General Obstetrics and Gynecology: Obstetrics
Cessation of asthma medication in early pregnancy

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Objective

The objective of the study was to determine whether women alter their use of asthma medications during pregnancy.

Study design

Weekly asthma medication use was determined from prescription claims data in a cohort of 112,171 pregnant women aged 15 to 44 years who were continuously enrolled in the Tennessee Medicaid program prior to their singleton pregnancy and who delivered a singleton birth during 1995 to 2001. Change in asthma medication use was evaluated using generalized estimating equation analyses.

Results

Women with asthma significantly (P ≤ 0.0005) decreased their asthma medication use from 5 to 13 weeks of pregnancy. During the first trimester, there was a 23% decline in inhaled corticosteroid prescriptions, a 13% decline in short-acting beta-agonist prescriptions, and a 54% decline in rescue corticosteroid prescriptions.

Conclusions

Utilization of all categories of asthma medications decreased in early pregnancy, with the largest declines occurring for inhaled and rescue corticosteroids.

Section snippets

Material and methods

We conducted a cohort study of 8149 pregnant women with asthma drawn from a population of 112,171 white and black pregnant women aged 15 to 44 years, with singleton gestations, enrolled in the Tennessee Medicaid program during 1995 to 2001, and with at least 180 days of continuous enrollment prior to their last menstrual period (LMP). These requirements captured 48% of deliveries to mothers enrolled in Medicaid and approximately 21% of all births to Tennessee residents from 1995 to 2001.

Results

The study cohort consisted of 8149 pregnant women with asthma. Mean maternal age was 24 ± 5 years, 67.9% were white, 39.1% were married, and 38.2% smoked. Overall, 83% of women used any asthma medication, 30% used inhaled anti-inflammatory agents, 77% used inhaled beta-agonists, and 28% used rescue corticosteroids during the study period. On average, in any single week prior to pregnancy 19% of women were users of any asthma medication, 5% used inhaled anti-inflammatory agents, 18% used inhaled

Comment

The results of this study suggest that women on Medicaid decrease and/or stop asthma medications during early pregnancy despite national guidelines recommending continued use.5 We observed a 23% drop in use of inhaled corticosteroids, a 13% drop in beta-agonist use, and a 54% drop in rescue corticosteroid use. These results are similar to results of a survey among women receiving asthma case management from a managed care organization, which found that 39% of women discontinued or reduced

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    Supported in part by research grants UO1 HL 72471, MO1 RR00095, and KO8 AI01582, Agency for Healthcare Research and Quality, Centers for Education and Research Grant U18-HS10384, Geriatric Research Education and Clinical Center, Department of Veterans Affairs, and the Food and Drug Administration FD-U-000073.

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