Asthma exacerbations during the first trimester of pregnancy and the risk of congenital malformations among asthmatic women

• Published in: Journal of allergy and clinical immunology Vol. 121; no. 6; pp. 1379 - 1384.e1
• Main Authors: Blais, Lucie, PhD, Forget, Amélie, MSc
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.06.2008; Elsevier; Elsevier Limited
• Subjects: administrative health databases; Adolescent; Adrenal Cortex Hormones - administration & dosage; Adult; Allergy and Immunology; Anti-Asthmatic Agents - administration & dosage; Asthma; Asthma - complications; Asthma - drug therapy; Biological and medical sciences; Birth defects; Cohort Studies; cohort study; Congenital Abnormalities - epidemiology; Congenital Abnormalities - etiology; congenital malformations; exacerbation; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Infant mortality; Medical sciences; Pregnancy; Pregnancy Complications; Pregnancy Trimester, First; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Studies; Womens health; cohort study; OR; Generalized estimating equation; GEE; ISQ; pregnancy; International Classification of Diseases–9th Revision; congenital malformations; Asthma; exacerbation; Régie de l'assurance-maladie du Québec; ICD-9; Emergency department; RAMQ; Institut de la statistique du Québec; administrative health databases; Odds ratio; ED; Human; Lung disease; Immunopathology; Congenital; Respiratory disease; Health; Administrative data; First trimester; Risk; Pregnancy; Exacerbation; Immunology; Malformation; Cohort study; Risk factor; Bronchus disease; Adult; Female; Obstructive pulmonary disease; Woman
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2008.02.038

Background Uncontrolled maternal asthma during pregnancy has been hypothesized as a cause of congenital malformation, but literature is scare on this topic. Objective The aim of this study was to investigate whether asthmatic women who had an exacerbation during the first trimester of pregnancy were more at risk of having a baby with a congenital malformation. Methods From the linkage of 3 Canadian administrative databases, we reconstructed a cohort of 4344 pregnancies of asthmatic women. Asthma exacerbations were assessed during the first trimester of pregnancy and were defined as a filled prescription for oral corticosteroids, an emergency department visit, or a hospitalization for asthma. Congenital malformations were assessed at birth and during the first year of life of the newborn by using diagnoses recorded in the databases. Generalized estimating equation models were used to estimate adjusted odds ratios of congenital malformations in association with asthma exacerbations. Results In the cohort we identified 398 (9.2%) babies with at least 1 malformation and 261 (6.0%) with a major malformation. The crude prevalences of malformations were 12.8% and 8.9%, respectively, for women who had and those who did not have an exacerbation. The adjusted odds ratio for all malformations was 1.48 (95% CI, 1.04-2.09) when comparing women who had and those who did not have an exacerbation. The corresponding figures were 1.32 (95% CI, 0.86-2.04) for major malformations. Conclusion Asthma exacerbations during the first trimester of pregnancy were found to significantly increase the risk of a congenital malformation.