Asthma ‘may complicate conception,’ with links to miscarriage, fertility issues

Key takeaways:

• Frequent asthma exacerbations were linked to a higher risk for needing fertility treatments.
• Having asthma did not reduce the number of live births, but did increase fetal loss.

Women with asthma required more fertility treatments and experienced more fetal loss in Denmark, according to an abstract presented at the European Respiratory Society International Congress.

According to Anne Vejen Hansen, MD, PhD candidate in the department of respiratory medicine at Copenhagen University Hospital Hvidovre, this study was prompted by a comment made in response to an oral presentation at last year’s meeting suggesting a need for a large-scale, population-based study to further investigate a potential link between asthma and fertility issues.

“Asthma is common among women of reproductive age, and previous research suggested associations between asthma and prolonged time to pregnancy as well as altered fecundability, however mostly in women with asthma who succeed in becoming pregnant,” Vejen Hansen told Healio. “Given that asthma is a chronic condition that affects millions of women globally, understanding its impact on reproductive health is crucial for better clinical care and patient outcomes.”

The study consisted of data from 769,880 women born between 1976 and 1999 in Denmark who researchers followed from 1994 to 2017. Researchers used the repeated use of anti-asthmatic drugs — including inhaled corticosteroids, long-acting beta agonists, long-acting muscarinic antagonists, short-acting beta agonists and leukotriene receptor antagonists — with severity per 2019 GINA guidelines in order to identify asthma in the study group.

The primary outcome of the study was the need for fertility treatments among women with asthma compared with the control group without asthma.

During a median follow-up of 10.8 years, 77% of the women gave birth regardless of asthma exposure.

Women with asthma saw an increased degree of fetal loss (17% vs. 15.7%) and a more frequent use of fertility treatments (5.6% vs. 5%) compared with the control group.

“The study found that while asthma did not affect the total number of live births, women with asthma were more likely to experience fetal loss and require fertility treatment compared to non-asthmatic women,” Vejen Hansen said.

The risk for needing fertility treatment was also higher among women with asthma (HR = 1.12; 95% CI, 1.08-1.15), with the highest need among women in GINA step 4 or 5 (HR = 1.62; 95% CI, 1.43-1.83). Women with at least three or more prior asthma exacerbations also saw a heightened risk for needing fertility treatment (HR = 1.38; 95% CI, 1.19-1.6).

“The risk of needing fertility treatment was particularly higher in women with severe asthma (GINA step 4-5) and those with three or more exacerbations,” Vejen Hansen said. “Women with severe asthma had a 62% higher risk of requiring fertility treatment compared to controls, and those with frequent exacerbations also had an elevated risk.”

Vejen Hansen further explained that the findings of this study are significant because they highlight a correlation between asthma severity and the need for fertility treatment, something that she says has not been widely recognized before.

“Although asthma did not appear to reduce the number of live births, the increased use of fertility treatment in women with asthma suggests that asthma, particularly in its more severe forms, may complicate conception,” Vejen Hansen said. “Suggesting that severe asthma could be an important factor in fertility treatment decisions, beside the results, also underscores the importance of asthma control in women planning to conceive.”

Vejen Hansen emphasized that clinicians can use these findings to improve the care they provide by closely monitoring asthma severity and exacerbations in women of reproductive age, especially those planning pregnancy or experiencing difficulties conceiving.

“Given the association between severe asthma and the need for fertility treatment, health care providers might consider early intervention or more close asthma management in women with asthma who are planning to conceive,” she said. “Additionally, discussions about fertility issues should be incorporated into asthma management plans for women of childbearing age, particularly those with uncontrolled or severe asthma, as improving asthma control could potentially improve reproductive outcomes.”

The study also points to the need of more integrated care approaches that address both respiratory and reproductive health, according to Vejen Hansen. Public health policies should educate women and their partners about reproductive health and asthma.

“Future research could explore the biological mechanisms linking asthma severity to fertility issues, potentially leading to targeted treatments or preventive strategies,” Vejen Hansen said. “Additionally, public health initiatives could emphasize the importance of asthma control in women of reproductive age as a factor that may influence fertility, improving both asthma outcomes and reproductive health outcomes.”