Medicines prescribed for asthma, discontinuation and perinatal outcomes, including breastfeeding: A population cohort analysis

Objectives To explore associations between exposures to medicines prescribed for asthma and their discontinuation in pregnancy and preterm birth [<37 or <32 weeks], SGA [<10th and <3rd centiles], and breastfeeding at 6–8 weeks. Methods Design. A population-based cohort study. Setting. The Secure Anonymised Information Linkage [SAIL] databank in Wales, linking maternal primary care data with infant outcomes. Population. 107,573, 105,331, and 38,725 infants born 2000–2010 with information on premature birth, SGA and breastfeeding respectively, after exclusions. Exposures. maternal prescriptions for asthma medicines or their discontinuation in pregnancy. Methods. Odds ratios for adverse pregnancy outcomes were calculated for the exposed versus the unexposed population, adjusted for smoking, parity, age and socio-economic status. Results Prescriptions for asthma, whether continued or discontinued during pregnancy, were associated with birth at<32 weeks’ gestation, SGA <10th centile, and no breastfeeding (aOR 1.33 [1.10–1.61], 1.10 [1.03–1.18], 0.93 [0.87–1.01]). Discontinuation of asthma medicines in pregnancy was associated with birth at<37 weeks’ and <32 weeks’ gestation (aOR 1.22 [1.06–1.41], 1.53 [1.11–2.10]). All medicines examined, except ICS and SABA prescribed alone, were associated with SGA <10th centile. Conclusions Prescription of asthma medicines before or during pregnancy was associated with higher prevalence of adverse perinatal outcomes, particularly if prescriptions were discontinued during pregnancy. Women discontinuing medicines during pregnancy could be identified from prescription records. The impact of targeting close monitoring and breastfeeding support warrants exploration.