Yland JJ, Crowe HM, Hatch EE, Willis SK, Wang TR, Mikkelsen EM, Savitz DA, Walkey AJ, Rothman KJ, Wise LA. A prospective study of preconception asthma and spontaneous abortion. Ann Epidemiol. 2022 May;69:27-33. doi: 10.1016/j.annepidem.2022.02.006

PURPOSE To evaluate the relationships among history of asthma, asthma severity, and spontaneous abortion (SAB).

METHODS: Pregnancy Study Online (PRESTO) is a preconception cohort study of North American couples. During the preconception period, female participants reported their history of physician-diagnosed asthma, age at first diagnosis, and use of asthma medications in the previous 4 weeks. Asthma severity was classified by medication use proximal to conception, from level 0 to 3 in increasing severity. Pregnancy and SAB were identified using data from follow-up questionnaires. We estimated hazard ratios (HRs) and 95% confidence intervals (CIs).

RESULTS: Among 6,325 participants who conceived, 19% experienced SAB and 17% reported a history of asthma. There was no appreciable association between asthma history and SAB incidence (HR=0.98; 95% CI: 0.84, 1.14). HRs comparing severity levels 0, 1, and 2-3 with no asthma were 0.82 (95% CI: 0.67, 1.01), 1.20 (95% CI: 0.91, 1.60), and 1.31 (95% CI: 0.97, 1.78), respectively. Among women who conceived without the use of fertility treatment, level 2-3 severity was associated with SAB (HR=1.39; 95% CI: 1.02, 1.89).

CONCLUSIONS: While history of asthma diagnosis was not materially associated with SAB, having severe asthma (based on medication use) was associated with greater SAB risk.

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