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Published ahead of print on September 18, 2003, doi:10.1164/rccm.200303-374OC

Am. J. Respir. Crit. Care Med., Volume 168, Number 11, December 2003, 1317-1323

A more recent version of this article appeared on December 1, 2003
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Submitted on March 13, 2003
Accepted on September 3, 2003

Maternal asthma is associated with reduced female fetal growth

Vanessa E Murphy1, Peter G Gibson2, Warwick B Giles1, Tamas Zakar1, Roger Smith1, Andrew M Bisits1, Carolyn G Kessell2, and Vicki L Clifton1*

1 Mothers and Babies Research Centre, Hunter Medical Research Institute/University of Newcastle, Newcastle, NSW, Australia, 2 Respiratory and Sleep Medicine, John Hunter Hospital/University of Newcastle, Newcastle, NSW, Australia

* To whom correspondence should be addressed. E-mail: vclifton{at}mail.newcastle.edu.au.

Asthma during pregnancy is associated with low birth weight, although the mechanisms contributing to this outcome remain unknown. The relationship between maternal asthma and its treatment, placental function, fetal gender and low birth weight was examined to establish the effect of asthma on fetal growth. Glucocorticoid intake by asthmatic women was assessed throughout pregnancy. The placenta was collected following delivery and 11{beta}-hydroxysteroid dehydrogenase type 2 (11{beta}-HSD2) activity measured. Fetal cortisol and estriol were measured in the umbilical vein plasma at delivery. Asthmatics were compared to a non-asthmatic control group. In women with asthma who did not use inhaled steroids and were pregnant with a female fetus, we observed significantly reduced birth weights, while male birth weights were unaffected. The presence of a female fetus was associated with significantly increased maternal circulating monocytes, significantly reduced placental 11{beta}-HSD2 activity and fetal estriol, and a trend towards elevated fetal plasma cortisol. This study provides evidence that in pregnancies complicated by asthma there is a fetal gender specific effect on the maternal immune system with adverse effects on placental function and female fetal growth.
Key words: asthma, inflammation, pregnancy, placenta, fetal growth, 11beta-HSD




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