The risk of congenital malformations, perinatal mortality and neonatal hospitalisation among pregnant women with asthma: a systematic review and meta-analysis
Article first published online: 26 MAR 2013
© 2013 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2013 RCOG
BJOG: An International Journal of Obstetrics & Gynaecology
Volume 120, Issue 7, pages 812–822, June 2013
How to Cite
The risk of congenital malformations, perinatal mortality and neonatal hospitalisation among pregnant women with asthma: a systematic review and meta-analysis. BJOG 2013;120:812–822., , , , , , .
- Issue published online: 10 MAY 2013
- Article first published online: 26 MAR 2013
- Manuscript Accepted: 17 FEB 2013
- Kaiser Permanente Southern California Regional Research Committee
Vol. 121, Issue 5, 652, Article first published online: 18 MAR 2014
- congenital anomaly;
- neonatal death;
- neonatal intensive care unit;
- perinatal mortality;
There is conflicting literature on the effect of maternal asthma on congenital malformations and neonatal outcomes.
This review and meta-analysis sought to determine if maternal asthma is associated with an increased risk of adverse neonatal outcomes.
We searched electronic databases for: (asthma or wheeze) and (pregnan* or perinat* or obstet*).
Cohort studies published between 1975 and March 2012 reporting at least one perinatal outcome of interest (congenital malformations, neonatal complications, perinatal mortality).
Data collection and analysis
In all, 21 studies met inclusion criteria in pregnant women with and without asthma. Further analysis was conducted on 16 studies where asthmatic women were stratified by exacerbation history, corticosteroid use, bronchodilator use or asthma severity.
Maternal asthma was associated with a significantly increased risk of congenital malformations (relative risk [RR] 1.11, 95% confidence interval [95% CI] 1.02–1.21, I2 = 59.5%), cleft lip with or without cleft palate (RR 1.30, 95% CI 1.01–1.68, I2 = 65.6%), neonatal death (RR 1.49, 95% CI 1.11–2.00, I2 = 0%), and neonatal hospitalisation (RR 1.50, 95% CI 1.03–2.20, I2 = 64.5%). There was no significant effect of asthma on major malformations (RR 1.31, 95% CI 0.57–3.02, I2 = 70.9%) or stillbirth (RR 1.06, 95% CI 0.9–1.25, I2 = 35%). Exacerbations and use of bronchodilators and inhaled corticosteroids were not associated with congenital malformation risk.
Despite limitations related to the observational nature of the primary studies, this review demonstrates a small increased risk of neonatal complications among pregnant women with asthma. Further investigations into mechanisms and potential preventive interventions to improve infant outcomes are required.