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

BMJ 2005; 330 doi: https://doi.org/10.1136/bmj.38313.624352.8F (Published 27 January 2005) Cite this as: BMJ 2005;330:230
  1. Marie-Josée Martel, PhD student1,
  2. Évelyne Rey, associated professor2,
  3. Marie-France Beauchesne, assistant clinical professor1,
  4. Sylvie Perreault, assistant professor1,
  5. Geneviève Lefebvre, PhD student3,
  6. Amélie Forget, research assistant4,
  7. Lucie Blais (lucie.blais{at}umontreal.ca), assistant professor1
  1. 1 Faculty of Pharmacy, Université de Montréal, CP 6128, Succursale Centre-ville, Montreal, QC, Canada H3C 3J7
  2. 2 Obstetric and Gynecology Department, Faculty of Medicine, Université de Montréal
  3. 3 Mathematics and Statistics Department, Université de Montréal
  4. 4 Research Center, Hôpital du Sacré-Coeur de Montréal, Montreal
  1. Correspondence to: L Blais
  • Accepted 11 November 2004

Abstract

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 measuresPregnancy 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 pre-eclampsia 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.

Footnotes

  • Embedded Image Definition of maternal chronic disease is on bmj.com

  • Contributors LB, ER, SP, and M-FB designed the study. AF, GL, and M-JM generated and prepared the cohort. M-JM analysed the data. M-JM, LB, and ÉR interpreted the findings. All authors wrote the paper. LB will act as guarantor.

  • Funding This research was funded by the Association pulmonaire du Québec and the Fondation Canadienne pour l'innovation.

  • Competing interests LB and M-FB are cochairs of the endowment chair AstraZeneca in respiratory health. LB is the recipient of a new investigator salary support from the Canadian Institutes for Health Research. M-FB has received a fee from GlaxoSmithKline for speaking at an educational programme on asthma. SP is the recipient of a Chercheur Boursier Junior II salary support from the Fonds de la recherche en santé du Québec and is pharmaceutical advisory expert for the Quebec health ministry. M-JM is the recipient of a K M Hunter Foundation-Canadian Institutes for Health Research doctoral research scholarship. GL is the recipient of a doctoral research scholarship from the Natural Science and Engineering Research Council of Canada.

  • Ethical approval This study was authorised by the Commission d'accès à l'information du Québec.

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