Adverse neonatal outcomes in pregnant women with asthma: An updated systematic review and meta‐analysis

Author:

Robijn Annelies L.12,Harvey Soriah M.12ORCID,Jensen Megan E.12,Atkins Samuel3,Quek Kiah J. D.1,Wang Gang45,Smith Hannah1,Chambers Christina6,Namazy Jennifer7,Schatz Michael8,Gibson Peter G.129,Murphy Vanessa E.12

Affiliation:

1. School of Medicine and Public Health University of Newcastle Newcastle Australia

2. The Asthma and Breathing Research Program Hunter Medical Research Institute Newcastle Australia

3. Department of Health Launceston General Hospital Launceston Australia

4. Department of Respiratory and Critical Care Medicine, Clinical Research Center for Respiratory Disease, West China Hospital Sichuan University Chengdu China

5. Laboratory of Pulmonary Immunology and Inflammation, Frontiers Science Center for Disease‐related Molecular Network Sichuan University Chengdu China

6. Pediatrics and Family and Preventative Medicine University of California San Diego California USA

7. Department of Allergy‐Immunology Scripps Clinic San Diego California USA

8. Department of Allergy Kaiser Permanente Medical Center San Diego California USA

9. Department of Respiratory and Sleep Medicine John Hunter Hospital Newcastle Australia

Abstract

AbstractBackgroundA systematic review and meta‐analysis from 2013 reported increased risks of congenital malformations, neonatal death and neonatal hospitalization amongst infants born to women with asthma compared to infants born to mothers without asthma.ObjectiveOur objective was to update the evidence on the associations between maternal asthma and adverse neonatal outcomes.Search StrategyWe performed an English‐language MEDLINE, Embase, CINAHL, and COCHRANE search with the terms (asthma or wheeze) and (pregnan* or perinat* or obstet*).Selection CriteriaStudies published from March 2012 until September 2023 reporting at least one outcome of interest (congenital malformations, stillbirth, neonatal death, perinatal mortality, neonatal hospitalization, transient tachypnea of the newborn, respiratory distress syndrome and neonatal sepsis) in a population of women with and without asthma.Data Collection and AnalysisThe study was reported following the 2020 Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) and the Meta‐Analysis of Observational Studies in Epidemiology (MOOSE) guidelines. Quality of individual studies was assessed by two reviewers independently using the Newcastle‐Ottawa Scale. Random effects models (≥3 studies) or fixed effect models (≤2 studies) were used with restricted maximum likelihood to calculate relative risk (RR) from prevalence data and the inverse generic variance method where adjusted odds ratios (aORs) from individual studies were combined.Main ResultsA total of 18 new studies were included, along with the 22 studies from the 2013 review. Previously observed increased risks remained for perinatal mortality (relative risk [RR] 1.14, 95% confidence interval [CI]: 1.05, 1.23 n = 16 studies; aOR 1.07, 95% CI: 0.98–1.17 n = 6), congenital malformations (RR 1.36, 95% CI: 1.32–1.40 n = 17; aOR 1.42, 95% CI: 1.38–1.47 n = 6), and neonatal hospitalization (RR 1.27, 95% CI: 1.25–1.30 n = 12; aOR 1.1, 95% CI: 1.07–1.16 n = 3) amongst infants born to mothers with asthma, while the risk for neonatal death was no longer significant (RR 1.33, 95% CI: 0.95–1.84 n = 8). Previously reported non‐significant risks for major congenital malformations (RR1.18, 95% CI: 1.15–1.21; aOR 1.20, 95% CI: 1.15‐1.26 n = 3) and respiratory distress syndrome (RR 1.25, 95% CI: 1.17–1.34 n = 4; aOR 1.09, 95% CI: 1.01–1.18 n = 2) reached statistical significance.ConclusionsHealthcare professionals should remain aware of the increased risks to neonates being born to mothers with asthma.

Publisher

Wiley

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