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Alvizi L, Nani D, Brito LA, Kobayashi GS, Passos-Bueno MR, Mayor R. Neural crest E-cadherin loss drives cleft lip/palate by epigenetic modulation via pro-inflammatory gene-environment interaction. Nat Commun 2023; 14:2868. [PMID: 37225711 DOI: 10.1038/s41467-023-38526-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 05/05/2023] [Indexed: 05/26/2023] Open
Abstract
Gene-environment interactions are believed to play a role in multifactorial phenotypes, although poorly described mechanistically. Cleft lip/palate (CLP), the most common craniofacial malformation, has been associated with both genetic and environmental factors, with little gene-environment interaction experimentally demonstrated. Here, we study CLP families harbouring CDH1/E-Cadherin variants with incomplete penetrance and we explore the association of pro-inflammatory conditions to CLP. By studying neural crest (NC) from mouse, Xenopus and humans, we show that CLP can be explained by a 2-hit model, where NC migration is impaired by a combination of genetic (CDH1 loss-of-function) and environmental (pro-inflammatory activation) factors, leading to CLP. Finally, using in vivo targeted methylation assays, we demonstrate that CDH1 hypermethylation is the major target of the pro-inflammatory response, and a direct regulator of E-cadherin levels and NC migration. These results unveil a gene-environment interaction during craniofacial development and provide a 2-hit mechanism to explain cleft lip/palate aetiology.
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Affiliation(s)
- Lucas Alvizi
- Department of Cell and Developmental Biology, University College London, Gower Street, London, WC1E 6BT, UK.
| | - Diogo Nani
- Centro de Estudos do Genoma Humano e Celulas-Tronco, Departamento de Genetica e Biologia Evolutiva, Instituto de Biociencias, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Luciano Abreu Brito
- Centro de Estudos do Genoma Humano e Celulas-Tronco, Departamento de Genetica e Biologia Evolutiva, Instituto de Biociencias, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Gerson Shigeru Kobayashi
- Centro de Estudos do Genoma Humano e Celulas-Tronco, Departamento de Genetica e Biologia Evolutiva, Instituto de Biociencias, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Maria Rita Passos-Bueno
- Centro de Estudos do Genoma Humano e Celulas-Tronco, Departamento de Genetica e Biologia Evolutiva, Instituto de Biociencias, Universidade de Sao Paulo, Sao Paulo, Brazil.
| | - Roberto Mayor
- Department of Cell and Developmental Biology, University College London, Gower Street, London, WC1E 6BT, UK.
- Center for Integrative Biology, Faculty of Sciences, Universidad Mayor, Santiago, Chile.
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2
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Shi FP, Huang YY, Dai QQ, Chen YL, Jiang HY, Liang SY. Maternal Common Cold or Fever During Pregnancy and the Risk of Orofacial Clefts in the Offspring: A Systematic Review and Meta-analysis. Cleft Palate Craniofac J 2023; 60:446-453. [PMID: 34918551 DOI: 10.1177/10556656211067695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The common cold and/or an associated fever during pregnancy have/has been suspected to harm the developing fetus. We sought possible correlations between a maternal common cold or fever during pregnancy and the risk of orofacial clefts in the offspring. We systematically searched PubMed and Embase using appropriate keywords, and we checked the reference lists of retrieved articles. We used random-effects models to estimate overall relative risks. Incidence of orofacial clefts. We included 13 case-control studies. Modest but statistically significant associations were found between a maternal common cold and cleft lip with or without a cleft palate (CL/CP) (odds ratio [OR] 2.17; 95% confidence interval [CI] 1.66-2.83) and a cleft palate only (CPO) (OR 3.08; 95% CI 1.5-6.34). Furthermore, maternal fever was also associated with an increased risk of CL/CP (OR 1.91, 95% CI 1.3-2.8) and CPO (OR 1.48, 95% CI 0.83-2.63) in the offspring. Further analyses of maternal influenza (alone) yielded similar results. Although evidence of heterogeneity should be carefully evaluated, our findings suggest that maternal common cold or fever during pregnancy may be associated with a greater risk of CL/CP or CPO in the offspring. Future cohort studies using valid assessments of maternal common cold exposure during pregnancy that consider the severity of fever are needed to clarify the contribution of maternal common cold or fever status to the risk of orofacial clefts in children.
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Affiliation(s)
- Fang-Ping Shi
- Ningbo Urology and Nephrology Hospital, Ningbo, Zhejiang, China
| | - Ying-Ying Huang
- Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qiao-Qun Dai
- Ningbo Urology and Nephrology Hospital, Ningbo, Zhejiang, China
| | - Yu-Lu Chen
- Ningbo Urology and Nephrology Hospital, Ningbo, Zhejiang, China
| | - Hai-Yin Jiang
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital, School of Medicine, 12377Zhejiang University, Hangzhou, Zhejiang, China
| | - Si-Yuan Liang
- Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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3
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Rumbo J, Madariaga-P I, Salazar-Reviakina A, Sierra-Breton M, Tovar C, Sequera D, Rodríguez C, Holguín J, Hurtado-Villa P, Sarmiento K, Zarante I. Association between maternal infections during pregnancy and congenital defects in their offspring: a population-based case-control study in Bogota and Cali, Colombia 2001-2018. J Matern Fetal Neonatal Med 2021; 35:8723-8727. [PMID: 34749588 DOI: 10.1080/14767058.2021.1999924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Infections are frequent during pregnancy and their teratogenic role is well documented in Toxoplasmosis, other infections, Rubella, Cytomegalovirus, and Herpes simplex (TORCH). However, the in-utero development effects of the rest of the infections that affect pregnant women are unknown. We described a cohort of patients with major Birth Defects (BD) and the exposure to infections during pregnancy from the information of Congenital Defects Surveillance Programs of two Colombian cities (Bogota and Cali) between 2001 and 2018. We evaluated associations between groups of maternal infections and BD among 3096 cases and 7446 controls that were registered. BD presentation was more frequent as isolated (64.3%), polymalformed (23.2%), and syndromic (12.4%). Infections during pregnancy were present in 52.5% of cases and 44.6% of controls. The most common single infection between cases and controls was vaginal infection. The most common polyinfection was vaginal and urinary tract infection. We found an association between BD and vaginal infections with an odds ratio (OR) 1.18 (CI 1.08-1.30), urinary tract infections OR 1.16 (CI 1.05-1.28), gastrointestinal infections OR 2.06 (IC 1.18-3.59), respiratory infections OR 1.56 (IC 1.28-1.9) and viral infections OR 1.88 (IC 1.18-3.0). Knowing the teratogenic effect of infections is important to extend prevention, screening, timely diagnosis, and appropriate treatment to pregnant women.
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Affiliation(s)
- Jose Rumbo
- Faculty of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
| | | | | | | | - Catherin Tovar
- Institute of Human Genetics, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Diana Sequera
- Faculty of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
| | | | - Jorge Holguín
- Department of Public Health and Epidemiology, Pontificia Universidad Javeriana, Cali, Colombia
| | - Paula Hurtado-Villa
- Department of Basic Sciences, Faculty of Health, Pontificia Universidad Javeriana, Cali, Colombia
| | - Karen Sarmiento
- Department of Physiological Sciences, Faculty of Medicine, Pontificia Universidad Javeriana, Bogota, Colombia
| | - Ignacio Zarante
- Institute of Human Genetics, Pontificia Universidad Javeriana, Bogota, Colombia.,Genetics Service, Hospital Universitario San Ignacio, Bogota, Colombia
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4
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Bhagirath AY, Medapati MR, de Jesus VC, Yadav S, Hinton M, Dakshinamurti S, Atukorallaya D. Role of Maternal Infections and Inflammatory Responses on Craniofacial Development. FRONTIERS IN ORAL HEALTH 2021; 2:735634. [PMID: 35048051 PMCID: PMC8757860 DOI: 10.3389/froh.2021.735634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 08/10/2021] [Indexed: 12/12/2022] Open
Abstract
Pregnancy is a tightly regulated immunological state. Mild environmental perturbations can affect the developing fetus significantly. Infections can elicit severe immunological cascades in the mother's body as well as the developing fetus. Maternal infections and resulting inflammatory responses can mediate epigenetic changes in the fetal genome, depending on the developmental stage. The craniofacial development begins at the early stages of embryogenesis. In this review, we will discuss the immunology of pregnancy and its responsive mechanisms on maternal infections. Further, we will also discuss the epigenetic effects of pathogens, their metabolites and resulting inflammatory responses on the fetus with a special focus on craniofacial development. Understanding the pathophysiological mechanisms of infections and dysregulated inflammatory responses during prenatal development could provide better insights into the origins of craniofacial birth defects.
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Affiliation(s)
- Anjali Y. Bhagirath
- Department of Pediatrics and Physiology, University of Manitoba, Winnipeg, MB, Canada
- Biology of Breathing, Children's Hospital Research Institute of Manitoba (CHRIM), Winnipeg, MB, Canada
- Department of Oral Biology, Dr. Gerald Niznick College of Dentistry, University of Manitoba, Winnipeg, MB, Canada
| | - Manoj Reddy Medapati
- Biology of Breathing, Children's Hospital Research Institute of Manitoba (CHRIM), Winnipeg, MB, Canada
- Department of Oral Biology, Dr. Gerald Niznick College of Dentistry, University of Manitoba, Winnipeg, MB, Canada
| | - Vivianne Cruz de Jesus
- Biology of Breathing, Children's Hospital Research Institute of Manitoba (CHRIM), Winnipeg, MB, Canada
- Department of Oral Biology, Dr. Gerald Niznick College of Dentistry, University of Manitoba, Winnipeg, MB, Canada
| | - Sneha Yadav
- Mahatma Gandhi Institute of Medical Sciences, Wardha, India
| | - Martha Hinton
- Department of Pediatrics and Physiology, University of Manitoba, Winnipeg, MB, Canada
- Biology of Breathing, Children's Hospital Research Institute of Manitoba (CHRIM), Winnipeg, MB, Canada
| | - Shyamala Dakshinamurti
- Department of Pediatrics and Physiology, University of Manitoba, Winnipeg, MB, Canada
- Biology of Breathing, Children's Hospital Research Institute of Manitoba (CHRIM), Winnipeg, MB, Canada
| | - Devi Atukorallaya
- Biology of Breathing, Children's Hospital Research Institute of Manitoba (CHRIM), Winnipeg, MB, Canada
- Department of Oral Biology, Dr. Gerald Niznick College of Dentistry, University of Manitoba, Winnipeg, MB, Canada
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5
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Nalbandyan M, Papadopoulos EA, Leckman-Westin E, Browne ML. Nongenetic risk factors for infantile cataracts: Systematic review of observational studies. Birth Defects Res 2021; 113:1112-1129. [PMID: 33949794 DOI: 10.1002/bdr2.1904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 04/12/2021] [Accepted: 04/26/2021] [Indexed: 11/06/2022]
Abstract
INTRODUCTION While infantile cataracts are a major cause of childhood blindness, risk factors remain unknown for approximately two-thirds of cases. METHODS We systematically searched electronic databases PubMed, Ovid MEDLINE, Web of Science, and Scopus, from inception through March 2018, to identify relevant cohort, case-control, cross-sectional studies, case reports, and case series. We also manually screened bibliographies and consulted with experts in the field to identify additional publications. We reviewed cross-sectional studies, case reports, and case series and provided a narrative summary of the reported potential risk factors. We evaluated methodological qualities of cohort and case-control studies, extracted relevant data, and described statistically significant associations with infant, maternal, and paternal characteristics. Quality assessment and data extraction were conducted by two reviewers independently. All discrepancies were discussed with the senior author and resolved by consensus. RESULTS Overall, 110 publications were included in the review, 33 of which were cohort and case-control studies. Most of these studies (n = 32) used population-based data and had either excellent (n = 31) or good (n = 2) methodological quality. Nine studies reported statistically significant associations with infant characteristics (preterm birth, low birth weight), maternal occupations and diseases during pregnancy (untreated hypertension, infections), and paternal sociodemographics (younger age, employment in sawmill industry during pregnancy). CONCLUSIONS This systematic literature review provided a comprehensive summary of the known nongenetic risk factors for infantile cataracts, identified gaps in the literature, and provided directions for future research. Studies identifying modifiable risk factors are warranted to design interventions aimed at primary prevention of infantile cataracts.
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Affiliation(s)
- Marine Nalbandyan
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York, USA
| | - Eleni A Papadopoulos
- Birth Defects Research Section, New York State Department of Health, Albany, New York, USA
| | - Emily Leckman-Westin
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York, USA.,New York State Office of Mental Health, Albany, New York, USA
| | - Marilyn L Browne
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York, USA.,Birth Defects Research Section, New York State Department of Health, Albany, New York, USA
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6
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Li P, Qin X, Tao F, Huang K. Maternal exposure to sulfonamides and adverse pregnancy outcomes: A systematic review and meta-analysis. PLoS One 2020; 15:e0242523. [PMID: 33264319 PMCID: PMC7710089 DOI: 10.1371/journal.pone.0242523] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 11/03/2020] [Indexed: 01/11/2023] Open
Abstract
Background Sulfonamides are widely used to treat infectious diseases during pregnancy. However, the safety of maternal exposure to sulfonamides is controversial. This study aims to systematically review the available studies and examine the effect of maternal sulfonamides use on adverse pregnancy outcomes. Methods We searched PubMed, Science Direct, Web of Science, ClinicalTrials.gov, CNKI and Wanfang Database (in Chinese). The meta-analysis used random effects model or fixed effects model to obtain the total odds ratio (OR) for each outcome through Stata11.0 software. Study on the relationship between sulfonamide exposure during pregnancy and adverse pregnancy outcomes. The study design covered randomized controlled trials, cohort studies and case-control studies. The study protocol was registered in PROSPERO with protocol number CRD42020178687. Results A total of 10 studies, and 1096350 participants were included for systematic review. Maternal exposure to sulfonamides was found to be possibly associated with increased risk of congenital malformations (OR = 1.21, 95% CI 1.07–1.37). The use of sulfonamides in the first trimester of pregnancy and during the entire pregnancy might be associated with congenital malformations. Conclusions Maternal exposure to sulfonamides may be associated with offspring’ s congenital malformations. Prescription of sulfonamides for pregnant women is suggested to be carefully censored.
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Affiliation(s)
- Peixuan Li
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China.,Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei, China.,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, China
| | - Xiaoyun Qin
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China.,Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei, China.,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, China
| | - Fangbiao Tao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China.,Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei, China.,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, China
| | - Kun Huang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, Hefei, China.,Key Laboratory of Population Health Across Life Cycle (AHMU), MOE, Hefei, China.,NHC Key Laboratory of Study on Abnormal Gametes and Reproductive Tract, Hefei, China.,Anhui Provincial Key Laboratory of Population Health and Aristogenics, Hefei, China.,Scientific Research Center in Preventive Medicine, School of Public Health, Anhui Medical University, Anhui Province, Hefei, China
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7
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Sexually transmitted infections in pregnancy - An update on Chlamydia trachomatis and Neisseria gonorrhoeae. Eur J Obstet Gynecol Reprod Biol 2020; 255:1-12. [PMID: 33059307 DOI: 10.1016/j.ejogrb.2020.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 12/14/2022]
Abstract
Routine screening for Chlamydia and gonococcal infection in pregnancy is not widespread, especially in low- and middle-income countries (LMICs), despite their potential adverse consequences on pregnancy outcome. We conducted a systematic literature search of three major databases to review current literature surrounding Chlamydia trachomatis and Neisseria gonorrhoeae infections in pregnancy. We discuss the epidemiology and burden of both infections, detection methods, potential adverse feto-maternal and infant outcomes and provide an overview of treatment options. A total of 67 articles met the inclusion criteria. The prevalence of C. trachomatis and N. gonorrhoeae across all trimesters ranged between 1.0%-36.8% and 0-14.2% worldwide, respectively. The most common diagnostic method is the Nucleic acid amplification test (NAAT). In pregnancy, chlamydia is associated with preterm birth, spontaneous miscarriage, stillbirth and neonatal conjunctivitis, while gonorrhoea is mainly associated with preterm birth and stillbirth. Amoxicillin, erythromycin and azithromycin showed similar efficacy in the treatment of chlamydia in pregnancy, while ceftriaxone and cefixime were effective in treating gonorrhoea in pregnancy. Being largely asymptomatic infections in women, we opine that detection strategies with locally appropriate tools should be combined with the syndromic approach in LMICs, where there is a high burden of disease.
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8
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Forestieri NE, Desrosiers TA, Freedman SF, Aylsworth AS, Voltzke K, Olshan AF, Meyer RE. Risk factors for primary congenital glaucoma in the National Birth Defects Prevention Study. Am J Med Genet A 2019; 179:1846-1856. [DOI: 10.1002/ajmg.a.61296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 02/05/2019] [Accepted: 07/03/2019] [Indexed: 02/04/2023]
Affiliation(s)
- Nina E. Forestieri
- North Carolina Birth Defects Monitoring Program, State Center for Health Statistics Raleigh North Carolina
| | - Tania A. Desrosiers
- Department of EpidemiologyGillings School of Global Public Health, University of North Carolina at Chapel Hill Chapel Hill North Carolina
| | - Sharon F. Freedman
- Department of Ophthalmology and PediatricsDuke University Medical Center Durham North Carolina
| | - Arthur S. Aylsworth
- Department of Pediatrics and GeneticsUniversity of North Carolina at Chapel Hill Chapel Hill North Carolina
| | - Kristin Voltzke
- Department of EpidemiologyGillings School of Global Public Health, University of North Carolina at Chapel Hill Chapel Hill North Carolina
| | - Andrew F. Olshan
- Department of EpidemiologyGillings School of Global Public Health, University of North Carolina at Chapel Hill Chapel Hill North Carolina
| | - Robert E. Meyer
- North Carolina Birth Defects Monitoring Program, State Center for Health Statistics Raleigh North Carolina
- Department of Maternal and Child HealthGillings School of Global Public Health, University of North Carolina at Chapel Hill Chapel Hill North Carolina
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9
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Howley MM, Feldkamp ML, Papadopoulos EA, Fisher SC, Arnold KE, Browne ML. Maternal genitourinary infections and risk of birth defects in the National Birth Defects Prevention Study. Birth Defects Res 2018; 110:1443-1454. [PMID: 30402975 PMCID: PMC6543540 DOI: 10.1002/bdr2.1409] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 09/11/2018] [Accepted: 09/14/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Genitourinary infections (GUIs) are common among sexually active women. Yet, little is known about the risk of birth defects associated with GUIs. METHODS Using data from the National Birth Defects Prevention Study, a multisite, population-based, case-control study, we assessed self-reported maternal GUIs in the month before through the third month of pregnancy (periconception) from 29,316 birth defect cases and 11,545 unaffected controls. We calculated odds ratios (ORs) and 95% confidence intervals to estimate the risk of 52 major structural birth defects associated with GUIs. We also calculated risk of birth defects associated with each type of GUI: urinary tract infection (UTI) and sexually transmitted infection (STI). RESULTS In our analysis, 10% (n = 2,972) of case and 9% (n = 1,014) of control mothers reported a periconceptional GUI. A GUI was significantly associated with 11 of the 52 birth defects examined (ORs ranging from 1.19 to 2.26): encephalocele, cataracts, cleft lip, esophageal atresia, duodenal atresia/stenosis, small intestinal atresia/stenosis, colonic atresia/stenosis, transverse limb deficiency, conoventricular septal defect, atrioventricular septal defect, and secundum atrial septal defect. A periconceptional UTI was significantly associated with nine birth defects (ORs from 1.21 to 2.48), and periconceptional STI was significantly associated with four birth defects (ORs ranging from 1.63 to 3.72). CONCLUSIONS While misclassification of GUIs in our analysis is likely, our findings suggest GUIs during the periconceptional period may increase the risk for specific birth defects.
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Affiliation(s)
- Meredith M. Howley
- Congenital Malformations Registry, New York State Department of Health, Albany, New York
| | - Marcia L. Feldkamp
- Division of Medical Genetics, Department of Pediatrics, University of Utah Health Sciences, Salt Lake City, Utah
| | - Eleni A. Papadopoulos
- Congenital Malformations Registry, New York State Department of Health, Albany, New York
| | - Sarah C. Fisher
- Congenital Malformations Registry, New York State Department of Health, Albany, New York
| | - Kathryn E. Arnold
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Marilyn L. Browne
- Congenital Malformations Registry, New York State Department of Health, Albany, New York
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York
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10
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Weber KA, Yang W, Carmichael SL, Lupo PJ, Dukhovny S, Yazdy MM, Lin AE, Van Bennekom CM, Mitchell AA, Shaw GM. An application of data mining to identify potential risk factors for anophthalmia and microphthalmia. Paediatr Perinat Epidemiol 2018; 32:545-555. [PMID: 30300919 DOI: 10.1111/ppe.12509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 07/24/2018] [Accepted: 08/22/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND We examined a large number of variables to generate new hypotheses regarding a wider range of risk factors for anophthalmia/microphthalmia using data mining. METHODS Data were from the National Birth Defects Prevention Study, a multicentre, case-control study from 10 centres in the United States. There were 134 cases of "isolated" and 87 "nonisolated" (with other major birth defects) of anophthalmia/microphthalmia and 11 052 nonmalformed controls with delivery dates October 1997-December 2011. Using random forest, a data mining procedure, we compared the two case types with controls for 201 variables. Variables considered important ranked by random forest were included in a multivariable logistic regression model to estimate odds ratios and 95% confidence intervals. RESULTS Predictors for isolated cases included paternal race/ethnicity, maternal intake of certain nutrients and foods, and childhood health problems in relatives. Using regression, inverse associations were observed with greater maternal education and with increasing intake of folate and potatoes. Odds were slightly higher with greater paternal education, for increased intake of carbohydrates and beans, and if relatives had a childhood health problem. For nonisolated cases, predictors included paternal race/ethnicity, maternal intake of certain nutrients, and smoking in the home the month before conception. Odds were higher for Hispanic fathers and smoking in the home and NSAID use the month before conception. CONCLUSIONS Results appear to support previously hypothesised risk factors, socio-economic status, NSAID use, and inadequate folate intake, and potentially provide new areas such as passive smoking pre-pregnancy, and paternal education and ethnicity, to explore for further understanding of anophthalmia/microphthalmia.
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Affiliation(s)
- Kari A Weber
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Wei Yang
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Suzan L Carmichael
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Philip J Lupo
- Division of Hematology and Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Stephanie Dukhovny
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon
| | - Mahsa M Yazdy
- Massachusetts Department of Public Health, Boston, Massachusetts
| | - Angela E Lin
- Massachusetts Department of Public Health, Boston, Massachusetts.,Medical Genetics Unit, MassGeneral Hospital for Children, Harvard Medical School, Boston, Massachusetts
| | | | - Allen A Mitchell
- Slone Epidemiology Center at, Boston University, Boston, Massachusetts
| | - Gary M Shaw
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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11
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Summers AD, Reefhuis J, Taliano J, Rasmussen SA. Nongenetic risk factors for holoprosencephaly: An updated review of the epidemiologic literature. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2018; 178:151-164. [PMID: 29761639 DOI: 10.1002/ajmg.c.31614] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 04/03/2018] [Accepted: 04/04/2018] [Indexed: 12/17/2022]
Abstract
Holoprosencephaly (HPE) is a major structural birth defect of the brain that occurs in approximately 1 in 10,000 live births. Although some genetic causes of HPE are known, a substantial proportion of cases have an unknown etiology. Due to the low birth prevalence and rarity of exposure to many potential risk factors for HPE, few epidemiologic studies have had sufficient sample size to examine risk factors. A 2010 review of the literature identified several risk factors that had been consistently identified as occurring more frequently among cases of HPE, including maternal diabetes, twinning, and a predominance of females, while also identifying a number of potential risk factors that had been less widely studied. In this article, we summarize a systematic literature review conducted to update the evidence for nongenetic risk factors for HPE.
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Affiliation(s)
- April D Summers
- Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jennita Reefhuis
- Division of Congenital and Developmental Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joanna Taliano
- LAC Group, Contractor to US Centers for Disease Control and Prevention, Library Science Branch, Division of Public Health Information Dissemination, Center for Surveillance, Epidemiology, and Laboratory Services, Atlanta, Georgia
| | - Sonja A Rasmussen
- Office of Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Usynina AA, Postoev V, Odland JØ, Grjibovski AM. Adverse Pregnancy Outcomes among Adolescents in Northwest Russia: A Population Registry-Based Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E261. [PMID: 29401677 PMCID: PMC5858330 DOI: 10.3390/ijerph15020261] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 11/17/2022]
Abstract
This study aimed to assess whether adolescents have an increased risk of adverse pregnancy outcomes (APO) compared to adult women. We used data on 43,327 births from the population-based Arkhangelsk County Birth Registry, Northwest Russia, for 2012-2014. The perinatal outcomes included stillbirth, preterm birth (<37 and <32 weeks), low and very low birthweight, 5 min Apgar score <7 and <4, perinatal infections, and the need for neonatal transfer to a higher-level hospital. Multivariable logistic regression was applied to assess the associations between age and APO. Altogether, 4.7% of deliveries occurred in adolescents. Both folic acid intake and multivitamin intake during pregnancy were more prevalent in adults. Adolescents were more likely to be underweight, to smoke, and to have infections of the kidney and the genital tract compared to adult women. Compared to adults, adolescents were at lower risk of low birthweight, a 5 min Apgar score <7, and need for neonatal transfer. Adolescents had no increased risk of other APO studied in the adjusted analysis, suggesting that a constellation of other factors, but not young age per se, is associated with APO in the study setting.
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Affiliation(s)
- Anna A Usynina
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø 9037, Norway.
- Department of Neonatology and Perinatology, Northern State Medical University, 51 Troitsky Ave., Arkhangelsk 163000, Russia.
| | - Vitaly Postoev
- Department of Public Health, Health Care and Social Work, Northern State Medical University, 51 Troitsky Ave., Arkhangelsk 163000, Russia.
| | - Jon Øyvind Odland
- Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø 9037, Norway.
| | - Andrej M Grjibovski
- Central Scientific Research Laboratory, Northern State Medical University, 51 Troitsky Ave., Arkhangelsk 163000, Russia.
- Department of Public Health and Healthcare, Hygiene and Bioethics, North-Eastern Federal University, 58 Belinsky Str., Yakutsk 677000, Russia.
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Horslev T, Binongo JN, Kancherla V. Maternal Chlamydia infection during pregnancy among younger mothers and risk of gastroschisis in singleton offspring. Birth Defects Res 2017; 110:429-442. [PMID: 29193865 DOI: 10.1002/bdr2.1179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/01/2017] [Accepted: 11/08/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND Prevalence of gastroschisis has been increasing in the United States (US) since 1980s. Genital infection with Chlamydia has also been increasing in prevalence, particularly among younger women. The etiology of gastroschisis is unknown. Ongoing research suggests multiple causal factors may be involved, including Chlamydia infection in mothers during pregnancy. METHODS Using birth certificate data from 2014 US vital records, we conducted a population-based case-control study to examine the association between prenatal Chlamydia exposure in young women (16-25 years of age) and gastroschisis in singleton offspring. Cases consisted of live births with gastroschisis, and controls had no major birth defects reported in their birth certificate. Logistic regression analysis was used to estimate crude and adjusted odds ratios (cOR and aOR) and 95% confidence intervals (CI). RESULTS There were 809 cases (95.6% were isolated cases) and 1,260,293 controls. Chlamydia during pregnancy was reported in 4.5% of case and 3.6% control mothers (p = .21). Case mothers were significantly more likely to be younger (16-20 years of age) at the time of delivery compared to control mothers (p < .0001). We found no significant association between Chlamydia infection during pregnancy and gastroschisis (cOR = 1.24; 95% CI = 0.89-1.73 and aOR = 1.06; 95% CI: 0.66-1.70). CONCLUSION With the caveat of possible misclassification of exposure and outcome variables in birth certificate data, we found no significant association between prenatal exposure to Chlamydia and gastroschisis in the offspring born to younger mothers. Future studies should refine measures by focusing on relevant risk period and biomarkers.
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Affiliation(s)
- Tessa Horslev
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - José N Binongo
- Department of Biostatistics & Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Vijaya Kancherla
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Walsh S, Donnan J, Morrissey A, Sikora L, Bowen S, Collins K, MacDonald D. A systematic review of the risks factors associated with the onset and natural progression of hydrocephalus. Neurotoxicology 2017; 61:33-45. [DOI: 10.1016/j.neuro.2016.03.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 03/14/2016] [Indexed: 01/08/2023]
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Dong DY, Binongo JN, Kancherla V. Maternal Chlamydia Infection During Pregnancy and Risk of Cyanotic Congenital Heart Defects in the Offspring. Matern Child Health J 2016; 20:66-76. [PMID: 26156829 DOI: 10.1007/s10995-015-1804-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Genital Chlamydia is a common bacterial sexually-transmitted infection among reproductive aged women, particularly younger populations. Cyanotic congenital heart defects (CCHDs) constitute about one quarter of all cardiac malformations at birth, and are associated with high rate of morbidity and mortality. Epidemiological research on the association between maternal Chlamydia during pregnancy and CCHDs in the offspring is lacking. METHODS Using data from the 2012 United States birth certificates, we examined the association between CCHDs and prenatal exposure to Chlamydia among live singleton births with CCHDs (n = 2487) and unaffected singleton births (n = 3,334,424). We estimated adjusted odds ratios (aORs) and 95% confidence intervals (CIs) using unconditional logistic regression analysis for all CCHDs combined, and isolated CCHDs (without other major congenital malformations). RESULTS Overall 1.7% of case and 1.7% of control women reported having Chlamydia during their pregnancies. After controlling for potential confounders, we found a weak positive association between maternal Chlamydia during pregnancy and all CCHDs combined (aOR = 1.39; 95% CI 1.02-1.90). The positive association persisted for isolated CCHD cases, but with marginal significance (aOR = 1.34; 95% CI 0.96-1.74). Subgroup analyses for younger women showed an increased risk for CCHDs; however, the associations were not statistically significant. CONCLUSIONS Maternal exposure to Chlamydia during pregnancy was weakly associated with a higher risk of CCHDs in the offspring. The finding should be interpreted with caution due to limitations of birth certificate data. Future studies using more robust data sources are warranted to further study the association between maternal Chlamydia during pregnancy and CCHDs in the offspring.
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Affiliation(s)
- Diane Y Dong
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, USA.,Department of Veterans Affairs, Center for Medication Safety, Hines, IL, USA
| | - José N Binongo
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Vijaya Kancherla
- Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, USA.
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Hansen C, Andrade SE, Freiman H, Dublin S, Haffenreffer K, Cooper WO, Cheetham TC, Toh S, Li DK, Raebel MA, Kuntz JL, Perrin N, Rosales AG, Carter S, Pawloski PA, Maloney EM, Graham DJ, Sahin L, Scott PE, Yap J, Davis R. Trimethoprim-sulfonamide use during the first trimester of pregnancy and the risk of congenital anomalies. Pharmacoepidemiol Drug Saf 2016; 25:170-8. [PMID: 26599424 PMCID: PMC4772767 DOI: 10.1002/pds.3919] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Revised: 10/15/2015] [Accepted: 10/20/2015] [Indexed: 11/10/2022]
Abstract
BACKGROUND Sulfonamide antibacterials are widely used in pregnancy, but evidence about their safety is mixed. The objective of this study was to assess the association between first-trimester sulfonamide exposure and risk of specific congenital malformations. METHODS Mother-infant pairs were selected from a cohort of 1.2 million live-born deliveries (2001-2008) at 11 US health plans comprising the Medication Exposure in Pregnancy Risk Evaluation Program. Mothers with first-trimester trimethoprim-sulfonamide (TMP-SUL) exposures were randomly matched 1:1 to (i) a primary comparison group (mothers exposed to penicillins and/or cephalosporins) and (ii) a secondary comparison group (mothers with no dispensing of an antibacterial, antiprotozoal, or antimalarial medication during the same time period). The outcomes were cardiovascular abnormalities, cleft palate/lip, clubfoot, and urinary tract abnormalities. RESULTS We first identified 7615 infants in the TMP-SUL exposure group, of which 7595 (99%) were exposed to a combination of TMP-SUL and the remaining 1% to sulfonamides alone. After matching (1:1) to the comparator groups and only including those with complete data on covariates, there were 20 064 (n = 6688 per group) in the primary analyses. Overall, cardiovascular defects (1.52%) were the most common and cleft lip/palate (0.10%) the least common that were evaluated. Compared with penicillin/cephalosporin exposure, and no antibacterial exposure, TMP-SUL exposure was not associated with statistically significant elevated risks for cardiovascular, cleft lip/palate, clubfoot, or urinary system defects. CONCLUSIONS First-trimester TMP-SUL exposure was not associated with a higher risk of the congenital anomalies studied, compared with exposure to penicillins and/or cephalosporins, or no exposure to antibacterials.
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Affiliation(s)
- Craig Hansen
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta, GA, USA
- South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Susan E Andrade
- Meyers Primary Care Institute, University of Massachusetts Medical School Worcester, Worcester, MA, USA
| | - Heather Freiman
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta, GA, USA
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Katie Haffenreffer
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - William O Cooper
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - T Craig Cheetham
- Pharmacy Analytical Services, Kaiser Permanente Southern California, Downey, CA, USA
| | - Sengwee Toh
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - De-Kun Li
- Division of Research, Kaiser Foundation Research Institute, Kaiser Permanente, Oakland, CA, USA
| | - Marsha A Raebel
- Kaiser Permanente Colorado Institute for Health Research, Denver, CO, USA
| | - Jennifer L Kuntz
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - Nancy Perrin
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | - A Gabriela Rosales
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR, USA
| | | | - Pamala A Pawloski
- Health Partners Institute for Education and Research, Minneapolis, MN, USA
| | - Elizabeth M Maloney
- Office of Surveillance and Epidemiology, Food and Drug Administration, Silver Spring, MD, USA
| | - David J Graham
- Office of Surveillance and Epidemiology, Food and Drug Administration, Silver Spring, MD, USA
| | - Leyla Sahin
- Office of New Drugs, Food and Drug Administration, Silver Spring, MD, USA
| | - Pamela E Scott
- Office of Women's Health, Food and Drug Administration, Silver Spring, MD, USA
| | - John Yap
- Office of Biostatistics, Food and Drug Administration, Silver Spring, MD, USA
| | - Robert Davis
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta, GA, USA
- Center in Biomedical Informatics, University of Tennessee, Memphis, TN, USA
- Department of Pediatrics, University of Tennessee, Memphis, TN, USA
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Bérard A, Sheehy O, Zhao JP, Nordeng H. Use of macrolides during pregnancy and the risk of birth defects: a population-based study. Pharmacoepidemiol Drug Saf 2015; 24:1241-8. [DOI: 10.1002/pds.3900] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 08/19/2015] [Accepted: 09/23/2015] [Indexed: 01/19/2023]
Affiliation(s)
- Anick Bérard
- Research Center; CHU Ste-Justine; Montreal Quebec Canada
- Faculty of Pharmacy; University of Montreal; Montreal Quebec Canada
| | - Odile Sheehy
- Research Center; CHU Ste-Justine; Montreal Quebec Canada
| | - Jin-Ping Zhao
- Research Center; CHU Ste-Justine; Montreal Quebec Canada
- Faculty of Pharmacy; University of Montreal; Montreal Quebec Canada
| | - Hedvig Nordeng
- PharmacoEpidemiology and Drug Safety Research Group, School of Pharmacy; University of Oslo; Norway
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Maternal bacterial infections impact expression of drug transporters in human placenta. Int Immunopharmacol 2015; 26:349-56. [DOI: 10.1016/j.intimp.2015.04.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 03/17/2015] [Accepted: 04/10/2015] [Indexed: 11/16/2022]
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Valent F, Gongolo F, Deroma L, Zanier L. Prescription of systemic antibiotics during pregnancy in primary care in Friuli Venezia Giulia, Northeastern Italy. J Matern Fetal Neonatal Med 2014; 28:210-5. [PMID: 24766037 DOI: 10.3109/14767058.2014.906572] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To investigate the prescriptions of systemic antibiotics in a population of pregnant women in Italy, to identify socio-demographic factors associated with increased risk of being prescribed potentially unsafe medications, to compare prescriptions before and during pregnancy and to identify the prescribing General Practitioners (GPs). METHODS A retrospective study based on administrative anonymous databases included all women resident of the Friuli Venezia Giulia Region who delivered babies in 2011 (n=9196). The antibiotic prescription risk was calculated by trimester and overall, and compared with that in the year before. Multivariate logistic regression analyses assessed the role of socio-demographic factors on the risk of being prescribed medications that should not be used as first-line. RESULTS 6688 women (72.7%) were prescribed medicines (27363 prescriptions) during their pregnancies. Antibiotics were prescribed to 2279 women (24.8%), less commonly during pregnancy than before. Prescriptions were more frequent in the second and third trimesters. 1736 women were prescribed antibiotics other than first-line medicines (of which, seven tetracyclines and 58 quinolones, which are frankly not recommended). Those women were more frequently younger and less educated. The GPs responsible for those prescriptions were identified. CONCLUSIONS In order to improve the prescription of antibiotics in pregnancy, an audit with the GPs is warranted to understand their motivations, discuss clinical cases and build consensus guidelines on which antibiotics should be preferred for use in pregnancy.
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Affiliation(s)
- Francesca Valent
- Planning and Programming Area, Central Health Directorate, Friuli Venezia Giulia Region , Udine , Italy
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Ahrens K, Lash TL, Louik C, Mitchell AA, Werler MM. Correcting for exposure misclassification using survival analysis with a time-varying exposure. Ann Epidemiol 2012; 22:799-806. [PMID: 23041654 DOI: 10.1016/j.annepidem.2012.09.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 08/25/2012] [Accepted: 09/06/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Survival analysis is increasingly being used in perinatal epidemiology to assess time-varying risk factors for various pregnancy outcomes. Here we show how quantitative correction for exposure misclassification can be applied to a Cox regression model with a time-varying dichotomous exposure. METHODS We evaluated influenza vaccination during pregnancy in relation to preterm birth among 2267 non-malformed infants whose mothers were interviewed as part of the Slone Birth Defects Study during 2006 through 2011. The hazard of preterm birth was modeled using a time-varying exposure Cox regression model with gestational age as the time-scale. The effect of exposure misclassification was then modeled using a probabilistic bias analysis that incorporated vaccination date assignment. The parameters for the bias analysis were derived from both internal and external validation data. RESULTS Correction for misclassification of prenatal influenza vaccination resulted in an adjusted hazard ratio (AHR) slightly higher and less precise than the conventional analysis: Bias-corrected AHR 1.04 (95% simulation interval, 0.70-1.52); conventional AHR, 1.00 (95% confidence interval, 0.71-1.41). CONCLUSIONS Probabilistic bias analysis allows epidemiologists to assess quantitatively the possible confounder-adjusted effect of misclassification of a time-varying exposure, in contrast with a speculative approach to understanding information bias.
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Patel SS, Burns TL, Botto LD, Riehle-Colarusso TJ, Lin AE, Shaw GM, Romitti PA. Analysis of selected maternal exposures and non-syndromic atrioventricular septal defects in the National Birth Defects Prevention Study, 1997-2005. Am J Med Genet A 2012; 158A:2447-55. [PMID: 22903798 DOI: 10.1002/ajmg.a.35555] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 06/06/2012] [Indexed: 11/08/2022]
Abstract
Although the descriptive epidemiology of atrioventricular septal defects (AVSDs), a group of serious congenital heart defects (CHDs), has been recently reported, non-genetic risk factors have not been consistently identified. Using data (1997-2005) from the National Birth Defects Prevention Study, an ongoing multisite population-based case-control study, the association between selected non-genetic factors and non-syndromic AVSDs was examined. Data on periconceptional exposures to such factors were collected by telephone interview from 187 mothers of AVSD case infants and 6,703 mothers of unaffected infants. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated from logistic regression models. Mothers who reported cigarette smoking during the periconceptional period were more likely to have infants with AVSDs compared with non-smokers, independent of maternal age, periconceptional alcohol consumption, infant gestational age, family history of CHDs, and study site (aOR 1.5, 95% CI 1.1-2.4). The association was strongest in mothers who smoked more than 25 cigarettes/day. In addition, mothers with periconceptional passive smoke exposure were more likely to have infants with AVSDs than unexposed mothers, independent of maternal age, active periconceptional smoking, infant gestational age, and family history of CHDs (aOR 1.4, 95% CI 1.0-2.0). No associations were observed between AVSDs and maternal history of a urinary tract infection or pelvic inflammatory disease, maternal use of a wide variety of medications, maternal occupational exposure, parental drug use, or maternal alcohol consumption. If the results of this preliminary study can be replicated, minimizing maternal active and passive smoke exposure may decrease the incidence of AVSDs.
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Affiliation(s)
- Sonali S Patel
- Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, USA.
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