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Pregnancy, asthma and exacerbations: a population-based cohort
Bohee Lee1, Ernie Wong1, Tricia Tan2
1National Heart and Lung Institute, Imperial College London, London, UK.
The European Respiratory Journal
|August 28, 2025
Summary
Asthma exacerbations during pregnancy decreased overall, but hospitalizations rose. Reducing inhaled corticosteroid (ICS) use during pregnancy was a major, modifiable risk factor for asthma exacerbations.
Area of Science:
- Reproductive medicine
- Pulmonology
- Public health
Background:
- Asthma exacerbations in pregnancy pose risks to mothers and newborns.
- Identifying modifiable risk factors is crucial for improving pregnancy outcomes.
- This study focuses on inhaled corticosteroid (ICS) use as a key modifiable factor.
Purpose of the Study:
- To analyze asthma exacerbation patterns during pregnancy.
- To identify risk factors for exacerbations, emphasizing modifiable ones like ICS use.
- To understand the impact of ICS reduction on asthma control in pregnant individuals.
Main Methods:
- A UK-based cohort study (2004-2020) analyzed primary care and hospital data.
- Pregnant women with asthma were identified, and exacerbations were defined by specific clinical events.
- Multivariable logistic regression assessed associations between maternal factors, exacerbations, and ICS use.
Main Results:
- Total asthma exacerbations decreased by ~30% during pregnancy, but hospital admission-related exacerbations increased 30-45% in trimesters 2 and 3.
- 31% of women reduced their ICS prescriptions during pregnancy.
- Reduced ICS use, a history of exacerbations, and high pre-pregnancy ICS+preventer prescriptions were significant risk factors for exacerbations.
Conclusions:
- Hospitalization-associated asthma exacerbations increased during pregnancy despite an overall decline.
- Reduced inhaled corticosteroid (ICS) use during pregnancy is a significant, modifiable risk factor for exacerbations.
- Type-2 inflammation and suboptimal pre-pregnancy asthma control are other key risk factors.
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