SLOW-RELEASE THEOPHYLLINE IN PREGNANT ASTHMATICS

Study objective: Oral theophylline treatment may be helpful in control ling severe asthma during pregnancy. This treatment, however, has been suspected of causing both complications and malformations. The object ive of this investigation was to study the influence of theo-phylline treatment on the course of pregnancy and delivery and on maternal and infant health. Setting: Respiratory unit, antenatal outpatient departm ents, and labor and delivery rooms. Design: Case-control study. Patien ts: The data of 212 pregnant asthmatics with theophylline treatment (A T) were compared with findings in 292 pregnant asthmatics without theo phylline (A) and 237 nonasthmatic pregnant control subjects (C). Resul ts: There were no significant differences among groups as to age, heig ht, age of onset of asthma, lung function, parity, or smoking. In the AT group, 19% were treated for acute exacerbations of the asthma as co mpared with 6% in the A group (p<0.001). The incidence of preeclampsia was higher in the AT (15.6%) than in the C (6.4%) group (p<0.03). The ophylline treatment at term was not associated with premature contract ions or premature rupture of membranes, hemorrhage, placenta previa, a bruption of the placenta, abnormal fetus position, frequent induction or augmentation of labor, prolonged third phase of delivery, or increa sed hemorrhage post partum. No differences among groups were seen with regard to gestational age, birth weight, Apgar scores, or perinatal d eaths. Jaundice in the newborn, necessitating treatment with blue ligh t, was more common in the AT (15.0%) than in the C group (7.8%) (p<0.0 5). Three infants of 121 patients treated with theophylline during the first trimester were born with malformations; in the 91 patients trea ted with theophylline only during the second and third trimester, and the asthmatic control group, the corresponding figures were 4 and 3. C onclusions: During the second and third trimesters until term, theophy lline treatment using moderate doses can be considered safe. The safet y of theophylline treatment during the first trimester with regard to teratogenicity remains to be determined.