***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background Asthma is the most prevalent chronic disease to complicate pregnancies worldwide , affecting around 12 % of pregnant women in Australia . Oxidative stress and inflammation manifest during pregnancy ; however asthma in pregnancies further intensifies oxidative stress . Consumption of antioxidant-rich foods has been shown to be beneficial for asthma control in non-pregnant asthmatic adults . It has not been investigated whether antioxidant-rich foods can improve the elevated oxidative stress that occurs with asthma in pregnancy , thereby improving asthma control . The primary aim of this study is to determine whether increased consumption of antioxidant-rich foods for 12 weeks will improve maternal asthma control , compared to st and ard dietary intake during pregnancy . Methods / design A 12 week , parallel r and omized controlled trial will be conducted . One hundred and sixty eight pregnant women with mild , moderate , or severe asthma , currently using inhaled corticosteroids , and with poor diet quality , will be recruited at approximately12 weeks gestation . Following a 4 week run-in period , women will be r and omized to either a 12 week antioxidant intervention ( increased consumption of antioxidant-rich foods ( ≥5 servings/day vegetables , ≥2 servings/day fruit , ≥8 ½ servings/day grains ( mostly wholegrains ) , 3–4 serving/week lean meat ) or st and ard pregnancy care . The primary outcome is asthma control score ( decrease of 0.5 , the minimally clinical ly significant change ) . Secondary outcomes include plasma antioxidants , markers of oxidative stress , and time to , and number of , exacerbations . With two-tailed t-tests at 80 % power , a sample size of 52 completions per group is required . Allowing for a 78 % retention including a 20 % removal of women from the analysis due to non-compliance , we will recruit 168 women . Discussion It is expected that this 12 week study will improve asthma control . This is significant because asthma is the most prevalent condition to complicate pregnancies and contributes to poor maternal , neonatal and infant health outcomes . Our research will provide the first evidence to show that , in pregnancy , consumption of antioxidant-rich foods is a key modifier of clinical asthma status . This research is crucial for contributing to the evidence base to inform future guidelines given existing clinical and research gaps . Trial registration Education on optimal medication use is an essential strategy to improve asthma control . The current authors investigated whether pharmacist interventions , focused on appropriate use of asthma medication and tailor-made to the patient 's current asthma control , would improve asthma control in adult patients . A 6-month r and omised , controlled , parallel-group trial was conducted in 66 community pharmacies in Belgium . Patients were r and omly assigned to receive usual pharmacist care ( n = 94 ) or a pre-defined pharmacist intervention ( n = 107 ) . This intervention mainly focused on improving inhalation technique and medication adherence . Primary outcome was the level of asthma control , as assessed by the Asthma Control Test ® ( ACT ) . Mean ACT scores did not change from baseline for both study groups . However , a pre-defined subgroup analysis of patients having insufficiently controlled asthma at baseline showed that the intervention had significantly increased the ACT score after 6 months compared with usual care . The intervention also reduced , for the complete study group , reliever medication use and the frequency of night-time awakenings due to asthma . Inhalation technique and adherence to controller medication were significantly better in the intervention group . In conclusion , pragmatic community pharmacy-based programmes can significantly improve therapeutic outcomes in adult asthma patients Objective To study the risk for congenital malformations among infants whose mothers used anti-asthmatic drugs during pregnancy . Material s and methods We studied 24,750 infants whose mothers reported the use of anti-asthmatic drugs in early pregnancy . Infants were identified from the Swedish Medical Birth Register where drug use reported at the first maternal health care visit is recorded . Congenital malformations among the infants born were identified from that register , the Swedish Register of Congenital Malformations , and the Hospital Discharge Register . Rates of malformations among infants exposed to anti-asthmatics were compared with the background population rate of malformations ( 4.7 % ) after adjustment for year of birth , maternal age , parity , smoking , and previous miscarriages . Results A weak increase in the risk for a congenital malformation was seen ( odds ratio = 1.09 , 95 % CI = 1.03–1.15 ) which could not be explained by the confounders studied . The risks for three specific types of malformations appeared to be increased : relatively severe cardiac defects , orofacial clefts and specifically median cleft palate , and anal atresia . For the two last mentioned groups , use of anti-asthmatics with inhaled corticosteroids showed a higher odds ratio than use of other anti-asthmatics , but the differences could be r and om . Conclusions Maternal asthma and use of anti-asthmatic drugs carry no major risk for congenital malformations in the offspring , but a slight teratogenic effect can not be excluded . It may be due to asthma , and arguments for a stronger effect of inhaled corticosteroids than of other anti-asthmatics are weak Background : Asthma is a serious medical problem in pregnancy and is often associated with stress , anger and poor quality of life . The aim of this study was to determine the efficacy of progressive muscle relaxation ( PMR ) on change in blood pressure , lung parameters , heart rate , anger and health-related quality of life in pregnant women with bronchial asthma . Methods : We treated a sample of 64 pregnant women with bronchial asthma from the local population in an 8-week r and omized , prospect i ve , controlled trial . Thirty-two were selected for PMR , and 32 received a placebo intervention . The systolic blood pressure , forced expiratory volume in the first second , peak expiratory flow and heart rate were tested , and the State-Trait Anger Expression Inventory and  Health Survey ( SF-36 ) were employed . Results : According to the intend-to-treat principle , a significant reduction in systolic blood pressure and a significant increase in both forced expiratory volume in the first second and peak expiratory flow were observed after PMR . The heart rate showed a significant increase in the coefficient of variation , root mean square of successive differences and high frequency ranges , in addition to a significant reduction in low and middle frequency ranges . A significant reduction on three of five State-Trait Anger Expression Inventory scales , and a significant increase on seven of eight SF-36 scales were observed . Conclusions : PMR appears to be an effective method to improve blood pressure , lung parameters and heart rate , and to decrease anger levels , thus enhancing health-related quality of life in pregnant women with bronchial asthma Objective Maternal asthma is the most common chronic disease complicating pregnancy and is a risk factor for bronchiolitis in infancy . Recurrent episodes of bronchiolitis are strongly associated with the development of childhood asthma . Methods We conducted a follow-up study of infants born to women with asthma who completed a double-blind r and omised controlled trial during pregnancy . In this trial , pregnant women with asthma were assigned to treatment adjustment by an algorithm using clinical symptoms ( clinical group ) or the fraction of exhaled nitric oxide ( FeNO group ) and we showed that the FeNO group had significantly lower asthma exacerbation rates in pregnancy . Results 146 infants attended the 12-month follow-up visit . Infants born to mothers from the FeNO group were significantly less likely to have recurrent episodes of bronchiolitis in the first year of life ( OR 0.08 , 95 % CI 0.01 to 0.62 ; p=0.016 ) as compared with the clinical group . Conclusions Optimised management of asthma during pregnancy may reduce recurrent episodes of bronchiolitis in infancy , which could potentially modulate the risk to develop or the severity of emerging childhood asthma Background Smoking and severe asthma exacerbations in pregnancy are risk factors for low birth weight babies . No studies have assessed the clinical implication s of smoking on asthma exacerbations in pregnancy . Methods Pregnant women with current asthma ( n=80 ) were prospect ively assessed at clinic visits ( 18 , 30 , 36 weeks ) , during exacerbations and with fortnightly phone calls . The asthma control question naire was administered at each contact and exacerbations classified as severe ( requiring medical intervention ) or mild ( self-managed ) .  Medications , self-management skills , smoking history , fractional exhaled nitric oxide ( FENO ) , exhaled carbon monoxide ( ECO ) and lung function were assessed . Pregnant women without asthma ( controls , n=46 ) were assessed prospect ively at clinic visits . Results Women with asthma were more likely to smoke ( 34 % current smokers ) than women without asthma ( 15 % current smokers ) . In women with asthma , the median ( IQR ) exacerbation rate during pregnancy was 2.0 ( 1.0–3.0 ) in current smokers , 2.0 ( 1.0–3.0 ) in ex-smokers and 1.5 ( 1.0–2.0 ) in never smokers . The asthma control score during exacerbations was higher in current smokers ( median ( IQR ) 2.17 ( 1.17–2.7 ) ) compared with never smokers ( 1.17 ( 0.8–2.17 ) , p=0.056 ) . An adjusted linear regression model found that smoking was significantly associated with higher asthma control score during exacerbation ( p=0.04 ) . Birth weights were lower among children of smokers than non-smokers ( p=0.023 control group , p=0.086 asthma group ) . Conclusions During pregnancy , asthma exacerbations are more common and more severe in current smokers than never smokers . The risk of effects of maternal asthma on the fetus may be greater among smokers Abstract Background Pregnancy presents a unique situation for the management of asthma as it can alter the course of asthma severity and its treatment , which in turn can affect pregnancy outcomes . Despite awareness of the substantial adverse effects associated with asthma during pregnancy , little has been done to improve its management and reduce associated perinatal morbidity and mortality . The aim of this r and omized controlled trial is to evaluate the clinical and cost effectiveness of an Antenatal Asthma Management Service . Methods / design Design : Multicentre , r and omized controlled trial . Inclusion criteria : Women with physician diagnosed asthma , which is not currently in remission , who are less than 20 weeks gestation with a singleton pregnancy and do not have a chronic medical condition . Trial entry and r and omization : Eligible women with asthma , stratified by treatment site , disease severity and parity , will be r and omized into either the ‘ St and ard Care Group ’ or the ‘ Intervention Group ’ . Study groups : Both groups will be followed prospect ively throughout pregnancy . Women in the ‘ St and ard Care Group ’ will receive routine obstetric care reflecting current clinical practice in Australian hospitals . Women in the ‘ Intervention Group ’ will receive additional care through the nurse-led Antenatal Asthma Management Service , based in the antenatal outpatient clinic . Women will receive asthma education with a full assessment of their asthma at 18 , 24 , 30 and 36 weeks gestation . Each antenatal visit will include a 60 min session where asthma management skills are assessed including : medication adherence and knowledge , inhaler device technique , recognition of asthma deterioration and possession of a written asthma action plan . Furthermore , subjects will receive education about asthma control and management skills including trigger avoidance and smoking cessation counseling when appropriate . Primary study outcome : Asthma exacerbations during pregnancy . Sample size : A sample size of 378 women will be sufficient to show an absolute reduction in asthma exacerbations during pregnancy of 20 % ( alpha 0.05 two-tailed , 90 % power , 5 % loss to follow-up ) . Discussion The integration of an asthma education program within the antenatal clinic setting has the significant potential to improve the participation of pregnant women in the self-management of their asthma , reduce asthma exacerbations and improve perinatal health outcomes .Trial registration Background Uncontrolled asthma during pregnancy is associated with the maternal hazards of disease exacerbation , and perinatal hazards including intrauterine growth restriction and preterm birth . Interventions directed at achieving better asthma control during pregnancy should be considered a high priority in order to optimise both maternal and perinatal outcomes . Poor compliance with prescribed asthma medications during pregnancy and suboptimal prescribing patterns to pregnant women have both been shown to be contributing factors that jeopardise asthma control . The aim is to design and evaluate an intervention involving multidisciplinary care for women experiencing asthma in pregnancy . Methods / design A pilot single-blinded parallel-group r and omized controlled trial testing a Multidisciplinary Approach to Management of Maternal Asthma ( MAMMA © ) which involves education and regular monitoring . Pregnant women with asthma will be recruited from antenatal clinics in Victoria , Australia . Recruited participants , stratified by disease severity , will be allocated to the intervention or the usual care group in a 1:1 ratio . Both groups will be followed prospect ively throughout pregnancy and outcomes will be compared between groups at three and six months after recruitment to 
    Output:
    
Based on eight included trials , of moderate quality overall , no firm conclusions about optimal interventions for managing asthma in pregnancy can be made .
Five trials assessing pharmacological interventions did not provide clear evidence of benefits or harms to support or refute current practice .
Three trials assessing non-pharmacological interventions provided some support for the use of such strategies , however were not powered to detect differences in important maternal and infant outcomes .
While a FENO-based algorithm reduced exacerbations , the effects on perinatal outcomes were less certain , and thus widespread implementation is not yet appropriate .