Maternal and Child Health Journal

, Volume 16, Issue 2, pp 448–455 | Cite as

The Moderating Influence of Asthma Diagnosis on Biobehavioral Health Characteristics of Women of Reproductive Age

  • RyaLynn M. Carter
  • Danielle Symons Downs
  • Rebecca Bascom
  • Anne-Marie Dyer
  • Carol S. Weisman


Promoting healthy behaviors to improve pregnancy outcomes requires an understanding of the factors influencing health behaviors among at-risk populations. We hypothesized that women with an asthma diagnosis would have poorer biobehavioral health risk factors and pregnancy outcomes compared to women without an asthma diagnosis. The Central Pennsylvania Women’s Health Study (CePAWHS) included a population-based survey examining health status indicators, risk factors and outcomes, and detailed pregnancy histories among 2,002 women (ages 18–45). 213 asthmatics were identified. Compared with Non-asthmatic women (NA), Asthmatic (A) women reported lower rates of excellent health status (45% A vs. 65% NA, P < 0.001), were more likely to be overweight or obese (68% A vs. 50% NA, P < 0.001), and were more likely to have smoked cigarettes during their first pregnancy (25% A vs. 17% NA, P < 0.01). Psychological measures (psychosocial hassles, low self-esteem, depression) were reported more often in asthmatics than non-asthmatics. Also, asthmatics reported a higher incidence of gestational diabetes (10% A vs. 6% of NA, P = 0.05), preterm births (25% A vs. 16% NA, P < 0.01), and had a higher proportion of low birth weight infants (20% A vs. 13% NA, P = 0.03) compared with non-asthmatics. As predicted, asthmatics had poorer biobehavioral risk factors and outcomes compared to non-asthmatics. These findings illustrate the need to target asthmatic women of reproductive age, particularly in this largely rural setting, with interventions to reduce biobehavioral risk factors as part of a strategy to improve pregnancy outcomes.


Asthma Preconceptional health Pregnancy Biobehavioral risk factors Women’s health 


  1. 1.
    Kwon, H. L., Belanger, K., & Bracken, M. B. (2003). Asthma prevalence among pregnant and childbearing-aged women in the United States: Estimates from national health surveys. Annals of Epidemiology, 13(5), 317–324.PubMedCrossRefGoogle Scholar
  2. 2.
    National Asthma Education and Prevention Program (NAEPP). (2004). In National Institutes of Health (Ed.), Managing asthma during pregnancy: Recommendations for pharmacologic treatmentupdate. U.S. Department of Health and Human Services.Google Scholar
  3. 3.
    Kwon HL, T. E., Belanger, K., & Bracken, M. B. (2006). The epidemiology of asthma during pregnancy: Prevalence, diagnosis, and symptoms. Immunology and Allergy Clinics of North America, 26(1), 29–62.PubMedCrossRefGoogle Scholar
  4. 4.
    Murphy, V. E., Gibson, P., Talbot, P. I., & Clifton, V. L. (2005). Severe asthma exacerbations during pregnancy. Obstetrics and Gynecology, 106(5 Pt 1), 1046–1054.PubMedCrossRefGoogle Scholar
  5. 5.
    Murphy, V. E., Clifton, V., & Gibson, P. G. (2006). Asthma exacerbations during pregnancy: Incidence and association with adverse pregnancy outcomes. Thorax, 61(2), 169–176.PubMedCrossRefGoogle Scholar
  6. 6.
    Schatz, M., & Dombrowski, M. (2009). Asthma in pregnancy. New England Journal of Medicine, 360, 1862–1869.PubMedCrossRefGoogle Scholar
  7. 7.
    Hendler, I., Schatz, M., Momirova, V., Wise, R., Landon, M., Mabie, W., et al. (2006). Association of obesity with pulmonary and nonpulmonary complications of pregnancy in asthmatic women. Obstetrics and Gynecology, 108(1), 77–82.PubMedCrossRefGoogle Scholar
  8. 8.
    Eberhardt, M. S., Ingram, D., & Makuc, D. M. (2001). Health United States 2001. Urban and rural health chartbook. Hyattsville, MD: National Center for Health Statistics.Google Scholar
  9. 9.
    Hartley, D. (2004). Rural health disparities, population health, and rural culture. American Journal of Public Health, 94(10), 1675–1678.PubMedCrossRefGoogle Scholar
  10. 10.
    National Heart, Lung, and Blood Institute, National Asthma Education Program. (1991). In Department of Health and Human Services (Ed.), Expert panel report: Guidelines for the diagnosis and management of asthma. NIH.Google Scholar
  11. 11.
    Demissie, K., Breckenridge, M., & Rhoads, G. G. (1998). Infant and maternal outcomes in the pregnancies of asthmatic women. American Journal of Respiratory and Critical Care Medicine, 158(4), 1091–1095.PubMedGoogle Scholar
  12. 12.
    Liu, S., Wen, S., Demissie, K., Marcoux, S., & Kramer, M. S. (2001). Maternal asthma and pregnancy outcomes: a retrospective cohort study. American Journal of Obstetrics and Gynecology, 184(2), 90–96.PubMedCrossRefGoogle Scholar
  13. 13.
    Whitty, J., & Dombrowski, M. P. (2004). Chapter 46: Respiratory diseases in pregnancy. In R. Crease & R. Resnik (Eds.), Maternal fetal medicine, principles and practice (pp. 953–974). Philadelphia: Saunders.Google Scholar
  14. 14.
    Kwon, H. L., Belanger, K., & Bracken, M. B. (2004). Effect of pregnancy and stage of pregnancy on asthma severity: A systematic review. American Journal of Obstetrics and Gynecology, 190(5), 1201–1210.PubMedCrossRefGoogle Scholar
  15. 15.
    Bracken, M., Triche, E. W., Belanger, K., Saftlas, A., Beckett, W. S., & Leaderer, B. P. (2003). Asthma symptoms, severity and drug therapy: A prospective study of effects on 2205 pregnancies. Obstetrics and Gynecology, 102, 739–752.PubMedCrossRefGoogle Scholar
  16. 16.
    Castro LC, A. R. (2002). Maternal obesity and pregnancy outcomes. Current Opinion in Obstetrics and Gynecology, 14(6), 601–606.PubMedCrossRefGoogle Scholar
  17. 17.
    Schatz, M., Dombrowski, M., Wise, R., Momirova, V., Landon, M., Mabie, W., et al. (2004). The relationship of asthma medication use to perinatal outcomes. Journal of Allergy and Clinical Immunology, 113, 1040–1045.PubMedCrossRefGoogle Scholar
  18. 18.
    Schneider, S., & Schütz, J. (2008). Who smokes during pregnancy? A systematic literature review of population-based surveys conducted in developed countries between 1997 and 2006. European Journal of Contraception Reproductive Health Care, 13(2), 138–147.PubMedCrossRefGoogle Scholar
  19. 19.
    Weisman CS, H. M., Chase, G. A., Dyer, A. M., Baker, S. A., Feinberg, M., Symons Downs, D., et al. (2006). Preconceptional health: Risks of adverse pregnancy outcomes by reproductive life stage in the Central Pennsylvania Women’s Health Study (CePAWHS). Womens Health Issues, 16(4), 216–224.PubMedCrossRefGoogle Scholar
  20. 20.
    American College of Sports Medicine. (2000). Guidelines for exercise testing, prescription (6th ed.). Philadelphia, PA: Lippincott Williams & Wilkins.Google Scholar
  21. 21.
    Curry, M. A., Campbell, R., & Christian, M. (1994). Validity and reliability testing of the prenatal psychosocial profile. Research in Nursing and Health, 17(2), 127–135.PubMedCrossRefGoogle Scholar
  22. 22.
    Rosenberg, M. (1965). Society, the adolescent self-image. Princeton, NJ: Princeton University Press.Google Scholar
  23. 23.
    Radloff, L. (1977). The CES-D Scale: a self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.CrossRefGoogle Scholar
  24. 24.
    Sherbourne, C. D., Dwight-Johnson, M., & Klap, R. (2001). Psychological distress, unmet need, and barriers to mental health care for women. Womens Health Issues, 11(3), 231–243.PubMedCrossRefGoogle Scholar
  25. 25.
    National Center for Health Statistics. (1994). Plan and operation of the Third National Health and Nutrition Examination Survey, 1988–1994. In Vital Health Statistics (Ed.), Series 1. Hyattsville, MD.Google Scholar
  26. 26.
    National Center for Health Statistics. (2000). Design and estimation for the National Health Interview Survey, 1995–2004. In National Center for Health Statistics (Ed.) Vital and Health Statistic. Hyattsville, MD.Google Scholar
  27. 27.
    Prevention, C.f.D.C.a. (1998). Behavioral risk factor surveillance system user’s guide. Atlanta, GA: Centers for Disease Control and Prevention.Google Scholar
  28. 28.
    CDC, C.f.D.C.a.P. (2007). Cigarette smoking among adultsUnited States, 2006. MMWR—Morbidity & Mortality Weekly Report, 56(44), 1157–1161.Google Scholar
  29. 29.
    Ford, E. S., & Mannino, D. (2005). Time trends in obesity among adults with asthma in the United States: Findings from three national surveys. Journal of Asthma, 42(2), 91–95.PubMedCrossRefGoogle Scholar
  30. 30.
    Romieu, I., Mannino, D., Redd, S. C., & McGeehin, M. A. (2004). Dietary intake, physical activity, body mass index, and childhood asthma in the Third National Health and Nutrition Survey (NHANES III). Pediatric Pulmonology, 38(1), 31–42.PubMedCrossRefGoogle Scholar
  31. 31.
    Weiss, J. L., Malone, F., Emig, D., Ball, R. H., Nyberg, D. A., Comstock, C. H., et al. (2004). Obesity, obstetric complications and cesarean delivery rate—a population-based screening study. American Journal of Obstetrics and Gynecology, 190(4), 1091–1097.PubMedCrossRefGoogle Scholar
  32. 32.
    Roelands, J., Jamison, M., Lyerly, A. D., & James, A. H. (2009). Consequences of smoking during pregnancy on maternal health. Journal of Womens Health, 18(6), 167–172.CrossRefGoogle Scholar
  33. 33.
    Kaiser, L. L., Allen, L., & American Dietetic Association. (2002). Position of the American Dietetic Association: Nutrition and lifestyle for a healthy pregnancy outcome. Journal of the American Dietetic Association, 102(10), 1479–1490.PubMedCrossRefGoogle Scholar
  34. 34.
    Camargo, C. A., Jr, Weiss, S., Zhang, S., Willett, W. C., & Speizer, F. E. (1999). Prospective study of body mass index, weight change, and risk of adult-onset asthma in women. Archives of Internal Medicine, 159(21), 2582–2588.PubMedCrossRefGoogle Scholar
  35. 35.
    Luder, E., Ehrlich, R., Lou, W. Y., Melnik, T. A., & Kattan, M. (2004). Body mass index and the risk of asthma in adults. Respiratory Medicine, 98(1), 29–37.PubMedCrossRefGoogle Scholar
  36. 36.
    Ford, E. S., Hagan, G., Mannino, D. M., & Redd, S. C. (2003). Leisure-time physical activity patterns among US adults with asthma. Chest, 124(2), 421–422.CrossRefGoogle Scholar
  37. 37.
    Westermann, H., Choi, T., Briggs, W. M., Charlson, M. E., & Mancuso, C. A. (2008). Obesity and exercise habits of asthmatic patients. Annals of Allergy, Asthma & Immunology, 101(5), 488–494.CrossRefGoogle Scholar
  38. 38.
    U.S. Department of Health and Human Services. (2008). 2008 Physical Activity Guidelines for Americans. February 8, 2009, [cited ODPHP Publication No. U0036;61]. Available from:
  39. 39.
    American College of Obstetricians and Gynecologists. (2002). Exercise during pregnancy and the postpartum period. ACOG Committee Opinion No. 267. Obstetrics & Gynecology, 99, 171–173.Google Scholar
  40. 40.
    Strine, T. W., Mokdad, A., Balluz, L. S., Gonzalez, O., Crider, R., Berry, J. T., et al. (2008). Depression and anxiety in the United States: Findings from the 2006 behavioral risk factor surveillance system. Psychiatric Services, 59(12), 1383–1390.PubMedCrossRefGoogle Scholar
  41. 41.
    Deshmukha, V., Toelle, B., Usherwoodb, T., O’Gradyc, B., & Jenkinsa, C. (2007). Anxiety, panic and adult asthma: A cognitive-behavioral perspective. Respiratory Medicine, 101(2), 194–202.CrossRefGoogle Scholar
  42. 42.
    American College of Obstetricians and Gynecologists. (2006). Psychosocial risk factors: perinatal screening and intervention. Obstetrics and Gynecology 469–747.Google Scholar
  43. 43.
    Dombrowski, M. P., Schatz, M., Wise, R., Momirova, V., Landon, M., Mabie, W., et al. (2004). Asthma during pregnancy. Obstetrics and Gynecology, 103(1), 5–12.Google Scholar
  44. 44.
    Dombrowski, M. (2000). Should the definitions of asthma severity be modified during pregnancy? American Journal of Obstetrics and Gynecology, 182(S167).Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • RyaLynn M. Carter
    • 1
  • Danielle Symons Downs
    • 3
  • Rebecca Bascom
    • 4
  • Anne-Marie Dyer
    • 5
  • Carol S. Weisman
    • 2
    • 5
  1. 1.Department of Obstetrics and GynecologyThe Pennsylvania State University College of MedicineHersheyUSA
  2. 2.Department of Obstetrics and GynecologyThe Pennsylvania State University College of MedicineHersheyUSA
  3. 3.Department of KinesiologyThe Pennsylvania State UniversityUniversity ParkUSA
  4. 4.Department of MedicineThe Pennsylvania State University College of MedicineHersheyUSA
  5. 5.Department of Public Health SciencesThe Pennsylvania State University College of MedicineHersheyUSA

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