Determinants of low risk of asthma exacerbation during pregnancy

Abstract

Background

Assessment of asthma control every 4-6 weeks during pregnancy is recommended to reduce risk of exacerbation, and by that improve outcome.

Objective

To identify determinants of pregnancies with low risk of asthma exacerbation.

Methods

All pregnant women enrolled into the Management of Asthma during Pregnancy (MAP) program at Hvidovre Hospital since 2007. Assessment of asthma control, adjustment of treatment, spirometry and measurement of exhaled nitric oxide (F_ENO) were performed, and baseline characteristics and exacerbation history was collected at enrolment. Determinants of low-exacerbation risk pregnancies were identified by logistic regression analysis (stepwise backward elimination).

Results

In 1,283 pregnancies, 107 exacerbations were observed. Multiple regression analysis revealed that no history of pre-pregnancy exacerbations (p<0.001), no prescribed controller medication (p<0.001), and clinically stable asthma at enrolment (p=0.002)were significantly associated with low risk of exacerbation during pregnancy, with these combined characteristics only two out of 385 pregnancies were complicated by an exacerbation (OR 0.04, 95% CI 0.01-0.18, p<0.001).

Conclusion and clinical relevance

Clinically stable asthma at enrolment, together with no history of previous exacerbations and no prescribed controller medication, are determinants of low risk of an asthma exacerbation during pregnancy, which may guide clinicians in individualising surveillance of asthma during pregnancy.

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