Asthma during pregnancy.
OBJECTIVE
To determine neonatal and maternal outcomes stratified by asthma severity during pregnancy by using the 1993 National Asthma Education Program Working Group on Asthma and Pregnancy definitions of asthma severity. The primary hypothesis was that moderate or severe asthmatics would have an increased incidence of delivery at <32 weeks of gestation compared with nonasthmatic controls.


METHODS
This was a multicenter, prospective, observational cohort study conducted over 4 years at 16 university hospital centers. Asthma severity was defined according to the National Asthma Education Program Working Group on Asthma and Pregnancy classification and modified to include medication requirements. This study had 80% power to detect a 2- to 3-fold increase in delivery less than 32 weeks of gestation among the cohort with the moderate or severe asthma compared with controls. Secondary outcome measures included obstetrical and neonatal outcomes.


RESULTS
The final analysis included 881 nonasthmatic controls, 873 with mild asthma, 814 with moderate, and 52 with severe asthma. There were no significant differences in the rates of preterm delivery less than 32 weeks (moderate or severe 3.0%, mild 3.4%, controls 3.3%; P =.873) or less than 37 weeks of gestation. There were no significant differences for neonatal outcomes except discharge diagnosis of neonatal sepsis among the mild group compared with controls, adjusted odds ratio 2.9, 95% confidence interval 1.2, 6.8. There were no significant differences for maternal complications except for an increase in overall cesarean delivery rate among the moderate-or-severe group compared with controls (adjusted odds ratio 1.4, 95% confidence interval 1.1, 1.8).


CONCLUSIONS
Asthma was not associated with a significant increase in preterm delivery or other adverse perinatal outcomes other than a discharge diagnosis of neonatal sepsis. Cesarean delivery rate was increased among the cohort with moderate or severe asthma.


METHODS
II-2
Dombrowski
Mitchell P
MP
Departments of Obstetrics and Gynecology at Wayne State University, Detroit, Michigan 48236, USA. Mitchell.Dombrowski@stjohn.org
Schatz
Michael
M
Wise
Robert
R
Momirova
Valerija
V
Landon
Mark
M
Mabie
William
W
Newman
Roger B
RB
McNellis
Donald
D
Hauth
John C
JC
Lindheimer
Marshall
M
Caritis
Steve N
SN
Leveno
Kenneth J
KJ
Meis
Paul
P
Miodovnik
Menachem
M
Wapner
Ronald J
RJ
Paul
Richard H
RH
Varner
Michael W
MW
O'Sullivan
Mary Jo
MJ
Thurnau
Gary R
GR
Conway
Deborah L
DL
D000328:Adult; D001249:Asthma / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D005865:Gestational Age; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D007752:Obstetric Labor, Premature / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology