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Association of Obesity With Pulmonary and Nonpulmonary Complications of Pregnancy in Asthmatic Women

From the ¹Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan; ²Department of Allergy at Kaiser Permanente, San Diego, California; ³the ⁴George Washington University Biostatistics Center, Washington, DC; ⁵Department of Pulmonary Medicine, Johns Hopkins University, Baltimore, Maryland; ⁶Department of Obstetrics and Gynecology, Ohio State University, Columbus, Ohio; ⁷Department of Obstetrics and Gynecology, University of Tennessee, Memphis, Tennessee; ⁸Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, South Carolina; ⁹the National Heart, Lung, and Blood Institute, Bethesda, Maryland; ¹⁰Department of Obstetrics and Gynecology, Alabama, Birmingham, Alabama; ¹¹Department of Obstetrics and Gynecology, University of Chicago, Chicago, Illinois; ¹²Department of Obstetrics and Gynecology, University of Pittsburgh, Pittsburgh, Pennsylvania; ¹³National Institute of Child Health and Human Development, Bethesda, Maryland; Department of Obstetrics and Gynecology, University of Texas Southwestern, Dallas, Texas; ¹⁴Department of Obstetrics and Gynecology, University of Cincinnati, Cincinnati, Ohio; ¹⁵Department of Obstetrics and Gynecology, Wake Forest University, Winston-Salem, North Carolina; ¹⁶Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia, Pennsylvania; ¹⁷Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, California; ¹⁸Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah; ¹⁹Department of Obstetrics and Gynecology, University of Miami, Miami, Florida; and ²⁰Department of Obstetrics and Gynecology, University of Oklahoma, Norman, Oklahoma; Department of Obstetrics and Gynecology, University of Texas, San Antonio, Texas.

OBJECTIVE: To evaluate whether maternal obesity is associated with pulmonary and nonpulmonary pregnancy complications in asthmatic women.

METHODS: This is a secondary analysis of the prospective cohort Asthma During Pregnancy Study. Asthma patients were classified as having either mild or moderate to severe disease at the beginning of the study. Rates of pulmonary complications of asthma in asthmatic women and rates of nonpulmonary complications of pregnancy among asthma patients and controls, were compared between obese (body mass index 30 kg/m²) and nonobese women.

RESULTS: Maternal body mass index and pregnancy outcome data were available for 1,699 of 1,812 asthmatic women and for 867 of 881 controls. Of the asthma subjects, 30.7% (521) were obese compared with 25.5% of the controls, P = .006. Obese women, regardless of whether they had asthma, were more likely to undergo cesarean delivery (OR 1.6, 95% confidence interval [CI]1.3–2.0) to develop preeclampsia or gestational hypertension (OR 1.7 95% CI 1.3–2.3) and gestational diabetes (OR 4.2, 95% CI 2.8–6.3). There were no differences in the rates of overall asthma improvement (20.6% compared with 23.6%, P = .36) or deterioration (33.3% compared with 28.8%, P = .20) between obese and nonobese asthma patients. After adjustment for confounding variables, obesity, not asthma, was associated with nonpulmonary complications of pregnancy, and obesity was associated with an increase in asthma exacerbations as well (OR 1.3, 95% CI 1.1–1.7).

CONCLUSION: Obesity is associated with an increased risk of asthma exacerbations during pregnancy. The increased rate of nonpulmonary complications of pregnancy in asthma patients is associated with obesity in this population and not with asthma status.

LEVEL OF EVIDENCE: II-1

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