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Ács L, Nemes B, Nagy K, Ács M, Bánhidy F, Rózsa N. Maternal factors in the origin of cleft lip/cleft palate: A population-based case-control study. Orthod Craniofac Res 2024; 27 Suppl 1:6-13. [PMID: 38010849 DOI: 10.1111/ocr.12738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVES Orofacial clefts are among the most common birth defects, with an estimated worldwide incidence of around 1.5-1.7 per 1000 live-born babies. The most frequent form of orofacial clefts is cleft lip with or without cleft palate (CL ± CP). The role of environmental factors in the development of clefts is unclear in most patients, thus the aim of this study was to estimate possible maternal risk factors in the origin of CL ± CP. MATERIALS AND METHODS 1648 CL ± CP cases, 2654 matched controls and 57 231 population controls were evaluated from The Hungarian Case-Control Surveillance of Congenital Abnormalities. Maternal factors during the critical period in cases and controls were compared. Adjusted odds ratios (OR) with 95% confidence intervals (CI) were estimated in a multivariable conditional logistic regression model. RESULTS Among socio-demographic data, we have found significant differences between maternal employment. The proportion of unskilled mothers (6.5%) were higher in the CL ± CP group than in controls (3.5%). Medically recorded maternal anaemia, excessive vomiting and threatened abortion were associated with a higher risk of CL ± CP. An elevated risk was also found in various acute illnesses such as influenza (OR: 2.4, 95% CI: 3.0-5.8), acute bronchitis (OR: 4.5, 95% CI: 1.6-12.6) and urinary tract infections (OR: 3.5, 95% CI: 2.0-6.0). Maternal migraine and essential hypertension occurred more frequently in the mothers of cases than in controls. CONCLUSION The findings of this study suggest that maternal diseases and lifestyle factors during the first trimester play a significant role in the development of CL ± CP.
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Affiliation(s)
- Lili Ács
- Department of Paediatric Dentistry and Orthodontics, Semmelweis University Faculty of Dentistry, Budapest, Hungary
| | - Bálint Nemes
- Department of Paediatric Dentistry and Orthodontics, Semmelweis University Faculty of Dentistry, Budapest, Hungary
| | - Krisztián Nagy
- Department of Paediatrics, Semmelweis University School of Medicine, Budapest, Hungary
- OMFS-IMPATH KU Research Group, Leuven, Belgium
| | - Márton Ács
- Department of Oro-Maxillofacial Surgery and Stomatology, Semmelweis University Faculty of Dentistry, Budapest, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Ferenc Bánhidy
- Department of Obstetrics and Gynaecology, Semmelweis University School of Medicine, Budapest, Hungary
| | - Noémi Rózsa
- Department of Paediatric Dentistry and Orthodontics, Semmelweis University Faculty of Dentistry, Budapest, Hungary
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Kapapa M, Weber D, Serra A. Parental risk factors for oesophageal atresia. J Formos Med Assoc 2023; 122:932-939. [PMID: 36925362 DOI: 10.1016/j.jfma.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/27/2023] [Accepted: 03/01/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND An Oesophageal atresia (OA) affects almost 1 in 3500 newborn and its aetiology for development between 4th to 6th pregnancy weeks had not yet been clarified. METHODS This retrospective, observational control group-supported (n = 30) examination was performed with OA mothers (n = 20) who were interrogated via specialized questionnaires and interviews to evaluate data on medical pregnancy history including hormonal treatment, changing of life habits (nutrition, diet, medication), drug consumption (alcohol, smoking, illicit drugs) as well as exposure to nuclear waste or poisonous substance exposition. Aim was to assess risk factors during pregnancy and in particular in the first trimester. RESULTS The body mass index (BMI) prior pregnancy of OA mothers was significant lower (p = 0.022) and the number of mothers with obesity (BMI>30) did not differ to control group mothers (p = 0.081). They had additionally more pre-existing illnesses (p = 0.009) and allergies (p = 0.001). Control group mothers changed dietary habits with higher meat (p = 0.032) and caffeine intake (p = 0.012) compared to OA mothers, which had higher rates of abnormalities during pregnancy (p < 0.001) and 38.7% of them suffered of ≥1 abortion in the past. The ethnical background of OA mothers was more often German (p < 0.033), while OA fathers had a lower socioeconomic status (p = 0.039). CONCLUSION Maternal factors like previous abortions, obesity and immunological predispositions like existence of allergies combined with increased daily dairy consumption influenced obviously the occurrence of OA.
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Affiliation(s)
- Melanie Kapapa
- Division of Paediatric Surgery, Department of Surgery, University Medical Centre Ulm, Eythstrasse 24, 89075 Ulm, Germany.
| | - Daniela Weber
- Division of Paediatric Surgery, Department of Surgery, University Medical Centre Ulm, Eythstrasse 24, 89075 Ulm, Germany
| | - Alexandre Serra
- Division of Paediatric Surgery, Department of Surgery, University Medical Centre Ulm, Eythstrasse 24, 89075 Ulm, Germany
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Le-Nguyen A, Piché N, Lee GE, Auger N. Maternal mental disorders and risk of pathological abdominal conditions in children. Arch Womens Ment Health 2021; 24:925-932. [PMID: 33834267 DOI: 10.1007/s00737-021-01126-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/30/2021] [Indexed: 11/24/2022]
Abstract
The etiology of pediatric abdominal disorders is poorly understood, and the relationship with maternal mental health is understudied. We sought to determine the association between maternal psychiatric disorders and abdominal conditions in childhood. We performed a retrospective cohort study of 1,080,518 newborns in Quebec, Canada, between 2006 and 2020. We identified maternal mental disorders before or during pregnancy and computed the incidence of abdominal disorders in offspring before 1 year of age. Outcomes included Hirschsprung disease; hypertrophic pyloric stenosis; and esophageal, intestinal, and biliary atresia. We calculated adjusted risk ratios (RR) with 95% confidence intervals (CI) for the association of maternal mental disorders with these pediatric abdominal disorders. Among 51,371 children exposed to maternal mental disorders, 200 children had an abdominal condition, for a rate of 38.9 cases per 10,000 children (95% CI 33.6-44.3) compared with 27.7 per 10,000 for children who were unexposed to maternal mental disorders (95% CI 26.7-28.7). Compared with no mental disorder, maternal mental disorders were associated with hypertrophic pyloric stenosis (RR 1.39, 95% CI 1.16-1.68). Associations were stronger for severe mental disorders and were more marked for depression and stress and anxiety disorders. Maternal mental disorders are associated with the risk of hypertrophic pyloric stenosis in offspring. The origin of hypertrophic pyloric stenosis may relate to maternal mental disorders that were present during pregnancy.
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Affiliation(s)
- Annie Le-Nguyen
- Department of General Surgery, University of Montreal, Montreal, Canada
| | - Nelson Piché
- Department of Pediatric Surgery, Sainte-Justine Hospital Centre for Children, University of Montreal, Montreal, Canada
| | - Ga Eun Lee
- University of Montreal Hospital Research Centre, Montreal, Canada.,Institut national de santé publique du Québec, Montreal, Canada
| | - Nathalie Auger
- University of Montreal Hospital Research Centre, Montreal, Canada. .,Institut national de santé publique du Québec, Montreal, Canada. .,Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Canada. .,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Canada.
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Impact of maternal education on the outcome of newborns requiring surgery for congenital malformations. PLoS One 2019; 14:e0214967. [PMID: 30958858 PMCID: PMC6453467 DOI: 10.1371/journal.pone.0214967] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 03/22/2019] [Indexed: 11/20/2022] Open
Abstract
Objective Numerous studies established a link between socioeconomic status (SES) and several dimensions of general health. This study examines the association between maternal education as a widely used indicator of SES and outcome in newborns requiring surgical correction of congenital anomalies. Methods Ambispective data analysis of newborns with esophageal atresia (EA), intestinal atresia (IA), congenital diaphragmatic hernia (CDH), omphalocele (OC), gastroschisis (GS) undergoing surgery between 01/2008-11/2017 accessing the clinical databases Neodat and Viewpoint. Maternal education was determined according to the validated education classification CASMIN and stratified into “low” SES and “high” SES group. Endpoints were incidence of postoperative complications, length of mechanical ventilation, and readmission to NICU. Results Inclusion of 169 patients with EA (n = 32), IA (n = 24), CDH (n = 47), OC (n = 19), GS (n = 47). Women of low SES (n = 67, 40%) attended fewer prenatal screenings (total, 4.6 vs. 7.9, P<0.0001; EA, 3.7 vs. 7.1, P = 0.0002; IA, 3.5 vs. 9.4, P = 0.0006; OC, 2.5 vs. 8.8, P = 0.009; GS, 4.1 vs. 7.0, P = 0.002). Low SES was associated with higher incidence of patients born small for gestational age (37% vs. 20%, P = 0.019), with additional congenital malformations (37% vs. 15%, P = 0.001), being born in a peripheral center (7% vs. 0%, P = 0.008), and with higher incidence of 5´APGAR scores <7 (23% vs. 7%, P = 0.004). Moreover, low SES was associated with higher incidence of postoperative complications (total 70% vs. 32%, P<0.0001; EA, 60% vs. 23%, P = 0.04; IA, 67% vs. 11%, P = 0.008; CDH, 83% vs. 46%, P = 0.009; GS, 74% vs. 25%, P = 0.001), and higher readmission rate to NICU (IA, 33% vs. 0%, P = 0.043; GS, 32% vs. 4%, P = 0.007). Conclusions Low maternal education is associated with a reduced uptake of prenatal screenings, adverse neonatal outcomes, and higher incidence of postoperative complications in newborns with congenital anomalies. Primary prevention and specific support should be provided prenatally for families with low SES to avoid adverse outcomes.
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Benevent J, Araujo M, Hurault-Delarue C, Montastruc JL, Sommet A, Lacroix I, Damase-Michel C. Pharmacoepidemiology in pregnancy. Therapie 2019; 74:289-300. [PMID: 30797568 DOI: 10.1016/j.therap.2018.11.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 11/12/2018] [Indexed: 02/05/2023]
Abstract
Taking a medication is usually a challenge for a pregnant woman as the beneficial drug effect on the mother has to be considered regarding its potential adverse effects, not only for her but also for her unborn child. As medication use is common in pregnant women, by chance or necessity, it gives the opportunity to evaluate the consequences of prenatal drug exposure in real life through pharmacoepidemiological studies. This paper provides an overview of data sources, study designs and data analysis methods that can be used for pregnancy medication safety studies. In the future, the implementation of responsive international networks may be the keystones of drug evaluation in pregnancy.
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Affiliation(s)
- Justine Benevent
- Laboratoire de pharmacologie médicale et clinique, faculté de médecine de Toulouse, 31000 Toulouse, France; Service de pharmacologie médicale et clinique, centre Midi-Pyrénées de pharmacovigilance, pharmacoépidémiologie et d'informations sur le médicament, pharmacopôle, centre hospitalier universitaire de Toulouse, 31000 Toulouse, France; Inserm UMR 1027, faculté de médecine de Toulouse, 31000 Toulouse, France.
| | - Mélanie Araujo
- Service de pharmacologie médicale et clinique, centre Midi-Pyrénées de pharmacovigilance, pharmacoépidémiologie et d'informations sur le médicament, pharmacopôle, centre hospitalier universitaire de Toulouse, 31000 Toulouse, France
| | - Caroline Hurault-Delarue
- Service de pharmacologie médicale et clinique, centre Midi-Pyrénées de pharmacovigilance, pharmacoépidémiologie et d'informations sur le médicament, pharmacopôle, centre hospitalier universitaire de Toulouse, 31000 Toulouse, France
| | - Jean-Louis Montastruc
- Laboratoire de pharmacologie médicale et clinique, faculté de médecine de Toulouse, 31000 Toulouse, France; Service de pharmacologie médicale et clinique, centre Midi-Pyrénées de pharmacovigilance, pharmacoépidémiologie et d'informations sur le médicament, pharmacopôle, centre hospitalier universitaire de Toulouse, 31000 Toulouse, France
| | - Agnès Sommet
- Laboratoire de pharmacologie médicale et clinique, faculté de médecine de Toulouse, 31000 Toulouse, France; Service de pharmacologie médicale et clinique, centre Midi-Pyrénées de pharmacovigilance, pharmacoépidémiologie et d'informations sur le médicament, pharmacopôle, centre hospitalier universitaire de Toulouse, 31000 Toulouse, France
| | - Isabelle Lacroix
- Service de pharmacologie médicale et clinique, centre Midi-Pyrénées de pharmacovigilance, pharmacoépidémiologie et d'informations sur le médicament, pharmacopôle, centre hospitalier universitaire de Toulouse, 31000 Toulouse, France
| | - Christine Damase-Michel
- Laboratoire de pharmacologie médicale et clinique, faculté de médecine de Toulouse, 31000 Toulouse, France; Service de pharmacologie médicale et clinique, centre Midi-Pyrénées de pharmacovigilance, pharmacoépidémiologie et d'informations sur le médicament, pharmacopôle, centre hospitalier universitaire de Toulouse, 31000 Toulouse, France; Inserm UMR 1027, faculté de médecine de Toulouse, 31000 Toulouse, France
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Benevent J, Montastruc F, Damase-Michel C. The importance of pharmacoepidemiology in pregnancy-implications for safety. Expert Opin Drug Saf 2017; 16:1181-1190. [PMID: 28777918 DOI: 10.1080/14740338.2017.1363177] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Prescription of medications to pregnant women is usually a challenge as the drug benefit has to be considered regarding its potential adverse effects. As medication use is common in pregnant women, by chance or necessity, it gives the opportunity to evaluate the consequences of prenatal drug exposure in real life through pharmacoepidemiologic studies. Area covered: Data sources are numerous. Some of them have been created for the particular purpose of assessing medications during pregnancy. Augmented databases enable the study of delayed effects in late childhood and provide information on potential confounders. Each data source exhibits strengths and weaknesses. Several designs can be used to assess the safety of medications during pregnancy. Innovative designs have been developed in order to bypass major limits of classical methods. Expert opinion: An efficient system could follow up each pregnant woman, who had taken a medication, and consider her as a precious information for the knowledge of drug potential adverse actions against the child, who must be followed up to identify long term-effects. The diversity of data sources and approaches of pharmacoepidemiologic studies, the implementation of international networks as well as the improvement of adverse signal detection are the keystones of such an evaluation.
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Affiliation(s)
- Justine Benevent
- a Faculté de Médecine , Université Toulouse III, CRPV Midi-Pyrénées, CHU Toulouse, UMR INSERM 1027/CIC 1436 , Toulouse , France
| | - Francois Montastruc
- a Faculté de Médecine , Université Toulouse III, CRPV Midi-Pyrénées, CHU Toulouse, UMR INSERM 1027/CIC 1436 , Toulouse , France
| | - Christine Damase-Michel
- a Faculté de Médecine , Université Toulouse III, CRPV Midi-Pyrénées, CHU Toulouse, UMR INSERM 1027/CIC 1436 , Toulouse , France
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Feng Y, Chen R, Li X, Mo X. Environmental factors in the etiology of isolated and nonisolated esophageal atresia in a Chinese population: A case-control study. ACTA ACUST UNITED AC 2016; 106:840-846. [PMID: 27494675 DOI: 10.1002/bdra.23550] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 07/07/2016] [Accepted: 07/08/2016] [Indexed: 11/05/2022]
Abstract
BACKGROUND Esophageal atresia (EA) is a common birth defect that occurs with tracheoesophageal fistula (TEF), although etiological studies on EA/TEF have produced inconsistent results. METHODS The aim of this study was to examine the association between environmental factors during pregnancy and the risk of EA/TEF in a Chinese population. Cases of isolated EA and nonisolated EA and unaffected controls were identified between July 2005 and November 2015, and face-to-face questionnaires concerning exposure to environmental factors were administered to the birth mothers of 130 cases and 400 controls. The adjusted odds ratio (OR) and 95% confidence interval (CI) were calculated to assess the association between environmental factors and the risk of EA/TEF. RESULTS The results of this case-control study suggest that lower maternal education (p < 0.0001), maternal binge drinking (OR = 2.63; 95% CI, 1.05-6.6) and pickled food consumption (OR = 2.04; 95% CI, 1.31-3.71) during pregnancy increase the risk of EA in offspring, while maternal folic acid supplementation (OR = 0.45; 95% CI, 0.29-0.71) is significantly associated with a decreased risk of EA. CONCLUSION These results suggest a role for environmental exposures in the etiology of EA/TEF; however, further studies are needed to replicate the observed associations. Birth Defects Research (Part A) 106:840-846, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Yu Feng
- Department of Cardiothoracic Surgery, The Affiliated Nanjing Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Runsen Chen
- Department of Cardiothoracic Surgery, The Affiliated Nanjing Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaonan Li
- Children's Health Care, The Affiliated Nanjing Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xuming Mo
- Department of Cardiothoracic Surgery, The Affiliated Nanjing Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
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Al-Shraim MM, Eid RA, Musalam AO, Radad K, Ibrahim AHM, Malki TA. Ultrastructural Changes of the Smooth Muscle in Esophageal Atresia. Ultrastruct Pathol 2015; 39:413-8. [PMID: 26548437 DOI: 10.3109/01913123.2015.1066913] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Esophageal atresia (EA) with or without tracheo-esophageal fistula (TEF) is a relatively rare congenital anomaly. Despite the advances in the management techniques and neonatal intensive care, esophageal dysmotility remains a very common problem following EA/TEF repair. Our current study aimed to describe the most significant ultrastructural changes of the smooth muscle cells (SMCs) trying to highlight some of the underlying mechanisms of esophageal dysmotility following EA/TEF repair. Twenty-three biopsies were obtained from the tip of the lower esophageal pouch (LEP) of 23 patients during primary repair of EA/TEF. Light microscopic examination was performed with hematoxylin and eosin (HE), and Van Gieson's stains. Ultrastructural examination was done using transmission electron microscopy (TEM). Histopathological examination showed distortion of smooth muscle layer and deposition of an abundant amount of fibrous tissue in-between smooth muscles. Using TEM, SMCs exhibited loss of the cell-to-cell adhesion, mitochondrial vacuolation, formation of myelin figures, and apoptotic fragmentation. There were also plasmalemmal projections and formation of ghost bodies. Interestingly, SMCs were found extending pseudopodia-like projections around adjacent collagen fibers. Engulfed collagen fibers by SMCs underwent degradation within autophagic vacuoles. Degeneration of SMCs and deposition of abundant extracellular collagen fibers are prominent pathological changes in LEP of EA/TEF. These changes might contribute to the pathogenesis of esophageal dysmotility in patients who have survived EA/TEF.
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Affiliation(s)
- Mubarak M Al-Shraim
- a Department of Pathology , College of Medicine, King Khalid University , Abha , Saudi Arabia
| | - Refaat A Eid
- a Department of Pathology , College of Medicine, King Khalid University , Abha , Saudi Arabia
| | - Adel Osman Musalam
- a Department of Pathology , College of Medicine, King Khalid University , Abha , Saudi Arabia
| | - Khaled Radad
- a Department of Pathology , College of Medicine, King Khalid University , Abha , Saudi Arabia
| | - Ashraf H M Ibrahim
- b Department of Surgery, Division of Pediatric Surgery , Armed Forces Hospital Southern Region , Khamis Mushait , Saudi Arabia , and
| | - Talal A Malki
- c Department of Pediatric Surgery , College of Medicine and Medical Sciences, Taif University , Taif , Saudi Arabia
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