The Experts below are selected from a list of 204 Experts worldwide ranked by ideXlab platform
Vicki L Clifton - One of the best experts on this subject based on the ideXlab platform.
-
factors associated with nonadherence to inhaled corticosteroids for Asthma During Pregnancy
The Journal of Allergy and Clinical Immunology: In Practice, 2021Co-Authors: Annelies L Robijn, Joerg Mattes, Peter G Gibson, Vicki L Clifton, Daniel Barker, Warwick B Giles, Michael J Peek, Helen L BarrettAbstract:Background Nonadherence is common among pregnant women prescribed inhaled corticosteroids (ICS) for Asthma and may have serious consequences for mother and baby. Factors associated with ICS nonadherence have not been determined in this population. Objectives To determine factors associated with {1} nonadherence to ICS in early-mid Pregnancy (cross-sectional) and {2} persistent nonadherence to ICS During Pregnancy (longitudinal). Methods Data used come from 3 prospective studies (2004-2019) involving women with Asthma recruited by 23 weeks' gestation (N = 1614). Demographics, Asthma history, and current symptoms were assessed, and spirometry was performed at baseline and throughout Pregnancy. Women self-reported current medication use and number of ICS doses missed in the past week. Nonadherence was defined as ≥20% of prescribed dosages missed in the past week (baseline) and on at least 2 occasions During follow-up (persistent). Factors associated with ICS nonadherence were examined using backward stepwise logistic regression. Results Of 610 (38%) women prescribed ICS at baseline, 236 (39%) were classified as nonadherent. Of 612 (38%) women prescribed ICS During at least 2 follow-up visits, 149 (24%) were classified as persistent nonadherent. Factors associated with nonadherence at baseline were current or ex-smoking, non-Caucasian/non-Indigenous ethnicity, adult diagnosis of Asthma, and lower lung function. Factors associated with persistent nonadherence to ICS were lower maternal age, higher parity, and no prescribed ICS at baseline. Conclusion Young multiparous non-Caucasian/non-Indigenous mothers are at increased risk of being nonadherent to ICS During Pregnancy. Strategies to improve ICS nonadherence should address maternal smoking and target women who (re-)initiate ICS use in Pregnancy.
-
the impact of maternal Asthma During Pregnancy on fetal growth and development a review
Expert Review of Respiratory Medicine, 2020Co-Authors: Ashley Meakin, Zarqa Saif, Nabila Seedat, Vicki L CliftonAbstract:Asthma is a highly prevalent co-morbidity During Pregnancy that can worsen as gestation progresses and is associated with several adverse perinatal outcomes. These adverse outcomes often result fro...
-
maternal allergic Asthma During Pregnancy alters fetal lung and immune development in sheep potential mechanisms for programming Asthma and allergy
The Journal of Physiology, 2019Co-Authors: Amy L Wooldridge, Vicki L Clifton, Timothy J M Moss, Beverly S Muhlhausler, Janna L Morrison, Monerih Jamali, Stefanie Agostino, Robert De MatteoAbstract:Experimental maternal allergic Asthma in sheep provides an experimental model in which to test impacts on progeny Fetuses from allergic Asthmatic ewes had fewer surfactant-producing cells in lungs A greater proportion of lymphocytes from thymus were CD44 positive in fetuses from allergic Asthmatic ewes than controls These changes to fetal development might contribute to poor neonatal lung function and increased risk of allergy seen in offspring of pregnancies complicated by Asthma ABSTRACT: Asthma is prevalent in Pregnancy and increases the risk of disease in offspring, including neonatal respiratory distress and childhood Asthma and allergy, but the mechanisms are not understood. We hypothesized that fetal lung structure and immune phenotype in late gestation fetal sheep would be impaired in our sheep model of maternal allergic Asthma During Pregnancy. Singleton-bearing ewes were either sensitized before Pregnancy to house dust mite (HDM, allergic, n = 7) or non-allergic (control, n = 5), and subsequently subjected to repeated airway challenges with HDM (allergic group) or saline (control group) throughout gestation. Tissues were collected at 140 ± 1 days gestational age (term, ∼147 days). The density of type II alveolar epithelial cells (surfactant protein C-immunostained) in the lungs was 30% lower in fetuses from allergic ewes than controls (P < 0.001), but tissue-to-airspace ratio and numbers of leukocytes and macrophages were not different between groups. The proportion of CD44 lymphocytes in the fetal thymus was 3.5-fold higher in fetuses from allergic ewes than control ewes (P = 0.043). Fewer surfactant-producing type II alveolar epithelial cells may contribute to the increased risk of neonatal respiratory distress in infants of Asthmatic mothers, suggesting that interventions to promote lung maturation could improve their neonatal outcomes. If the elevated lymphocyte expression of CD44 persists postnatally, this would confer greater susceptibility to allergic diseases in progeny of Asthmatic mothers, consistent with observations in humans. Further experiments are needed to evaluate postnatal phenotypes of progeny and investigate potential interventions. This article is protected by copyright. All rights reserved.
-
review placental adaptations to the presence of maternal Asthma During Pregnancy
Placenta, 2017Co-Authors: Ashley Meakin, Zarqa Saif, A R Jones, P Valenzula F Aviles, Vicki L CliftonAbstract:Asthma is a highly prevalent chronic medical condition affecting an estimated 12% of pregnant, women each year, with prevalence of Asthma greatest (up to 16%) among the socially disadvantaged. Maternal Asthma is associated with significant perinatal morbidity and mortality including preterm births, neonatal hospitalisations and low birthweight outcomes each year. We have identified that the placenta adapts to the presence of chronic, maternal Asthma During Pregnancy in a sex specific manner that may confer sex differences in fetal outcome. The male fetus was at greater risk of a poor outcome than a female fetus in the presence of maternal Asthma and an acute inflammatory event such as an Asthma exacerbation. This review will examine the role of sex specific differences in placental function on fetal growth and survival.
-
development of an experimental model of maternal allergic Asthma During Pregnancy
The Journal of Physiology, 2016Co-Authors: Vicki L Clifton, Timothy J M Moss, Amy L Wooldridge, Kathryn L Gatford, Bahar Liravi, Dasom Kim, Beverly S Muhlhausler, Janna L MorrisonAbstract:Maternal Asthma During Pregnancy adversely affects Pregnancy outcomes but identification of the cause/s, and the ability to evaluate interventions, is limited by the lack of an appropriate animal model. We therefore aimed to characterise maternal lung and cardiovascular responses and fetal-placental growth and lung surfactant levels in a sheep model of allergic Asthma. Immune and airway functions were studied in singleton-bearing ewes, either sensitised before Pregnancy to house dust mite (HDM, allergic, n = 7) or non-allergic (control, n = 5), and subjected to repeated airway challenges with HDM (allergic group) or saline (control group) throughout gestation. Maternal lung, fetal and placental phenotypes were characterised at 140 ± 1 days gestational age (term, ∼147 days). The eosinophil influx into lungs was greater after HDM challenge in allergic ewes than after saline challenge in control ewes before mating and in late gestation. Airway resistance increased throughout Pregnancy in allergic but not control ewes, consistent with increased airway smooth muscle in allergic ewes. Maternal allergic Asthma decreased relative fetal weight (-12%) and altered placental phenotype to a more mature form. Expression of surfactant protein B mRNA was 48% lower in fetuses from allergic ewes than controls, with a similar trend for surfactant protein D. Thus, allergic Asthma in pregnant sheep modifies placental phenotype, and inhibits fetal growth and lung development consistent with observations from human pregnancies. Preconceptional allergen sensitisation and repeated airway challenges in pregnant sheep therefore provides an animal model to identify mechanisms of altered fetal development and adverse Pregnancy outcomes caused by maternal Asthma in Pregnancy.
Peter G Gibson - One of the best experts on this subject based on the ideXlab platform.
-
factors associated with nonadherence to inhaled corticosteroids for Asthma During Pregnancy
The Journal of Allergy and Clinical Immunology: In Practice, 2021Co-Authors: Annelies L Robijn, Joerg Mattes, Peter G Gibson, Vicki L Clifton, Daniel Barker, Warwick B Giles, Michael J Peek, Helen L BarrettAbstract:Background Nonadherence is common among pregnant women prescribed inhaled corticosteroids (ICS) for Asthma and may have serious consequences for mother and baby. Factors associated with ICS nonadherence have not been determined in this population. Objectives To determine factors associated with {1} nonadherence to ICS in early-mid Pregnancy (cross-sectional) and {2} persistent nonadherence to ICS During Pregnancy (longitudinal). Methods Data used come from 3 prospective studies (2004-2019) involving women with Asthma recruited by 23 weeks' gestation (N = 1614). Demographics, Asthma history, and current symptoms were assessed, and spirometry was performed at baseline and throughout Pregnancy. Women self-reported current medication use and number of ICS doses missed in the past week. Nonadherence was defined as ≥20% of prescribed dosages missed in the past week (baseline) and on at least 2 occasions During follow-up (persistent). Factors associated with ICS nonadherence were examined using backward stepwise logistic regression. Results Of 610 (38%) women prescribed ICS at baseline, 236 (39%) were classified as nonadherent. Of 612 (38%) women prescribed ICS During at least 2 follow-up visits, 149 (24%) were classified as persistent nonadherent. Factors associated with nonadherence at baseline were current or ex-smoking, non-Caucasian/non-Indigenous ethnicity, adult diagnosis of Asthma, and lower lung function. Factors associated with persistent nonadherence to ICS were lower maternal age, higher parity, and no prescribed ICS at baseline. Conclusion Young multiparous non-Caucasian/non-Indigenous mothers are at increased risk of being nonadherent to ICS During Pregnancy. Strategies to improve ICS nonadherence should address maternal smoking and target women who (re-)initiate ICS use in Pregnancy.
-
prematurity and respiratory function at 6 weeks of age in infants born to mothers with Asthma During Pregnancy and active tobacco smoking
European Respiratory Journal, 2019Co-Authors: Ediane De Queiroz Andrade, Vanessa E Murphy, Peter G Gibson, Patricia De Gouveia Belinelo, Kathryn Jesson, Adam Collison, Paul Robinson, Alexander Wong, Peter D Sly, Joerg MattesAbstract:Introduction: Asthma in Pregnancy and tobacco smoking in Pregnancy are common, and adversely affect Pregnancy outcomes and respiratory health in the offspring. Aim: Our aim was to describe the effect of tobacco smoking on outcomes in offspring born to women with Asthma in Pregnancy who participated in the ongoing multicentre Breathing for Life trial, a controlled randomized trial comparing usual Asthma management with inflammatory (Fraction of exhaled nitric oxide, FeNO)-guided Asthma management. Results: Currently Pregnancy outcome data are available from 400 women and of those 16.0% (64) reported having smoked tobacco any time During Pregnancy. The mean exhaled (e)CO concentration in self-reported smokers was 15.8 ppm and non-smokers it was 3.6 ppm. 14.3% of women (n=48) who self-reported not to smoke had eCO levels of equal or greater than 6ppm. Preterm birth occurred in 12.1% (38 of 314) of women who reported not to smoke and in 11.9% (7 of 59) of women who smoked (p=0.9). Using an eCO level of 6ppm as recommended by Gomez et al (Prev Med 2005) as cut-off to define active smoking, preterm birth occurred in 21.1% (19 of 90) of actively smoking women and in 9.2% (26 of 284) of non-actively smoking women (p=0.002). At six weeks of age, premature infants had a lower mean time to reach peak tidal expiratory flow as a proportion of total expiratory time (tPTEF/TE): 26.2 (95% CI 23.4 to 29.0) vs. 32.4 (95% CI 31.0 to 33.9) in term babies (p=0.004). Conclusion: Active tobacco smoking identified by eCO was associated with increased rates of premature birth. Prematurity was associated with impaired lung function at six weeks of age in the offspring.
-
late breaking abstract maternal Asthma weight gain in early life and infant lung function
European Respiratory Journal, 2019Co-Authors: Patricia De Gouveia Belinelo, Vanessa E Murphy, Kathryn Jesson, Adam Collison, Paul Robinson, Rhea Appenzeller, Olga Gorlanova, Christopher Oldmeadow, Philipp Latzin, Peter G GibsonAbstract:Background: Maternal Asthma is a strong risk factor for the development of respiratory disease in the offspring. Objective: To determine the effect of maternal Asthma on Tidal Breathing Flow Volume Loop (TBFVL) parameters in babies at 6 weeks of age. Methods: TBFVL were measured in accordance with ERS/ATS standards using an ultrasonic flow meter (Spiroson®; EcoMedics AG). Data were merged from two cohorts, the Breathing for Life Trial (BLT) and the Bern Infant Lung Development (BILD) birth cohort. BLT is an ongoing multicentre study including children born to mothers with Asthma During Pregnancy. BILD is a cohort study including children born to mothers with and without Asthma (90%). Results: TBFVL of 497 (83%) were acceptable for the final analysis of whom 344 infants were BLT and 252 infants were from BILD. Mean (±STD) time to peak tidal expiratory flow divided by total time expiratory flow percentage ratio (tPTEF/tE%) for the different sites were: Sydney (32.9 ±9.4), Newcastle (31.5 ±9.9) and Bern (34.9 ±10.3). Maternal Asthma (parameter estimate: 2.31, p=0.023), gestational age (1.38, p Conclusion: Maternal Asthma may be associated with lower tPTEF/tE% but the maternal Asthma significance could be due to a centre effect. Weight gain in first 6 weeks of life is associated with a higher tPTEF/tE%. Optimising weight gain in early life could improve lung function.
-
Asthma During Pregnancy exacerbations management and health outcomes for mother and infant
Seminars in Respiratory and Critical Care Medicine, 2017Co-Authors: Vanessa E Murphy, Peter G Gibson, Megan E JensenAbstract:One in 10 pregnant women worldwide has Asthma and of these, 10% will have a severe exacerbation requiring oral corticosteroids (OCSs) in Pregnancy. This review of recent publications in the field will describe the effects of exacerbation on maternal and neonatal health, the use of Asthma medications During Pregnancy, and will suggest novel management approaches for Asthma in Pregnancy. Pregnancy results in unpredictable changes in the disease; therefore, regular monitoring of symptoms is recommended. Uncontrolled Asthma is frequently described in cohorts of pregnant women with Asthma, and some recent studies show associations with adverse perinatal outcomes, as previously demonstrated with exacerbations. Guidelines for the management of Asthma recommend the continued use of inhaled corticosteroids (ICSs) in Pregnancy, with budesonide having a particularly good safety profile. Recent data suggest small effects of Asthma and/or Asthma medication use on congenital malformations; however, there is less data available on the safety of ICS/long-acting β agonist combinations, which are increasingly used for maintenance treatment. Novel management strategies are needed to address the complex needs of pregnant women with Asthma. These include medication nonadherence and the presence of numerous comorbidities which can affect Asthma, such as rhinitis, cigarette smoking, obesity, and mental health issues. Inflammation-based management has been shown to be effective in reducing exacerbations in Pregnancy and may also improve perinatal outcomes. The involvement of a multidisciplinary team and the assessment of comorbidities have potential to improve the health of mothers and their offspring.
-
differential dna methylation profiles of infants exposed to maternal Asthma During Pregnancy
Pediatric Pulmonology, 2014Co-Authors: Lakshitha P Gunawardhana, Katherine J Baines, Joerg Mattes, Vanessa E Murphy, Jodie L Simpson, Peter G GibsonAbstract:Summary Background Asthma is a complex disease that involves both genetic factors and environmental exposures. Aberrant epigenetic modifications, such as DNA methylation, may be important in Asthma development. Fetal exposure to maternal Asthma During critical periods of in utero development may lead to epigenetic alterations that predispose infants to a greater risk of developing Asthma themselves. We investigated alterations in the DNA methylation profile of peripheral blood from infants exposed to maternal Asthma During Pregnancy. Methods Peripheral blood was collected from 12-month-old infants born to women with (n = 25) and without (n = 15) doctor diagnosed Asthma During Pregnancy. Genomic DNA was extracted, bisulfite converted, and hybridized to Infinium Methylation 27 arrays (Illumina), containing over27,000 CpGs from 14,495 genes. CpG loci in only autosomal genes were classified as differentially methylated at the 99% level (P 22 and delta beta >0.06). Results There were 70 CpG loci, corresponding to 67 genes that were significantly differentially methylated. Twelve CpG loci (11 genes) showed greater than 10% comparative difference in DNA methylation, including hyper-methylated loci of FAM181A, MRI1, PIWIL1, CHFR, DEFA1, MRPL28, AURKA, and hypo-methylated loci of NALP1L5, MAP8KIP3, ACAT2, and PM20D1 in maternal Asthma. Methylation of MAPK8IP3 was significantly negatively correlated with maternal blood eosinophils (r = −0.38; P = 0.022), maternal eNO (r = −0.44; P = 0.005), and maternal serum total IgE (r = −0.39, P = 0.015). Methylation of AURKA negatively correlated with maternal hemoglobin (r = −0.43; P = 0.008), infants height (r = −0.51; P < 0.001) and weight (r = −0.36; P = 0.021). Methylation of PM20D1 was lower in infants born to mothers with Asthma on inhaled corticosteroid treatment. Methylation of PM20D1 was lower and MRI1 was higher in infants born to atopic mothers without Asthma. Conclusions In an Australian study population, exposure to maternal Asthma During Pregnancy is associated with differential methylation profiles of infants' peripheral blood DNA, which may act as risk factors for future Asthma development. Pediatr Pulmonol. 2014; 49:852–862. © 2013 Wiley Periodicals, Inc.
Vanessa E Murphy - One of the best experts on this subject based on the ideXlab platform.
-
prematurity and respiratory function at 6 weeks of age in infants born to mothers with Asthma During Pregnancy and active tobacco smoking
European Respiratory Journal, 2019Co-Authors: Ediane De Queiroz Andrade, Vanessa E Murphy, Peter G Gibson, Patricia De Gouveia Belinelo, Kathryn Jesson, Adam Collison, Paul Robinson, Alexander Wong, Peter D Sly, Joerg MattesAbstract:Introduction: Asthma in Pregnancy and tobacco smoking in Pregnancy are common, and adversely affect Pregnancy outcomes and respiratory health in the offspring. Aim: Our aim was to describe the effect of tobacco smoking on outcomes in offspring born to women with Asthma in Pregnancy who participated in the ongoing multicentre Breathing for Life trial, a controlled randomized trial comparing usual Asthma management with inflammatory (Fraction of exhaled nitric oxide, FeNO)-guided Asthma management. Results: Currently Pregnancy outcome data are available from 400 women and of those 16.0% (64) reported having smoked tobacco any time During Pregnancy. The mean exhaled (e)CO concentration in self-reported smokers was 15.8 ppm and non-smokers it was 3.6 ppm. 14.3% of women (n=48) who self-reported not to smoke had eCO levels of equal or greater than 6ppm. Preterm birth occurred in 12.1% (38 of 314) of women who reported not to smoke and in 11.9% (7 of 59) of women who smoked (p=0.9). Using an eCO level of 6ppm as recommended by Gomez et al (Prev Med 2005) as cut-off to define active smoking, preterm birth occurred in 21.1% (19 of 90) of actively smoking women and in 9.2% (26 of 284) of non-actively smoking women (p=0.002). At six weeks of age, premature infants had a lower mean time to reach peak tidal expiratory flow as a proportion of total expiratory time (tPTEF/TE): 26.2 (95% CI 23.4 to 29.0) vs. 32.4 (95% CI 31.0 to 33.9) in term babies (p=0.004). Conclusion: Active tobacco smoking identified by eCO was associated with increased rates of premature birth. Prematurity was associated with impaired lung function at six weeks of age in the offspring.
-
late breaking abstract maternal Asthma weight gain in early life and infant lung function
European Respiratory Journal, 2019Co-Authors: Patricia De Gouveia Belinelo, Vanessa E Murphy, Kathryn Jesson, Adam Collison, Paul Robinson, Rhea Appenzeller, Olga Gorlanova, Christopher Oldmeadow, Philipp Latzin, Peter G GibsonAbstract:Background: Maternal Asthma is a strong risk factor for the development of respiratory disease in the offspring. Objective: To determine the effect of maternal Asthma on Tidal Breathing Flow Volume Loop (TBFVL) parameters in babies at 6 weeks of age. Methods: TBFVL were measured in accordance with ERS/ATS standards using an ultrasonic flow meter (Spiroson®; EcoMedics AG). Data were merged from two cohorts, the Breathing for Life Trial (BLT) and the Bern Infant Lung Development (BILD) birth cohort. BLT is an ongoing multicentre study including children born to mothers with Asthma During Pregnancy. BILD is a cohort study including children born to mothers with and without Asthma (90%). Results: TBFVL of 497 (83%) were acceptable for the final analysis of whom 344 infants were BLT and 252 infants were from BILD. Mean (±STD) time to peak tidal expiratory flow divided by total time expiratory flow percentage ratio (tPTEF/tE%) for the different sites were: Sydney (32.9 ±9.4), Newcastle (31.5 ±9.9) and Bern (34.9 ±10.3). Maternal Asthma (parameter estimate: 2.31, p=0.023), gestational age (1.38, p Conclusion: Maternal Asthma may be associated with lower tPTEF/tE% but the maternal Asthma significance could be due to a centre effect. Weight gain in first 6 weeks of life is associated with a higher tPTEF/tE%. Optimising weight gain in early life could improve lung function.
-
Asthma During Pregnancy exacerbations management and health outcomes for mother and infant
Seminars in Respiratory and Critical Care Medicine, 2017Co-Authors: Vanessa E Murphy, Peter G Gibson, Megan E JensenAbstract:One in 10 pregnant women worldwide has Asthma and of these, 10% will have a severe exacerbation requiring oral corticosteroids (OCSs) in Pregnancy. This review of recent publications in the field will describe the effects of exacerbation on maternal and neonatal health, the use of Asthma medications During Pregnancy, and will suggest novel management approaches for Asthma in Pregnancy. Pregnancy results in unpredictable changes in the disease; therefore, regular monitoring of symptoms is recommended. Uncontrolled Asthma is frequently described in cohorts of pregnant women with Asthma, and some recent studies show associations with adverse perinatal outcomes, as previously demonstrated with exacerbations. Guidelines for the management of Asthma recommend the continued use of inhaled corticosteroids (ICSs) in Pregnancy, with budesonide having a particularly good safety profile. Recent data suggest small effects of Asthma and/or Asthma medication use on congenital malformations; however, there is less data available on the safety of ICS/long-acting β agonist combinations, which are increasingly used for maintenance treatment. Novel management strategies are needed to address the complex needs of pregnant women with Asthma. These include medication nonadherence and the presence of numerous comorbidities which can affect Asthma, such as rhinitis, cigarette smoking, obesity, and mental health issues. Inflammation-based management has been shown to be effective in reducing exacerbations in Pregnancy and may also improve perinatal outcomes. The involvement of a multidisciplinary team and the assessment of comorbidities have potential to improve the health of mothers and their offspring.
-
the breathing for life trial a randomised controlled trial of fractional exhaled nitric oxide feno based management of Asthma During Pregnancy and its impact on perinatal outcomes and infant and childhood respiratory health
BMC Pregnancy and Childbirth, 2016Co-Authors: Vanessa E Murphy, Joerg Mattes, Warwick B Giles, Michael J Peek, Megan E Jensen, M J Hensley, Andrew Bisits, Leonie K CallawayAbstract:Asthma exacerbations are common During Pregnancy and associated with an increased risk of adverse perinatal outcomes. Adjusting Asthma treatment based on airway inflammation rather than symptoms reduces the exacerbation rate by 50 %. The Breathing for Life Trial (BLT) will test whether this approach also improves perinatal outcomes. BLT is a multicentre, parallel group, randomised controlled trial of Asthma management guided by fractional exhaled nitric oxide (FENO, a marker of eosinophilic airway inflammation) compared to usual care, with prospective infant follow-up. Women with physician-diagnosed Asthma, Asthma symptoms and/or medication use in the previous 12 months, who are 12–22 weeks gestation, will be eligible for inclusion. Women randomised to the control group will have one clinical assessment of their Asthma, including self-management education. Any treatment changes will be made by their general practitioner. Women randomised to the intervention group will have clinical assessments every 3–6 weeks During Pregnancy, and Asthma treatments will be adjusted every second visit based on an algorithm which uses FENO to adjust inhaled corticosteroid (ICS) dose (increase in dose when FENO >29 parts per billion (ppb), decrease in dose when FENO <19 ppb, and no change when FENO is between 19 and 29 ppb). A long acting beta agonist (LABA) will be added when symptoms remain uncontrolled. Both the control and intervention groups will report on exacerbations at a postpartum phone interview. The primary outcome is adverse perinatal outcome (a composite measure including preterm birth, intrauterine growth restriction, neonatal hospitalisation at birth or perinatal mortality), assessed from hospital records. Secondary outcomes will be each component of the primary outcome, maternal exacerbations requiring medical intervention During Pregnancy (both smokers and non-smokers), and hospitalisation and emergency department presentation for wheeze, bronchiolitis or croup in the first 12 months of infancy. Outcome assessment and statistical analysis of the primary outcome will be blinded. To detect a reduction in adverse perinatal outcomes from 35 % to 26 %, 600 pregnant women with Asthma per group are required. This trial will provide evidence for the effectiveness of a FENO-based management strategy in improving perinatal outcomes in pregnant women with Asthma. If successful, this would improve the management of pregnant women with Asthma worldwide. Australian New Zealand Clinical Trials Registry ACTRN12613000202763 .
-
differential dna methylation profiles of infants exposed to maternal Asthma During Pregnancy
Pediatric Pulmonology, 2014Co-Authors: Lakshitha P Gunawardhana, Katherine J Baines, Joerg Mattes, Vanessa E Murphy, Jodie L Simpson, Peter G GibsonAbstract:Summary Background Asthma is a complex disease that involves both genetic factors and environmental exposures. Aberrant epigenetic modifications, such as DNA methylation, may be important in Asthma development. Fetal exposure to maternal Asthma During critical periods of in utero development may lead to epigenetic alterations that predispose infants to a greater risk of developing Asthma themselves. We investigated alterations in the DNA methylation profile of peripheral blood from infants exposed to maternal Asthma During Pregnancy. Methods Peripheral blood was collected from 12-month-old infants born to women with (n = 25) and without (n = 15) doctor diagnosed Asthma During Pregnancy. Genomic DNA was extracted, bisulfite converted, and hybridized to Infinium Methylation 27 arrays (Illumina), containing over27,000 CpGs from 14,495 genes. CpG loci in only autosomal genes were classified as differentially methylated at the 99% level (P 22 and delta beta >0.06). Results There were 70 CpG loci, corresponding to 67 genes that were significantly differentially methylated. Twelve CpG loci (11 genes) showed greater than 10% comparative difference in DNA methylation, including hyper-methylated loci of FAM181A, MRI1, PIWIL1, CHFR, DEFA1, MRPL28, AURKA, and hypo-methylated loci of NALP1L5, MAP8KIP3, ACAT2, and PM20D1 in maternal Asthma. Methylation of MAPK8IP3 was significantly negatively correlated with maternal blood eosinophils (r = −0.38; P = 0.022), maternal eNO (r = −0.44; P = 0.005), and maternal serum total IgE (r = −0.39, P = 0.015). Methylation of AURKA negatively correlated with maternal hemoglobin (r = −0.43; P = 0.008), infants height (r = −0.51; P < 0.001) and weight (r = −0.36; P = 0.021). Methylation of PM20D1 was lower in infants born to mothers with Asthma on inhaled corticosteroid treatment. Methylation of PM20D1 was lower and MRI1 was higher in infants born to atopic mothers without Asthma. Conclusions In an Australian study population, exposure to maternal Asthma During Pregnancy is associated with differential methylation profiles of infants' peripheral blood DNA, which may act as risk factors for future Asthma development. Pediatr Pulmonol. 2014; 49:852–862. © 2013 Wiley Periodicals, Inc.
Charlotte Suppli Ulrik - One of the best experts on this subject based on the ideXlab platform.
-
determinants of low risk of Asthma exacerbation During Pregnancy
Clinical & Experimental Allergy, 2018Co-Authors: Zarqa Ali, Charlotte Suppli Ulrik, Lisbeth NilasAbstract:Background Assessment of Asthma control every 4-6 weeks During Pregnancy is recommended to reduce risk of exacerbation, and by that improve outcome. Objective To identify determinants of pregnancies with low risk of Asthma exacerbation. Methods All pregnant women enrolled into the Management of Asthma During Pregnancy (MAP) program at Hvidovre Hospital since 2007. Assessment of Asthma control, adjustment of treatment, spirometry and measurement of exhaled nitric oxide (FENO) were performed, and baseline characteristics and exacerbation history was collected at enrolment. Determinants of low-exacerbation risk pregnancies were identified by logistic regression analysis (stepwise backward elimination). Results In 1,283 pregnancies, 107 exacerbations were observed. Multiple regression analysis revealed that no history of pre-Pregnancy exacerbations (p<0.001), no prescribed controller medication (p<0.001), and clinically stable Asthma at enrolment (p=0.002)were significantly associated with low risk of exacerbation During Pregnancy, with these combined characteristics only two out of 385 pregnancies were complicated by an exacerbation (OR 0.04, 95% CI 0.01-0.18, p<0.001). Conclusion and clinical relevance Clinically stable Asthma at enrolment, together with no history of previous exacerbations and no prescribed controller medication, are determinants of low risk of an Asthma exacerbation During Pregnancy, which may guide clinicians in individualising surveillance of Asthma During Pregnancy. This article is protected by copyright. All rights reserved.
-
fertility treatment among women with Asthma a case control study of 3689 women with live births
European Respiratory Journal, 2017Co-Authors: Anne Vejen Hansen, Zarqa Ali, Charlotte Suppli Ulrik, Sara S Malchau, Joan Blafoss, Anja PinborgAbstract:Asthma has been linked with prolonged time to Pregnancy. Our aim was to explore a possible association between Asthma and need for fertility treatment among women with live births. All women enrolled in the Management of Asthma During Pregnancy (MAP) program at Hvidovre Hospital (HH), Denmark, (cases) were each matched with the three consecutive women giving birth at HH (controls). Information from the Danish National Assisted Reproductive Technology registry was cross-linked with the Danish Medical Birth registry to identify live births. The primary outcome of interest was births following fertility treatment. Our sample comprised pregnancies from Asthmatic (n=932, cases) and non-Asthmatic (n=2757, controls) mothers (n=932), with 12% (n=114) and 8% (n=212), respectively, having had fertility treatment (OR 1.67, 95% CI 1.32–2.13, p A higher proportion of the births from Asthmatic mothers, compared to non-Asthmatic mothers, involved fertility treatment, not least among women aged 35 years and older.
-
fertility treatment among women with Asthma a case control study of 3689 women with live births
European Respiratory Journal, 2017Co-Authors: Anne Vejen Hansen, Zarqa Ali, Charlotte Suppli Ulrik, Sara S Malchau, Joan Blafoss, Anja PinborgAbstract:Asthma has been linked with prolonged time to Pregnancy. Our aim was to explore a possible association between Asthma and need for fertility treatment among women with live births. All women enrolled in the Management of Asthma During Pregnancy (MAP) programme at Hvidovre Hospital, Denmark were each matched with the next three consecutive women giving birth at Hvidovre Hospital. Information from the Danish National Assisted Reproductive Technology (ART) registry was cross-linked with the Danish Medical Birth registry to identify live births. The primary outcome of interest was births following fertility treatment. Our sample comprised pregnancies from Asthmatic mothers (n=932, described as “cases”) and non-Asthmatic mothers (n=2757, described as “controls”), with 12% (n=114) and 8% (n=212), respectively, having had fertility treatment (OR 1.67, 95% CI 1.32–2.13; p A higher proportion of the births from Asthmatic mothers involved fertility treatment compared to non-Asthmatic mothers, not least among women aged ≥35 years.
-
excessive gestational weight gain in first trimester is a risk factor for exacerbation of Asthma During Pregnancy a prospective study of 1283 pregnancies
The Journal of Allergy and Clinical Immunology, 2017Co-Authors: Zarqa Ali, Lisbeth Nilas, Charlotte Suppli UlrikAbstract:Background Acute exacerbation During Pregnancy is the most important risk factor for an unfavorable outcome of Pregnancy in women with Asthma. Objective We sought to identify Pregnancy-related risk factors for acute exacerbations of Asthma During Pregnancy. Methods Since 2007, all pregnant women referred to give birth at Hvidovre Hospital, Denmark, have been offered participation in the prospective Management of Asthma During Pregnancy (MAP) program. Women were included in the present analysis if they fulfilled the following criteria: (1) diagnosed with Asthma, (2) prescribed at least rescue bronchodilator, and (3) had the first visit to the respiratory outpatient clinic within the first 18 weeks of Pregnancy. Data were analyzed using multiple logistic regression models with backward stepwise elimination (Proc Logistic procedure in SAS). Results Over an 8-year study period, a total of 1283 pregnancies in 1208 women fulfilled the criteria for inclusion in the MAP cohort. Women with Asthma exacerbation(s) had larger gestational weight gain (GWG) in the first trimester of Pregnancy ( P P P Conclusions Excessive GWG in the first trimester is a risk factor for Asthma exacerbation During Pregnancy and the risk increases in a dose-dependent manner with increasing GWG.
-
safety of bronchodilators and corticosteroids for Asthma During Pregnancy what we know and what we need to do better
Journal of Asthma and Allergy, 2013Co-Authors: Thorbjorn Lomholt Gregersen, Charlotte Suppli UlrikAbstract:Asthma is a common medical condition complicating Pregnancy with potentially serious effects on Pregnancy outcome. The aim of this review is to provide an update on efficacy and safety of Asthma medications, primarily bronchodilators and corticosteroids, used During Pregnancy with focus on Pregnancy outcome, and, furthermore, to discuss limitations of available studies and point to possible improvements in future studies. A planned series of systematic searches was conducted using the PubMed database. Use of short-acting β2-agonists has generally been established as safe, and the few studies stating otherwise appear to have, perhaps critical, methodological limitations. The safety of long-acting β2-agonists remains to be further investigated, and the few available studies have methodological limitations and, therefore, provide no definite answers, although a very recent study supports the safety of add-on long-acting β2-agonists to inhaled corticosteroids. Inhaled corticosteroids are generally found to be safe, although further research is needed to investigate both the efficacy and safety of high dose therapy with inhaled corticosteroids. Studies have reported associations between the use of systemic corticosteroids and adverse perinatal outcomes, such as preterm birth, low birth weight, and pre-eclampsia. This must, however, be weighed against the potential serious impact of severe, uncontrolled Asthma itself on Pregnancy outcome. The main obstacle to a valid interpretation of several of the available studies is the inadequate stratification for Asthma severity and control. Overall, Asthma in itself and not just poor Asthma control poses a greater risk to Pregnancy outcomes than Asthma medication. Nonetheless, more studies focusing on disentangling the effects of Asthma alone and Asthma medications are needed. Increased use of stratified risk assessments, taking the concept of Asthma severity into greater consideration, is much warranted in future studies.
Joerg Mattes - One of the best experts on this subject based on the ideXlab platform.
-
factors associated with nonadherence to inhaled corticosteroids for Asthma During Pregnancy
The Journal of Allergy and Clinical Immunology: In Practice, 2021Co-Authors: Annelies L Robijn, Joerg Mattes, Peter G Gibson, Vicki L Clifton, Daniel Barker, Warwick B Giles, Michael J Peek, Helen L BarrettAbstract:Background Nonadherence is common among pregnant women prescribed inhaled corticosteroids (ICS) for Asthma and may have serious consequences for mother and baby. Factors associated with ICS nonadherence have not been determined in this population. Objectives To determine factors associated with {1} nonadherence to ICS in early-mid Pregnancy (cross-sectional) and {2} persistent nonadherence to ICS During Pregnancy (longitudinal). Methods Data used come from 3 prospective studies (2004-2019) involving women with Asthma recruited by 23 weeks' gestation (N = 1614). Demographics, Asthma history, and current symptoms were assessed, and spirometry was performed at baseline and throughout Pregnancy. Women self-reported current medication use and number of ICS doses missed in the past week. Nonadherence was defined as ≥20% of prescribed dosages missed in the past week (baseline) and on at least 2 occasions During follow-up (persistent). Factors associated with ICS nonadherence were examined using backward stepwise logistic regression. Results Of 610 (38%) women prescribed ICS at baseline, 236 (39%) were classified as nonadherent. Of 612 (38%) women prescribed ICS During at least 2 follow-up visits, 149 (24%) were classified as persistent nonadherent. Factors associated with nonadherence at baseline were current or ex-smoking, non-Caucasian/non-Indigenous ethnicity, adult diagnosis of Asthma, and lower lung function. Factors associated with persistent nonadherence to ICS were lower maternal age, higher parity, and no prescribed ICS at baseline. Conclusion Young multiparous non-Caucasian/non-Indigenous mothers are at increased risk of being nonadherent to ICS During Pregnancy. Strategies to improve ICS nonadherence should address maternal smoking and target women who (re-)initiate ICS use in Pregnancy.
-
prematurity and respiratory function at 6 weeks of age in infants born to mothers with Asthma During Pregnancy and active tobacco smoking
European Respiratory Journal, 2019Co-Authors: Ediane De Queiroz Andrade, Vanessa E Murphy, Peter G Gibson, Patricia De Gouveia Belinelo, Kathryn Jesson, Adam Collison, Paul Robinson, Alexander Wong, Peter D Sly, Joerg MattesAbstract:Introduction: Asthma in Pregnancy and tobacco smoking in Pregnancy are common, and adversely affect Pregnancy outcomes and respiratory health in the offspring. Aim: Our aim was to describe the effect of tobacco smoking on outcomes in offspring born to women with Asthma in Pregnancy who participated in the ongoing multicentre Breathing for Life trial, a controlled randomized trial comparing usual Asthma management with inflammatory (Fraction of exhaled nitric oxide, FeNO)-guided Asthma management. Results: Currently Pregnancy outcome data are available from 400 women and of those 16.0% (64) reported having smoked tobacco any time During Pregnancy. The mean exhaled (e)CO concentration in self-reported smokers was 15.8 ppm and non-smokers it was 3.6 ppm. 14.3% of women (n=48) who self-reported not to smoke had eCO levels of equal or greater than 6ppm. Preterm birth occurred in 12.1% (38 of 314) of women who reported not to smoke and in 11.9% (7 of 59) of women who smoked (p=0.9). Using an eCO level of 6ppm as recommended by Gomez et al (Prev Med 2005) as cut-off to define active smoking, preterm birth occurred in 21.1% (19 of 90) of actively smoking women and in 9.2% (26 of 284) of non-actively smoking women (p=0.002). At six weeks of age, premature infants had a lower mean time to reach peak tidal expiratory flow as a proportion of total expiratory time (tPTEF/TE): 26.2 (95% CI 23.4 to 29.0) vs. 32.4 (95% CI 31.0 to 33.9) in term babies (p=0.004). Conclusion: Active tobacco smoking identified by eCO was associated with increased rates of premature birth. Prematurity was associated with impaired lung function at six weeks of age in the offspring.
-
the breathing for life trial a randomised controlled trial of fractional exhaled nitric oxide feno based management of Asthma During Pregnancy and its impact on perinatal outcomes and infant and childhood respiratory health
BMC Pregnancy and Childbirth, 2016Co-Authors: Vanessa E Murphy, Joerg Mattes, Warwick B Giles, Michael J Peek, Megan E Jensen, M J Hensley, Andrew Bisits, Leonie K CallawayAbstract:Asthma exacerbations are common During Pregnancy and associated with an increased risk of adverse perinatal outcomes. Adjusting Asthma treatment based on airway inflammation rather than symptoms reduces the exacerbation rate by 50 %. The Breathing for Life Trial (BLT) will test whether this approach also improves perinatal outcomes. BLT is a multicentre, parallel group, randomised controlled trial of Asthma management guided by fractional exhaled nitric oxide (FENO, a marker of eosinophilic airway inflammation) compared to usual care, with prospective infant follow-up. Women with physician-diagnosed Asthma, Asthma symptoms and/or medication use in the previous 12 months, who are 12–22 weeks gestation, will be eligible for inclusion. Women randomised to the control group will have one clinical assessment of their Asthma, including self-management education. Any treatment changes will be made by their general practitioner. Women randomised to the intervention group will have clinical assessments every 3–6 weeks During Pregnancy, and Asthma treatments will be adjusted every second visit based on an algorithm which uses FENO to adjust inhaled corticosteroid (ICS) dose (increase in dose when FENO >29 parts per billion (ppb), decrease in dose when FENO <19 ppb, and no change when FENO is between 19 and 29 ppb). A long acting beta agonist (LABA) will be added when symptoms remain uncontrolled. Both the control and intervention groups will report on exacerbations at a postpartum phone interview. The primary outcome is adverse perinatal outcome (a composite measure including preterm birth, intrauterine growth restriction, neonatal hospitalisation at birth or perinatal mortality), assessed from hospital records. Secondary outcomes will be each component of the primary outcome, maternal exacerbations requiring medical intervention During Pregnancy (both smokers and non-smokers), and hospitalisation and emergency department presentation for wheeze, bronchiolitis or croup in the first 12 months of infancy. Outcome assessment and statistical analysis of the primary outcome will be blinded. To detect a reduction in adverse perinatal outcomes from 35 % to 26 %, 600 pregnant women with Asthma per group are required. This trial will provide evidence for the effectiveness of a FENO-based management strategy in improving perinatal outcomes in pregnant women with Asthma. If successful, this would improve the management of pregnant women with Asthma worldwide. Australian New Zealand Clinical Trials Registry ACTRN12613000202763 .
-
differential dna methylation profiles of infants exposed to maternal Asthma During Pregnancy
Pediatric Pulmonology, 2014Co-Authors: Lakshitha P Gunawardhana, Katherine J Baines, Joerg Mattes, Vanessa E Murphy, Jodie L Simpson, Peter G GibsonAbstract:Summary Background Asthma is a complex disease that involves both genetic factors and environmental exposures. Aberrant epigenetic modifications, such as DNA methylation, may be important in Asthma development. Fetal exposure to maternal Asthma During critical periods of in utero development may lead to epigenetic alterations that predispose infants to a greater risk of developing Asthma themselves. We investigated alterations in the DNA methylation profile of peripheral blood from infants exposed to maternal Asthma During Pregnancy. Methods Peripheral blood was collected from 12-month-old infants born to women with (n = 25) and without (n = 15) doctor diagnosed Asthma During Pregnancy. Genomic DNA was extracted, bisulfite converted, and hybridized to Infinium Methylation 27 arrays (Illumina), containing over27,000 CpGs from 14,495 genes. CpG loci in only autosomal genes were classified as differentially methylated at the 99% level (P 22 and delta beta >0.06). Results There were 70 CpG loci, corresponding to 67 genes that were significantly differentially methylated. Twelve CpG loci (11 genes) showed greater than 10% comparative difference in DNA methylation, including hyper-methylated loci of FAM181A, MRI1, PIWIL1, CHFR, DEFA1, MRPL28, AURKA, and hypo-methylated loci of NALP1L5, MAP8KIP3, ACAT2, and PM20D1 in maternal Asthma. Methylation of MAPK8IP3 was significantly negatively correlated with maternal blood eosinophils (r = −0.38; P = 0.022), maternal eNO (r = −0.44; P = 0.005), and maternal serum total IgE (r = −0.39, P = 0.015). Methylation of AURKA negatively correlated with maternal hemoglobin (r = −0.43; P = 0.008), infants height (r = −0.51; P < 0.001) and weight (r = −0.36; P = 0.021). Methylation of PM20D1 was lower in infants born to mothers with Asthma on inhaled corticosteroid treatment. Methylation of PM20D1 was lower and MRI1 was higher in infants born to atopic mothers without Asthma. Conclusions In an Australian study population, exposure to maternal Asthma During Pregnancy is associated with differential methylation profiles of infants' peripheral blood DNA, which may act as risk factors for future Asthma development. Pediatr Pulmonol. 2014; 49:852–862. © 2013 Wiley Periodicals, Inc.
-
prenatal origins of bronchiolitis protective effect of optimised Asthma management During Pregnancy
Thorax, 2014Co-Authors: Joerg Mattes, Vanessa E Murphy, Peter G Gibson, Heather PowellAbstract:Objective Maternal Asthma is the most common chronic disease complicating Pregnancy and is a risk factor for bronchiolitis in infancy. Recurrent episodes of bronchiolitis are strongly associated with the development of childhood Asthma. Methods We conducted a follow-up study of infants born to women with Asthma who completed a double-blind randomised controlled trial During Pregnancy. In this trial, pregnant women with Asthma were assigned to treatment adjustment by an algorithm using clinical symptoms (clinical group) or the fraction of exhaled nitric oxide (FeNO group) and we showed that the FeNO group had significantly lower Asthma exacerbation rates in Pregnancy. Results 146 infants attended the 12-month follow-up visit. Infants born to mothers from the FeNO group were significantly less likely to have recurrent episodes of bronchiolitis in the first year of life (OR 0.08, 95% CI 0.01 to 0.62; p=0.016) as compared with the clinical group. Conclusions Optimised management of Asthma During Pregnancy may reduce recurrent episodes of bronchiolitis in infancy, which could potentially modulate the risk to develop or the severity of emerging childhood Asthma.
