Extrapulmonary treatable traits in pregnant women with asthma

<bold>Introduction:</bold> Asthma exacerbations in pregnancy confer poor maternal and perinatal outcomes. A Treatable traits multimodality approach has promise in addressing the complexity and heterogeneity of asthma in pregnancy. We sought to determine the prevalence of extrapulmonary treatable traits (ETTs) for asthma in pregnancy, as data are limited. <bold>Methods:</bold> Data were extracted from patient histories and medical record reviews of 725 pregnant women with mostly mild asthma enrolled in the Breathing for Life Trial. Five ETTs were identified: mental health (MH) conditions, gastroesophageal reflux disease (GORD), rhinitis, iron deficiency and hyperemesis gravidarum/nausea & vomiting of pregnancy (HG/NVP). <bold>Results:</bold> The median number of ETTs expressed was 1 (IQR 1). 17.5% had none, 37.1% had one, 29.4% had two, 12.6% had three, 3.3% had four and 0.1% had five ETTs. Iron deficiency was highly prevalent at 64% (95% CI 0.60-0.68), followed by GORD at 32% (95% CI 0.29-0.36), MH conditions 28% (95% CI 0.25-0.32), HG/NVP 14% (95% CI 0.12-0.17) and rhinitis 8% (95% CI 0.06-0.11). Anxiety had a prevalence of 17% (95% CI 0.14-0.20), depression 18% (95% CI 0.16-0.21) and other MH conditions 5% (95% CI 0.04-0.07) including bipolar disorder, post-traumatic stress disorder, obsessive compulsive disorder, adjustment disorder, eating disorder or a past history of postnatal depression. <bold>Conclusion:</bold> In this population with predominantly mild asthma in pregnancy, ETTs show similar trait heterogeneity to more severe asthma and COPD, but have reduced trait complexity (median 1 ETT/person). The clinical implications of this are that while trait assessment needs to be broad, trait intervention is less complex as there are fewer traits to treat.