Certain asthma medication tied to infertility in women
Managing asthma with short-acting β-agonists (SABAs) was associated with reduced fertility in women, while the use of inhaled corticosteroids (ICS) with or without long-acting β-agonists (LABAs) was not, according to the SCOPE* study.
“Studying the effect of asthma treatments in women who are pregnant or trying to get pregnant is important as women often express concerns about exposing their unborn babies to potentially harmful effects of medications,” said lead author Dr Luke Grzeskowiak of the University of Adelaide, Australia, who added that the findings provide reassurance for women with asthma to use ICS.
The multicentre prospective cohort study involved 5,617 healthy, nulliparous pregnant women enrolled in the SCOPE study. Women with physician-diagnosed asthma (n=1,106 [19.7 percent]) were identified based on self-reported responses to questionnaires. Women with asthma were classified into having former asthma (n=450) or current asthma (n=656); and those with current asthma were further grouped according to asthma medication use: SABA only, or ICS ± LABA. [Eur Respir J 2018;doi:10.1183/13993003.02035-2017]
Compared with women without asthma, women with current asthma who were managed with SABAs were 15 percent less likely to get pregnant (adjusted odds ratio [OR] for fecundability, 0.85, 95 percent confidence interval [CI], 0.75– 0.96).
On the other hand, women with current asthma who used ICS ± LABA (OR, 1.00) or those with former asthma (OR, 0.98) showed similar likelihood of getting pregnant as those without asthma.
Also, women with current asthma who used SABAs took a longer time to get pregnant (OR for subfertility [defined as >12 months in time to pregnancy], 1.30, 95 percent CI, 0.93–1.81) compared with women without asthma; but not for those using ICS ± LABA or with former asthma.
“The lack of associations with ICS ± LABAs use suggests that preventer medications may play a protective role in improving asthma control and reducing associated systemic inflammation which may drive impaired fertility,” said Grzeskowiak and co-authors.
As concerns regarding the safety of using preventer medications (eg, ICS) during pregnancy can lead to poor adherence and subsequent negative pregnancy outcomes, the researchers said the results are important in reassuring women to continue using their preventer medications even when they are planning for pregnancy.
“There is plenty of evidence that maternal asthma has a negative impact on the health of pregnant mothers and their babies, and so our general advice is that women should take steps to get their asthma under control before trying to conceive,” said Grzeskowiak. “These findings support appropriate management of asthma with ICS preventer medications to ensure optimal asthma control.”
According to the researchers, the exact mechanisms underlying the association between asthma or asthma treatment and fertility were still unclear, but previous studies have suggested that inflammation triggered during an asthma attack can affect other organs, such as the uterus, besides affecting the lung. [Eur Respir J 2014;43:1077-1085; J Asthma 2015;52:336-342]
As the data on lung function and asthma control were unavailable, the researchers were unable to assess the associations according to asthma severity. They also recognized the assumption that medication use reported at 15 weeks of gestation reflected the entire periconceptual period as a study limitation.