The relationship of asthma medication use to perinatal outcomes.
BACKGROUND
Maternal asthma has been reported to increase the risk of preeclampsia, preterm deliveries, and lower-birth-weight infants, but the mechanisms of this effect are not defined.


OBJECTIVE
We sought to evaluate the relationship between the use of contemporary asthma medications and adverse perinatal outcomes.


METHODS
Asthmatic patients were recruited from the 16 centers of the National Institute of Child Health and Human Development Maternal Fetal Medicine Units Network from December 1994 through February 2000. Gestational medication use was determined on the basis of patient history at enrollment and at monthly visits during pregnancy. Perinatal data were obtained at postpartum chart reviews. Perinatal outcome variables included gestational hypertension, preterm births, low-birth-weight infants, small-for-gestational-age infants, and major malformations.


RESULTS
The final cohort included 2123 asthmatic participants. No significant relationships were found between the use of inhaled beta-agonists (n=1828), inhaled corticosteroids (n=722), or theophylline (n=273) and adverse perinatal outcomes. After adjusting for demographic and asthma severity covariates, oral corticosteroid use was significantly associated with both preterm birth at less than 37 weeks' gestation (odds ratio, 1.54; 95% CI, 1.02-2.33) and low birth weight of less than 2500 g (odds ratio, 1.80; 95% CI, 1.13-2.88).


CONCLUSIONS
Use of inhaled beta-agonists, inhaled steroids, and theophylline do not appear to increase perinatal risks in pregnant asthmatic women. The mechanism of the association between maternal oral corticosteroid use and prematurity remains to be determined.
Schatz
Michael
M
Allergy Department, Kaiser Permanente Medical Center, 7060 Clairemont Mesa Boulevard, San Diego, CA 92111, USA. michael.x.schatz@kp.org
Dombrowski
Mitchell P
MP
Wise
Robert
R
Momirova
Valerija
V
Landon
Mark
M
Mabie
William
W
Newman
Roger B
RB
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
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000009:adverse effects*; D001249:Asthma / Q000188:drug therapy*; D001724:Birth Weight / Q000187:drug effects; D015331:Cohort Studies; D005260:Female; D005333:Fetus / Q000187:drug effects*; D006801:Humans; D007231:Infant, Newborn; D007752:Obstetric Labor, Premature / Q000139:chemically induced; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy*; D011446:Prospective Studies
D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents