Effect of pregnancy on maternal asthma symptoms and medication use.
Effect of pregnancy on maternal asthma symptoms and medication use.
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DOI：
10.1097/aog.0b013e3181d06945
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发表时间：
2010-03
影响因子：
7.2
通讯作者：
Bracken M
中科院分区：
文献类型：
--
作者：
Belanger K;Hellenbrand ME;Holford TR;Bracken M
检查与患者或她的治疗相关的因素是否影响怀孕期间哮喘的严重程度。症状和用药数据是通过面对面和电话采访收集的。妇女在怀孕24周前通过私人产科医生和医院诊所招募。872名女性被医生诊断为哮喘，686名为活动性哮喘患者，641名数据完整的患者被分析。全球哮喘倡议衡量了哮喘的严重程度。重复测量的累积Logistic回归模型评估了怀孕每个月期间哮喘严重程度的变化。根据全球哮喘倡议指南，有两个因素对哮喘的病程有重大而深远的影响：孕前严重程度和药物的使用。虽然分析了几个因素(种族、年龄、特应性状态、体重指数、产次、胎儿性别和吸烟)，但没有一个因素是哮喘严重程度变化的显著危险因素，以临床重要的方式衡量，作为全球哮喘倡议类别的一步变化。患有轻度哮喘的女性从适当的治疗中受益最多，间歇性哮喘患者的哮喘恶化风险降低了62%(0.38，95%可信区间0.23-0.64)，轻度持续性哮喘患者的风险降低了52%(优势比0.48，95%可信区间0.28-0.84)。妊娠一个月或三个月与哮喘严重程度的变化并不一致。如果患者继续使用处方药物，怀孕期间哮喘的严重程度与怀孕前一年的严重程度相似。如果女性停止服药，即使是轻微的哮喘也可能变得更加严重。第二部分：
To examine whether factors related to the patient or her treatment influence asthma severity during pregnancy. Symptom and medication data were collected by in-person and telephone interviews. Women were recruited before 24 weeks of gestation through private obstetricians and hospital clinics. Eight hundred seventy-two women had physician-diagnosed asthma, 686 were active asthmatics, and 641 with complete data were analyzed. The Global Initiative for Asthma measured severity. Cumulative logistic regression models for repeated measures assessed changes in asthma severity during each month of pregnancy. Two factors had significant and profound effects on the course of asthma: prepregnancy severity and use of medication according to Global Initiative for Asthma guidelines. Although several factors were analyzed (race, age, atopic status, body mass index, parity, fetal sex, and smoking), none were significant risk factors for changes in asthma severity, measured in a clinically important way as a one-step change in Global Initiative for Asthma category. Women with milder asthma received most benefit from appropriate treatment, 62% decreased risk for worsening asthma among those with intermittent asthma (0.38, 95% confidence interval 0.23–0.64) and 52% decreased risk among those with mild persistent asthma (odds ratio 0.48, 95% confidence interval 0.28–0.84). Month or trimester of gestation was not consistently associated with changes in asthma severity. Asthma severity during pregnancy is similar to severity in the year before pregnancy, provided patients continue to use their prescribed medication. If women discontinue medication, even mild asthma is likely to become significantly more severe. II