Pregnant women with mild asthma experience few complex treatable traits

Key takeaways:

• More than 80% of pregnant women experienced two or fewer extrapulmonary treatable traits.
• Iron deficiency was the most common extrapulmonary treatable trait among pregnant women.

Pregnant women with mild asthma experienced few extrapulmonary treatable traits, according to research presented at the European Respiratory Society International Congress.

“The clinical implications of this are that while trait assessment needs to be broad for women with mild asthma who are pregnant, trait intervention is less complex as there are fewer traits to treat,” Esha Joshi, MBBS, FRACP, a respiratory and sleep physician at the University of Newcastle School of Medicine and Public Health, Australia, said during her presentation.

Asthma is the most common chronic condition in pregnancy, affecting 8% to 13% of pregnant women globally, with the highest prevalence in Australia, she continued.

“Asthma exacerbations occur in 20% to 45% of pregnant women with asthma and are problematic as they confer a higher odds of developing maternal adverse outcomes, such as preeclampsia, as well as adverse outcomes for the baby, such as low birth weight,” Joshi said. “It is known that the risk for complications is small in those with well-controlled asthma. Hence, therapeutic goals for asthma management during pregnancy should focus on reducing asthma exacerbation and maintaining asthma control ... A multimodality treatable traits approach could address the complexity and heterogeneity of [asthma in pregnancy].”

Researchers sought to determine the prevalence of five extrapulmonary treatable traits (ETTs) for asthma in pregnancy — mental health conditions, GERD, rhinitis, iron deficiency and significant nausea — in 725 pregnant women (mean age, 30 years; 81.8% white) at 12 weeks’ to less than 24 weeks’ gestation with mostly mild asthma enrolled in the Breathing for Life Trial.

According to study results, iron deficiency was the most common ETT among participants (64%). This was followed by GERD (32.3%); mental health conditions (28.6%), including depression (18.2%; 95% CI, 0.16-0.21) and anxiety (17%; 95% CI, 0.14-0.2); significant nausea (16.3%); and rhinitis (8.3%).

Additionally, pregnant women experienced one out of five ETTs, with more than 80% of pregnant women experiencing two or fewer treatable ETTs (one ETT, 37.1%; two ETTs, 29.4%; no ETTs, 17.5%).

“ETTs showed similar trait heterogeneity as more severe asthma and COPD in this group of women with predominantly mild asthma and have reduced trait complexity,” Joshi said. “Data on the prevalence of treatable traits and whether they predict exacerbation in pregnancy are required to inform better management approaches in pregnant women with asthma. [In addition], a feasibility randomized control trial that applies a treatable trait multidimensional intervention in the clinical setting against the stepwise conventional approach [is also needed].”