GESTATIONAL diabetes mellitus (GDM) significantly increases the risk of asthma exacerbations during pregnancy, particularly among individuals with higher blood glucose levels, emphasising the need for proactive management in this population.
Asthma affects approximately 13% of pregnancies globally, and gestational diabetes mellitus (GDM) is present in about 14%, with both conditions linked to adverse maternal and perinatal outcomes. Despite this, limited data exist on how GDM impacts asthma control during pregnancy. A retrospective cohort study sought to address this gap by examining the relationship between GDM and asthma exacerbations during pregnancy and the first postpartum year, defined by the need for oral corticosteroids.
The study analysed electronic health records of 10,985 pregnant individuals with pre-existing asthma, of whom 1,492 (13.6%) had GDM. Patients with GDM were older (median age 30 vs 27.5 years; 95% confidence interval [CI], 2.2-2.9) and had higher BMIs (mean BMI, 31.2 vs 28.3 kg/m²; 95% CI, 2.0-3.3) compared to those without GDM. Multivariable logistic regression revealed that GDM increased the odds of asthma exacerbations during pregnancy by 36% (adjusted odds ratio [OR], 1.36; 95% CI, 1.10-1.67), though no significant association was observed postpartum. Among 4,331 individuals with blood glucose measurements, a doubling of blood glucose levels was associated with a twofold increased risk of asthma exacerbations during pregnancy (adjusted OR, 2.02; 95% CI, 1.45-2.81). Other factors linked to exacerbations included pre-pregnancy asthma exacerbation history, older maternal age, and Medicaid coverage.
These findings highlight the importance of early and universal screening for GDM in pregnant individuals with asthma, as well as interventions to optimise blood glucose control. Poorly managed asthma during pregnancy poses severe risks, including heightened maternal and perinatal morbidity and mortality. Tailored management strategies should focus on reducing baseline asthma severity and addressing comorbidities such as insulin resistance. Future studies should explore whether targeted interventions, such as combining glucose-lowering therapies with enhanced asthma management, can further reduce exacerbation rates and improve outcomes in this high-risk group.
Abigail Craig, EMJ
Reference
Zhang P et al. Asthma Exacerbation Risk in Pregnancy and Postpartum: Assessing the Impact of Gestational Diabetes Mellitus and Other Key Factors. J Allergy Clin Immunol Pract. 2024;S2213-2198(24):01255-8.
