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

BMJ 2005; 330 doi: (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}, 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


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.


  • Embedded Image Definition of maternal chronic disease is on

  • 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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