哮喘孕妇、哮喘加重及平喘药物应用对后代先天畸形发生率的影响
2009/03/09
尽管临床医生常常建议哮喘孕妇应该坚持使用最佳治疗剂量的平喘药物，但目前，我们仍不明确这种疾病状态及治疗药物是否会影响胎儿的发育。因此孕期使用平喘药物的安全性有待进一步的研究证实。最近英国的一项研究评估了哮喘孕妇及孕期使用平喘药物对新生儿发生先天畸形风险的影响。他们的研究包括5124例具有先天畸形的活产婴儿，以及30053例对照。
结果发现，尽管哮喘孕妇生产畸形婴儿的风险稍高于非哮喘孕妇，但孕期或怀孕前1年使用平喘药物与先天畸形儿的出生率并不相关。对平喘药物评价过程中，并未发现长效或短效β受体激动剂，吸入或口服糖皮质激素以及其它支气管扩张剂有增加先天畸形风险。
因此，他们得出结论，尽管不能排除克米罗（cromones）有中度的致畸风险，但总体上孕期使用平喘药物是安全的；虽然有些证据提示哮喘孕妇有低度的致畸风险，但这种风险与孕期使用平喘药物无关。
（毛辉 四川大学华西医院呼吸科 610041 摘译）
（Thorax. 2008 Nov;63(11):981-987）
Tata LJ, Lewis SA, McKeever TM, Smith CJ, Doyle P, Smeeth L, Gibson JE, Hubbard RB. Effect of maternal asthma, exacerbations and asthma medication use on congenital malformations in offspring: a UK population-based study.
Thorax. 2008 Nov;63(11):981-7. Epub 2008 Aug 4.
BACKGROUND: Clinical advice to pregnant women with asthma is to maintain optimal therapeutic management; however, potential adverse effects of asthma treatments on fetal development remain uncertain. A study was undertaken to assess the association between maternal asthma and gestational exposure to asthma medications with risk of congenital malformation in offspring.
METHODS: A matched case-control study was performed using The Health Improvement Network primary care database. Children with malformations were matched to control children on birth year, general practice and singleton or twin delivery.
RESULTS: 5124 cases of liveborn children with major congenital malformations and 30,053 controls were included in the study. The risk of any malformation in children born to women with asthma was marginally higher than that in children born to women without asthma (adjusted OR 1.10, 95% CI 1.01 to 1.20). However, no association was present in children born to mothers receiving asthma treatment in the year before or during pregnancy (OR 1.06, 95% CI 0.94 to 1.20). In assessing teratogenicity of medications, no increased risk of malformation was found with gestational exposures to short- or long-acting beta agonists, inhaled corticosteroids, oral corticosteroids, other bronchodilators or cromones. These findings were similar for each of 11 system-specific malformation groups, except for an increase in musculo-skeletal system malformation associated with cromone exposure.
CONCLUSIONS: Gestational exposure to commonly used asthma medications was found to be safe overall, although a moderate teratogenic risk of cromones cannot be excluded. There was some evidence of a small increased risk of congenital malformation in children born to women with asthma, but this was not explained by gestational exposure to asthma drugs.
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哮喘与精神健康的关系---美国的一项人口普查结果分析
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