A32-39 Impact of Housing Instability and Asthma Medication Prescription on Risk of Asthma Exacerbation During Pregnancy

Rationale

Asthma complicates>10% pregnancies, and poor control is linked to adverse maternal and perinatal outcomes. Prior studies have identified medical factors(e.g.baseline uncontrolled asthma) and non-medical factors(e.g.Medicaid/Medicare status) as predictors of exacerbations in pregnancy. However, the impact of asthma medication prescription and neighborhood-level factors on disease control remains unknown.

Methods

We conducted a retrospective cohort study using electronic health records from a large healthcare network. We included adult pregnant women with a live birth between 2012 and 2025, with pre-existing asthma but no other chronic respiratory diseases. Pre-specified covariates included maternal age, baseline body mass index, race, insurance status, comorbidities, oral corticosteroid(OCS) bursts(OCS prescription duration <28 days), asthma maintenance regimen(MR, excluding short-acting beta agonists) prescription before and during pregnancy, and Area Deprivation Index (ADI) at the block group level. Housing instability was defined as > 1 residential move during pregnancy. The primary outcome was asthma exacerbations during pregnancy, defined by OCS burst. Univariable and multivariable logistic regression were used to analyze associations with asthma exacerbation risk.

Results

The cohort comprised 12866 pregnant women with pre-existing asthma, of whom 501(3.9%) experienced at least one asthma exacerbation during pregnancy. Housing instability occurred in 1160 women(9.0%). Among 4474(34.8%) women who were prescribed asthma MR before pregnancy, 3537(79.1%) discontinued therapy during pregnancy. In multivariable analysis, housing instability was independently associated with increased asthma exacerbation risk(adjusted OR 1.75, 95% CI 1.24-2.43, p = 0.002). Medicaid/Medicare status and minority race (non-Black, non-White) were associated with higher exacerbation risk. Relocation to a neighborhood with lower social deprivation was associated with lower exacerbation risk(Figure). Compared with women who were never prescribed asthma MR before or during pregnancy, those who continued, discontinued, or increased therapy all had higher exacerbation risk, reflecting greater overall asthma disease severity. However, women who increased MR during pregnancy had a much lower exacerbation risk compared to those who continued or discontinued therapy.

Conclusions

In this large cohort of US pregnant women with pre-existing asthma, both neighborhood-level factors and asthma medication use were independently associated with asthma exacerbation risk. These findings underscore the importance of proactive counseling and optimization of maintenance therapy, including specialist referral when appropriate, to maintain adequate disease control. Additionally, bedside identification of patients exposed to social risk factors, including housing instability, may allow targeted follow-up and outreach efforts. Together, these results support integrated clinical and social risk stratification to improve asthma outcomes during pregnancy.

This abstract is funded by: Cleveland Clinic internal grant (InRICh)