Presentation: Impact of Pregnancy in Asthma on Healthcare Use and Perinatal Outcomes ( World Allergy Congress)

Friday, 16 October 2015

Hall D1 Foyer (Floor 3) (Coex Convention Center)

Sujeong Kim, MD , Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, South Korea

Jinhee Kim, PhD , Department of Nursing, College of Medicine, Chosun University, Gwangju, South Korea

So Young Park, MD , Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

Hye-Yeon Um, MS , Korea Institute of Drug Safety and Risk Management, Seoul, South Korea

Seunghee Baek, PhD , Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, South Korea

Hyouk-Soo Kwon, MD, PhD , Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

You Sook Cho, MD, PhD , Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

Hee-Bom Moon, MD, PhD , Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

Tae-Bum Kim, MD, PhD , Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

Background: It is generally known that pregnancy in asthma increases the risk of asthma exacerbations and poor perinatal outcomes. However, the impact of pregnancy in asthma on healthcare use is not known well. In addition, its impact on perinatal outcomes is still controversial because of study limitations due to ethical issues. Objective: To evaluate the impact of pregnancy on asthma in terms of asthma-related healthcare use and prescription patterns, in company with the effect of asthma exacerbations on adverse pregnancy outcomes. Methods: Among all asthma patients in the Korean NHI claim database from 2009 to 2013, pregnant women who delivered in 2011 with pre-existing asthma were enrolled. Analyses included asthma-related healthcare use and prescription patterns compared between pregnant asthmatic women and non-pregnant female asthmatic controls, as well as within the pregnant subjects from pre-pregnancy throughout postpartum periods. In addition, the association between asthma exacerbation during pregnancy and adverse pregnancy outcomes was assessed. Results: A total of 3,357 pregnant asthmatics were compared with 50,355 non-pregnant asthmatics and 10,311 pregnant patients were included to determine the effect of asthma exacerbations on adverse pregnancy outcome in the study. Pregnant asthmatics underwent more asthma-related hospitalization (1.3% vs 0.8%, p=0.005), but significantly less outpatient visits and prescriptions for most asthma medications than non-pregnant asthmatics. The prevalence of asthma exacerbation during pregnancy was 5.3%, and the patients who had acute exacerbation during pregnancy showed significantly higher asthma-related healthcare utilization in terms of hospitalization, ICU admission, ED and outpatient visits within 1 year preceding delivery than those who had not. However, asthma exacerbation during pregnancy was not significantly related to adverse perinatal outcomes except for caesarean section (27.1% vs 18.9%, p<0.001). All exacerbations were managed with systemic corticosteroids and the patients who ever experienced acute exacerbations maintained asthma medications including inhaled corticosteroid (ICS)-based inhalers throughout the pregnancy period. Conclusion: Pregnancy profoundly affects asthma-related healthcare use, but to a different degree whether the patient experienced exacerbation or not. Asthma exacerbation during pregnancy is not associated with adverse pregnancy outcomes while it was managed appropriately with systemic corticosteroids.

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