Uncontrolled Asthma in Pregnancy Leads to Complications for Children

Jeannette Y. Wick, RPh, MBA, FASCP
Published Online: Friday, August 9, 2013
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A new study finds that children whose mothers had asthma attacks during pregnancy were at increased risk of a range of health problems.

Children born to mothers who experience asthma attacks during pregnancy appear to be at higher risk for numerous childhood diseases, and the results of a new study suggest that better control of asthma during pregnancy could benefit women’s offspring. It also suggests that clinicians should carefully monitor children born to women with uncontrolled asthma. Earlier studies have indicated that maternal asthma during pregnancy was associated with adverse obstetric outcomes, slower fetal development, and some diseases in childhood. The new study, published online on August 5, 2013, in Pediatrics, identifies potential long-term outcomes for offspring.
 
The researchers used data collected as part of a nationwide Danish study on 66,712 mothers who gave birth between 1996 and 2002. Of note, a large portion of the mothers in the study—25%—were smokers. Otherwise, most participants were in good health. Of the participants, 6.2% experienced an asthma attack during pregnancy. The researchers followed all children born to these women for approximately 6 years using statistics from the Danish National Hospital Register.
 
The results indicated that asthma during pregnancy was associated with a significantly increased risk for 8 of 16 diagnostic categories in offspring. These included infectious and parasitic diseases; endocrine and metabolic disorders; diseases of the nervous system, ear, respiratory system, digestive system, and skin; and malformations. Asthma during pregnancy also significantly increased children’s risk of diagnosis with any disease. When the data was adjusted for multiple comparisons, the risk of endocrine and metabolic disorders was no longer significant, but these complications were deemed “potentially increased.”
 
Pharmacists are well placed in the community to remind pregnant woman who have asthma that they should be mindful of their triggers and treatments. Pharmacists should emphasize that uncontrolled asthma can harm the fetus and is associated with health risks for the child.
 
While many women will avoid asthma medications because they fear birth defects, most asthma medications are safe during pregnancy. If nonadherence leads to uncontrolled asthma, clinicians need to discuss risks and benefits with the woman. In general, inhaled medications (corticosteroids, ipratropium, leukotrienes, and long-acting beta-agonists) have been found to be safe in asthma, as have allergy shots. Evidence varies regarding the safety of the oral agents, so clinicians should work with patients to identify the safest drug for each individual.

Ms. Wick is a visiting professor at the University of Connecticut School of Pharmacy and a freelance writer from Virginia.

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