Review and appraisal of guidelines for the management of asthma during pregnancy

Women Birth. 2018 Dec;31(6):e349-e357. doi: 10.1016/j.wombi.2018.01.008. Epub 2018 Feb 21.


Background: Asthma affects 12.7% of pregnancies in Australia. Poorly controlled asthma is associated with increased maternal and infant morbidity and mortality. Optimal antenatal management of asthma during pregnancy has the potential to reduce complications relating to asthma. Evidence-based clinical practice guidelines help to translate health research findings into practice and when implemented can improve health outcomes. National and International guidelines currently provide recommendations for optimal asthma care in pregnancy.

Aim: To appraise the existing asthma in pregnancy guidelines with respect to their evidence for recommendations, consistency of recommendations and appropriateness for clinical practice.

Method: The Appraisal of Guidelines for Research and Evaluation (AGREE II) tool was used to appraise four English language asthma in pregnancy guidelines, published or updated between 2007 and 2016. The recommendations, range and level of evidence was analysed.

Results: Two of the four guidelines scored highly in most domains of the appraisal. Many of the recommendations made in the appraised guidelines were consistent. Due to the lack of randomised controlled trials involving pregnant women with asthma, most recommendations were evidenced by consensus and expert opinion rather than high quality meta-analysis, systematic reviews of randomised controlled trials.

Conclusion: The recommended antenatal asthma management was generally consistent among the guidelines but lacked clarity in some areas which then leave them open to interpretation. More randomised controlled trials involving pregnant women with asthma are required to fortify the recommendations made and asthma management guidelines should be included in Australian Antenatal Care Guidelines as they currently are not.

Keywords: Appraisal; Asthma; Guidelines; Pregnancy; Review.

Publication types

  • Review

MeSH terms

  • Adult
  • Asthma / drug therapy*
  • Australia
  • Disease Management
  • Evidence-Based Medicine*
  • Female
  • Humans
  • Practice Guidelines as Topic*
  • Pregnancy
  • Pregnancy Complications / drug therapy*
  • Prenatal Care