title: An observational study of the impact of an antenatal asthma management service on asthma control during pregnancy.
abstract: OBJECTIVE
  We sought to investigate the impact of introducing an antenatal asthma management service (AMS) on asthma control during pregnancy and subsequent perinatal outcomes.
  
  
  METHODS
  Prospective, observational cohort study of pregnant asthmatic women attending a tertiary hospital antenatal clinic. Asthmatic women were recruited from the antenatal clinic and were followed prospectively with visits at 12, 20, 28 and 36 weeks gestation. A new nurse-led AMS was introduced offering asthma self-management education and support. Outcomes were compared between women recruited before and after the AMS was introduced (n=89 and 80, respectively) and included; prevalence of exacerbations during pregnancy, asthma control throughout pregnancy and perinatal outcomes, including preterm birth and small-for-gestational-age (SGA).
  
  
  RESULTS
  The relative risk for exacerbations (0.69; CI: 0.33-1.42), loss of control (0.67; CI 0.46-0.99) and persistent uncontrolled asthma (0.48; CI 0.26-0.9) were all reduced with attendance to AMS during pregnancy. AMS was associated with non-statistically significant reductions in asthma exacerbations (19.1-15.0%; p=0.480) and uncontrolled asthma at ≥ 2 study visits (21.3-11.3%; p=0.078).
  
  
  CONCLUSIONS
  These findings demonstrate the potential impact of an AMS in improving asthma control during pregnancy, supporting the need for an adequately powered RCT to determine its clinical- and cost-effectiveness.
authors.affiliation: Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia.
authors.forename: L E
authors.initials: LE
authors.lastname: Grzeskowiak
authors.affiliation: Respiratory Medicine Unit, The Queen Elizabeth Hospital, Adelaide, Australia.
authors.forename: B
authors.initials: B
authors.lastname: Smith
authors.affiliation: Respiratory Medicine Unit, The Queen Elizabeth Hospital, Adelaide, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Roy
authors.affiliation: Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia.
authors.forename: G A
authors.initials: GA
authors.lastname: Dekker
authors.affiliation: Robinson Research Institute, School of Paediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia; Mater Medical Research Institute, University of Queensland, Brisbane, Australia. Electronic address: Vicki.clifton@mater.uq.edu.au.
authors.forename: V L
authors.initials: VL
authors.lastname: Clifton
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D015331:Cohort Studies; D019468:Disease Management; D018450:Disease Progression; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D008297:Male; D010044:Outpatient Clinics, Hospital; D010865:Pilot Projects; D057184:Practice Patterns, Nurses'; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy* / Q000503:physiopathology; D047928:Premature Birth / Q000453:epidemiology; D011446:Prospective Studies; D012648:Self Care; D012907:Smoking / Q000628:therapy; D016540:Smoking Cessation; D062606:Tertiary Care Centers; D014797:Vital Capacity; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents
keywords: Asthma; Asthma management; Nurse-led care; Pregnancy; Respiratory