Published ahead of print on February 1, 2007, doi:10.1164/rccm.200611-1641OC
© 2007 American Thoracic Society doi: 10.1164/rccm.200611-1641OC
A Comprehensive Analysis of Adverse Obstetric and Pediatric Complications in Women with Asthma1 Epidemiology and Public Health, and 2 Respiratory Medicine, University of Nottingham, Nottingham, United Kingdom; and 3 Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom Correspondence and requests for reprints should be addressed to L. J. Tata, M.Sc., Epidemiology & Public Health, Clinical Sciences Building, City Hospital, Hucknall Road, Nottingham NG5 1PB, UK. E-mail: laila.tata{at}nottingham.ac.uk Rationale: Previous studies have raised concern that women with asthma have increased risks of adverse obstetric and pediatric complications, but these have generally been underpowered. Objectives: To quantify risks of major adverse pregnancy outcomes and obstetric complications in women with and without asthma. Methods: We extracted information on 281,019 pregnancies from the Health Improvement Network database between 1988 and 2004. We analyzed the data using logistic regression. Measurements and Main Results: In 37,585 pregnancies of women with asthma compared with 243,434 pregnancies of women without asthma, risks of stillbirth and therapeutic abortion were similar; however, the risk of miscarriage was slightly higher (odds ratio [OR], 1.10; 95% confidence interval [CI], 1.06–1.13). Risks of most obstetric complications (placental abruption, placental insufficiency, placenta previa, preeclampsia, hypertension, gestational diabetes, thyroid disorders in pregnancy, and assisted delivery) were not higher in pregnancies of women with asthma compared with those without asthma, with the exception of increases in antepartum (OR, 1.20; 95% CI, 1.08–1.34) or postpartum (OR, 1.38; 95% CI, 1.21–1.57) hemorrhage, anemia (OR, 1.06; 95% CI, 1.01–1.12), depression (OR, 1.52; 95% CI, 1.36–1.69), and caesarean section (OR, 1.11; 95% CI, 1.07–1.16). Risks of miscarriage, depression, and caesarean section increased moderately in women with more severe asthma and previous asthma exacerbations. Conclusions: We found some increased risks in women with asthma that need to be considered in the future; however, our results indicate that women with asthma have similar reproductive risks compared with women without asthma in the general population for most of the range of outcomes studied.
Key Words: asthma • asthma severity • obstetric/pregnancy complication • adverse pregnancy outcomes • case-control
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