Psychosocial Variables Are Related to Future Exacerbation Risk and Perinatal Outcomes in Pregnant Women with Asthma

Abstract

Objective. To determine the relationship between psychosocial variables, future exacerbation risk during pregnancy, and perinatal outcomes. Methods. A secondary analysis of a randomized controlled trial of exhaled nitric oxide versus guideline-based treatment adjustment in pregnant women with asthma. Women were recruited between 12 and 20 weeks gestation and monitored for the remainder of the pregnancy. Psychosocial questionnaires including the Perceived Control of Asthma Questionnaire, the Brief Illness Perception Questionnaire, and the Six-Item Short-Form State Trait Anxiety Inventory were assessed at randomization. Exacerbations were defined as hospitalization, emergency visit, unscheduled doctor visit, or oral corticosteroid use for worsening asthma. Perinatal outcomes included preterm birth, small for gestational age, and cesarean section. Multiple logistic regressions were performed with predictor variables, including demographics and psychosocial and clinical variables. Results. The 175 participants had a mean (SD) age = 28.5(5.4) years, forced expiratory volume in 1 second (FEV₁%) predicted = 95.9(13.4), and asthma control score = 0.88(0.70). Greater perceived control of asthma reduced the odds of subsequent exacerbation (odds ratio (OR) [95%CI] 0.92 [0.85, 0.98], p = .016), cesarean without labor (0.84 [0.75, 0.94], p = .003), and preterm birth (0.84 [0.72, 0.97], p = .019), while increased anxiety increased the odds of subsequent exacerbation (1.05 [1.01, 1.08], p = .008). Conclusion. Women’s perceptions of asthma control and their psychosocial state (anxiety) are related to future exacerbation risk, cesarean section, and preterm birth.

• asthma control
• exacerbation risk
• perception
• perinatal outcomes
• pregnancy

Acknowledgments

We thank Kelly Steel, Karen McLaughlin, Linda Howell, Katie Baines and Sandra Dowley for their assistance, the midwives of the antenatal unit, and the women who participated in this study.