Asthma During Pregnancy Remains Poorly Controlled

Uncontrolled asthma during pregnancy may come with an elevated risk for adverse maternal and neonatal outcomes, and is estimated to complicate between 3 percent and 10 percent of pregnancies. A new study shows that poorly controlled asthma during pregnancy continues to be common in the United States.

Furthermore, the study, from The Journal of Allergy and Clinical Immunology: In Practice (JACI: In Practice), points out that pregnant women utilizing public insurance are more likely to have poorly controlled asthma than pregnant women with private insurance. Among all patients, the dispensing of long-term controller medications during pregnancy was low, even for women consistently displaying symptoms.

"Adhering to recommended asthma treatments is extremely important, and what we're seeing is that many pregnant women with poorly-controlled asthma aren't filling prescriptions for long-term asthma care," said first author Jacqueline M. Cohen, PhD. "Getting asthma symptoms under control could improve health outcomes for both the mothers and their children."

Medication Non-Adherence

It's estimated that about one third of women may choose to discontinue asthma controller medications early due to fears of fetal toxicity, or simply due to overall uncertainty about the medications. Medication non-adherence is a major trigger for asthma exacerbations, which can be dangerous for both the mother and the baby.

Two cohorts of pregnancies ending in a live birth were identified using two large, nationwide U.S. healthcare claims databases. The Truven Health MarketScan® Commercial Claims and Encounters Database (MarketScan, private insurance) was examined from 2011-2015 and the Medicaid Analytic eXtract (MAX, public insurance) was examined from 2000-2013 for the study.

Among pregnant women with asthma on private insurance (MarketScan), 19.0 percent had severe asthma and 16.5 percent had poorly-controlled asthma. Of those with poorly-controlled asthma, 38.4 percent of women were not dispensed a long-term medication. Among asthmatic pregnant women using public insurance (MAX), 18.8 percent had severe asthma and an alarming 28 percent had poorly-controlled asthma.

Hospitalization Due to Asthma

Of those with poorly-controlled asthma, 43.3 percent were not dispensed a long-term medication. No matter the type of insurance, women with poor control were more likely to be obese, smoke, have more comorbidities and used more concomitant non-asthma medications. They were also more likely to be hospitalized before and during pregnancy. During their pregnancy, 1.6 percent of women in MarketScan and 5.1 percent in MAX required hospitalization due to asthma.

The study was funded by GSK as part of the Vaccines and Medications in Pregnancy Surveillance System (VAMPSS) collaboration. In 2010, VAMPSS, which is coordinated by the AAAAI, started to look at the safety of both long-acting and short-acting beta agonists in pregnancy, and more recently, added surveillance for the new biologics used to treat severe asthma.

Greater Risks

"While it's understandable that mothers are concerned about the safety of their children and the effect medications may have during pregnancy, current asthma guidelines recommend that women continue their asthma treatment plan throughout the entire pregnancy because the risks of uncontrolled asthma appear to be greater than the risk of recommended asthma medications," said Michael Schatz, MD, MS, FAAAAI, also an author of the study and Principal Investigator for VAMPSS.

"There is an urgent need to provide additional evidence on the risks and benefits of asthma medications during pregnancy to improve asthma control and reduce anxiety regarding medication safety in our patients," Schatz said. "Our hope is that the information gleaned through VAMPSS will contribute to more complete risk and safety information on pharmaceutical labels for pregnant and lactating women."

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