Asthma researcher wants moms, babies to breathe easier through pregnancy research

Vanessa Murphy, PhD, started her research career in a lab studying preterm birth, which is where she fell in love with pregnancy research.

During her PhD program, Murphy was offered the chance to expand to a new research topic within the lab: asthma and pregnancy. Since then, Murphy has built her entire career in this field, currently serving as deputy chair of the Asthma and Breathing Program at Hunter Medical Research Institute in Australia.

“My ultimate research goal is to identify an asthma management strategy for pregnancy that improves outcomes for both mother and baby,” Murphy, who also is a Medical Research Future Fund investigator research fellow and associate professor in the School of Medicine and Public Health at The University of Newcastle, told Healio.

She has worked on numerous studies about asthma during pregnancy, and she led the development of the Asthma in Pregnancy Toolkit, a resource for health care providers and pregnant women with asthma in Australia.

Murphy’s latest research — a systematic review and meta-analysis of studies looking into the outcomes of babies born to women with asthma — was presented at this year’s American Academy of Allergy, Asthma & Immunology Annual Meeting. The study was an update to research she has been working on since 2007 with researchers like Michael Schatz, MD, MS, FAAAAI, and Healio’s Women in Allergy Peer Perspective Board Member Jennifer Namazy, MD, FAAAAI.

“[In 2007], we recognized that while there were many studies publishing on perinatal and neonatal outcomes among women with asthma in pregnancy, there were conflicting outcomes reported, and no one had synthesized the literature with a systematic review or meta-analysis,” Murphy told Healio. “So, we set out to do this and published a comprehensive set of meta-analyses on the range of maternal, placental, perinatal and neonatal outcomes in this population between 2011 and 2014. We are now updating these reviews since many new studies have been published, some with very large sample sizes, which increased the validity of our findings.”

The study presented at AAAAI was an update to one from 2013 that outlined the neonatal outcomes of women with asthma during pregnancy. The original meta-analysis included 21 studies published between 1975 and 2012 that reported congenital malformations, neonatal complications or perinatal mortality among infants born to mothers with asthma.

The updated meta-analysis included 18 studies published between 2012 and 2023 — in addition to the 21 studies used before — for a total of 785,000 pregnancies with asthma compared with 16 million pregnancies without asthma.

Murphy and colleagues calculated the relative risk and adjusted odds ratios for outcomes among pregnancies with asthma.

In the original meta-analysis from 2013, data suggested the risk for neonatal death was significantly higher among mothers with vs. those without asthma (RR = 1.49; 95% CI, 1.11-2). However, the updated research showed that is no longer the case, with the association losing significance (RR = 1.33; 95% CI, 0.95-1.84).

“This is a very reassuring finding,” Murphy said. “However, there are still numerous other risks to the baby of mothers with asthma. These include having to go to the NICU, respiratory distress syndrome and congenital malformations.”

The updated study corroborated statistically significant risks for congenital malformations (RR = 1.36; 95% CI, 1.32-1.4; adjusted OR = 1.42; 95% CI, 1.38-1.47) and neonatal hospitalization (RR = 1.27, 95% CI 1.25-1.3; aOR = 1.1; 95% CI, 1.07-1.16) associated with maternal asthma. Murphy said the risk for perinatal mortality was only statistically significant in the unadjusted analyses (RR = 1.14; 95% CI, 1.05-1.23; aOR = 1.07; 95% CI, 0.9-1.17).

Some outcomes that were not considered significant before reaching statistical significance in the updated study, like risk for major congenital malformations (RR = 1.18; 95% CI, 1.15-1.21; aOR = 1.2; 95% CI, 1.15-1.26) and respiratory distress syndrome (RR 1.25; 95% CI, 1.17-1.34; aOR = 1.09; 95% CI, 1.01-1.18).

“We need to do more research to understand the mechanisms behind these effects,” Murphy said. “We do not fully understand what drives these increased risks in the baby; how much of it is genetic, due to asthma exacerbations during pregnancy, whether medication use is involved and whether more active management of asthma can improve outcomes.”

Murphy said that overall, it’s been rewarding to conduct this research to be able to inform health care professionals of the latest evidence in this space.

“It is important for all health professionals involved in the clinical care of pregnant women with asthma to be aware of the potential for poor outcomes for mom and baby,” she said. “However, with good asthma control, most women will experience normal pregnancy outcomes.”

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Vanessa Murphy, PhD, can be reached at vanessa.murphy@newcastle.edu.au.