Grossesse

Question 1

Causes de l’exacerbation d’asthme pendant la grossesse ?

Answer 1

• Mechanical or hormonal changes
• cessation or reduction of asthma medications
• Particularly susceptible to the effects of viral respiratory infections (including influenza)

Question 2

Quels sont les risques pour la mère ? (1) Pour l’enfant ? (3)

Answer 2

Mère : pre-eclampsia
Enfant :
- Pre-term delivery
- Low birth weight
- Increased perinatal mortality

Question 3

FR d’exacerbation d’asthme pendant la grossesse ? (7)

Answer 3

• Severe asthma
• Multiparity
• Black ethnicity
• Depression and anxiety
• Current smoking
• Age >35 years
• Obesity

Question 4

L’utilisation de CSI pendant la grossesse protège-t-elle de l’asthme dans l’enfance ?

Answer 4

Use of ICS during pregnancy by women with asthma may also be protective for asthma in their children. A study using administrative data reported that uncontrolled maternal asthma increased the risk of early-onset asthma in the offspring

Question 5

Quel est le risque d’exa pendant la grossesse des patientes contrôlése sans ttt de fond et sans atcd d’exa antérieure ?

Answer 5

One observational study found that pregnant women whose asthma was well controlled without controller therapy and who had no history of previous exacerbations were at low risk for exacerbations during pregnancy.
However, such women should still be closely monitored.

Question 6

CSO dans l’asthme et allaitement : quelles précautions selon la dose (+/- 60mg) ? (CRAT)

Answer 6

On préfèrera la prednisone (Cortancyl®), la prednisolone (Solupred®,…) ou la méthylprednisolone (Solumédrol®)

A des doses ≤ 60 mg / j : l’allaitement est possible.
A des doses > 60 mg / j pendant une durée courte ( <1 semaine) : l’allaitement est possible.
A des doses > 60 mg / j pendant une durée supérieure à une semaine ou après une injection IV de méthylprednisolone : l’allaitement est possible mais il est préférable d’attendre si possible environ 4 heures entre la prise du traitement et la tétée.

Question 7

Les association de B2/antichol/CSI/montelukast/Omalizumab sont possibles pendant la grossesse et l’allaitement. Un B2 longue durée à éviter car peu de donnée, lequel ?

Answer 7

Vilantérol

Question 8

Quels IPP chez la femme enceinte ?

Answer 8

On préférera si possible l’ésoméprazole, le lansoprazole ou l’oméprazole, mieux connus chez la femme enceinte.
Si ces options ne conviennent pas, l’utilisation du pantoprazole est envisageable quel que soit le terme de la grossesse.

Question 9

L’allaitement diminue-t-il le risque d’asthme chez l’enfant ?

Answer 9

Despite the existence of many studies reporting a beneficial effect of breastfeeding on asthma prevention, results are conflicting, and caution should be taken in advising families that breastfeeding will prevent asthma. Breastfeeding decreases wheezing episodes in early life; however, it may not prevent development of persistent asthma (Evidence D). Regardless of any effect on development of asthma, breastfeeding should be encouraged for all of its other positive benefits (Evidence A).

Question 10

La prise de poids chez la mère est-elle liée à l’asthme chez l’enfant ?

Answer 10

Each 1 kg/m2 increase in maternal body-mass index (BMI) was associated with a 2% to 3% increase in the odd of childhood asthma. High gestational weight gain was associated with higher odds of ever asthma or wheeze. However, no recommendations can be made at present, as unguided weight loss in pregnancy should not be encouraged.

Question 11

La supplémentation en vitamine D joue-t-elle un rôle dans le développement de l’asthme chez l’enfant ?

Answer 11

The results from two trials were combined, there was a 25% reduction of risk of asthma/recurrent wheeze at ages 0–3 years. The effect was greatest among women who maintained** 25(OH)vitamin D levels of at least 30 ng/mL** from the time of study entry through delivery, suggesting that sufficient levels of Vitamin D during early pregnancy may be important in decreasing risk for early life wheezing episodes, although in both trials, no effects of vitamin D supplementation on the development of asthma and recurrent wheeze were evident at the age of 6 years. Secondary analysis of the VDAART study suggested that earlier supplementation may be more effective in reducing the risk of asthma

Question 12

Faut-il recommander un régime pendant la grossesse ?

Answer 12

Current evidence does not clearly demonstrate that ingestion of any specific foods during pregnancy increases the risk for asthma. However, a study of a pre-birth cohort observed that maternal intake of foods commonly considered allergenic (peanut and milk) was associated with a decrease in allergy and asthma in the offspring.

Epidemiological studies and randomized controlled trials on maternal dietary intake of fish or long-chain polyunsaturated fatty acids during pregnancy showed no consistent effects on the risk of wheeze, asthma or atopy in the child.
Dietary changes during pregnancy are therefore not recommended for prevention of allergies or asthma.