The rate of Asthma complications among low-income pregnant women is high, with black women being especially vulnerable, a new study suggests.
Among more than 4,300 pregnant, asthmatic women in the Tennessee Medicaid program, researchers found that 11 percent had to visit the emergency room and 6 percent had to be hospitalized for Asthma exacerbations during pregnancy.
Complication rates were higher among black women than white women, despite the fact that all had health coverage through Medicaid.
The reasons for the racial disparity are unclear, said study co-author Dr. Tina V. Hartert. But, she add, that even though black women had the same access to healthcare as white women, that does not mean they received comparable care.
When it came to prenatal care, Hartert and her colleagues found, black women did appear to get lesser care than white women, based on the timing of their first prenatal visits and the number of services they received.
Overall, the study findings “give a clue that the adequacy of care was not the same,” said Hartert, of Vanderbilt University School of Medicine in Nashville.
She and her colleagues report the results in the July issue of the journal Obstetrics and Gynecology.
It’s estimated that pregnancy worsens Asthma in about 30 percent of women who initially have mild symptoms. Asthma management during pregnancy is similar to treatment of the condition in general, with the goal being to prevent attacks of wheezing and breathlessness.
Short- and long-acting inhaled medications are considered safe during pregnancy, and experts recommend that pregnant women with persistent asthma keep taking inhaled corticosteroids or other daily medications to prevent exacerbations. Uncontrolled asthma can diminish the amount of oxygen getting to the fetus, potentially impairing fetal growth.
Still, Hartert pointed out, many women, and even some doctors, may be unaware that many asthma medications can be taken safely during pregnancy, and some women may stop taking their medications on their own.
Among the 4,315 asthmatic women in this study, only 16 percent were on inhaled medications during their pregnancy. Overall, 13 percent ended up needing at least one prescription for “rescue” corticosteroids to control asthma exacerbations.
Black women were more likely than white women to need such prescriptions (nearly 15 percent versus 12 percent) and had higher rates of emergency room visits and hospitalization for Asthma. They were anywhere from 35 percent to 89 percent more likely to suffer these complications, even when factors such as education, smoking and region of residence were considered.
This study, Hartert said, cannot answer the question of why complications were more common among black women. Besides differences in quality of care, other factors such as racial differences in response to medications could be involved, she noted.
More research, she said, is needed to find out why these racial disparities persist even when women have the same health coverage.
SOURCE: Obstetrics and Gynecology, July 2005.
Revision date: July 4, 2011
Last revised: by Jorge P. Ribeiro, MD