Inhaled corticosteroid use and outcomes in pregnancy.
BACKGROUND
Current asthma management guidelines recommend aggressive asthma treatment for women who are pregnant.


OBJECTIVE
To examine asthma medication use and asthma-related health care use before and during pregnancy.


METHODS
Women aged 15 to 45 years with a pregnancy claim (index event) and an asthma claim (diagnosis or asthma medication prescription) were identified from a database of US managed care organizations (PharMetrics Patient-Centric Database). Medical claims 6 months before and after the index event were studied to determine the impact of pregnancy on asthma medication use (ie, prescription claims) and asthma-related physician visits, emergency department (ED) visits, and hospitalizations.


RESULTS
Of 7,235 women with a pregnancy claim and 6 months of preindex and postindex data, 633 had an asthma claim (334 had an asthma-related medication claim and 299 had no asthma-related medication claim before the index event). During the preindex period, 142 patients were using asthma controller medications, with inhaled corticosteroids (ICSs) the most commonly used controller (n = 101); 283 were using short-acting beta2-adrenergic agonists (SABAs) with or without controllers. Among the 334 patients using asthma medication before pregnancy, the number using any controller decreased from 142 to 94 (-34%), those using ICSs decreased from 101 to 65 (-36%), and those using SABAs decreased from 283 to 137 (-52%) after the pregnancy claim. For these 334 patients, the number with an asthma-related ED visit increased from 14 to 17 (21%) after the pregnancy claim. Among those without a pharmacy record of medication use before pregnancy (n = 299), the number with an asthma-related ED visit increased from 4 to 7 (75%) after the pregnancy claim. For the 101 patients using ICSs before pregnancy, the number with an asthma-related physician visit decreased from 39 to 25 (-36%) and the number with an ED visit was unchanged. For the 532 patients not using an ICS before pregnancy, the number with an asthma-related physician visit increased from 84 to 107 (27%) and the number with an ED visit increased from 12 to 18 (50%).


CONCLUSIONS
For patients using an ICS before pregnancy, the rate of asthma-related physician visits decreased and the number of ED visits was unchanged after pregnancy, whereas physician and ED visits increased after pregnancy for patients not using an ICS before pregnancy. Overall, the data suggest that asthma is undertreated in women contemplating pregnancy and in those who are pregnant.
Schatz
Michael
M
Kaiser-Permanente Medical Center, San Diego, California, USA. michael.x.schatz@kp.org
Leibman
Christopher
C
D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents