Ar t i k e l a s l i

PREVALENSI ASMA EKSASERBASI PADA IBU HAMIL DAN PENGARUHNYA TERHADAP JANIN DAN IBU DI RSUP SANGLAH DENPASAR
IB Ng u r a hRa i Di v i s i P u l mo n o l o g i Ba g / S M FI l muP e n y a k i t Da l a mF K Un u d / RS UPS a n g l a hDe n pa s a r Ema i l : i b n r a i s ps 19 58@ y a h o o . c o m
ABS TRACT As t h mai so n eo ft h emo s tc o mmo nc h r o n i cme d i c a l Th epr e v a l e n c eo fa s t h maa mo n g pr e g n a n tf e ma l e si si n c r e a s i n g . c o n d i t i o n st h a t c a u s ec o mpl i c a t i o n si npr e g n a n c y . Th e r ei se v i d e n c et h a t a s t h mac a na d v e r s e l yi mpa c t o npr e g n a n c yo u t c o me s , a n dc o n v e r s e l yt h a t pr e g n a n c yma yr e s u l t i nac h a n g ei nt h ec l i n i c a l s t a t u so faf e ma l ewi t ha s t h ma . Th ea i mt h i ss t u d ywa st o k n o w pr e v a l e n c eo fa s t h mae x a c e r b a t i o ni npr e g n a n c ya n dt h ee f f e c t st oi n f a n t a n dma t e r n a l i nS a n g l a hGe n e r a l Ho s pi t a l . Th i s s t u d yi sr e t r o s pe c t i v es t u d yt ome d i c a l r e c o r do f pr e g n a n c ypa t i e n t sd e l i v e r ya t S a n g l a hGe n e r a l Ho s pi t a l . I nt h i ss t u d ywef o u n d 19 59 pr e g n a n c y pa t i e n t sa n d pr e v a l e n c eo fa s t h mae x a c e r b a t i o n wa s0 . 71% (14 a s t h ma t i cpa t i e n t s )P r o po r t i o no fpa t h o l o g i c e c l a mps i aa n dc o n g e n i t a l ma l f o r ma t i o n so ft h ef e t u swa sl o we ri na s t h ma t i cg r o u pt h a ni ng r o u p wi t h o u t a s t h ma d e l i v e r y , pr e h a ni ng r o u p wi t h o u t a s t h ma(310 7. 14 521. 78 g r a ms b u t n o t s i g n i c a n t . Th eme a no f b i r t hwe i g h t wa sl o we r i na s t h mag r o u pt Th ec o n c l u s i o nt h i ss t u d yi spr e v a l e n c eo fa s t h mae x a c e r b a t i o n s : 330 6. 70 366. 21 g r a ms )p = 0 . 0 59 5%CI(39 9 . 14 0 . 0 12) . o npr e g n a n t f e ma l e si nS a n g l a hGe n e r a l Ho s pi t a l wa s0 . 71%. Bi r t hwe i g h t b o t hi npr e g n a n t f e ma l e swi t ha s t h maa n dpr e g n a n t f e ma l e swi t h o u t a s t h mawa si nn o r ma l l i mi t b u t t r e n dwa sl o we r i npr e g n a n t f e ma l e swi t ha s t h mat h a npr e g n a n t f e ma l e swi t h o u t a s t h ma . Ke y wo r d s : a s t h mae x a c e r b a t i o n , pr e g n a n c y , S a n g l a hh o s pi t a l

P ENDAHULUAN As ma me r u pa k a n pe n y a k i ti n a ma s ik r o n i s s a l u r a nn a f a sy a n gme l i b a t k a nb a n y a ks e l d a ne l e me n s e l u l e ry a n gme n g a k i b a t k a nh i pe r r e s po n s i fj a l a nn a f a s y a n g me n i mb u l k a ng e j a l ae pi s o d i kb e r u l a n gb e r u pa me n g i , s e s a kn a f a s , d a d at e r a s ab e r a td a nb a t u k b a t u k t e r u t a mapa d ama l a mh a r id a na t a ud i n ih a r i . Epi s o d e t e r s e b u tb e r h u b u n g a nd e n g a no b s t r u k s ij a l a nn a f a s d a ns e r i n g k a l ib e r s i f a tr e v e r s i b e ld e n g a na t a ut a n pa 1 pe n g o b a t a n . S e i r i n gd e n g a n pe n i n g k a t a n pr e v a l e n s ia s mad i ma s y a r a k a tk e j a d i a na s ma pa d ak e h a mi l a nj u g aa k a n 186

s e r i n gd i j u mpa i . P r e v a l e n s i a s mapa d ak e h a mi l a npa d a 2 k e pu s t a k a a nt e r d a h u l ud i l a po r k a n0 , 4 s a mpa i1, 3%, s e d a n g k a n pe n e l i t i a ny a n gl e b i h mu t a h i rme l a po r k a n s e k i t a r 3, 7 s a mpa i 8, 4%. Di Au s t r a l i a d e n g a n pr e v a l e n s ia s ma t e r t i n g g id id u n i a ,pa d at a h u n 19 9 5 d i d a pa t k a n12, 4% wa n i t ah a mi l d e n g a na s mad a n8, 8% me n g a l a mi e k s a s e r b a s i d a nme n g g u n a k a no b a t s e l a ma 3 k e h a mi l a n n y a . P e n e l i t i a n j u g a me n u n j u k a nb a h wa i b uh a mi l y a n g me n d e r i t aa s ma b e r a ta t a u t i d a k t e r k o n t r o l s e c a r as t a t i s t i kb e r h u b u n g a ne r a td e n g a nk e j a d i a n l a h i r pr e ma t u r ,b e r a tb a d a nl a h i rr e n d a h ,h i po k s i a n e o n a t u sd a nk e ma t i a nd is a mpi n gk o mpl i k a s ii b u
J Peny Dalam, Volume 10 Nomor 3 September 2009

a n t a r al a i nh i pe r e me s i sg r a v i d a r u m, pe r d a r a h a nv a g i n a d a nt o k s e mi ad i b a n d i n g k a nd e n g a ni b uy a n gt i d a k 47 me n d e r i t aa s maa t a ui b uy a n ga s ma n y at e r k o n t r o l . De n g a n s e ma k i n me n i n g k a t n y a k e j a d i a n a s ma b a i k pa d a ma s y a r a k a tma u pu n pa d ak e h a mi l a n s e r t a pe n g a r u ha s ma t e r h a d a p i b ud a nj a n i ny a n g d i k a n d u n g n y a , k a mi i n g i nme n g e t a h u i pr e v a l e n s i a s ma e k s a s e r b a s ipa d ai b uh a mi ld a n pe n g a r u h n y a pa d a j a n i nd a ni b u d iRS UP S a n g l a h De n pa s a r .P e n e l i t i a n i n ib e r t u j u a n u n t u k me n g e t a h u i pr e v a l e n s ia s ma e k s a s e r b a s ipa d ai b uh a mi ld a n pe n g a r u h n y at e r h a d a p j a n i nd a ni b ud i RS UPS a n g l a hDe n pa s a r BAHAN DAN CARA P e n e l i t i a n i n i me r u pa k a n s t u d ir e t r o s pe k t i f t e r h a d a pr e k a m me d i spa s i e ny a n gd a t a n gb e r s a l i nd i r u a n gb e r s a l i n RS UP S a n g l a h De n pa s a rpa d ape r i o d e wa k t uJ a n u a r is a mpa iDe s e mb e r20 0 9 .P a d a pe r i o d e t e r s e b u t d i d a pa t k a n19 59pe r s a l i n a nd a n14 d i a n t a r a n y a d e n g a na s ma . S a mpe l y a n gd i ma s u k a nd a l a ms t u d i i n i a d a l a hs e l u r u hi b ub e r s a l i nd e n g a na s ma d a ns a mpe l i b ub e r s a l i nb u k a na s mad i l a k u k a nme l a l u i r a n d o mi s a s i y a i t ud i a mb i ls a t us e t i a p h a r i n y a ,s e h i n g g aj u ml a h s a mpe l s e b a n y a k378 y a n gt e r d i r i a t a s14 o r a n gd e n g a n a s mad a n364 o r a n gt a n paa s ma . An a l i s i sd a t ad e n g a nu j i s t a t i s t i kd e s k r i pt i f u n t u k me n g g a mb a r k a nk a r a k t e r i s t i kr e s po n d e nd a nd i s t r i b u s i f r e k u e n s i b e b e r a pav a r i a b e l . Hu b u n g a na n t a r as e r a n g a n a s mad e n g a nk e a d a a nj a n i ns a a t i b ub e r s a l i nd i a n a l i s i s d e n g a nd e n g a nt a b e l 2 X2 u n t u kd u av a r i a b e l n o mi n a l , s e d a n g k a nu n t u kv a r i a b e ln o mi n a ld e n g a nn u me r i k d i l a k u k a nd e n g a nb e d ar e r a t ad e n g a nt t e s td e n g a n n i l a i p <0 , 0 5s e b a g a i b a t a sk e ma k n a a nme n g g u n a k a n pe r a n g k a t l u n a ks t a t i s t i ku n t u kk o mpu t e r . HAS I L S e l a ma pe r i o d e J a n u a r i s a mpa i De s e mb e r 20 0 9d i d a pa t k a ni b ub e r s a l i ns e b a n y a k 19 59 o r a n g d a nd i d a pa t k a na s ma e k s a s e r b a s is e b a n y a k 14 o r a n g (0 , 71%) . Ra t a r a t au mu r pa s i e nb e r s a l i n a d a l a h

28, 29 5, 533 t a h u n ,d e n g a nu mu rt e r mu d a16 t a h u n d a nt e r t u a42 t a h u n . Ra t a r a t au mu rk e h a mi l a na d a l a h 39 , 0 8 1, 45 mi n g g u , d e n g a nu mu r k e h a mi l a nt e r mu d a 34 mi n g g ud a nt e r t u a 44 mi n g g u .Un t u k me n g e t a h u i pe r b e d a a nk a r a k t e r i s t i ka n t a r apa s i e nb e r s a l i nd e n g a n a s ma d a nt a n pa a s ma d a pa td i l i h a t pa d aT a b e l1 b e r i k u t .

T a b e l 1. Ka r a k t e r i s t i ki b ub e r s a l i nd e n g a nd a nt a n paa s mad i RS UPS a n g l a ht a h u n20 0 9
Ka r a k t e r i s t i k J e n i sk e l a mi nb a y i La k i l a k i 10(71, 43) 172 (47, 25) Wa n i t a 4 (28, 57) 19 2 (52, 75) Re r a t ab e r a t 310 7, 14 521, 78 330 6, 70366, 21 b a d a nb a y i (g r a m) Ke l a i n a nb a wa a n 1 (7, 14) 11 (30 , 22) pa d ab a y i Ca r ape r s a l i n a n No r ma l 11(78, 57) 268 (73, 63) S e k s i os e s a r i a 3 (21, 43) 77 (21, 15) T i n d a k a nl a i n 0(0 ) 19(5, 22) I b ud e n g a n pr e e k l a ms i a / 1 (7, 14) 40(10 , 9 8) e k l a ms i a Umu rk e h a mi l a n 38, 502, 31 39 , 11 1, 41 I b ub e r s a l i n d e n g a na s ma I b ub e r s a l i n t a n paa s ma p

0 , 0 5 0 , 37

0 , 68

0 , 9 9

Ra t a r a t ab e r a tb a d a nb a y it a mpa kl e b i hr e n d a h pa d a i b ud e n g a na s ma ,wa l a u pu ns e c a r ak u a n t i t a t i fma s i h d a l a m b a t a sb e r a tb a d a nl a h i rb a y iy a n gn o r ma l (l e b i hd a r i30 0 0g r a m) .S e d a n g k a n pr o po r s ik e l a i n a n k o n g e n i t a l , pe r s a l i n a n d e n g a n t i n d a k a n , pr o po r s i a d a n y a pr e e k l a ms i ad a nr a t a r a t au mu rk e h a mi l a n t a mpa kl e b i hr e n d a h pa d ak e l o mpo ka s ma .Na mu n pe r b e d a a ny a n gt e r j a d id a r iv a r i a b e l v a r i a b e lt e r s e b u t d i a t a ss e b a g i a nb e s a rt i d a kb e r ma k n as e c a r as t a t i s t i k d e n g a np > 0 , 0 5 d a ny a n g me mi l i k in i l a ip = 0 , 0 5 a d a l a hpe r b e d a a nr a t a r a t ab e r a t b a d a nb a y i d e n g a nKI 9 5% (39 9 , 14 0 , 0 12) . DI S KUS I As ma d a pa t me r u pa k a n ma s a l a h me d i sy a n g 35 P r e v a l e n s i a s mapa d a d a pa t t e r j a d i s e l a mak e h a mi l a n . 187

P r e v a l e n s i As maEk s a s e r b a s i pa d aI b uHa mi l d a nP e n g a r u h n y aT e r h a d a pJ a n i nd a nI b ud i RS UPS a n g l a hDe n pa s a r IB Ng urahRai

k e h a mi l a n pa d ak e pu s t a k a a nt e r d a h u l ud i l a po r k a n0 , 4 2 s a mpa i 1, 3%, s e d a n g k a nk e pu s t a k a a ny a n gl e b i h b a r u , o l e hM u r ph y , d k k . (20 0 5)d i d a pa t k a npr e v a l e n s i a s ma pa d a wa n i t ah a mi ly a n g me n i n g k a t .S e d a n g k a n 4 S c h a t z , d k k . me n d a pa t k a na n g k a pa d ak i s a r a n 8% 5 wa n i t ah a mi ly a n g me n d e r i t aa s ma .Re yd a n Bo u l e t pa d a t a h u n 20 0 7 me n d a pa t k a n pr e v a l e n s i wa n i t a h a mi ld e n g a na s ma a n t a r a 3, 4 -12, 4%.P a d at a h u n 19 9 7 20 0 1 d iAme r i k aS e r i k a td i pe r k i r a k a n 3, 7 8, 4% wa n i t ah a mi ld e n g a na s mad a nl e b i ht i n g g id a r i 3, 2% pa d at a h u n 19 88 19 9 4.DiAu s t r a l i ad e n g a n pr e v a l e n s ia s ma t e r t i n g g id id u n i a ,pa d at a h u n 19 9 5 d i d a pa t k a n12, 4% wa n i t ah a mi l d e n g a na s mad a n8, 8% me n g a l a mi e k s a s e r b a s i d a nme n g g u n a k a no b a t s e l a ma 3 k e h a mi l a n n y a . P a d a pe n e l i t i a ni n id i d a pa t k a n pr e v a l e n s ia s ma e k s a s e r b a s ipa d ai b uh a mi ls e b e s a r0 , 71% l e b i hk e c i l b i l a d i b a n d i n gd e n g a nk e j a d i a nd i Au s t r a l i a y a n gs e b e s a r 8, 8%. I n i mu n g k i nt e r j a d i o l e hk a r e n apr e v a l e n s i a s ma d i De n pa s a rk h u s u s n y ad i RS UPS a n g l a hl e b i hr e n d a h d i b a n d i n gd iAu s t r a l i as e h i n g g ak e j a d i a ne k s a s e r b a s i j u g al e b i hr e n d a h . Na mu nb i l ak i t ab a n d i n g k a nd e n g a n pr e v a l e n s iy a n gd i l a po r k a no l e hs t u d it e r d a h u l ud i RS UP S a n g l a h ,(0 , 4 1, 3%)t a mpa k pr e v a l e n s ipa d a s t u d i i n i t i d a kb e r b e d a . As ma d a pa t me n g a k i b a t k a n k e a d a a n me d i s y a n gs e r i u ss a a tk e h a mi l a n . Be b e r a pas t u d it e r d a h u l u , wa n i t ad e n g a na s mame mi l i k ir i s i k ok o mpl i k a s iy a n g l e b i h t i n g g i pa d ak e h a mi l a n n y ad i b a n d i n g wa n i t a t a n pas e r a n g a na s ma . Ad a pu npe n g a r u ha s mat e r h a d a p k e h a mi l a n a d a l a h b a y ib e r a tb a d a n l a h i rr e n d a h , b a y i pr e ma t u r , pr e e k l a ms i a ,s e r t al a h i r ma t i .S t u d i o b s e r v a s i o n a l me n u n j u k k a nb a h wak o n t r o l a s may a n g b u r u ks e l a ma k e h a mi l a na k a n me n i n g k a t k a nr i s i k o 4, 6, 7 k o mpl i k a s i k e h a mi l a n . 6 P e n e l i t i a nk o h o r t o l e hBr e t o n , d k k . t a h u n20 0 9 pa d a 13. 10 0d a n 28. 0 42 wa n i t ah a mi ld e n g a na s ma d i d a pa t k a npe n i n g k a t a nmo r t a l i t a spe r i n a t a l (RO 1, 35) d a n9 5% KI(1, 0 8 1, 67)d i b a n d i n g k a n wa n i t ah a mi l t a n pa a s ma .P a d a wa n i t ad e n g a na s ma d i d a pa t k a n k e j a d i a nb e r a tb a d a nb a y il a h i rr e n d a hd a n pe r s a l i a n pr e ma t u rl e b i ht i n g g i d i b a n d i n gwa n i t at a n paa s ma . 188

7 pa d at a h u n S t u d ik o h o r tl a i n y ao l e hT a t a ,d k k . 20 0 7 me mb a n d i n g k a nwa n i t ad e n g a na s mas e d a n gd a n b e r a t d e n g a nwa n i t at a n paa s mad i d a pa t k a nme n i n g k a t r i s i k os e k s i os e s a r i a(RO 1, 4)d a n9 5% KI(1, 1 1, 8) . An a l i s i sd e n g a nr e g r e s il o g i s t i k , pa d aa s ma b e r a t d i d a pa t k a n pe n i n g k a t a nr i s i k od i a b e t e sg e s t a s i o n a l (RO 3)d a n9 5% KI(1, 2 7, 8) , pe r s a l i n a npr e ma t u r< 37 mi n g g u(RO 2, 2) d a n9 5% KI (1, 2 4, 2) , t a pi h a l i n i mu n g k i nd a pa t t e r j a d i o l e hk a r e n ae f e kk o r t i k o s t e r o i d . S e d a n g k a n pa d a pe n e l i t i a ni n it i d a kk a mi t e mu k a n k e j a d i a nd i a b e t e sg e s t a s i o n a ld a r is e l u r u hi b uh a mi l d e n g a na s ma . Ya l e a s t h ma s t u d y me n d a pa t k a n t i d a k a d a h u b u n g a na n t a r a b e r a t n y a g e j a l a a s ma d e n g a npe r s a l i n a n pr e ma t u r ,t a pi t e r a pi k o r t i k o s t e r o i d me n i n g k a t k a n t e r j a d i n y a pe r s a l i a n pr e ma t u rd a n me mpe r pe n d e k u mu rk e h a mi l a ns e l a ma 2, 2 mi n g g u (RO 1, 0 5)d a n 9 5% KI(1, 0 1 1, 0 9 ) . Ge j a l aa s may a n gt i mb u l s e t i a p h a r i b e r h u b u n g a nd e n g a npe n i n g k a t a nr i s i k og a n g g u a n pe r t u mb u h a nj a n i n(RO 2, 25) d a n9 5% KI (1, 25 4, 0 6) d a n 24%, i n ij u g ad i d u k u n go l e hb e b e r a pas t u d iy a n g me n y i mpu l k a nb a h wae k s a s e r b a s i a s mas a a t k e h a mi l a n me n i n g k a t k a nr i s i k ob a y i b e r a t b a d a nl a h i r r e n d a h . ( RR 2, 54) d a n9 5% KI (1, 52 4, 25) d i b a n d i n gwa n i t at a n pa 8 a s ma .P a d a pe n e l i t i a ni n it i d a kk a mid a pa t k a nb a y i d e n g a nb e r a tb a d a nl a h i rr e n d a h .Ko n d i s ii n ib e l u m d a pa tk a mij e l a s k a n pe n y e b a b n y aa k i b a tk e t e r b a t a s a n d a t a me n g e n a is t a t u sk o n t r o la s ma s a mpe lpe n e l i t i a n s a a t ante natal c are (ANC) . P a d ape n e l i t i a ni n i d i d a pa t k a npr o po r s i k e l a i n a n k o n g e n i t a l ,pr o po r s ipe r s a l i n a nd e n g a ns e k s i os e s a r i a d a nt i n d a k a n , pr o po r s i a d a n y apr e e k l a ms i ad a nr a t a r a t a u mu rk e h a mi l a nt a mpa kl e b i hr e n d a h pa d ak e l o mpo k a s ma ,n a mu n pe r b e d a a ny a n gt e r j a d id a r iv a r i a b e l v a r i a b e l t e r s e b u t t i d a kb e r ma k n as e c a r as t a t i s t i kd e n g a n p >0 , 0 5,s e d a n g k a n y a n g me mi l i k in i l a ip = 0 , 0 5 a d a l a hpe r b e d a a nr a t a r a t ab e r a t b a d a nb a y i d e n g a nKI 9 5% (39 9 , 14 0 , 0 12) , y a i t ur a t a r a t ab e r a t b a d a nb a y i pa d ak e l o mpo ka s mal e b i hr e n d a hd i b a n d i n gk e l o mpo k t a n paa s ma . P e r b e d a a nr e r a t ab e r a t b a d a nl a h i rb a y i i n i me ma n gk a mit e mu k a ns i g n i k a n , t e t a pib i l ad i t e l a a h

J Peny Dalam, Volume 10 Nomor 3 September 2009

l e b i hl a n j u tma s i hd a l a mb a t a sb e r a tb a d a nl a h i rb a y i y a n gn o r ma l . J e n i s k e l a mi n j a n i n d i s e b u t k a n d a pa t me mpe n g a r u h i k o n d i s i a s ma s e l a ma k e h a mi l a n . Be b e r a pape n e l i t i a nme n y a t a k a nb a h waa s mame n j a d i b e r a tb i l a pa s i e na s ma h a mi ld e n g a nj e n i sk e l a mi n j a n i npe r e mpu a ns e d a n gt i d a kme n u n j u k k a npe r u b a h a n a t a ub a h k a n me mb a i k pa d ak e h a mi l a nd e n g a nj e n i s 3 k e l a mi nl a k i l a k i . Ha l i n i me n j a d i s u a t uf e n o me n ay a n g me n a r i ku n t u kd i k a j i l e b i hl a n j u t . S a mpa i s a a t i n i b e l u m a d ape n j e l a s a n me n g e n a ime k a n i s mey a n g me n d a s a r i k e a d a a nt e r s e b u t .P a d a pe n e l i t i a ni n i me n d a pa t k a n k o n d i s ib e r b e d ay a i t u pr o po r s ib a y il a k i l a k il e b i h b a n y a k pa d ak e l o mpo ka s ma d i b a n d i n gk e l o mpo k t a n pa a s ma ,h a li n id a pa tt e r j a d imu n g k i nt e r j a d i n y a e k s a s e r b a s ia k i b a tf a k t o r pe n c e t u sd a r il u a rb u k a n a k i b a tpe n i n g k a t a ni n a ma s ipa d ai b us e b a g a i ma n a pa d ai b ud e n g a nj a n i nwa n i t a . S e b a g a i ma n a pe n e l i t i a n pe n e l i t i a n d e s k r i pt i f l a i ny a n gb e r b a s i sc a t a t a n me d i spa s i e n ,k e l e n g k a pa n d a t a me ma n g ma s i h me n j a d ik e l e ma h a n pe n e l i t i a n i n i .Da t a me n g e n a ir i wa y a tk o n t r o la s ma i b uh a mi l , pe r j a l a n a n pe r s a l i n a n ,s e r t ah a l h a ll a i ny a n gs e c a r a t e o r i t i sb e r pe n g a r u hpa d aoutc ome b a y i pa d ai b uh a mi l d e n g a na s mat i d a kd a pa t k a mi a n a l i s i sd e n g a nb a i k . KES I MP ULAN Da r ipe n e l i t i a ni n id i d a pa t k a n pr e v a l e n s ia s ma e k s a s e r b a s ipa d ai b uh a mi lb e r s a l i nd iRS UP S a n g l a h s e b e s a r0 , 71%.Ra t a r a t ab e r a tb a d a nb a y ib a i k pa d a i b ud e n g a na s mad a nt a n paa s mad a l a mb a t a sn o r ma l n a mu nd e n g a nk e c e n d r u n g a nb e r a tb a d a nl a h i rb a y i pa d ak e l o mpo ki b uh a mi ld e n g a na s ma l e b i hr e n d a h d i b a n d i n gd e n g a nk e l o mpo ki b uh a mi l t a n paa s ma .

Di pe r l u k a n pe n e l i t i a n l e b i h l a n j u t d e n g a n me t o d e , c a r ad a ns a mpe l l e b i ha k u r a t u n t u kme n g e t a h u i pr e v a l e n s id a n pe n g a r u ha s ma t e r h a d a p i b u ma u pu n j a n i npa d ai b uh a mi l d e n g a na s ma . P e n g o n t r o l a na s ma k h u s u s n y a pa d ai b ud a l a m u s i ak e h a mi l a n mu t l a k d i pe r l u k a n DAF T AR P US T AKA 1. Gl o b a lI n i t i a t i v eF o rAs t h ma (GI NA) .Gl o b a l s t r a t e g yf o r a s t h mama n a g e me n t a n dpr e v e n t i o n , 20 0 7. We i n s t e i nAM , Du b i nBD, P o d l e s k i W K, S pe c t o r S L,F a r r RS .As t h ma a n d pr e g n a n c y .J AM A 19 79 ; 241: 11615. Mu r ph y V E,Gi b s o n P G,S mi t h R,Cl i f t o nV L.As t h ma d u r i n g pr e g n a n c y :me c h a n i s msa n d t r e a t me n ti mpl i c a t i o n s ,Eu rRe s pi rJ 20 0 5; 25: 73150 . S c h a t z M , Do mb r o ws k iM P . As t h ma i n P r e g n a n c y . N En g l JM e d20 0 9 ; 360 : 18629 . Re y E,Bo u l e tL P . As t h mai n pr e g n a n c y .BM J 20 0 7; 334: 5825. Br e t o n M C,Be a u c h e s n eM F ,Le mi e ` r e C,Re y E, F o r g e t A, Bl a i sL. Ri s ko fpe r i n a t a l mo r t a l i t y a s s o c i a t e dwi t ha s t h mad u r i n gpr e g n a n c y . Th o r a x 20 0 9 ; 64: 10 16. T a t a LJ , Le wi sS A, M c Ke e v e r TM ,S mi t h CJ P , Do y l eP , S me e t hL, e t a l . Ac o mpr e h e n s i v e a n a l y s i so fa d v e r s e o b s t e t r i c a n d pe d i a t r i c c o mpl i c a t i o n si n wo me n wi t ha s t h ma .Am J Re s pi rCr i t Ca r eM e d20 0 7; 175: 9 9 17. Br i t i s h Th o r a c i cS o c i e t y .Br i t i s hg u i d e l i n eo n t h e ma n a g e me n to fa s t h ma a n a t i o n a lc l i n i c a l g u i d e l i n e 20 0 8. Av a i l a b l e f r o m: www. b r i t t h o r a c i c o r g u k . Ac e s s e do n : 12t hDe s20 0 9 .

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