Jennifer A. Namazy

A meta-analysis of adverse perinatal outcomes in women with asthma

Please cite this paper as: Murphy V, Namazy J, Powell H, Schatz M, Chambers C, Attia J, Gibson P. A meta‐analysis of adverse perinatal outcomes in women with asthma. BJOG 2011;118:1314–1323.

The Xolair Pregnancy Registry (EXPECT): The safety of omalizumab use during pregnancy

BACKGROUND For many asthma medications, pregnancy safety data remains insufficient. OBJECTIVE The omalizumab pregnancy registry, EXPECT, evaluates maternal, pregnancy, and infant outcomes after exposure to omalizumab, including incidence of congenital anomalies. METHODS EXPECT is a prospective, observational study of pregnant women exposed to ≥1 dose of omalizumab within 8 weeks prior to conception or at any time during pregnancy. Primary outcome measures include rates of live births, elective terminations, stillbirths, and congenital anomalies. Data were collected at enrollment, each trimester, birth, and every 6 months up to 18 months post-delivery. RESULTS As of November 2012, 188 of 191 pregnant women were exposed to omalizumab during their first trimester. Of 169 pregnancies with known outcomes (median exposure during pregnancy, 8.8 months), there were 156 live births of 160 infants (4 twin pairs), 1 fetal death/stillbirth, 11 spontaneous abortions, and 1 elective termination. Among 152 singleton infants, 22 (14.5%) were born prematurely. Of 147 singleton infants with weight data, 16 (10.9%) were small for gestational age. Among 125 singleton full-term infants, 4 (3.2%) had low birth weights. Overall, 20 infants had congenital anomalies confirmed, 7 (4.4%) of whom had 1 major defect. No pattern of anomalies was observed. CONCLUSIONS To date, proportions of major congenital anomalies, prematurity, low birth weight, and small size for gestational age observed in the EXPECT registry are not inconsistent with findings from other studies in this asthma population. Recognizing the small sample size available, no apparent increased birth prevalence of major anomalies or patterns of major anomalies has been observed.

Effects of asthma severity, exacerbations and oral corticosteroids on perinatal outcomes

This systematic review and meta-analysis sought to investigate whether asthma exacerbations, oral corticosteroid use or asthma severity are associated with prematurity and intrauterine growth restriction. Cohort studies published between 1975 and March 11, 2012 were considered for inclusion. 138 publications were identified for possible inclusion, and nine papers met the inclusion criteria, by reporting perinatal outcomes of interest (low birth weight, <2500 g), pre-term birth (<37 weeks gestation unless otherwise stated) and small for gestational age (<10th percentile for gestational age and sex) in groups of asthmatic patients stratified by history of exacerbations, oral corticosteroid use or asthma severity. Maternal asthma exacerbations and oral corticosteroid use had a significant effect on outcomes, including low birth weight (RR 3.02, 95% CI 1.87–4.89 and RR 1.41, 95% CI 1.04–1.93, respectively) and pre-term delivery (RR 1.54, 95% CI 0.89–2.69 and RR 1.51, 95% CI 1.15–1.98, respectively). Moderate-to-severe asthma during pregnancy was associated with an increased risk of small for gestational age (RR 1.24, 95% CI 1.15–1.35) and low birth weight (RR 1.15, 95% CI 1.05–1.26) infants. These data suggest that asthma exacerbations, oral corticosteroid use or asthma severity defined as moderate-to-severe may be associated with pre-term delivery, low birth weight, and small for gestational age infants. Further studies on the effect of maternal asthma control on perinatal outcomes are warranted.

The risk of congenital malformations, perinatal mortality and neonatal hospitalisation among pregnant women with asthma: a systematic review and meta-analysis.

There is conflicting literature on the effect of maternal asthma on congenital malformations and neonatal outcomes.

Sensitivity to nonsteroidal anti-inflammatory drugs

BACKGROUND Aspirin can provoke reactions ranging from respiratory to cutaneous in susceptible individuals. There has been particular attention looking at the role of cyclo-oxygenase enzymes 1 and 2 and their role in aspirin-exacerbated respiratory disease. OBJECTIVE Patients who present with a spectrum of allergic and pseudoallergic reactions to aspirin pose a special challenge for the physician. This article discusses proposed classification system, clinical manifestations, pathogenesis of disease, and current treatment options of aspirin-related disease. DATA SOURCES Relevant articles in the medical literature were derived from searching the MEDLINE database with key terms aspirin-sensitive asthma, cyclo-oxygenase enzymes 1 and 2. Sources also include review articles, randomized control trials, and standard textbooks of allergy and immunology. RESULTS Aspirin-exacerbated respiratory disease remains a complex, heterogenous disease with varied clinical presentations. There have been many advances in trying to elucidate the pathogenesis of this disease. The classification system presented will provide greater ease when reading the literature and communicating with one another. Oral aspirin challenge remains the diagnostic test of choice for both respiratory and cutaneous reactions. Aspirin desensitization is an option for those with refractory respiratory disease or who require aspirin for other medical conditions. CONCLUSIONS This review discusses the challenges in classification, diagnosis, and treatment of those patients with a sensitivity to aspirin. Special attention is made to the possible mechanisms mediating disease progression and how specific therapies, such as leukotriene modifiers, may be helpful.

The risk of maternal and placental complications in pregnant women with asthma: a systematic review and meta-analysis.

Abstract Objective: To investigate if maternal asthma is associated with an increased risk of maternal and placental complications in pregnancy. Methods: Electronic databases were searched for the following terms: (asthma or wheeze) and (pregnan* or perinat* or obstet*). Cohort studies published between January 1975 and March 2012 were considered for inclusion. Forty publications met the inclusion criteria, reporting at least one maternal or placental complication in pregnant women with and without asthma. Relative risk (RR) with 95% confidence intervals (CIs) was calculated. Results: Maternal asthma was associated with a significantly increased risk of cesarean section (RR = 1.31, 95%CI = [1.22–1.39]), gestational diabetes (RR = 1.39, 95%CI = [1.17–1.66]), hemorrhage (antepartum: RR = 1.25, 95%CI = [1.10–1.42]; postpartum: RR = 1.29, 95%CI = [1.18–1.41]), placenta previa (RR = 1.23, 95%CI = [1.07–1.40]), placental abruption (RR = 1.29, 95%CI = [1.14–1.47]) and premature rupture of membranes (RR = 1.21, 95%CI = 1.07–1.37). Moderate to severe asthma significantly increased the risk of cesarean section (RR = 1.19, 95%CI = [1.09–1.31]) and gestational diabetes (RR = 1.19, 95%CI = [1.06–1.33]) compared to mild asthma. Bronchodilator use was associated with a significantly lowered risk of gestational diabetes (RR = 0.64, 95%CI = [0.57–0.72]). Conclusions: Pregnant women with asthma are at increased risk of maternal and placental complications, and women with moderate/severe asthma may be at particular risk. Further studies are required to elucidate whether adequate control of asthma during pregnancy reduces these risks.

Pregnancy and asthma: recent developments

Purpose of review Asthma is the most common potentially serious medical problem to complicate pregnancy. Asthmatic women have been shown to be at an increased risk of complications during pregnancy. Managing asthma during pregnancy is unique because the effects of both the illness and the treatment on the developing fetus and the patient must be considered. Recent findings This review summarizes the recent studies addressing the interrelationships between asthma and pregnancy and general aspects of pharmacologic therapy of gestational asthma. Summary The prevalence of asthma in pregnant women appears to be increasing. Recent evidence supports that pregnant asthmatic women with moderate to severe asthma may have an increased risk of adverse perinatal outcomes. The goal of asthma management during pregnancy is to optimize maternal and fetal health.

Treatment of asthma during pregnancy and perinatal outcomes.

Purpose of reviewAsthma is the most common, potentially serious medical problem to complicate pregnancy. Women with asthma have been shown to be at increased risk of complications during pregnancy. Managing asthma during pregnancy is unique because the effect of both the illness and the treatment on the developing fetus as well as the patient must be considered. This review summarizes the recent studies addressing the effects of asthma or asthma medications on perinatal outcomes, including the 2004 Asthma and Pregnancy Working Group of the National Asthma Education and Prevention Program. Recent findingsThis review summarizes the recent studies addressing the effect of asthma or asthma medications on perinatal outcomes. SummaryThe prevalence of asthma in pregnant women appears to be increasing. Recent evidence supports that pregnant women with moderate to severe asthma may have an increased risk of adverse perinatal outcomes. The goal of asthma management during pregnancy is to optimize maternal and fetal health.

Update in the treatment of asthma during pregnancy.

Asthma is the most common potentially serious medical problem to complicate pregnancy. Recent reports suggest that 7 of every 100 pregnant women suffer from asthma during pregnancy. Asthmatic women have been shown to be at an increased risk of complications during pregnancy. This may be secondary to inadequately controlled asthma or perhaps the results of the effects of certain asthma medications taken during pregnancy. The choice to use a specific medication during pregnancy is based on available human and animal data. Much of the information currently available regarding the safety of various asthma medications during pregnancy comes from several large cohort studies. This article reviews the specific aspects of pharmacological therapy during pregnancy as provided in the recommendations of the joint ad hoc committee of the American College of Allergy Asthma and Immunology and the American College of Obstetricians and Gynecologists. This article presents practical strategies for the management of asthma in our pregnant patients.

Adverse reactions to aspirin and nonsteroidal antiinflammatory drugs (NSAIDs)

BackgroundAspirin can provoke reactions ranging from respiratory to cutaneous in those susceptible individuals. There has been particular attention looking at the role of cyclo-oxygenase enzymes and 2 and their role in aspirin exacerbated respiratory disease.ObjectivePatients who present with a spectrum of allergic and pseudoallergic reactions to aspirin pose a special challenge for the physician. This article discusses proposed classification system, clinical manifestations, pathogenesis of disease, and current treatment options of aspirin related disease.MethodsRelevant articles in the medical literature were, derived from searching the MEDLINE database. Soures also include review articles, randomized control trials, and standard textbooks of allergy and immunology.ResultsAspirin-exacerbated respiratory disease remains a complex, heterogenous disease with manvaried clinical presentations. There have been many advances in trying to elucidate the pathogenesis of this disease. The classification system presented will provide greater ease when reading the literature and communicating with one another. Oral aspirin challenge remains the diagnostic test of choice for both respiratory and cutaneous reactions. Aspirin desensitization is an option for those with refractory respiratory diuease or who require aspirin for other medical conditions.ConclusionsThis review discusses the challenges in classification, diagnosis and treatment of those patients with a sensitivity to aspirin. Special attention is made to the possible mechanisms mediating disease progression and how specific. Therapies, such as the leukotriene modifiers may be helpful.