الفهرس 
Introduction& aim of the workOnly 14 pages are availabe for public view
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Abstract
Bronchial asthma is one of the most common medical conditions to affect pregnancy. The course of asthma changes by pregnancy, and the incidence of asthma exacerbations is high. which can lead to maternal and fetal morbidity and mortality in pregnant asthmatic patients. So our study aimed at detection of the burden of bronchial asthma among pregnant women attending to Sohag university hospital, the effect of pregnancy on the course of asthma and the effect of asthma and its severity on the pregnancy outcome in the setting of advancements in the management and pharmacotherapy of asthma compared with that previously. Also explore if bronchial asthma or the exacerbation of asthma can affect the perinatal outcome?
Our study included 1084 pregnant women of them 137(12,64%) were asthmatic and 947(87,36%) were non asthmatic who attended to Sohag university hospital during the period from April 2019 to May 2020. We found that the prevalence of asthma among the studied pregnant women was (12.64%).
Asthmatic pregnant women had significant older age, lower socioeconomic status, more rural residence and lower educational level than non-asthmatic pregnant women and there were non statistically significant differences between the two groups as regard smoking status, parity and body mass index.
As regard comorbidities we found that asthmatic pregnant women had significantly higher frequency of allergic rhinitis and allergic conjunctivitis than non-asthmatic pregnant women but we found statistically non significant differences between the two groups as regard frequency of allergic dermatitis, diabetes mellitus, hypertension, hypothyroidism and symptoms of gastritis or reflux.
As regard the pregnancy complications we found that asthmatic pregnant women had statistically non significant increase in frequency of placental
separation, oligohydramnios, intrauterine fetal death, preterm premature rupture of membrane, preeclampsia, hypertension of pregnancy and gestational diabetes than non-asthmatic pregnant women (P=0.95, 0.10, 0.80, 0.54, 0.66, 0.66&0.08 respectively). Non asthmatic pregnant women had statistically non significant increase in placenta previa, rupture uterus, ectopic pregnancy, polyhydramnios, abortion, preterm contraction, antepartum hemorrhage and postpartum hemorrhage than asthmatic pregnant women (P=0.95, 0.95, 0.95, 0.10, 0.90,
0.75, 0.70&0.70 respectively).
Also we found in our study that asthmatic pregnant women had increase in frequency of cesarean section delivery (elective and emergency CS) and assisted delivery than non-asthmatic pregnant women but this increase did not reach the statistically significant difference (P=0.68 for both).
By comparing the neonatal outcome of asthmatic and non asthmatic pregnant women we found that neonates of the asthmatic pregnant women had significant decrease in the level of Apgar scores at 5 minute and increase in the frequency of preterm labor than neonates of the non-asthmatic pregnant women (P=0.001&0.02 respectively), and statistically non significant increase in frequency of low birth weight, hydrocephalus and congenital anomalies than neonates of the non-asthmatic pregnant women (P=0.99, 0.86& 0.40 respectively). Neonates of the non asthmatic pregnant women had statistically non significant increase in the frequency of small for gestational age and microcephaly than neonates of the asthmatic pregnant women(P=0.8&0.86 respectively).
In our study we classify the pregnant asthmatic group according to the baseline asthma severity and found that (20,4%) of the asthmatic pregnant women had intermittent asthma, (29,19%) had mild persistent asthma, (40.15%) had moderate persistent asthma and (10.22%) had severe persistent asthma.
In our study by comparing intermittent and mild persistent asthmatic pregnant women with moderate and severe persistent asthmatic pregnant women
as regard maternal complications there were statistically non significant differences between the two groups as regard placenta previa, placental separation, polyhydramnios, oligohydramnios, intrauterine fetal death, abortion, membrane related disorders, preterm contraction, preeclampsia, hypertension of pregnancy, gestational diabetes and antepartum hemorrhage(P=0.61, 0.57, 1, 0.24, 0.44, 0.49, 0.72, 1&1 respectively).
There were statistically non significant differences between (intermittent and mild persistent asthmatic pregnant women) and (moderate and severe persistent asthmatic pregnant women) as regard the method of delivery (vaginal non instrumental, elective caesarian section, emergency caesarian section and assisted delivery) (P=0.38) and the neonatal outcome (small for gestational age, large for gestational age, low birth weight, microcephaly, hydrocephalus, preterm labor, congenital anomalies, infant sex and Apgar score at 5 minute) (P= 0.25, 0.18, 1, 0.32, 0.62, 0.32&0.1 respectively).
We found that moderate and severe persistent asthmatic pregnant women had significant higher rate of receiving oral steroid, emergency department visit and hospitalization than intermittent and mild persistent asthmatic pregnant women (P=0.04, 0.03 &0.03 respectively).
As regard asthma exacerbation during pregnancy we found that 40.88% of asthmatic pregnant women had moderate to severe exacerbation during pregnancy.
As regard asthma control during pregnancy we found that 20.44% of the cases had persistent uncontrolled asthma, 51.09% had loss of control and 30.66% were controlled.
We observed in our study that exacerbated asthmatic pregnant women and non-exacerbated asthmatic pregnant women had statistically non significant differences as regard demographic data (age, body mass index, socioeconomic status, residence, education , smoking, parity and history of abortion) (P=0.38, 0.35, 0.89, 0.49, 0.39, 0.5, 0.68 & 0.19 respectively) and frequency of
comorbidities( allergic rhinitis, allergic conjunctivitis , allergic dermatitis, hypertension , symptoms of gastritis, diabetes mellitus, hypothyroidism, anemia and thrombocytopenia) (P=0.49, 0.37, 1, 0.07, 0.22, 1, 0.51, 0.53& 0.53 respectively)
In our study exacerbated asthmatic pregnant women had significant increase in baseline blood eosinophil percent, decrease in baseline FEV1(P= 0.04&0.0003) and higher frequency of obstructive PFT (68.42% vs 44.12% ).
We found in our study that women who did not use inhaled corticosteroid before pregnancy and start ICS only during pregnancy had significantly higher frequency of exacerbations during pregnancy (P<0.0001).
We did not find in our study statistically significant differences between the exacerbated asthmatic pregnant women and non exacerbated asthmatic pregnant women as regard regular or interrupted use of ICS during pregnancy and baseline ICS use (P=0.73&0.27 respectively).
In our study by comparing the rate of asthma exacerbation in each trimester we found that 27.74% of the pregnant asthmatic women developed exacerbation in the1st trimester, 25.55% of the pregnant asthmatic women developed exacerbation in the 2nd trimester and 18.25% of the pregnant asthmatic women developed exacerbation in the 3rd trimester.
We observed no relationship between increase asthma exacerbation during pregnancy and the sex of the fetus(P= 0.41).
In our study, by comparing pregnancy complications in exacerbated asthmatic pregnant women with non-exacerbated asthmatic pregnant women there were statistically non significant differences in placental complication, oligohydramnios, polyhydramnios, intrauterine fetal death, abortion, prom, preterm contraction, hypertensive disorders of pregnancy, gestational diabetes and antepartum hemorrhage (P= 0.43, 0.7, 0.7, 1, 0.23, 0.59, 0.27, 0.88, 1&0.69 respectively). Also there were statistically non significant differences between the two groups as regard method of delivery (vaginal non instrumental, elective
cesarean section, emergency cesarean section and assisted delivery) (P= 0.58) and the neonatal outcome (frequency of small for gestational age, low birth weight, hydrocephalus, preterm labor, congenital anomalies, infant sex and Apgar score at 5 minute) (P=0.65, 0.85, 0.21, 0.87, 0.4, 0.41&0.07 respectively).
In our study we observed that 69(50.36%) cases were using inhaled corticosteroid before pregnancy of them 34(49.27%) cases decrease or stop their ICS during pregnancy.
In our study we found that acute exacerbation of asthma during pregnancy triggered in 46.43% of the cases due to potential viral infection, in 26.79% of the cases due to allergen exposure and in 26.79% of the cases due to stop of asthma medication.
In our study we found that 11,6% of pregnant asthmatic cases develop asthma symptoms during labor.
In our study asthma control in asthmatic pregnant women as evaluated by asthma control questionnaire were in periods of(1st trimester, 2nd trimester, 3rd trimester, post-partum) poor controlled in (24.82%, 24.22%, 27.5%&10.94 % respectively), gray zone in (14.6%, 14.84%, 12.5%&14.59 % respectively) and controlled in(60.58%, 60.94%, 60%&74.45% respectively), demonstrating that there was significant improvement in asthma control postpartum as compared by asthma control in 1st, 2nd and 3rd trimester (P=0.009, 0.01&0.003 respectively). There were non statistically significant differences in asthma control between (1st and 3rd trimester)& (2nd and 3rd trimester) (P=0.82&0.77 respectively).
Conclusion
Conclusion
Our study provided some insights into the course of asthma during pregnancy and the effects of asthma and asthma exacerbations on the maternal and fetal outcomes which can be concluded in the following points:
1. The prevelance of asthma among the studied pregnant women was (12.64%).
2. Asthmatic pregnant women had statistically significant higher frequency of allergic rhinitis and allergic conjunctivitis than non-asthmatic pregnant women but we found statistically non significant differences between the two groups as regard frequency of allergic dermatitis, diabetes mellitus, hypertension, hypothyroidism and symptoms of gastritis.
3. There was no statistically significant relationship between bronchial asthma and adverse maternal outcome or the frequency of cesarean section delivery.
4. Neonates of asthmatic pregnant women had statistically significant decrease in level of Apgar score at 5 minute and increase frequency of preterm labor than neonates of non-asthmatic pregnant women. But bronchial asthma not related to the frequency of other adverse neonatal outcomes as low birth weight, hydrocephalus and congenital anomalies, small for gestational age and microcephaly.
5. There was no statistically significant relationship between asthma severity and adverse maternal and fetal outcome and the frequency of cesarean section delivery.
6. Moderate to severe persistent asthmatic pregnant women had statistically significant higher rate of receiving oral steroid, emergency department visit and hospitalization than intermittent and mild persistent asthmatic pregnant women.
7. 40.88% of the studied asthmatic pregnant women had moderate to severe exacerbation during pregnancy, 20.44% of cases had persistent uncontrolled asthma, 51.09% of cases had loss of control and 30.66% of cases were controlled.
Recommendations
Limitations:
The limitations of follow up asthmatic women during pregnancy include irregularity of asthmatic pregnant women in follow up visits and small sample size which limit good evaluation of the maternal and neonatal outcomes.
Recommendations:
1. Further studies with larger sample size and longer follow up of the neonates of athmatic pregnant women to evaluate possipility of their affection by bronchial asthma.
2. All asthmatic pregnant women shoud have strict follow up of their pregnancy.
3. All asthmatic pregnant women shoud be good adherent to their asthma medication during pregnancy.
4. Asthma exacerbation during pregnancy shoud be managed properly and rapidly.
5. Education about asthma during pregnancy.