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Do improvements in clinical practice guidelines alter pregnancy outcomes in asthmatic women? A single-center retrospective cohort study.

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dc.contributor.authorRobinson, J.L.
dc.contributor.authorGatford, K.L.
dc.contributor.authorHurst, C.P.
dc.contributor.authorClifton, V.L.
dc.contributor.authorMorrison, J.L.
dc.contributor.authorStark, M.J.
dc.date.issued2023
dc.descriptionData source: Supplementary information, https://doi.org/10.1080/02770903.2023.2200824
dc.description.abstractOBJECTIVE: Asthma occurs in ∼17% of Australian pregnancies and is associated with adverse perinatal outcomes, which worsen with poor asthma control . Consequently, the South Australian 'Asthma in Pregnancy' perinatal guidelines were revised in 2012 to address management according to severity. This study investigated if these revised guidelines reduced the impact of maternal asthma on risks of adverse perinatal outcomes before (Epoch 1, 2006-2011) and after the revision (Epoch 2, 2013-2018). METHODS: Routinely collected perinatal and neonatal datasets from the Women's and Children's Hospital (Adelaide, Australia) were linked. Maternal asthma (prevalence:7.5%) was defined as asthma medication use or symptoms described to midwives. In imputation (n = 59131) and complete case datasets (n = 49594), analyses were conducted by inverse proportional weighting and multivariate logistic regression, accounting for confounders. RESULTS: Overall, maternal asthma was associated with increased risks of any antenatal corticosteroid treatment for threatened preterm birth (aOR 1.319, 95% CI 1.078-1.614), any Caesarean section (aOR 1.196, 95% CI 1.059-1.351), Caesarean section without labor (aOR 1.241, 95% CI 1.067-1.444), intrauterine growth restriction (IUGR, aOR 1.285, 95% CI 1.026-1.61), and small for gestational age (aOR 1.324, 95% CI 1.136-1.542). After guideline revision, asthma-associated risks of any Caesarean section (p < 0.001), any antenatal corticosteroids (p = 0.041), and small for gestational age (p = 0.050), but not IUGR and Caesarean section without labour, were reduced. CONCLUSIONS: Clinical practice guidelines based on the latest evidence do not guarantee clinical efficacy. Since adverse perinatal outcomes did not all improve, this work highlights the need to evaluate the ongoing impact of guidelines on clinical outcomes.
dc.identifier.citationJournal of Asthma, 2023; 60(10):1907-1917
dc.identifier.doi10.1080/02770903.2023.2200824
dc.identifier.issn0277-0903
dc.identifier.issn1532-4303
dc.identifier.orcidRobinson, J.L. [0000-0001-5267-1496]
dc.identifier.orcidGatford, K.L. [0000-0002-2823-3004]
dc.identifier.orcidClifton, V.L. [0000-0002-4892-6748]
dc.identifier.orcidStark, M.J. [0000-0001-5518-1580] [0000-0003-1835-8679]
dc.identifier.urihttps://hdl.handle.net/11541.2/33982
dc.language.isoen
dc.publisherTaylor and Francis Group
dc.rightsCopyright 2023 Taylor & Francis Group Access Condition Notes: Accepted manuscript available after 1 July 2024
dc.source.urihttps://doi.org/10.1080/02770903.2023.2200824
dc.subjectclinical guidelines
dc.subjectmaternal asthma
dc.subjectobstetrics
dc.subjectperinatal medicine
dc.subjectpregnancy
dc.titleDo improvements in clinical practice guidelines alter pregnancy outcomes in asthmatic women? A single-center retrospective cohort study.
dc.typeJournal article
pubs.publication-statusPublished
ror.fileinfo12262470420001831 13262480420001831 Open Access Postprint
ror.mmsid9916736928501831

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