Journal
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE
Volume 9, Issue 3, Pages 1242-+Publisher
ELSEVIER
DOI: 10.1016/j.jaip.2020.09.045
Keywords
Pregnancy; Asthma; Smoking; Prospective studies; Spirometry
Categories
Funding
- Hunter Medical Research Institute
- Port Waratah Coal Services
- University of Newcastle
- Asthma Foundation of NSW
- National Health and Medical Research Council
- Singleton Foundation
- John Hunter Hospital Charitable Trust
- University of Newcastle Priority Research Centre GrowUpWell
- Woodend Foundation
- National Health and Medical Research Council of Australia (NHMRC) [1155810]
- Peggy Lang Hunter Children's Research Foundation Early Career Fellowship
- NHMRC [APP1084816]
- Gladys M Brawn Memorial Career Development Fellowship from the University of Newcastle
- National Health and Medical Research Council of Australia [1155810] Funding Source: NHMRC
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Nonadherence to inhaled corticosteroids (ICS) is common among pregnant women with asthma, with factors such as smoking, non-Caucasian/non-Indigenous ethnicity, adult asthma diagnosis, and lower lung function being associated with nonadherence at baseline, while factors like younger maternal age, higher parity, and not being prescribed ICS at baseline are associated with persistent nonadherence during pregnancy.
BACKGROUND: Nonadherence is common among pregnant women prescribed inhaled corticosteroids (ICS) for asthma and may have serious consequences for mother and baby. Factors associated with ICS nonadherence have not been determined in this population. OBJECTIVES: To determine factors associated with {1} nonadherence to ICS in early-mid pregnancy (cross-sectional) and {2} persistent nonadherence to ICS during pregnancy (longitudinal). METHODS: Data used come from 3 prospective studies (2004-2019) involving women with asthma recruited by 23 weeks' gestation (N = 1614). Demographics, asthma history, and current symptoms were assessed, and spirometry was performed at baseline and throughout pregnancy. Women self-reported current medication use and number of ICS doses missed in the past week. Nonadherence was defined as >= 20% of prescribed dosages missed in the past week (baseline) and on at least 2 occasions during follow-up (persistent). Factors associated with ICS nonadherence were examined using backward stepwise logistic regression. RESULTS: Of 610 (38%) women prescribed ICS at baseline, 236 (39%) were classified as non-adherent. Of 612 (38%) women prescribed ICS during at least 2 follow-up visits, 149 (24%) were classified as persistent nonadherent. Factors associated with nonadherence at baseline were current or ex-smoking, non-Caucasian/non-Indigenous ethnicity, adult diagnosis of asthma, and lower lung function. Factors associated with persistent nonadherence to ICS were lower maternal age, higher parity, and no prescribed ICS at baseline. CONCLUSION: Young multiparous non-Caucasian/nonIndigenous mothers are at increased risk of being nonadherent to ICS during pregnancy. Strategies to improve ICS nonadherence should address maternal smoking and target women who (re-)initiate ICS use in pregnancy. (C) 2020 American Academy of Allergy, Asthma & Immunology
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