Asthmaandpregnancy:aprospective study of198 pregnancies

A study was designed toinvestigate whether asthma, whencarefully managed, is associated with anincreased risk ofcomplications inconnection with pregnancy.Onehundred and eighty one asthmatic women were monitored during 198pregnancies. Antiasthmatic treatment consisted ofinhaled f2adrenergic drugs, beclomethasone, sodium cromoglycate, oral theophylline, andsystemic corticosteroids asneeded. Postpartum information onasthmatic symptomsandinfant feeding wascollected bymeans ofaquestionnaire. A control groupof198non-asthmatic pregnant women was matched forageandparity. Atopic women hadless severeasthma thannon-atopic women. During pregnancy40% ofthepatients were managedwiththesame antiasthmatic medication asbefore pregnancy;18%needed less and42%moremedication. Pre-eclampsia occurred more ofteninasthmatic thancontrol subjects, especially inpatients withsevereasthma. Hypoglycaemia occurred more often ininfants ofmothers with severeasthma thanininfants of mothers withless severedisease. Theophylline medication attermdidnotinfluence labour or delivery. Asthmacaused noemergencies during labour. Amongtheasthmatic subjects 28%ofbabies weredelivered bycaesareansection compared with17%inthecontrol group.There was nodifference between asthmatic andcontrol subjects withregard tolength ofgestation, birth weight, incidence of perinatal deaths, lowApgarscores,neonatal respiratory difficulties, hyperbilirubinaemia, or malformations. Itisconcluded that severeasthma orsystemic corticosteroid treatment (orboth) during pregnancyseems toincrease theincidence ofmildpre-eclampsia inthemotherand hypoglycaemia intheinfant. Thefindings suggest thatcareful supervision ofasthmaduring pregnancyandlabour byobstetricians andchest physicians working inclose collaboration should prevent mostoftheserious obstetric andneonatal complications ofasthma inpregnancyreported by previous authors. Gluck andGluck,' after aprospective study, reported that symptoms ofasthma worsened during pregnancy in43%ofpatients andimproved in14%.Exacerba- tion ofasthmatic symptoms usually occurs during the last trimester,' although womenwith extrinsic (atopic) asthma tendtohavefewer symptoms during preg- nancythanpatients withintrinsic asthma.2 Bronchial asthmainthemotherhasbeenassociated with increased perinatal morbidity andmortality,34 and alsowithincreased morbidity during infancy.3 Obstetric complications havebeenobserved more