The Journal of Allergy and Clinical Immunology
Volume 112, Issue 2 , Pages 283-288, August 2003

Asthma morbidity during pregnancy can be predicted by severity classification☆☆

Presented at the 56th Annual Meeting of the American Academy of Allergy, Asthma and Immunology, San Diego, Calif, April 2000.

San Diego and Los Angeles, Calif, Detroit, Mich, Baltimore and Bethesda, Md, Washington, DC, Columbus and Cincinnati, Ohio, Memphis, Tenn, Charleston, SC, Birmingham, Ala, Chicago, Ill, Pittsburgh and Philadelphia, Pa, Dallas and San Antonio, Tex, Winston-Salem, NC, Salt Lake City, Utah, Miami, Fla, and Oklahoma City, Okla

From the aDepartment of Allergy, Kaiser Permanente.bDepartment of Obstetrics and Gynecology, Wayne State University.cDepartment of Pulmonary Medicine, Johns Hopkins University.dBiostatistics Center, George Washington University.eDepartment of Obstetrics and Gynecology, the Ohio State University.fDepartment of Obstetrics and Gynecology, University of Tennessee.gDepartment of Obstetrics and Gynecology, Medical College of South Carolina.hDepartment of Obstetrics and Gynecology, University of Alabama.iDepartment of Obstetrics and Gynecology, University of Chicago.jDepartment of Obstetrics and Gynecology, University of Pittsburgh-Magee Women's Hospital.kDepartment of Obstetrics and Gynecology, University of Texas Southwestern Medical Center.lDepartment of Obstetrics and Gynecology, Wake Forest University.mDepartment of Obstetrics and Gynecology, University of Cincinnati.nDepartment of Obstetrics and Gynecology, Thomas Jefferson University.oDepartment of Obstetrics and Gynecology, University of Southern California.pDepartment of Obstetrics and Gynecology, University of Utah.qDepartment of Obstetrics and Gynecology, University of Miami.rDepartment of Obstetrics and Gynecology, University of Oklahoma.sDepartment of Obstetrics and Gynecology, University of Texas; and the tNational Institute of Child Health and Human Development

Received 5 February 2003; received in revised form 3 March 2003; accepted 12 March 2003.

Abstract 

Background: The 1993 National Asthma Education Program Working Group on Asthma and Pregnancy defined asthma severity as mild, moderate, or severe on the basis of symptoms and spirometry, but no studies have evaluated the relationship between this classification system and subsequent asthma morbidity during pregnancy. Objective: The objective of this study was to evaluate the relationship between asthma severity classification during pregnancy and gestational asthma exacerbations. Methods: Asthma severity was defined according to the 1993 classification, adjusted to include medication requirements, in a volunteer sample of 1739 pregnant asthmatic patients who were less than 26 weeks' gestation. Results: Initial asthma classification (mild, moderate, or severe) was significantly related to subsequent asthma morbidity during pregnancy (hospitalizations, unscheduled visits, corticosteroid requirements, and asthma symptoms during labor and delivery). Exacerbations during pregnancy occurred in 12.6% of patients initially classified as mild, 25.7% of patients classified as moderate, and 51.9% of patients classified as severe (P < .001). Asthma morbidity was similar, whether patients were classified as moderate or severe by symptoms and spirometry or by medication requirement. Thirty percent of initially mild patients were reclassified as moderate-severe during pregnancy, and 23% of the initially moderate-severe patients were reclassified as mild later in pregnancy; asthma morbidity in these patients changed accordingly. Conclusion: The National Asthma Education Program Working Group on Asthma and Pregnancy classification of asthma severity, adapted to include medication use, predicts subsequent asthma morbidity during pregnancy. (J Allergy Clin Immunol 2003;112:283-8.)

Keywords:  Asthma, pregnancy, morbidity, severity

Abbreviations:  GINA , Global Initiative for Asthma, NAEPP , National Asthma Education and Prevention Program

 

 Supported by grants from the National Institute of Child Health and Human Development (HD21410, HD21414, HD21434, HD27869, HD27917, HD27905, HD27889, HD27860, HD27861, HD27915, HD27883, HD34122, HD34116, HD34208, HD34136, HD19897) and the National Heart, Lung, and Blood Institute

☆☆ *Participants in the Network of Maternal-Fetal Medicine Units are listed in Appendix 1.

 Reprint requests: Michael Schatz, MD, MS, Chief, Department of Allergy, Kaiser-Permanente Medical Center, 7060 Clairemont Mesa Blvd, San Diego, CA 92111.

PII: S0091-6749(03)01250-8

doi:10.1067/mai.2003.1516

The Journal of Allergy and Clinical Immunology
Volume 112, Issue 2 , Pages 283-288, August 2003