A population analysis of prescriptions for asthma medications during pregnancy

doi:10.1016/j.jaci.2012.08.027

Journal of Allergy and Clinical Immunology

Volume 131, Issue 3, March 2013, Pages 711-717

https://doi.org/10.1016/j.jaci.2012.08.027 Get rights and content

Background

It is important to control asthma during pregnancy. However, some studies indicate that women stop or change their asthma medications when they become pregnant.

Objective

We used a population database to analyze changes in prescriptions for asthma medications to patients before, during, and after pregnancy.

Methods

We collected information from a pregnancy database that is part of the population-based pharmacy prescription InterAction Database from the northern Netherlands. Our study cohort comprised 25,709 pregnancies for which prescription data were available. We collected data over a study period of 1 year before pregnancy until 6 months after birth and analyzed data from pregnant women who received at least 1 prescription for asthma medication during the study period (n = 2072), identifying all prescriptions for asthma medication and oral corticosteroids.

Results

Prescriptions for asthma medications did not change during pregnancies from 1994-2003. However, during the 2004-2009 period, there was a significant decrease (P = .017) in prescriptions for asthma medications during the first months of pregnancy compared with the months before pregnancy, especially prescriptions of long-acting bronchodilators. Although most asthma prescriptions continued throughout pregnancy, prescriptions for controller therapies were reduced by 30% during the first months of pregnancy.

Conclusions

Many women stop or reduce their use of asthma medications when they become pregnant. Strategies to safely control asthma during pregnancy are needed.

Section snippets

Database

This study was performed by using a pregnancy database that is part of the population-based pharmacy prescription InterAction Database (IADB). The IADB contains data on prescriptions filled at 55 pharmacies in the northern Netherlands, covering a population of approximately 500,000 subjects from 1994 to 2009. Because of the high level of commitment of patients to their pharmacies, the IADB contains an almost-complete medication history for each subject registered. The database contains

Results

The study cohort comprised 25,709 pregnancies for which prescription data were available during the study period (from 1 year before until 6 months after pregnancy). Of these pregnancies, 2072 (8.1%) in 1695 women involved at least 1 prescription of asthma medication during the study period, including 55 twin pregnancies and 1 triplet pregnancy. The women were a mean age of 30.0 years (range, 15-48 years) when they gave birth after the 2072 pregnancies. In 52 (2.5%) of the pregnancies, the

Discussion

This study shows a significant increase in prescriptions for asthma medications among pregnant women in the period from 2004 to 2009 compared with the period before 2004. The increase was greatest for long-acting bronchodilators and combination preparations (Fig 3). The increase in prescriptions of asthma medications was likely due to the increasing prevalence and awareness of asthma.1, 2 Long-acting bronchodilators and combination preparations are relatively new agents that have been

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Successful and safe treatment of severe steroid depended eosinophilic asthma with mepolizumab in a woman during pregnancy
2023, Respiratory Medicine Case Reports
Citation Excerpt :
The child was breastfed during her first weeks and to this day, she is healthy and shows no symptoms of allergic diseases. The use of any drugs during pregnancy causes concern from the mother and often from her doctors [11]. Nonetheless, exacerbations and poor asthma control that may come as a result of treatment withdrawal or poor compliance during pregnancy, are associated with worse outcomes for both the baby (increased perinatal mortality, preterm delivery, low birth weight) and the mother (pre-eclampsia) [12].
A 26-year-old female with steroid dependent eosinophilic asthma and nasal polyps who had successfully been treated with mepolizumab for 17 consecutive months with complete steroid withdrawal and symptoms control, stopped biologic treatment due to pregnancy efforts. Mepolizumab discontinuation resulted in frequent exacerbations and daily symptoms despite high dose ICS/LABA and re-initiation of oral steroids. Mepolizumab was initiated again, followed by improvement of asthma control and gradual withdrawal of steroids within 2 months. The patient became pregnant during the fourth month of mepolizumab re-initiation. The patient presented two asthma exacerbations during pregnancy treated with short course (3 days) oral steroids and delivery was uneventful (female, Apgar 9, weight 2750 g, length 59 cm) in week 40 by caesarean section.
Sex and Gender in Lung Disease and Sleep Disorders: A State-of-the-Art Review
2022, Chest
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Asthma course during pregnancy can be variable, with about one-third of patients experiencing worsening.45 Lack of adherence to controller medication use may contribute to clinical worsening.46 Women seeking answers about the safety of these medications throughout pregnancy and breastfeeding need to be reassured by their health care providers.
The terms sex and gender often are used interchangeably, but have specific meaning when it comes to their effects on lung disease. Ample evidence is now available that sex and gender affect the incidence, susceptibility, presentation, diagnosis, and severity of many lung diseases. Some conditions are more prevalent in women, such as asthma. Other conditions are seen almost exclusively in women, like lymphangioleiomyomatosis. Some life stages—such as pregnancy—are unique to women and can affect the onset and course of lung disease. Clinical presentation may differ as well, such as higher number of exacerbations experienced by women with COPD and greater cardiovascular morbidity in women with sleep-disordered breathing. In addition, response to therapy and medication safety may also differ by sex, and yet, pharmacogenomic factors often are not addressed adequately in clinical trials. Various aspects of lung and sleep biology and pathobiology are impacted by female sex and female reproductive transitions. Differential gene expression or organ development can be impacted by these biological differences. Understanding these differences is the first step in moving toward precision medicine for women. This article is a state-of-the-art review of specific effects of sex and gender focused on epidemiology, disease presentation, risk factors, and management of lung diseases. Pathobiological mechanisms explaining sex differences in these diseases are beyond the scope of this article. We review the literature and focus on recent guidelines about using sex and gender in research. We also review sex and gender differences in lung diseases.
Asthma in Pregnancy
2021, Encyclopedia of Respiratory Medicine, Second Edition
Worldwide, 3–12% of pregnant women have asthma, making it one of the most common chronic conditions to affect pregnancy. Maternal asthma is associated with an increased risk of adverse perinatal outcomes, notably low birth weight and preterm birth, which are further increased with asthma exacerbations or oral corticosteroid use in pregnancy. Guidelines recommend use of medication as for non-pregnant adults with asthma, regular monitoring and a multi-disciplinary management approach. Exacerbations occur commonly, with risk factors including severe asthma, obesity, smoking and respiratory viral infection. Further research is needed to optimize outcomes for both mothers with asthma, and their infants.
Advances in pediatric asthma in 2013: Coordinating asthma care
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Citation Excerpt :
Tegethoff et al10 reported on a wide spectrum of diseases in offspring during childhood, suggesting that careful monitoring of women with asthma during pregnancy and their offspring is important. On that note, Zetstra-van der Woude et al11 reported that many women stop or reduce their use of asthma medications when they become pregnant and that strategies to safely control asthma during pregnancy are needed. Harpsoe et al12 examined the effect of body mass index and gestational weight gain and reported that maternal obesity during pregnancy was associated with increased risk of asthma and wheezing in offspring but not with atopic eczema and hay fever.
Last year's “Advances in pediatric asthma: moving toward asthma prevention” concluded that “We are well on our way to creating a pathway around wellness in asthma care and also to utilize new tools to predict the risk for asthma and take steps to not only prevent asthma exacerbations but also to prevent the early manifestations of the disease and thus prevent its evolution to severe asthma.” This year's summary will focus on recent advances in pediatric asthma on prenatal and postnatal factors altering the natural history of asthma, assessment of asthma control, and new insights regarding potential therapeutic targets for altering the course of asthma in children, as indicated in Journal of Allergy and Clinical Immunology publications in 2013 and early 2014. Recent reports continue to shed light on methods to understand factors that influence the course of asthma, methods to assess and communicate levels of control, and new targets for intervention, as well as new immunomodulators. It will now be important to carefully assess risk factors for the development of asthma, as well as the risk for asthma exacerbations, and to improve the way we communicate this information in the health care system. This will allow parents, primary care physicians, specialists, and provider systems to more effectively intervene in altering the course of asthma and to further reduce asthma morbidity and mortality.
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Citation Excerpt :
The guidelines for treatment of asthma in pregnancy27 and clinical strategies to manage asthma28 are well described. Recent reports suggest that medication use is lower during early pregnancy than before pregnancy,29,30 which appears to be consistent with active step therapy, although it may also indicate a reluctance of patients to continue medications. To that end, patients should be reassured that continuing asthma medication during pregnancy at the level needed to control the disease is important to improve both maternal and fetal outcomes.31
Maternal asthma is associated with serious pregnancy complications, but newborn morbidity is understudied.
We wanted to determine whether infants of asthmatic mothers have more neonatal complications.
The Consortium on Safe Labor (2002-2008), a retrospective cohort, included 223,512 singleton deliveries at ≥23 weeks' gestation. Newborns of mothers with asthma (n = 17,044) were compared with newborns of women without asthma by using logistic regression models with generalized estimating equations to calculate adjusted odds ratios (ORs) and 95% CIs. Electronic medical record data included gestational week at delivery, birth weight, resuscitation, neonatal intensive care unit (NICU) admission, NICU length of stay, hyperbilirubinemia, respiratory distress syndrome, apnea, sepsis, anemia, transient tachypnea of the newborn, infective pneumonia, asphyxia, intracerebral hemorrhage, seizure, cardiomyopathy, periventricular or intraventricular hemorrhage, necrotizing enterocolitis, aspiration, retinopathy of prematurity, and perinatal mortality.
Preterm delivery was associated with maternal asthma for each week after 33 completed weeks of gestation and not earlier. Maternal asthma also increased the adjusted odds of small for gestational age (OR = 1.10; 95% CI, 1.05-1.16), NICU admission (OR = 1.12; 95% CI, 1.07-1.17), hyperbilirubinemia (OR = 1.09; 95% CI, 1.04-1.14), respiratory distress syndrome (OR = 1.09; 95% CI, 1.01-1.19), transient tachypnea of the newborn (OR = 1.10; 95% CI, 1.02-1.19), and asphyxia (OR = 1.34; 95% CI, 1.03-1.75). Findings persisted for term infants (≥37 weeks) who had additional increased odds of intracerebral hemorrhage (OR = 1.84; 95% CI, 1.11-3.03) and anemia (OR = 1.30; 95% CI, 1.04-1.62).
Maternal asthma was associated with prematurity and small for gestational age. Adverse neonatal outcomes, including respiratory complications, hyperbilirubinemia, and NICU admission, were increased in association with maternal asthma even among term deliveries.
Advances in adult asthma diagnosis and treatment in 2013
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In 2013, several themes emerged: (1) a dedicated search for new therapies using new mechanisms; (2) the importance of the plasticity of the immune system (eg, that molecules that mediate inflammation in one setting can promote its resolution and return to homeostasis in other circumstances); (3) the complex role of viruses in asthma exacerbations; (4) the similarities and differences among asthma, asthma in smokers, and chronic obstructive pulmonary disease; and (5) the importance of understanding asthma phenotypes and their stability over time. Once new therapeutics pass the initial clinical trials, patient-oriented and real-world research will be needed.

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: Disclosure of potential conflict of interest: L. T. W. de Jong–van den Berg is a board member for the ISPE and has received one or more grants from or has one or more grants pending with PROTECT and EUROmediCAT. The rest of the authors declare that they have no relevant conflicts of interest.

View full text

Asthma and lower airway diseaseA population analysis of prescriptions for asthma medications during pregnancy

Background

Objective

Methods

Results

Conclusions

Section snippets

Database

Results

Discussion

Clin Chest Med

Ann Epidemiol

Ann Allergy Asthma Immunol

Case Manager

Am J Obstet Gynecol

J Clin Epidemiol

J Allergy Clin Immunol

Eur J Obstet Gynecol Reprod Biol

Expert Panel Report: managing asthma during pregnancy: recommendations for pharmacologic treatment—2004 update

J Allergy Clin Immunol

Presciption drugs and pregnancy

Expert Opin Pharmacother

Treatment of asthma during pregnancy [in Dutch]

Ned Tijdschr Geneeskd

Asthma and lower airway disease
A population analysis of prescriptions for asthma medications during pregnancy