Skip to main content

Advertisement

Log in

Medication Exposure in Pregnancy Risk Evaluation Program: The Prevalence of Asthma Medication Use During Pregnancy

  • Published:
Maternal and Child Health Journal Aims and scope Submit manuscript

Abstract

Asthma is one of the most common chronic diseases in women of reproductive age, occurring in up to 8 % of pregnancies. The objective of this study is to assess the prevalence of asthma medication use during pregnancy in a large diverse cohort. We identified women aged 15–45 years who delivered a live born infant between 2001 and 2007 across 11 U.S. health plans within the Medication Exposure in Pregnancy Risk Evaluation Program (MEPREP). Using health plans’ administrative and claims data, and birth certificate data, we identified deliveries for which women filled asthma medications from 90 days before pregnancy through delivery. Prevalence (%) was calculated for asthma diagnosis and medication dispensing. There were 586,276 infants from 575,632 eligible deliveries in the MEPREP cohort. Asthma prevalence among mothers was 6.7 %, increasing from 5.5 % in 2001 to 7.8 % in 2007. A total of 9.7 % (n = 55,914) of women were dispensed asthma medications during pregnancy. The overall prevalence of maintenance-only medication, rescue-only medication, and combined maintenance and rescue medication was 0.6, 6.7, and 2.4 % respectively. The prevalence of maintenance-only use doubled during the study period from 0.4 to 0.8 %, while rescue-only use decreased from 7.4 to 5.8 %. In this large population-based pregnancy cohort, the prevalence of asthma diagnoses increased over time. The dispensing of maintenance-only medication increased over time, while rescue-only medication dispensing decreased over time.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Abbreviations

ICS:

Inhaled corticosteroid

LABA:

Long acting beta agonist

LMP:

Last menstrual period

LRA:

Leukotriene receptor antagonist

MEPREP:

Medication Exposure in Pregnancy Risk Evaluation Program

SABA:

Short acting beta agonist

References

  1. Kwon, H. L., Belanger, K., & Bracken, M. B. (2003). Asthma prevalence among pregnant and childbearing-aged women in the United States: Estimates from national health surveys. Annals of Epidemiology, 13(5), 317–324.

    Article  PubMed  Google Scholar 

  2. Dombrowski, M. P., & Schatz, M. (2010). Asthma in pregnancy. Clinical Obstetrics and Gynecology, 53(2), 301–310.

    Article  PubMed  Google Scholar 

  3. National Asthma Education and Prevention Program. Managing Asthma During Pregnancy: Recommendations for Pharmacologic Treatment: National Institutes of Health, National Heart, Lung, and Blood Institute. NIH Publication No. 055232005.

  4. Bakhireva, L. N., Schatz, M., & Chambers, C. D. (2007). Effect of maternal asthma and gestational asthma therapy on fetal growth. Journal of Asthma, 44(2), 71–76.

    Article  CAS  PubMed  Google Scholar 

  5. Namazy, J. A., & Schatz, M. (2005). Pregnancy and asthma: Recent developments. Current Opinion in Pulmonary Medicine, 11(1), 56–60.

    Article  PubMed  Google Scholar 

  6. Chambers, C. (2006). Safety of asthma and allergy medications in pregnancy. Immunology and Allergy Clinics of North America, 26(1), 13–28. doi:10.1016/j.iac.2005.10.001.

    Article  PubMed  Google Scholar 

  7. Andrade, S. E., Davis, R. L., Cheetham, T. C., et al. (2012). Medication exposure in pregnancy risk evaluation program. Maternal Child Health Journal, 16(7), 1349–1354.

    Article  PubMed  Google Scholar 

  8. Martin, J. A., Hamilton, B. E., Sutton, P. D., et al. (2010). Births: Final data for 2007. National Vital Statistics Reports, 58(24), 1–85.

    PubMed  Google Scholar 

  9. Cooper, W. O., Hernandez-Diaz, S., Arbogast, P. G., et al. (2006). Major congenital malformations after first-trimester exposure to ACE inhibitors. New England Journal of Medicine, 354(23), 2443–2451.

    Article  CAS  PubMed  Google Scholar 

  10. Raebel, M. A., Ellis, J. L., & Andrade, S. E. (2005). Evaluation of gestational age and admission date assumptions used to determine prenatal drug exposure from administrative data. Pharmacoepidemiology and Drug Safety, 14(12), 829–836.

    Article  PubMed  Google Scholar 

  11. Toh, S., Mitchell, A. A., Werler, M. M., et al. (2008). Sensitivity and specificity of computerized algorithms to classify gestational periods in the absence of information on date of conception. American Journal of Epidemiology, 167(6), 633–640.

    Article  PubMed  Google Scholar 

  12. Centers for Disease Control and Prevention (2011). Vital signs: Asthma prevalence, disease characteristics, and self-management education—United States, 2001–2009. MMWR weekly 60(17).

  13. Enriquez, R., Griffin, M. R., Carroll, K. N., et al. (2007). Effect of maternal asthma and asthma control on pregnancy and perinatal outcomes. Journal of Allergy and Clinical Immunology, 120(3), 625–630.

    Article  PubMed  Google Scholar 

  14. Berg, C. J., Mackay, A. P., Qin, C., et al. (2009). Overview of maternal morbidity during hospitalization for labor and delivery in the United States: 1993–1997 and 2001–2005. Obstetrics and Gynecology, 113(5), 1075–1081.

    PubMed  Google Scholar 

  15. Cleary, B. J., Butt, H., Strawbridge, J. D., et al. (2010). Medication use in early pregnancy-prevalence and determinants of use in a prospective cohort of women. Pharmacoepidemiology and Drug Safety, 19(4), 408–417.

    PubMed  Google Scholar 

  16. Andrade, S. E., Gurwitz, J. H., Davis, R. L., et al. (2004). Prescription drug use in pregnancy. American Journal of Obstetrics and Gynecology, 191(2), 398–407.

    Article  PubMed  Google Scholar 

  17. Mitchell, A. A., Gilboa, S. M., Werler, M. M., et al. (2011). Medication use during pregnancy, with particular focus on prescription drugs: 1976–2008. American Journal of Obstetrics and Gynecology, 205(1), 51.e1–51.e8.

    Article  Google Scholar 

  18. Higashi, A., Zhu, S., Stafford, R. S., et al. (2011). National trends in ambulatory asthma treatment, 1997–2009. Journal of General Internal Medicine, 26(12), 1465–1470.

    Article  PubMed  Google Scholar 

  19. National Asthma Education and Prevention Program (2007). Guidelines for the Diagnosis and Management of Asthma: National Institutes of Health, National Heart, Lung, and Blood Institute. NIH Publication No. 08-5846.

  20. Scow, D. T., Luttermoser, G. K., & Dickerson, K. S. (2007). Leukotriene inhibitors in the treatment of allergy and asthma. American Family Physician, 75(1), 65–70.

    PubMed  Google Scholar 

Download references

Acknowledgments

We would like to thank Group Health Research Institute (Washington), Harvard Pilgrim Health Care Institute (Massachusetts), HealthPartners Research Foundation (Minnesota), Kaiser Permanente Colorado, Kaiser Permanente Northwest (Oregon, Washington), Meyers Primary Care Institute (Massachusetts), Lovelace Clinic Foundation (New Mexico), Kaiser Permanente Northern California, Kaiser Permanente Southern California, TennCare Bureau, and the Tennessee Department of Health for providing study data. We would also like to thank the MEPREP programmers at each site for their time and effort in extracting the data. This study was supported through funding from contracts HHSF223200510012C, HHSF223200510009C, and HHSF223200510008C from the U.S. Food and Drug Administration (Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research). Dr. Dublin was supported by National Institute on Aging grant K23AG028954. Birth certificate data for each site was provided by the corresponding State Department of Health, we appreciate their collaborations.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Craig Hansen.

Additional information

The views expressed in this paper are those of the authors and are not intended to convey official U.S. Food and Drug Administration (FDA) policy or guidance. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Aging or the National Institutes of Health.

Appendix

Appendix

List of asthma medications

Maintenance medications

Combinations (ICS and LABA)

Mast cell stabilizers

BUDESONIDE/FORMOTEROL

CROMOLYN

FLUTICASONE/SALMETEROL

NEDOCROMIL

Inhaled corticosteroids (ICS)

Long acting beta-agonists (LABA)

BECLOMETHASONE

ARFORMOTEROL

BUDESONIDE

FORMOTEROL

FLUNISOLIDE

SALMETEROL

FLUNISOLIDE/MENTHOL

 

FLUTICASONE

Leukotriene antagonist (LRA)

MOMETASONE

MONTELUKAST

TRIAMCINOLONE

ZAFIRLUKAST

 

ZILEUTON

Methylxanthines

AEROLATE

THEOP/ISOPROTERENOL/EPD/KI/PB

AMINOPHYLLIN/EPHED/POT IOD/PB

THEOPHYLL/CAFF/AA13/CINN/HC135

AMINOPHYLLINE

THEOPHYLL/EPHED HCL/PHENOBARB

AMINOPHYLLINE/EPHED/AMOBARB

THEOPHYLL/EPHED/BUTABARBITAL

AMINOPHYLLINE/EPHED/PHENOBARB

THEOPHYLL/EPHED/POT IODIDE/PB

AMINOPHYLLINE/EPHEDRINE

THEOPHYLLINE

AMINOPHYLLINE/PHENOBARB

THEOPHYLLINE-EPHED-BUTABA

AMINOPHYLLINE/QUININE

THEOPHYLLINE-EPHED-PHENOB

DYPHYLLINE

THEOPHYLLINE-EPHEDRINE

DYPHYLLINE-EPHEDRINE-PHEN

THEOPHYLLINE-EPHEDRINE-GG

GUAIFEN/DYPHYLLIN/EPHED/PB

THEOPHYLLINE-EPHEDRINE-PB

GUAIFEN/THEOP ANHYD/P-EPHED

THEOPHYLLINE-GUAIFENESIN

GUAIFENESIN/DYPHYLLINE

THEOPHYLLINE-IODINATED GL

GUAIFENESIN/OXTRIPHYLLINE

THEOPHYLLINE-KI

GUAIFENESIN/THEOPHYLLINE

THEOPHYLLINE-PSE-GG

OXTRIPHYLLINE

THEOPHYLLINE/DIETARY SUP.CMB9

OXTRIPHYLLINE-GUAIFENESIN

THEOPHYLLINE/EPHED/HYDROXYZINE

 

THEOPHYLLINE/POTASSIUM IODIDE

Rescue medications

Combinations

Short acting beta-agonists

IPRATROPIUM/ALBUTEROL

ALBUTEROL

 

BITOLTEROL

Anticholinergics

ISOETHARINE

IPRATROPIUM

ISOPROTERENOL

TIOTROPIUM

 
 

LEVALBUTEROL

 

METAPROTERENOL

 

PIRBUTEROL

 

TERBUTALINE

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hansen, C., Joski, P., Freiman, H. et al. Medication Exposure in Pregnancy Risk Evaluation Program: The Prevalence of Asthma Medication Use During Pregnancy. Matern Child Health J 17, 1611–1621 (2013). https://doi.org/10.1007/s10995-012-1173-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10995-012-1173-x

Keywords

Navigation