Gestational Diabetes increases risk of asthma exacerbation in pregnancy: Study
A recent study published in The Journal of Allergy and Clinical Immunology: In Practice found that gestational diabetes mellitus is associated with asthma exacerbations in pregnancy.
Pregnancy is associated with an increased risk of asthma and gestational diabetes mellitus globally. Research shows that 13% of pregnancies develop asthma, and 14% of pregnancies develop gestational diabetes mellitus. Both these conditions are associated with adverse maternal and perinatal outcomes. However, there is ambiguity on how gestational diabetes affects asthma in pregnancy. Hence, Cleveland and Mayo Clinic researchers conducted a study to evaluate whether GDM is associated with an increased risk of asthma exacerbations during pregnancy and the first year postpartum.
A retrospective cohort study analyzed electronic health records of pregnant asthma patients from 2010-2023. Pregnant women with pre-existing diabetes mellitus or concurrent chronic lung diseases were excluded from the study. Pregnant women who participated in the study were considered to have Asthma exacerbation when they needed an oral corticosteroid (OCS) prescription. Multivariable logistic regression and zero-inflated Poisson regression were used to adjust for age, race, body mass index (BMI), pre-pregnancy asthma exacerbation history, and insurance status.
Findings:
- Among 10985 individuals, 1492 had GDM.
- Old age and high BMIs were seen in Patients with GDM.
- Increased asthma exacerbations were seen in individuals with GDM during pregnancy (adjusted OR 1.36, 95% CI 1.10-1.67) but not postpartum.
- The doubling of blood glucose levels doubled the risk of asthma exacerbations during pregnancy as seen in the Stratified analyses of 4331 individuals with gestational blood glucose measurement (adjusted OR of 2.02, 95% CI 1.45–2.81).
- Pre-pregnancy asthma exacerbations and older age were also associated with asthma exacerbation.
Thus, the study concluded that gestational diabetes in pregnancy increased the risk of asthma exacerbations. The study emphasizes the importance of Early and universal screening for GDM in pregnant individuals with pre-existing asthma to identify individuals with exacerbations.
Multidisciplinary care with tailored treatment approaches helps achieve better glycemic control and control asthma exacerbations. Educating pregnant individuals, identifying high-risk individuals, and implementing preventive measures helps mitigate adverse outcomes.
Further reading: Zhang P, Lappen JR, Attaway A, et al. Asthma Exacerbation Risk in Pregnancy and Postpartum: Assessing the Impact of Gestational Diabetes Mellitus and Other Key Factors. J Allergy Clin Immunol Pract. Published online December 19, 2024. doi:10.1016/j.jaip.2024.12.013.
