B22-15 Effects of Biologic Treatment of Asthma on Preeclampsia, Postpartum Hemorrhage, Preterm Labor, and Gestational Diabetes

Abstract Rationale Poorly controlled asthma in pregnancy raises risks of preeclampsia, preterm labor/birth, postpartum hemorrhage, and gestational diabetes. Preeclampsia is a major contributor to maternal-fetal morbidity and mortality while postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide and thus a core focus of obstetric pharmacotherapy. Current guidelines recommend continuing necessary therapy throughout pregnancy, noting that although IgE and type-2-inflammation targeting biologics have transformed care, high-quality pregnancy data for most biologics remain limited. Methods A retrospective cohort study was conducted using the TriNetX research network, a database containing de-identified patient data collected from 30 countries. Two cohorts were constructed for comparison by utilizing ICD10 codes. The first cohort was composed of pregnant patients with asthma treated during pregnancy with omalizumab, dupilumab, benralizumab, mepolizumab, or tezepelumab and the second was composed of patients with no biologic exposure during pregnancy or in the year prior. Propensity scores matched 39 variables (demographics, risk factors, and possible confounding variables), and asthma severity, yielding 601 patients per cohort. Outcomes analyzed within TriNetX were preeclampsia, postpartum hemorrhage, preterm birth, and gestational diabetes. Results 25 patients in the group not using biologics were diagnosed with postpartum hemorrhage compared to 11 in the group which used biologics (4.2% vs. 1.8%, p = 0.0178). 33 patients in the group not using biologics were diagnosed with preterm labor compared to 17 in the group which used biologics (5.5% vs. 2.8%, p = 0.0208). 49 patients in the group not using biologics and 28 in the group which used biologics were diagnosed with gestational diabetes (8.2% vs. 4.7%, p = 0.0134). 58 patients in the group not using biologics were diagnosed with preeclampsia compared to 36 patients in the group using biologics (9.7% vs. 6.0%, p = 0.0181). Conclusion Omalizumab, dupilumab, benralizumab, mepolizumab, and tezepelumab when used to treat asthma during pregnancy is associated with decreased risk of postpartum hemorrhage, preterm labor, gestational diabetes, and preeclampsia. These findings suggest that biologic treatment may be preferred to prevent adverse pregnancy outcomes in those with severe, uncontrolled, or refractory asthma. Prospective studies are needed to confirm this hypothesis. Although propensity score matching was performed, the data may still be affected by confounding variables due to the nature of the retrospective study. Other factors that may have influenced the results of this study include differences in ICD and CPT code documentation of healthcare professionals. This abstract is funded by: None.