒用力呼气容积(forced expiratory volume in one second,FEV1)没有变化,用力肺活量(forced vital capacity,FVC)在14~16周孕龄后也仅有轻度变化,整个妊娠期间一秒率(FEV1/FVC)亦没有明显变化[3].因此,伴有支气管哮喘的孕妇如果出现以上肺活量参数的下降,应对其进行密切监测. ...
Multidisciplinary Approach to Management of Maternal Asthma (MAMMA): a randomized controlled trial
1
2014
... 有效控制妊娠期哮喘能减少早产的发生率,且定期随访能改善妊娠期哮喘患者的自我管理和症状.有研究将60例妊娠期哮喘患者分为药师指导治疗组和常规治疗组,并对其进行随访.结果证明,药师的指导能有效降低患者哮喘控制问卷(asthma control questionnaire,ACQ)评分,明显降低患者住院率和就诊率[6]. ...
Prevalence of prescription medication use among non-pregnant women of childbearing age and pregnant women in the United States: NHANES,1999-2006
Inhaler Errors in the CRITIKAL study: type,frequency,and association with asthma outcomes
1
2017
... 妊娠期哮喘与非妊娠期哮喘治疗原则相同.慢性持续期需要借助哮喘控制测试(asthma control test,ACT)、ACQ等工具反复评估患者症状以调整吸入药物的剂量.在调整哮喘治疗方案前应仔细评估和纠正患者吸入器运用是否正确.高达三分之一的患者在使用干粉吸入器时存在吸气力度不足,四分之一的患者在吸入器药物未安装到位前就开始吸入药物,PRICE等[10]研究证实这些错误与哮喘控制不良有关.轻度妊娠期哮喘急性发作的患者可以考虑在有密切随访的情况下进行门诊或急诊治疗,中-重度患者建议住院治疗. ...
Risk of perinatal mortality associated with inhaled corticosteroid use for the treatment of asthma during pregnancy
The risk of congenital malformations,perinatal mortality and neonatal hospitalisation among pregnant women with asthma: a systematic review and meta-analysis
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