摘要
背景与目的：患有哮喘的女性应在怀孕期间继续控制治疗，但目前关于吸入皮质类固醇（ICS）和长效β2受体激动剂（LABA）对不良胎儿结局影响的证据尚不清楚。
方法：这是一项基于人群的回顾性队列研究。数据来自2007年1月1日至2018年12月31日台湾健康与福利数据库，出生证明申请和妇幼健康数据库。患有哮喘的孕妇被纳入研究。三个独立变量包括ICS使用，ICS剂量反应效应和怀孕期间LABA的使用。不良胎儿结局包括低出生体重，小于胎龄，早产和先天性异常。倾向评分匹配（PSM）和治疗加权逆概率（IPTW）用于调整混杂因素，包括社会人口统计学，合并症，合并用药和哮喘严重程度。Logistic回归模型用于计算调整后的优势比（AOR）。
结果：共有4538名患有哮喘的孕妇参加了这项研究。调整后，ICS和LABA的使用与任何不良胎儿结局均无显著相关性。然而，在接触ICS的女性中，怀孕期间使用高剂量ICS与分娩后1年内先天性异常的风险显著相关（aOR:3.87；95%CI:1.29-11.60）。
结论：怀孕期间使用ICS或LABA与不良胎儿结局的风险无关。应建议患有哮喘的孕妇维持控制治疗，避免潜在的过敏原，以减少对大剂量ICS的需求。
The Association Between Use of Inhaled Corticosteroids and Long-Acting Beta2-Agonists During Pregnancy and Adverse Fetal Outcomes
Yea-Chwen Wu, I-Te Wang, Hsin-Yi Huang, Chung-Hsuen Wu
Abstract
Background and objective: Women with asthma should continue controller therapy during pregnancy, but current evidence on the effects of inhaled corticosteroids (ICS) and long-acting beta2-agonists (LABA) on adverse fetal outcomes remains unclear.
Methods: This was a population-based retrospective cohort study. Data were derived from the Health and Welfare Database, Birth Certificate Application, and Maternal and Child Health Database in Taiwan, from January 1, 2007 to December 31, 2018. Pregnant women with asthma were enrolled. Three independent variables included ICS use, ICS dose-response effects, and LABA use during pregnancy. Adverse fetal outcomes included low birth weight, small for gestational age, preterm birth, and congenital anomalies. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used to adjust for confounders, including sociodemographics, comorbidities, comedications, and asthma severity. Logistic regression models were used to calculate adjusted odds ratios (aORs).
Results: There were 4538 pregnant women with asthma enrolled in this study. After adjustment, neither ICS nor LABA use was significantly associated with any adverse fetal outcomes. However, among women exposed to ICS, high-dose ICS use during pregnancy was associated with a significantly higher risk of congenital anomalies (aOR: 3.87; 95% CI: 1.29-11.60) within 1 year of delivery.
Conclusions: ICS or LABA use during pregnancy was not associated with the risk of adverse fetal outcomes. Pregnant women with asthma should be advised to maintain controller therapy and avoid potential allergens to reduce the need for high-dose ICS.
背景与目的：患有哮喘的女性应在怀孕期间继续控制治疗，但目前关于吸入皮质类固醇（ICS）和长效β2受体激动剂（LABA）对不良胎儿结局影响的证据尚不清楚。
方法：这是一项基于人群的回顾性队列研究。数据来自2007年1月1日至2018年12月31日台湾健康与福利数据库，出生证明申请和妇幼健康数据库。患有哮喘的孕妇被纳入研究。三个独立变量包括ICS使用，ICS剂量反应效应和怀孕期间LABA的使用。不良胎儿结局包括低出生体重，小于胎龄，早产和先天性异常。倾向评分匹配（PSM）和治疗加权逆概率（IPTW）用于调整混杂因素，包括社会人口统计学，合并症，合并用药和哮喘严重程度。Logistic回归模型用于计算调整后的优势比（AOR）。
结果：共有4538名患有哮喘的孕妇参加了这项研究。调整后，ICS和LABA的使用与任何不良胎儿结局均无显著相关性。然而，在接触ICS的女性中，怀孕期间使用高剂量ICS与分娩后1年内先天性异常的风险显著相关（aOR:3.87；95%CI:1.29-11.60）。
结论：怀孕期间使用ICS或LABA与不良胎儿结局的风险无关。应建议患有哮喘的孕妇维持控制治疗，避免潜在的过敏原，以减少对大剂量ICS的需求。
（中日友好医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校）
（Respirology. 2025 Sep 9. doi: 10.1111/resp.70124.）
The Association Between Use of Inhaled Corticosteroids and Long-Acting Beta2-Agonists During Pregnancy and Adverse Fetal Outcomes
Yea-Chwen Wu, I-Te Wang, Hsin-Yi Huang, Chung-Hsuen Wu
Abstract
Background and objective: Women with asthma should continue controller therapy during pregnancy, but current evidence on the effects of inhaled corticosteroids (ICS) and long-acting beta2-agonists (LABA) on adverse fetal outcomes remains unclear.
Methods: This was a population-based retrospective cohort study. Data were derived from the Health and Welfare Database, Birth Certificate Application, and Maternal and Child Health Database in Taiwan, from January 1, 2007 to December 31, 2018. Pregnant women with asthma were enrolled. Three independent variables included ICS use, ICS dose-response effects, and LABA use during pregnancy. Adverse fetal outcomes included low birth weight, small for gestational age, preterm birth, and congenital anomalies. Propensity score matching (PSM) and inverse probability of treatment weighting (IPTW) were used to adjust for confounders, including sociodemographics, comorbidities, comedications, and asthma severity. Logistic regression models were used to calculate adjusted odds ratios (aORs).
Results: There were 4538 pregnant women with asthma enrolled in this study. After adjustment, neither ICS nor LABA use was significantly associated with any adverse fetal outcomes. However, among women exposed to ICS, high-dose ICS use during pregnancy was associated with a significantly higher risk of congenital anomalies (aOR: 3.87; 95% CI: 1.29-11.60) within 1 year of delivery.
Conclusions: ICS or LABA use during pregnancy was not associated with the risk of adverse fetal outcomes. Pregnant women with asthma should be advised to maintain controller therapy and avoid potential allergens to reduce the need for high-dose ICS.
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