Researchers at The Ohio State University Medical Center sought to determine if pregnant women who come to the emergency department with acute asthma symptoms receive the same anti-inflammatory medicines and steroids to treat flare-ups as non-pregnant women.
“We found that pregnant asthmatics were less likely to receive steroids while in the emergency department or were not discharged with a prescription for steroids if they presented with a mild or moderate exacerbation,” says Dr. Jennifer McCallister, an asthma expert at Ohio State’s Medical Center. “This potentially increases the risk of complications to the mother and her unborn child.”
“Some physicians are reluctant to give pregnant asthmatic patients steroids out of fear of the impact it may have on the unborn child. However, those same women who were not treated appropriately during their first trip were nearly four times as likely to return to the emergency department with persistent asthma symptoms within two weeks,” adds McCallister, who is also a pulmonologist and critical care specialist at the Medical Center.
Adverse pregnancy outcomes can be attributed to poor asthma control, and severe maternal asthma has been linked to an increased risk of infant death, preeclampsia, premature birth and low birth weight. Asthma, which affects nearly 16 million American adults and between four and eight percent of pregnant women, is a chronic respiratory disease characterized by variable bronchial inflammation, airflow obstruction and hyperresponsiveness.
“Controlling asthma during pregnancy is far safer for the pregnant patient and her unborn child, than not doing so,” says McCallister.
Ohio State researchers analyzed the medical records of 123 pregnant women and 123 non-pregnant women, ranging in age from 16 to 40 years, who were treated for asthma in the emergency department between 1996 and 2009. Only 50.8 percent of pregnant women received steroids compared to 72.4 percent of non-pregnant women who received steroids. Similarly, 69.2 percent of non-pregnant women received a prescription for steroids upon discharge, yet only 41.3 percent of pregnant women were discharged with a steroid prescription.
In addition, the level of severity for asthma attacks influenced therapy. Pregnant women presenting with mild or moderate symptoms were less likely to be prescribed steroids at discharge from the emergency department compared to non-pregnant women (13.5 percent vs. 47.8 percent for mild exacerbations; and 50.9 percent vs. 75.7 percent for moderate exacerbations).
“It is extremely important to the improvement of pregnancy outcomes that there is well-controlled, on-going asthma management and treatments of exacerbations are aggressive during pregnancy,” McCallister adds.
McCallister presented the findings as an abstract at the May American Thoracic Society International Conference in New Orleans. The information is available online in a recent issue of the American Journal of Respiratory and Critical Care Medicine.