Severe asthma exacerbations during pregnancy

Obstet Gynecol. 2005 Nov;106(5 Pt 1):1046-54. doi: 10.1097/01.AOG.0000185281.21716.02.


Objective: To estimate the frequency of severe asthma exacerbations in pregnant women and to estimate whether there is an association with adverse perinatal outcomes.

Methods: Asthma exacerbations were evaluated in 146 women who were enrolled in a prospective cohort study of asthma and pregnancy. A severe exacerbation was defined as a hospital admission, emergency department presentation, or unscheduled doctor visit for asthma or a course of oral corticosteroids. Women were classified as having mild (n = 63), moderate (n = 34), or severe (n = 49) asthma.

Results: Severe exacerbations occurred in 8% (95% confidence interval [CI] 1.3-14.6%) of women with mild asthma, 47% (95% CI 30.3-63.8%) of women with moderate asthma, and 65% (95% CI 52-78.6%) of women with severe asthma at a mean gestational age of 25.1 +/- 0.9 (range 9-39) weeks of gestation. Among women who had severe exacerbations, there were 2 male stillbirths (P = .102) and a significantly increased rate of male low birth weight (P = .03). Maternal age, lung function, body mass index, gravidity, and parity were not different between women who did or those who did not have a severe exacerbation. Maternal pregnancy weight gain was significantly lower in women who had a severe exacerbation (P = .039). Forty-three percent of severe exacerbations occurred in winter, 34% were associated with self-reported viral infection, and 29% with nonadherence to inhaled corticosteroid medication.

Conclusion: The exacerbation rate among pregnant women with asthma is high and associated with poor outcomes for the male fetus. Improvements in asthma management to prevent severe exacerbations may lead to a better outcome for both mother and baby.

Level of evidence: II-2.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adrenal Cortex Hormones / administration & dosage
  • Adult
  • Anti-Asthmatic Agents / administration & dosage
  • Asthma / complications*
  • Cohort Studies
  • Dyspnea / epidemiology*
  • Dyspnea / etiology
  • Emergency Service, Hospital
  • Female
  • Hospitalization
  • Humans
  • Infant, Newborn
  • Male
  • Office Visits
  • Pregnancy
  • Pregnancy Complications / epidemiology*
  • Pregnancy Complications / etiology
  • Pregnancy Outcome
  • Severity of Illness Index


  • Adrenal Cortex Hormones
  • Anti-Asthmatic Agents