Gestational diabetes, asthma link highlights need for early screening in pregnant women

Key takeaways:

• Older age and higher BMI increased risk for gestational diabetes among pregnant women.
• A link was found between gestational diabetes and increased asthma exacerbation risk during pregnancy but not postpartum.

Gestational diabetes led to an increased risk for asthma exacerbations during pregnancy among a cohort of women with pre-existing asthma, according to results of a retrospective cohort study.

The findings indicate a need for early universal screening and interventions to improve blood glucose control among this population of pregnant women, researchers concluded.

‘Unique and complex scenario’

“My interest in asthma-related research has focused on how metabolic dysfunction, insulin resistance, obesity and female sex hormones interact to influence asthma severity and outcomes,” Peng Zhang, MD, MSc, staff physician and researcher in the department of pulmonary and critical care medicine at Integrated Hospital Care Institute and Center for Computational Life Sciences at Cleveland Clinic, told Healio.

Peng Zhang

“In pregnant individuals with asthma, the physiological changes during pregnancy, including surges in sex hormones and the development of insulin resistance, create a unique and complex scenario,” Zhang continued. “Unfortunately, this population remains significantly understudied. As an asthma specialist, I frequently encounter expectant mothers who struggle to manage their asthma in addition to the physical and emotional challenges of pregnancy. These experiences have motivated me to understand this intersection better and explore ways to improve outcomes for these patients.”

Researchers sought to examine the potential association between gestational diabetes and increased risk for asthma exacerbations during pregnancy and the first year postpartum among a cohort of 10,985 pregnant women without pre-existing diabetes or concurrent chronic lung diseases. For the purpose of this study, researchers defined asthma exacerbations by the need for an oral corticosteroid prescription.

They pooled data from electronic health records between 2010 and 2023, and used multivariable logistic regression and zero-inflated Poisson regression to adjust for age, race, BMI, pre-pregnancy asthma exacerbation history and insurance status.

Asthma exacerbation risk

Overall, 1,492 (13.6%) women had gestational diabetes. Results showed an association with older age and higher BMIs and risk for gestational diabetes.

Researchers observed an association between gestational diabetes and an increased risk for asthma exacerbation during pregnancy (adjusted OR = 1.36; 95% CI 1.1-1.67). Conversely, they found no association during postpartum.

“Our findings are aligned with our initial hypothesis: gestational diabetes is associated with increased risk for asthma exacerbations during pregnancy, which underscores the need for prospective and mechanistic studies to assess causality,” Zhang said. “While this result was anticipated, it also highlighted the critical need to address metabolic health and pre-existing conditions as part of asthma management in pregnant patients.”

In addition, results from stratified analyses that included 4,331 women with gestational blood glucose measurement showed an association between each doubling of blood glucose levels and a twofold increased risk for asthma exacerbations during pregnancy (adjusted OR = 2.02; 95% CI 1.45-2.81).

Data also showed that pre-pregnancy asthma exacerbations, older age and Medicaid coverage increased risk for asthma exacerbations.

“Pregnant individuals with pre-existing asthma face a substantial risk for asthma exacerbations during pregnancy,” Zhang said. “Factors contributing to this increased risk include gestational diabetes, older maternal age and uncontrolled asthma before conception. These findings emphasize the importance of proactive asthma management during pregnancy, particularly for patients with these risk factors.”

Planned collaboration

Looking ahead, Zhang and colleagues will aim to collaborate with other health care networks across Northeast Ohio to expand upon the study population.

“This study was conducted as a single-center investigation at Cleveland Clinic,” Zhang told Healio. “A broader, more diverse sample will help validate our findings and enhance their generalizability. We are committed to deepening our understanding of asthma in pregnancy and identifying interventions that can mitigate risks and improve outcomes for this vulnerable population.”

For more information:

• Peng Zhang MD, MSc, can be reached at zhangp@ccf.org.