PERINATAL OUTCOMES IN WOMEN WITH ASTHMA DURING PREGNANCY

Objective: To determine whether adverse perinatal outcome is associate d with asthma or asthma medication use during pregnancy. Methods: A re trospective cohort study was conducted of women who resided in Halifax County, Nova Scotia, and delivered between 1991 and 1993. Asthmatic w omen were classified into three groups, according to medication usage: no medications, beta agonists only, and steroids with or without othe r asthma medications. Outcomes compared among asthmatic and nonasthmat ic women included maternal complications (pregnancy-induced hypertensi on, cesarean delivery, gestational diabetes, preterm birth, and antepa rtum and postpartum hemorrhage) and neonatal outcomes (low birth weigh t, congenital malformations, hyperbilirubinemia, and respiratory distr ess syndrome). Results: The cohort included 817 asthmatic women and 13 ,709 nonasthmatic women. Overall, the prevalence of pregnancies compli cated by asthma increased from 4.8% in 1991 to 6.9% in 1993. Asthmatic women were at increased risk for antepartum and postpartum hemorrhage , independent of medication usage. Asthmatic women taking steroids wer e at increased risk for pregnancy-induced hypertension (odds ratio [OR ] 1.7; 95% confidence interval [CI] 1.0, 2.9). The only significant di fference in neonatal outcome between asthma medication groups and nona sthmatic women was of an increased risk of hyperbilirubinemia in infan ts of women taking steroids (OR 1.9; 95% CI 1.1, 3.4). Conclusion: Ris k of antepartum and postpartum hemorrhage is increased in asthmatic wo men, independent of meditation usage. The increased incidence of neona tal hyperbilirubinemia and the borderline increased risk of pregnancy- induced hypertension may be complications of steroid use or may be rel ated to poorly controlled asthma. (Obstet Gynecol 1998;92:435-40. (C) 1998 by The American College of Obstetricians and Gynecologists.)