BMJ, doi: 10.1136/bmj.38313.624352.8F, (Published 19 January 2005)

PRIMARY CARE

Use of inhaled corticosteroids during pregnancy and risk of pregnancy induced hypertension: nested case-control study

Marie-Josée Martel ¹, Évelyne Rey ², Marie-France Beauchesne ¹, Sylvie Perreault ¹, Geneviève Lefebvre ³, Amélie Forget ⁴, Lucie Blais ¹

¹ Faculty of Pharmacy, Université de Montréal, CP 6128, Succursale Centre-ville, Montreal, QC, Canada H3C 3J7
² Obstetric and Gynecology Department, Faculty of Medicine, Université de Montréal
³ Mathematics and Statistics Department, Université de Montréal
⁴ Research Center, Hôpital du Sacré-Cur de Montréal, Montreal

Objective To determine whether the use of inhaled corticosteroids during pregnancy increases the risk of pregnancy induced hypertension and pre-eclampsia among asthmatic women.

Design Nested case-control study.

Setting Three administrative health databases from Quebec: RAMQ, MED-ECHO, and Fichier des événements démographiques.

Participants 3505 women with asthma, totalling 4593 pregnancies, between 1990 and 2000.

Main outcome measures Pregnancy induced hypertension and pre-eclampsia.

Results 302 cases of pregnancy induced hypertension and 165 cases of pre-eclampsia were identified. Use of inhaled corticosteroids from conception until date of outcome was not associated with an increased risk of pregnancy induced hypertension (adjusted odds ratio 1.02, 95% confidence interval 0.77 to 1.34) or pre-eclampsia (1.06, 0.74 to 1.53). No significant dose-response relation was observed between inhaled corticosteroids and pregnancy induced hypertension or pre-eclampsia. Oral corticosteroids were significantly associated with the risk of pregnancy induced hypertension (adjusted odds ratio 1.57, 1.02 to 2.41), and a trend was seen for pre-eclampsia (1.72, 0.98 to 3.02).

Conclusion No significant increase of the risk of pregnancy-induced hypertension or preeclampsia was detected among users of inhaled corticosteroids during pregnancy, while markers of uncontrolled and severe asthma were found to significantly increase the risks of pregnancy-induced hypertension and pre-eclampsia.

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(Accepted 11 November 2004)
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