- Title
- Inhaled corticosteroid non-adherence during pregnancy: prevalence, predictors and consequences
- Creator
- Robijn, Annemarie Louise
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2021
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Background: Asthma is the most common chronic disease among pregnant women in Australia, affecting 12.7% of pregnant women. Asthma increases the risk of adverse perinatal outcomes, such as caesarean section, preterm birth and low birthweight infants. Women with moderate-severe asthma, those with uncontrolled asthma, and those who experience exacerbations may be at an even higher risk than those with mild asthma or controlled asthma. Uncontrolled asthma and exacerbations may be the result of inhaled corticosteroid (ICS) non-adherence. However, limited studies have investigated ICS non-adherence during pregnancy in women with asthma. Aim: The studies contained in this thesis examine the prevalence of non-adherence, local trend of non-adherence, factors associated with non-adherence, and consequences of ICS non-adherence during pregnancy, and the impact of repeated asthma self-management education on ICS non-adherence during pregnancy. Methods: A systematic review and meta-analysis was used to determine the prevalence of ICS use and non-adherence during pregnancy and changes in asthma medication use during pregnancy compared to pre-pregnancy (Study 1). Cross-sectional and longitudinal studies were undertaken to determine the local trend of ICS non-adherence among pregnant women with asthma (Study 2); the effect of self-management education on ICS non-adherence (Study 2); factors associated with ICS non-adherence in mid-pregnancy and from mid-pregnancy until delivery (Study 3); the association between ICS non-adherence at study entry and future exacerbation risk and the association between ICS non-adherence during pregnancy and adverse perinatal outcomes and infant respiratory health (Study 4). A population-based register study was used to determine the association between asthma exacerbations and adverse perinatal outcomes (Study 5). Results: Worldwide, 41% of pregnant women with asthma used ICS during pregnancy and 39-56% of ICS users were non-adherent. Locally, a consistent prevalence of non-adherence of around 40% was observed in three clinical studies conducted between 2004 and 2017. Asthma self-management education significantly reduced ICS non-adherence by 17% with 23% of women non-adherent after four sessions. Smoking history, reduced lung function, Non- Indigenous/Non-Caucasian ethnicity and being diagnosed with asthma as an adult were associated with ICS non-adherence in mid-pregnancy whereas younger maternal age, increased parity and treatment at study entry were associated with non-adherence during the remainder of pregnancy. Among women with mild asthma who were actively treated during pregnancy, ICS non-adherence at study baseline was not associated with an increased risk of future exacerbations and ICS non-adherence during pregnancy was not associated with increased risks of adverse perinatal or infant respiratory outcomes. However, data from a population-based database/register showed that exacerbations were associated with reduced birth weight (2.5-3 kilograms), small for gestational age and caesarean sections, both elective and emergency; especially among women with moderate-severe asthma and women who exacerbated more than once. Conclusion: ICS non-adherence during pregnancy is common and persists in some women after asthma self-management education. Furthermore, more research into ICS non-adherence is needed in large population-based registers and reasons and motivations for ICS non-adherence during pregnancy need to be assessed in qualitative studies. This would inform the design of targeted strategies to reduce ICS non-adherence during pregnancy are needed.
- Subject
- asthma; pregnancy; adherence; women; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1460935
- Identifier
- uon:46073
- Rights
- Copyright 2021 Annemarie Louise Robijn
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 5 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 2 MB | Adobe Acrobat PDF | View Details Download |