Asthma and lower airway diseaseHigh doses of inhaled corticosteroids during the first trimester of pregnancy and congenital malformations
Section snippets
Source of data
Data for this study were retrieved from 3 administrative databases from the Canadian province of Quebec. The database of the Régie de l'assurance-maladie du Québec (RAMQ) provides information on medical services dispensed to all residents of Quebec and prescribed medications filled in community pharmacies for residents insured by the RAMQ Drug Insurance Plan, about 42% of the residents of the province.19 These include the elderly, and the recipients of social welfare since 1980, and since
Results
The cohort was formed of 13,280 pregnancies from 10,099 women with asthma: 2570 women (25.5%) contributed 2 pregnancies or more to the analysis. Only 154 women used more than 1000 μg/d ICS (1.1%), whereas 4392 (33.1%) used a daily dose varying between >0 and 1000 μg/d, and 8734 (65.8%) did not use any ICSs during the first trimester. Among patients using more than 1000 μg/d, 33% filled prescriptions of beclomethasone dipropionate only, 38% filled prescriptions of fluticasone propionate only,
Discussion
In this study, we observed that women who took high doses of ICSs during the first trimester of pregnancy were 63% more likely to have a baby with a congenital malformation than women taking low to moderate doses of ICSs. This study also showed no increased risk of congenital malformation with low to moderate doses of ICSs compared with nonusers of ICSs. Nonsignificant associations of similar magnitude were observed for major malformations.
This study is the first to observe a statistically
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L.B. and C.L. are the recipients of a Salary Award from the Fonds de la recherche en santé du Québec (FRSQ).This study was funded through grants received from the FRSQ, the Canadian Institutes of Health Research, and the Canadian Foundation for Innovation. The research was completely independent from the funders.
Disclosure of potential conflict of interest: L. Blais receives research support from AstraZeneca and Amgen. M.-F. Beauchesne receives honoraria for CE programs from AstraZeneca, GSK Canada, and BI/Pfizer Canada. C. Lemière receives research support from NIOSH and GlaxoSmithKline. The other author declares that she has no conflict of interest.