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Ailes EC, Werler MM, Howley MM, Jenkins MM, Reefhuis J. Real-world data are not always big data: the case for primary data collection on medication use in pregnancy in the context of birth defects research. Am J Epidemiol 2024; 193:1211-1214. [PMID: 38751306 PMCID: PMC11372710 DOI: 10.1093/aje/kwae060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 04/25/2024] [Accepted: 05/10/2024] [Indexed: 09/04/2024] Open
Abstract
Many examples of the use of real-world data in the area of pharmacoepidemiology include "big data," such as insurance claims, medical records, or hospital discharge databases. However, "big" is not always better, particularly when studying outcomes with narrow windows of etiologic relevance. Birth defects are such an outcome, for which specificity of exposure timing is critical. Studies with primary data collection can be designed to query details about the timing of medication use, as well as type, dose, frequency, duration, and indication, that can better characterize the "real world." Because birth defects are rare, etiologic studies are typically case‑control in design, like the National Birth Defects Prevention Study, Birth Defects Study to Evaluate Pregnancy Exposures, and Slone Birth Defects Study. Recall bias can be a concern, but the ability to collect detailed information about both prescription and over-the-counter medication use and other exposures such as diet, family history, and sociodemographic factors is a distinct advantage over claims and medical record data sources. Case‑control studies with primary data collection are essential to advancing the pharmacoepidemiology of birth defects. This article is part of a Special Collection on Pharmacoepidemiology.
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Affiliation(s)
- Elizabeth C Ailes
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Martha M Werler
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Meredith M Howley
- Birth Defects Registry, New York State Department of Health, Albany, New York, USA
| | - Mary M Jenkins
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennita Reefhuis
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Varney B, Brett J, Zoega H, Gillies MB, Powell M, Bateman BT, Shand AW, Pearson SA, Havard A. Opioid analgesic exposure during the first trimester of pregnancy and the risk of major congenital malformations in infants: a systematic review and meta-analysis †. Anaesthesia 2024; 79:967-977. [PMID: 38715235 DOI: 10.1111/anae.16307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2024] [Indexed: 08/09/2024]
Abstract
BACKGROUND Prescribed opioid analgesics are frequently used to manage pain in pregnancy. However, the available literature regarding the teratogenic potential of opioid use during pregnancy has not been systematically summarised. This systematic review and meta-analysis aimed to assess the quality of the evidence on these potential risks and calculate a pooled estimate of risk for any opioid analgesic and individual opioids. METHODS We searched PubMed, Embase and CINAHL for published studies assessing the risk of major congenital malformations in infants following first-trimester exposure to opioid analgesics compared with a reference group, excluding studies examining opioid agonist therapy or illicit opioid use. We assessed the risk of bias using the Risk of Bias in Non-Randomised Studies of Intervention tool. We pooled adjusted risk estimates from studies rated at serious risk of bias or better in a random-effects meta-analysis. RESULTS Of 12 identified studies, 11 were at high risk of bias (eight serious; three critical). Relative to unexposed infants, those exposed to any opioid use during the first trimester of pregnancy were not at an increased risk of major congenital malformations overall (relative risk 1.04, 95%CI 0.98-1.11); cardiovascular malformations (relative risk 1.07, 95%CI 0.96-1.20); or central nervous system malformations (relative risk 1.06, 95%CI 0.92-1.21). Raised risk estimates were observed for gastrointestinal malformations (relative risk 1.40, 95%CI 0.38-5.16) and cleft palate (relative risk 1.57, 95%CI 0.48-5.13) following any opioid exposure and atrial septal defects (relative risk 1.20, 95%CI 1.05-1.36) following codeine exposure. CONCLUSIONS Although the meta-analysis did not indicate substantial increased risk for most malformations examined, this risk remains uncertain due to the methodological limitations of the included studies. Healthcare professionals and pharmaceutical regulators should be aware of the issues related to the quality of research in this field.
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Affiliation(s)
- Bianca Varney
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
| | - Jonathan Brett
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
- St. Vincent's Clinical School, St. Vincent's Hospital, Sydney, NSW, Australia
| | - Helga Zoega
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Malcolm B Gillies
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
| | - Madeline Powell
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
- National Drug and Alcohol Research Centre, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
| | - Brian T Bateman
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University, Stanford, CA, USA
| | - Antonia W Shand
- Department of Maternal Fetal Medicine, Royal Hospital for Women, Randwick, Sydney, NSW, Australia
- Faculty of Medicine and Health, Children's Hospital at Westmead Clinical School, Sydney, NSW, Australia
| | - Sallie-Anne Pearson
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
| | - Alys Havard
- School of Population Health, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
- National Drug and Alcohol Research Centre, Faculty of Medicine and Health, UNSW Sydney, Sydney, NSW, Australia
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Laursen TQ, Ramlau-Hansen CH, Tøttenborg SS, Liew Z, Toft G, Gaml-Sørensen A, Hougaard KS, Bonde JPE, Ernst A. Maternal intake of paracetamol during pregnancy and biomarkers of male fecundity in young adult sons. Reprod Toxicol 2024; 127:108626. [PMID: 38815769 DOI: 10.1016/j.reprotox.2024.108626] [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: 03/21/2024] [Revised: 05/12/2024] [Accepted: 05/27/2024] [Indexed: 06/01/2024]
Abstract
Paracetamol is suggested to have endocrine disrupting properties possibly affecting fetal programming of reproductive health that might lead to impaired semen quality and changes in reproductive hormones. In this longitudinal study, we included 1058 young adult men born 1998-2000 into the Danish National Birth Cohort with follow-up at 18-21 years of age. The exposure, maternal intake of paracetamol, was modelled in three ways: dichotomized, trimester-specific, and as duration of exposure categorized into: short (1-2 weeks), medium (3-9 weeks) or long duration (>9 weeks) vs. no intake. Outcomes included semen characteristics, self-measured testis volume, and reproductive hormone levels. We used negative binominal regression to estimate the percentage difference and 95% confidence interval (CI) for each outcome. In total, 547 (48%) sons were prenatally exposed to paracetamol due to maternal intake at least once. Maternal intake of paracetamol during pregnancy was not associated with any of the biomarkers in the dichotomized or trimester-specific exposure models. For duration of exposure, sons of mothers with long duration of maternal intake of paracetamol showed tendencies towards lower semen concentration (-14% [95% CI: -31%; 8%]), a higher proportion of nonprogressive and immotile spermatozoa (8% [95% CI: -4%; 21%]) and higher DNA Fragmentation Index (16% [95% CI: -1%; 36%]) compared to son of mothers with no intake. Maternal intake of paracetamol during pregnancy was not clearly associated with biomarkers of male fecundity in adult sons. However, it cannot be ruled out that long duration of maternal intake of paracetamol might be associated with impaired semen characteristics.
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Affiliation(s)
- Tina Quist Laursen
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus, Denmark
| | | | - Sandra Søgaard Tøttenborg
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Zeyan Liew
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
| | - Gunnar Toft
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Anne Gaml-Sørensen
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Karin Sørig Hougaard
- Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark; National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Jens Peter Ellekilde Bonde
- Department of Occupational and Environmental Medicine, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Andreas Ernst
- Department of Public Health, Research Unit for Epidemiology, Aarhus University, Aarhus, Denmark; Department of Urology, Aarhus University Hospital, Aarhus, Denmark.
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MacDonald LA, Johnson CY, Lu ML, Santiago-Colón A, Adam GP, Kimmel HJ, Napolitano PG, Saldanha IJ. Physical job demands in pregnancy and associated musculoskeletal health and employment outcomes: a systematic review. Am J Obstet Gynecol 2024; 230:583-599.e16. [PMID: 38109950 PMCID: PMC11139607 DOI: 10.1016/j.ajog.2023.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 12/12/2023] [Accepted: 12/12/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE A decline in musculoskeletal health during pregnancy is an underappreciated adverse outcome of pregnancy that can have immediate and long-term health consequences. High physical job demands are known risk factors for nontraumatic musculoskeletal disorders in the general working population. Evidence from meta-analyses suggest that occupational lifting and prolonged standing during pregnancy may increase risk of adverse pregnancy outcomes. This systematic review examined associations between occupational lifting or postural load in pregnancy and associated musculoskeletal disorders and related sequalae. DATA SOURCES Five electronic databases (Medline, Embase, CINAHL, NIOSHTIC-2, and Ergonomic Abstracts) were searched from 1990 to July 2022 for studies in any language. A Web of Science snowball search was performed in December 2022. Reference lists were manually reviewed. STUDY ELIGIBILITY CRITERIA Eligible studies reported associations between occupational lifting or postural load and musculoskeletal health or sequelae (eg, employment outcomes) among pregnant and postpartum workers. METHODS Data were extracted using a customized form to document study and sample characteristics; and details of exposures, outcomes, covariates, and analyses. Investigators independently assessed study quality for 7 risk-of-bias domains and overall utility, with discrepant ratings resolved through discussion. A narrative synthesis was conducted due to heterogeneity. RESULTS Sixteen studies (11 cohort studies, 2 nested case-control studies, and 3 cross-sectional studies) from 8 countries were included (N=142,320 pregnant and N=1744 postpartum workers). Limited but consistent evidence with variable quality ratings, ranging from critical concern to high, suggests that pregnant workers exposed to heavy lifting (usually defined as ≥22 lbs or ≥10 kg) may be at increased risk of functionally limiting pelvic girdle pain and antenatal leave. Moreover, reports of dose-response relationships suggest graded risk levels according to lifting frequency, ranging from 21% to 45% for pelvic girdle pain and 58% to 202% for antenatal leave. Limited but consistent evidence also suggests that postural load increases the risk of employment cessation. CONCLUSION Limited but consistent evidence suggests that pregnant workers exposed to heavy lifting and postural load are at increased risk of pelvic girdle pain and employment cessation. Job accommodations to reduce exposure levels may promote safe sustainable employment for pregnant workers.
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Affiliation(s)
- Leslie A MacDonald
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health (NIOSH), Cincinnati, OH.
| | - Candice Y Johnson
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health (NIOSH), Cincinnati, OH; Division of Occupational and Environmental Medicine, Department of Family Medicine and Community Health, Duke University, Durham, NC
| | - Ming-Lun Lu
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health (NIOSH), Cincinnati, OH
| | - Albeliz Santiago-Colón
- World Trade Center Health Program, National Institute for Occupational Safety and Health, Cincinnati, OH
| | - Gaelen P Adam
- Center for Evidence Synthesis in Health, Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI
| | | | - Peter G Napolitano
- Department of Obstetrics and Gynecology, University of Washington, Seattle, WA
| | - Ian J Saldanha
- Center for Evidence Synthesis in Health, Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI; Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Xu M, Wang R, Du B, Zhang Y, Feng X. Association of acetaminophen use with perinatal outcomes among pregnant women: a retrospective cohort study with propensity score matching. BMC Pregnancy Childbirth 2024; 24:268. [PMID: 38605288 PMCID: PMC11010302 DOI: 10.1186/s12884-024-06480-5] [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: 01/08/2024] [Accepted: 04/03/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Although acetaminophen is widely used in women during pregnancy, its safety has not been clearly stated. The study aimed to investigate the association between acetaminophen use and adverse pregnancy outcomes in pregnant women in China. METHODS We conducted a retrospective cohort study by collecting data on pregnant women who delivered in the Beijing Obstetrics and Gynecology Hospital from January 2018 to September 2023. An acetaminophen use group and a control group were formed based on prenatal exposure to acetaminophen. The pregnancy outcomes that we focused on were stillbirth, miscarriage, preterm birth, APGAR score, birth weight, and congenital disabilities. Pregnant women exposed to acetaminophen were matched to unexposed in a 1:1 ratio with propensity score matching, using the greedy matching macro. SPSS software was used for statistical analysis. Multivariable logistics regression was used to assess the association between acetaminophen use during pregnancy and adverse pregnancy outcomes. RESULTS A total of 41,440 pregnant women were included, of whom 501 were exposed to acetaminophen during pregnancy, and 40,939 were not exposed. After the propensity score matching, the acetaminophen use and control groups consisted of 501 pregnant women each. The primary analysis showed that acetaminophen exposure during pregnancy was associated with an increased risk of stillbirth (adjusted OR (aOR) = 2.29, 95% CI, 1.19-4.43), APGAR score < 7 at 1 min (aOR = 3.28, 95% CI, 1.73-6.21), APGAR score < 7 at 5 min (aOR = 3.54, 95% CI, 1.74-7.20), APGAR score < 7 at 10 min (aOR = 3.18, 95% CI, 1.58-6.41), and high birth weight (HBW) (aOR = 1.75, 95% CI, 1.05-2.92). Drug exposure during the first and second trimesters increased the odds of stillbirth, miscarriage, APGAR < 7, and the occurrence of at least one adverse pregnancy outcome. In addition, the frequency of drug use more than two times was associated with a higher risk of preterm birth and APGAR score < 7. CONCLUSIONS Exposure to acetaminophen during pregnancy was significantly associated with the occurrence of adverse pregnancy outcomes, particularly exposure in the first and second trimesters and frequency of use more than twice. It is suggested that acetaminophen should be prescribed with caution in pregnant women.
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Affiliation(s)
- Man Xu
- Department of Pharmacy, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No.17, Qi He Lou Street, Dongcheng District, Beijing, 100010, China
- Department of Clinical Pharmacology, College of Pharmaceutical Sciences, Capital Medical University, Beijing, China
| | - Ran Wang
- Department of Pharmacy, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No.17, Qi He Lou Street, Dongcheng District, Beijing, 100010, China
| | - Boran Du
- Department of Pharmacy, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No.17, Qi He Lou Street, Dongcheng District, Beijing, 100010, China
| | - Ying Zhang
- Department of Pharmacy, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No.17, Qi He Lou Street, Dongcheng District, Beijing, 100010, China
- Department of Clinical Pharmacology, College of Pharmaceutical Sciences, Capital Medical University, Beijing, China
| | - Xin Feng
- Department of Pharmacy, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, No.17, Qi He Lou Street, Dongcheng District, Beijing, 100010, China.
- Laboratory for Clinical Medicine, Capital Medical University, Beijing, China.
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Chen X, Yang Y, Chen L, Wang K. Pregnancy outcomes and birth defects in offspring following Non-steroidal anti-inflammatory drugs exposure during pregnancy: A systematic review and meta-analysis. Reprod Toxicol 2024; 125:108561. [PMID: 38423229 DOI: 10.1016/j.reprotox.2024.108561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/03/2024] [Accepted: 02/19/2024] [Indexed: 03/02/2024]
Abstract
There is a high global prevalence of NSAIDs during pregnancy. However, current evidence is largely conflicting regarding the safety of gestational NSAIDs use both for the pregnancy and offspring health. The aim of this study is to systematically review the relationship between NSAIDs use during pregnancy and the risk of adverse pregnancy outcomes and congenital abnormalities. Cohort studies and case control studies on congenital malformations, miscarriage and preterm birth in infants born to mothers who were exposed to NSAIDs during pregnancy were identified via PubMed, Medline, Embase, the Cochrane Library databases and the Reprotox® database from inception to 26 March 2021, and updated on 6 April 2023. On the whole, compared with the unexposed group, infants exposed to NSAIDs during early pregnancy showed a 28% increased risk of overall congenital anomalies (OR 1.28, 95%CI 1.16-1.40), and 19% for major birth defects (OR 1.19, 95%CI 1.08-1.30). Contrary to previous beliefs, there appeared to be a trend towards a higher risk of miscarriage among women who were exposed to NSAIDs during pregnancy, but the association was not statistically significant (OR 1.20, 95%CI 0.93-1.55). According to our study findings, the use of NSAIDs by pregnant women has been linked to a higher risk of congenital anomalies and a negative impact on preterm birth. Therefore, we advise pregnant women to carefully consider the potential benefits and risks before using NSAIDs during pregnancy.
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Affiliation(s)
- Xiaohong Chen
- Department of pharmacy, Women and Children's Hospital of Chongqing Medical University, Chongqing, China; Department of pharmacy, Chongqing Health Center for Women and Children, Chongqing, China
| | - Yang Yang
- Department of pharmacy, Women and Children's Hospital of Chongqing Medical University, Chongqing, China; Department of pharmacy, Chongqing Health Center for Women and Children, Chongqing, China
| | - Lin Chen
- Department of pharmacy, Women and Children's Hospital of Chongqing Medical University, Chongqing, China; Department of pharmacy, Chongqing Health Center for Women and Children, Chongqing, China.
| | - Kejing Wang
- Department of pharmacy, Women and Children's Hospital of Chongqing Medical University, Chongqing, China; Department of pharmacy, Chongqing Health Center for Women and Children, Chongqing, China.
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Rouget F, Bihannic A, Le Bot B, Mercier F, Gilles E, Garlantezec R, Multigner L, Cordier S, Arnaud A, Pladys P, Chevrier C. Meconium Concentrations of Pesticides and Risk of Hypospadias: A Case-Control Study in Brittany, France. Epidemiology 2024; 35:185-195. [PMID: 37934147 DOI: 10.1097/ede.0000000000001688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
BACKGROUND Hypospadias is a male genital tract defect for which an increase in prevalence has been documented over the last few decades. A role for environmental risk factors is suspected, including prenatal exposure to pesticides. OBJECTIVES To study the risk of hypospadias in association with multiple pesticide measurements in meconium samples. METHODS The Brittany Registry of Congenital Anomalies (France) conducted a case-control study between 2012 and 2018. Cases were hypospadias, ascertained by a pediatrician and a pediatric surgeon, excluding genetic conditions, following European Surveillance of Congenital Anomalies guidelines (N = 69). Controls (N = 135) were two male infants without congenital anomaly born after each case in the same maternity unit. Mothers in the maternity units completed a self-administered questionnaire, we collected medical data from hospital records, and medical staff collected meconium samples. We performed chemical analysis of 38 pesticides (parent compound and/or metabolite) by UHPLC/MS/MS following strict quality assurance/quality control criteria and blind to case-control status. We carried out logistic regression accounting for frequency-matching variables and major risk factors. RESULTS Among the 38 pesticides measured, 16 (42%) were never detected in the meconium samples, 18 (47%) were in <5% of samples, and 4 (11%) in ≥5% of the samples. We observed an association between the detection of fenitrothion in meconium and the risk of hypospadias (OR = 2.6 [1.0-6.3] with n cases = 13, n controls = 21), but not the other pesticides. CONCLUSIONS Our small study provides a robust assessment of fetal exposure. Fenitrothion's established antiandrogenic activities provide biologic plausibility for our observations. Further studies are needed to confirm this hypothesis.
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Affiliation(s)
- Florence Rouget
- From the Brittany Registry of Congenital Anomalies, CHU Rennes, University of Rennes, Inserm, EHESP, Irset - UMR 1085, Rennes, France
| | - Adèle Bihannic
- Brittany Registry of Congenital Anomalies, CHU Rennes, Rennes, France
| | - Barbara Le Bot
- University of Rennes, EHESP, Inserm, Irset - UMR 1085, Rennes, France
| | - Fabien Mercier
- University of Rennes, EHESP, Inserm, Irset - UMR 1085, Rennes, France
| | - Erwann Gilles
- University of Rennes, EHESP, Inserm, Irset - UMR 1085, Rennes, France
| | - Ronan Garlantezec
- CHU Rennes, University of Rennes, Inserm, EHESP, Irset - UMR 1085, Rennes, France
| | - Luc Multigner
- University of Rennes, Inserm, EHESP, Irset - UMR 1085, Rennes, France
| | - Sylvaine Cordier
- University of Rennes, Inserm, EHESP, Irset - UMR 1085, Rennes, France
| | - Alexis Arnaud
- Department of Pediatric Surgery, CHU Rennes, Rennes, France
| | - Patrick Pladys
- CHU Rennes, University of Rennes, Inserm, LTSI-UMR 1099, Rennes, France
| | - Cécile Chevrier
- University of Rennes, Inserm, EHESP, Irset - UMR 1085, Rennes, France
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Baldacci S, Santoro M, Mezzasalma L, Pierini A, Coi A. Medication use during pregnancy and the risk of gastroschisis: a systematic review and meta-analysis of observational studies. Orphanet J Rare Dis 2024; 19:31. [PMID: 38287353 PMCID: PMC10826191 DOI: 10.1186/s13023-023-02992-z] [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: 10/14/2022] [Accepted: 12/12/2023] [Indexed: 01/31/2024] Open
Abstract
OBJECTIVES The aetiology of gastroschisis is considered multifactorial. We conducted a systematic review and meta-analysis to assess whether the use of medications during pregnancy, is associated with the risk of gastroschisis in offspring. METHODS PubMed, EMBASE, and Scopus were searched from 1st January 1990 to 31st December 2020 to identify observational studies examining the association between medication use during pregnancy and the risk of gastroschisis. The Newcastle-Ottawa Scale was used for the quality assessment of the individual studies. We pooled adjusted measures using a random-effect model to estimate relative risk [RR] and the 95% confidence interval [CI]. I2 statistic for heterogeneity and publication bias was calculated. RESULTS Eighteen studies providing data on 751,954 pregnancies were included in the meta-analysis. Pooled RRs showed significant associations between aspirin (RR 1.66, 95% CI 1.16-2.38; I2 = 58.3%), oral contraceptives (RR 1.52, 95% CI 1.21-1.92; I2 = 22.0%), pseudoephedrine and phenylpropanolamine (RR 1.51, 95% CI 1.16-1.97; I2 = 33.2%), ibuprofen (RR 1.42, 95% CI 1.26-1.60; I2 = 0.0%), and gastroschisis. No association was observed between paracetamol and gastroschisis (RR 1.16, 95% CI 0.96-1.41; I2 = 39.4%). CONCLUSIONS These results suggest that the exposure in the first trimester of pregnancy to over the counter medications (OTC) such as aspirin, ibuprofen, pseudoephedrine and phenylpropanolamine as well as to oral contraceptives, was associated with an increased risk of gastroschisis. However, these associations are significant only in particular subgroups defined by geographic location, adjustment variables and type of control. Therefore, further research is needed to investigate them as potential risk factors for gastroschisis, to assess their safety in pregnancy and to develop treatment strategies to reduce the risk of gastroschisis in offspring. PROSPERO registration number: CRD42021287529.
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Affiliation(s)
- Silvia Baldacci
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Via G. Moruzzi 1, 56124, Pisa, Italy.
| | - Michele Santoro
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Via G. Moruzzi 1, 56124, Pisa, Italy
| | - Lorena Mezzasalma
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Via G. Moruzzi 1, 56124, Pisa, Italy
| | - Anna Pierini
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Via G. Moruzzi 1, 56124, Pisa, Italy
- Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Alessio Coi
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council, Via G. Moruzzi 1, 56124, Pisa, Italy
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Porter GA. Environmental Signals. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2024; 1441:397-416. [PMID: 38884722 DOI: 10.1007/978-3-031-44087-8_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Environmental factors have long been known to play a role in the pathogenesis of congenital heart disease (CHD), but this has not been a major focus of research in the modern era. Studies of human exposures and animal models demonstrate that demographics (age, race, socioeconomic status), diseases (e.g., diabetes, hypertension, obesity, stress, infection, high altitude), recreational and therapeutic drug use, and chemical exposures are associated with an increased risk for CHD. Unfortunately, although studies suggest that exposures to these factors may cause CHD, in most cases, the data are not strong, are inconclusive, or are contradictory. Although most studies concentrate on the effects of maternal exposure, paternal exposure to some agents can also modify this risk. From a mechanistic standpoint, recent delineation of signaling and genetic controls of cardiac development has revealed molecular pathways that may explain the effects of environmental signals on cardiac morphogenesis and may provide further tools to study the effects of environmental stimuli on cardiac development. For example, environmental factors likely regulate cellular signaling pathways, transcriptional and epigenetic regulation, proliferation, and physiologic processes that can control the development of the heart and other organs. However, understanding of the epidemiology and risk of these exposures and the mechanistic basis for any effects on cardiac development remains incomplete. Further studies defining the relationship between environmental exposures and human CHD and the mechanisms involved should reveal strategies to prevent, diagnose, and treat CHD induced by environmental signals.
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Affiliation(s)
- George A Porter
- Departments of Pediatrics (Cardiology), Pharmacology and Physiology, and Medicine (Aab Cardiovascular Research Institute), University of Rochester Medical Center, Rochester, NY, USA.
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Smith CJ, Payne VM. Epidemiology studies on effects of lithium salts in pregnancy are confounded by the inability to control for other potentially teratogenic factors. Hum Exp Toxicol 2024; 43:9603271241236346. [PMID: 38394684 DOI: 10.1177/09603271241236346] [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] [Indexed: 02/25/2024]
Abstract
INTRODUCTION In bipolar women who took lithium during pregnancy, several epidemiology studies have reported small increases in a rare fetal cardiac defect termed Ebstein's anomaly. METHODS Behavioral, environmental, and lifestyle-associated risk factors associated with bipolar disorder and health insurance status were determined from an Internet search. The search was conducted from October 1, 2023, through October 14, 2023. The search terms employed included the following: bipolar, bipolar disorder, mood disorders, pregnancy, congenital heart defects, Ebstein's anomaly, diabetes, hypertension, Medicaid, Medicaid patients, alcohol use, cigarette smoking, marijuana, cocaine, methamphetamine, narcotics, nutrition, diet, obesity, body mass index, environment, environmental exposures, poverty, socioeconomic status, divorce, unemployment, and income. No quotes, special fields, truncations, etc., were used in the searches. No filters of any kind were used in the searches. RESULTS Women who remain on lithium in the United States throughout their pregnancy are likely to be experiencing mania symptoms and/or suicidal ideation refractory to other drugs. Pregnant women administered the highest doses of lithium salts would be expected to have been insufficiently responsive to lower doses. Any small increases in the retrospectively determined risk of fetal cardiac anomalies in bipolar women taking lithium salts cannot be disentangled from potential developmental effects resulting from very high rates of cigarette smoking, poor diet, alcohol abuse, ingestion of illegal drugs like cocaine or opioids, marijuana smoking, obesity, and poverty. CONCLUSIONS The small risks in fetal cardiac abnormalities reported in the epidemiology literature do not establish a causal association for lithium salts and Ebstein's anomaly.
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Affiliation(s)
- Carr J Smith
- Department of Alzheimer's Section, Society for Brain Mapping and Therapeutics, Mobile, AL, USA
| | - Victoria M Payne
- Psychiatric Associates of North Carolina Professional Association, Raleigh, NC, USA
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11
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Tepper NK, Chowdhury J, Moore CA, Werler MM, Mishkin K, Reefhuis J. Public health priorities for gastroschisis: Summary of a meeting sponsored by the Centers for Disease Control and Prevention and the March of Dimes. Birth Defects Res 2024; 116:e2299. [PMID: 38277411 PMCID: PMC10983047 DOI: 10.1002/bdr2.2299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/15/2023] [Accepted: 12/22/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Gastroschisis has increased worldwide over several decades; however, there are significant gaps in understanding risk factors for development of the defect, particularly those that might be modifiable. Despite advances in survival, little is known about longer-term outcomes for affected individuals. METHODS On April 27- and 28, 2023, the National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention (CDC) and March of Dimes sponsored a meeting entitled "Public Health Priorities for Gastroschisis". The meeting goals were to review current knowledge on gastroschisis, discuss research gaps, and identify future priorities for public health surveillance, research, and action related to gastroschisis. Meeting participants encompassed a broad range of expertise and experience, including public health, clinical care of individuals with gastroschisis, affected individuals and families, and representatives from professional organizations and federal agencies. RESULTS Several goals were identified for future public health surveillance and research, including focused theory-driven research on risk factors and increased study of longer-term effects of gastroschisis through improved surveillance. Certain public health actions were identified, that which could improve the care of affected individuals, including increased education of providers and enhanced resources for patients and families. CONCLUSIONS These efforts may lead to an improved understanding of pathogenesis, risk factors, and outcomes and to improved care throughout the lifespan.
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Affiliation(s)
- Naomi K. Tepper
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Julia Chowdhury
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | | | | | - Jennita Reefhuis
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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12
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Woodbury ML, Geiger SD, Schantz SL. The relationship of prenatal acetaminophen exposure and attention-related behavior in early childhood. Neurotoxicol Teratol 2024; 101:107319. [PMID: 38199313 PMCID: PMC11018143 DOI: 10.1016/j.ntt.2024.107319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 01/12/2024]
Abstract
Acetaminophen is currently the only analgesic considered safe for use throughout pregnancy, but recent studies indicate that prenatal exposure to acetaminophen may be related to poorer neurodevelopmental outcomes. Multiple studies have suggested that it may be associated with attention problems, but few have examined this association by trimester of exposure. The Illinois Kids Development Study is a prospective birth cohort located in east-central Illinois. Exposure data were collected between December 2013 and March 2020, and 535 newborns were enrolled during that period. Mothers reported the number of times they took acetaminophen at six time points across pregnancy. When children were 2, 3, and 4 years of age, caregivers completed the Child Behavior Checklist for ages 1.5-5 years (CBCL). Associations of acetaminophen use during pregnancy with scores on the Attention Problems and ADHD Problems syndrome scales, the Internalizing and Externalizing Behavior composite scales, and the Total Problems score were evaluated. Higher acetaminophen exposure during the second trimester of fetal development was associated with higher Attention Problems, ADHD Problems, Externalizing Behavior, and Total Problems scores at ages 2 and 3. Higher second trimester exposure was only associated with higher Externalizing Behavior and Total Problems scores at 4 years. Higher cumulative exposure across pregnancy was associated with higher Attention Problems and ADHD Problems scores at ages 2 and 3. Findings suggest that prenatal acetaminophen exposure, especially during the second trimester, may be related to problems with attention in early childhood.
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Affiliation(s)
- Megan L Woodbury
- Neuroscience Program, University of IL at Urbana-Champaign, Urbana, IL, United States of America; Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America.
| | - Sarah D Geiger
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America; Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America.
| | - Susan L Schantz
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America; Department of Comparative Biosciences, University of Illinois at Urbana-Champaign, Urbana, IL, United States of America.
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13
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Werler MM, Kerr SM, Ailes EC, Reefhuis J, Gilboa SM, Browne ML, Kelley KE, Hernandez-Diaz S, Smith-Webb RS, Garcia MH, Mitchell AA. Patterns of Prescription Medication Use during the First Trimester of Pregnancy in the United States, 1997-2018. Clin Pharmacol Ther 2023; 114:836-844. [PMID: 37356083 PMCID: PMC10949220 DOI: 10.1002/cpt.2981] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 06/16/2023] [Indexed: 06/27/2023]
Abstract
The objective of this analysis was to describe patterns of prescription medication use during pregnancy, including secular trends, with consideration of indication, and distributions of use within demographic subgroups. We conducted a descriptive secondary analysis using data from 9,755 women whose infants served as controls in two large United States case-control studies from 1997-2011 and 2014-2018. After excluding vitamin, herbal, mineral, vaccine, i.v. fluid, and topical products and over-the-counter medications, the proportion of women that reported taking at least one prescription medication in the first trimester increased over the study years, from 37% to 50% of women. The corresponding proportions increased with increasing maternal age and years of education, were highest for non-Hispanic White women (47%) and lowest for Hispanic women (24%). The most common indication for first trimester use of a medication was infection (12-15%). Increases were observed across the years for medications used for indications related to nausea/vomiting, depression/anxiety, infertility, thyroid disease, diabetes, and epilepsy. The largest relative increase in use among women was observed for medications to treat nausea/vomiting, which increased from 3.8% in the earliest years of the study (1997-2001) to 14.8% in 2014-2018, driven in large part by ondansetron use. Prescription medication use in the first trimester of pregnancy is common and increasing. Many medical conditions require treatments among pregnant women, often involving pharmacotherapy, which necessitates consideration of the risk and safety profiles for both mother and fetus.
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Affiliation(s)
- Martha M. Werler
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Stephen M. Kerr
- Slone Epidemiology Center at Boston University School of Medicine, Boston, Massachusetts, USA
| | - Elizabeth C. Ailes
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jennita Reefhuis
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Suzanne M. Gilboa
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Marilyn L. Browne
- Birth Defects Registry, New York State Department of Health; Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York, USA
| | - Katherine E. Kelley
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Sonia Hernandez-Diaz
- Department of Epidemiology, Harvard TH Chan School of Public Health, Harvard University, Cambridge, Massachusetts, USA
| | - Rashida S. Smith-Webb
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Michelle Huezo Garcia
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Allen A. Mitchell
- Slone Epidemiology Center at Boston University School of Medicine, Boston, Massachusetts, USA
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14
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Fisher SC, Howley MM, Tran EL, Ailes EC, Papadopoulos EA, Nembhard WN, Browne ML. Maternal cyclobenzaprine exposure and risk of birth defects in the National Birth Defects Prevention Study (1997-2011) and Birth Defects Study to Evaluate Pregnancy exposureS (2014-2018). Pharmacoepidemiol Drug Saf 2023; 32:855-862. [PMID: 36942828 PMCID: PMC10926911 DOI: 10.1002/pds.5619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 03/06/2023] [Accepted: 03/14/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE Cyclobenzaprine is a muscle relaxant indicated for acute pain. Little is known about cyclobenzaprine's safety during pregnancy. We explored the association between maternal cyclobenzaprine exposure and risk of birth defects among offspring. METHODS We combined data from two large, multi-site, population-based case-control studies in the United States. Cases were identified from birth defects registries across 10 states; controls were liveborn infants without birth defects randomly selected from the same catchment areas. Participants reported cyclobenzaprine use during the month before conception through the third month of pregnancy ("periconception") via computer-assisted telephone interview. We used logistic regression to assess associations between periconceptional cyclobenzaprine exposure and selected structural birth defects. We calculated crude odds ratios (OR) with corresponding 95% confidence intervals (CI). RESULTS Our study included 33 615 cases and 13 110 controls. Overall, 51 case (0.15%) and 9 control (0.07%) participants reported periconceptional cyclobenzaprine use. We observed increased risk for all seven defects with ≥3 exposed cases: cleft palate (OR = 4.79, 95% CI 1.71-13.44), cleft lip (OR = 2.50, 95% CI 0.89-7.02), anorectal atresia/stenosis (OR = 6.91, 95% CI 1.67, 28.65), d-transposition of the great arteries (OR = 6.97, 95% CI 2.17-22.36), coarctation of the aorta (OR = 5.58, 95% CI 1.88-16.58), pulmonary valve stenosis (OR = 4.55, 95% CI 1.10-18.87), and secundum atrial septal defect (OR = 3.08, 95% CI 0.83-11.45). CONCLUSIONS Even in our large sample, cyclobenzaprine use was rare. Our estimates are unadjusted and imprecise so should be interpreted cautiously. These hypothesis-generating results warrant confirmation and further research to explore possible mechanisms.
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Affiliation(s)
- Sarah C. Fisher
- Birth Defects Registry, New York State Department of Health, Albany, New York, USA
| | - Meredith M. Howley
- Birth Defects Registry, New York State Department of Health, Albany, New York, USA
| | - Emmy L. Tran
- Eagle Global Scientific LLC, Atlanta, Georgia, USA
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Elizabeth C. Ailes
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Wendy N. Nembhard
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Marilyn L. Browne
- Birth Defects Registry, New York State Department of Health, Albany, New York, USA
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York, USA
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15
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Rai S, Leydier L, Sharma S, Katwala J, Sahu A. A quest for genetic causes underlying signaling pathways associated with neural tube defects. Front Pediatr 2023; 11:1126209. [PMID: 37284286 PMCID: PMC10241075 DOI: 10.3389/fped.2023.1126209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 02/28/2023] [Indexed: 06/08/2023] Open
Abstract
Neural tube defects (NTDs) are serious congenital deformities of the nervous system that occur owing to the failure of normal neural tube closures. Genetic and non-genetic factors contribute to the etiology of neural tube defects in humans, indicating the role of gene-gene and gene-environment interaction in the occurrence and recurrence risk of neural tube defects. Several lines of genetic studies on humans and animals demonstrated the role of aberrant genes in the developmental risk of neural tube defects and also provided an understanding of the cellular and morphological programs that occur during embryonic development. Other studies observed the effects of folate and supplementation of folic acid on neural tube defects. Hence, here we review what is known to date regarding altered genes associated with specific signaling pathways resulting in NTDs, as well as highlight the role of various genetic, and non-genetic factors and their interactions that contribute to NTDs. Additionally, we also shine a light on the role of folate and cell adhesion molecules (CAMs) in neural tube defects.
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Affiliation(s)
- Sunil Rai
- Department of Molecular Biology, Medical University of the Americas, Charlestown, Saint Kitts and Nevis
| | - Larissa Leydier
- Department of Molecular Biology, Medical University of the Americas, Charlestown, Saint Kitts and Nevis
| | - Shivani Sharma
- Department of Molecular Biology, Medical University of the Americas, Charlestown, Saint Kitts and Nevis
| | - Jigar Katwala
- Department of Molecular Biology, Medical University of the Americas, Charlestown, Saint Kitts and Nevis
| | - Anurag Sahu
- Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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16
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Wu T, Zhou K, Hua Y, Zhang W, Li Y. The molecular mechanisms in prenatal drug exposure-induced fetal programmed adult cardiovascular disease. Front Pharmacol 2023; 14:1164487. [PMID: 37153765 PMCID: PMC10157035 DOI: 10.3389/fphar.2023.1164487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 04/03/2023] [Indexed: 05/10/2023] Open
Abstract
The "developmental origins of health and disease" (DOHaD) hypothesis posits that early-life environmental exposures have a lasting impact on individual's health and permanently shape growth, structure, and metabolism. This reprogramming, which results from fetal stress, is believed to contribute to the development of adulthood cardiovascular diseases such as hypertension, coronary artery disease, heart failure, and increased susceptibility to ischemic injuries. Recent studies have shown that prenatal exposure to drugs, such as glucocorticoids, antibiotics, antidepressants, antiepileptics, and other toxins, increases the risk of adult-onset cardiovascular diseases. In addition, observational and animal experimental studies have demonstrated the association between prenatal drug exposure and the programming of cardiovascular disease in the offspring. The molecular mechanisms underlying these effects are still being explored but are thought to involve metabolism dysregulation. This review summarizes the current evidence on the relationship between prenatal drug exposure and the risk of adult cardiovascular disorders. Additionally, we present the latest insights into the molecular mechanisms that lead to programmed cardiovascular phenotypes after prenatal drug exposure.
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Affiliation(s)
- Ting Wu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, West China Second University Hospital, Sichuan University, Chengdu, China
- Department of Ultrasonic Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Kaiyu Zhou
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, West China Second University Hospital, Sichuan University, Chengdu, China
- Department of Ultrasonic Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yimin Hua
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, West China Second University Hospital, Sichuan University, Chengdu, China
- Department of Ultrasonic Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Wen Zhang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, West China Second University Hospital, Sichuan University, Chengdu, China
- Department of Ultrasonic Medicine, West China Second University Hospital, Sichuan University, Chengdu, China
- *Correspondence: Wen Zhang, ; Yifei Li,
| | - Yifei Li
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of MOE, West China Second University Hospital, Sichuan University, Chengdu, China
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- *Correspondence: Wen Zhang, ; Yifei Li,
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17
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Fiat F, Merghes PE, Scurtu AD, Almajan Guta B, Dehelean CA, Varan N, Bernad E. The Main Changes in Pregnancy—Therapeutic Approach to Musculoskeletal Pain. Medicina (B Aires) 2022; 58:medicina58081115. [PMID: 36013582 PMCID: PMC9414568 DOI: 10.3390/medicina58081115] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/27/2022] [Accepted: 08/15/2022] [Indexed: 11/30/2022] Open
Abstract
Background and Objectives: During pregnancy, women undergo various physiological and anatomical changes that are accentuated as the pregnancy progresses, but return to their previous state a few weeks/months after the pregnancy. However, a targeted therapeutic approach is needed. Most of the time, during this period, these changes precipitate the appearance of pain, musculoskeletal pain being the most common. Pregnant women should avoid treating musculoskeletal pain with medication and should choose alternative and complementary methods. Exercise along with rest is the basis for treating chronic musculoskeletal pain. Side effects of physical therapy are rare and, in addition, it is not contraindicated in pregnant women. The benefits of this type of treatment in combating pain far outweigh the risks, being an easy way to improve quality of life. The objective of this article is to discuss the management of musculoskeletal pain during pregnancy, to identify the main musculoskeletal pain encountered in pregnant women along with drug treatment, and to expose the beneficial effects of alternative and complementary methods in combating pain. Materials and Methods: A literature search was conducted using medical databases, including PubMed, Google Scholar, and ScienceDirect, using the keywords “changes of pregnancy”, “musculoskeletal pain”, “pregnancy pain”, “pain management”, “pharmacological approach”, “alternative and complementary treatment” and specific sites. Information was collected from studies whose target population included pregnant women who complained of musculoskeletal pain during the 9 months of pregnancy; pregnant women with other pathologies that could increase their pain were not included in this review. Results: The articles related to the most common non-obstetric musculoskeletal pain in pregnancy along with pharmacological treatment options and alternative and complementary methods for musculoskeletal pain management during pregnancy were selected. Conclusions: The results were used to guide information towards the safest methods of therapy but also to raise awareness of the treatment criteria in order to compare the effectiveness of existing methods. Treatment must consider the implications for the mother and fetus, optimizing non-pharmacological therapeutic options.
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Affiliation(s)
- Felicia Fiat
- Department of Obstetrics-Gynecology II, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Petru Eugen Merghes
- Department of Physical Education and Sport, Banat’s University of Agricultural Sciences and Veterinary Medicine “King Mihai I of Romania” from Timisoara, Calea Aradului 119, 300645 Timisoara, Romania
| | - Alexandra Denisa Scurtu
- Department of Toxicology and Drug Industry, Faculty of Pharmacy, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Research Centre for Pharmaco-Toxicological Evaluation, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Correspondence: (A.D.S.); (B.A.G.)
| | - Bogdan Almajan Guta
- Department of Physical Therapy and Special Motor Skills, Faculty of Physical Education and Sport, West University of Timisoara, Vasile Parvan Boulevard, No. 4, 300223 Timisoara, Romania
- Correspondence: (A.D.S.); (B.A.G.)
| | - Cristina Adriana Dehelean
- Department of Toxicology and Drug Industry, Faculty of Pharmacy, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
- Research Centre for Pharmaco-Toxicological Evaluation, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
| | - Narcis Varan
- Department of Physical Education and Sport, Banat’s University of Agricultural Sciences and Veterinary Medicine “King Mihai I of Romania” from Timisoara, Calea Aradului 119, 300645 Timisoara, Romania
| | - Elena Bernad
- Department of Obstetrics-Gynecology II, Faculty of Medicine, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Square, No. 2, 300041 Timisoara, Romania
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18
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García MH, Petersen JM, Parker SE, Rubenstein E, Werler MM. Medication use during pregnancy among women with congenital physical disabilities. Birth Defects Res 2022; 114:785-796. [PMID: 35652163 DOI: 10.1002/bdr2.2048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/05/2022] [Accepted: 04/07/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Medication use during pregnancy is common, with up to 90% of pregnant women taking at least one medication. Women with congenital physical disabilities often report co-occurring conditions during pregnancy that may warrant pharmaceutical treatment, however, research is limited. We aim to describe medication use during pregnancy including: pain, psychotropic, and antibacterial medication, among women with and without congenital physical disabilities. METHODS We used data from the Slone Birth Defects Study (1976-2015), a case-control study that collected information on pre-pregnancy health conditions and exposures among participating mothers. Women with congenital physical disabilities (n = 132) included women with spina bifida, cerebral palsy, muscular dystrophy, limb deficiencies, and other skeletal/connective tissue conditions and were matched by interview year and study site to women without congenital physical disabilities (n = 528). Proportions and difference in proportions for each medication were compared between groups. Simple proportions were also calculated for duration and multiple medication use variables. RESULTS Women with congenital physical disabilities more frequently reported use of pain (acetaminophen and opioids), psychotropic (antidepressants), and antibacterial medications during pregnancy. Women with congenital physical disabilities used pain and psychotropic medications for longer, frequent durations, and more frequently reported haven taken multiple medications during pregnancy. CONCLUSION Women with congenital physical disabilities report higher medication use during pregnancy compared to women without physical disabilities. Patterns may be attributable to co-occurring conditions or increased risk of pregnancy complications in this population. Further research is needed to describe the patterns of medication use for clinical decisions regarding treatment of pregnant women with disabilities.
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Affiliation(s)
- Michelle Huezo García
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Julie M Petersen
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Samantha E Parker
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Eric Rubenstein
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Martha M Werler
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
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19
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Zafeiri A, Raja EA, Mitchell RT, Hay DC, Bhattacharya S, Fowler PA. Maternal over-the-counter analgesics use during pregnancy and adverse perinatal outcomes: cohort study of 151 141 singleton pregnancies. BMJ Open 2022; 12:e048092. [PMID: 35504638 PMCID: PMC9066494 DOI: 10.1136/bmjopen-2020-048092] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 04/07/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To identify any associations between in utero exposure to five over-the-counter (non-prescription) analgesics (paracetamol, ibuprofen, aspirin, diclofenac, naproxen) and adverse neonatal outcomes. DESIGN Retrospective cohort study using the Aberdeen Maternity and Neonatal Databank. PARTICIPANTS 151 141 singleton pregnancies between 1985 and 2015. MAIN OUTCOME MEASURES Premature delivery (<37 weeks), stillbirth, neonatal death, birth weight, standardised birthweight score, neonatal unit admission, APGAR score at 1 and 5 min, neural tube and amniotic band defects, gastroschisis and, in males, cryptorchidism and hypospadias. RESULTS 83.7% of women taking over-the-counter analgesics reported first trimester use when specifically asked about use at their first antenatal clinic visit. Pregnancies exposed to at least one of the five analgesics were significantly independently associated with increased risks for premature delivery <37 weeks (adjusted OR (aOR)=1.50, 95% CI 1.43 to 1.58), stillbirth (aOR=1.33, 95% CI 1.15 to 1.54), neonatal death (aOR=1.56, 95% CI 1.27 to 1.93), birth weight <2500 g (aOR=1.28, 95% CI 1.20 to 1.37), birth weight >4000 g (aOR=1.09, 95% CI 1.05 to 1.13), admission to neonatal unit (aOR=1.57, 95% CI 1.51 to 1.64), APGAR score <7 at 1 min (aOR=1.18, 95% CI 1.13 to 1.23) and 5 min (aOR=1.48, 95% CI 1.35 to 1.62), neural tube defects (aOR=1.64, 95% CI 1.08 to 2.47) and hypospadias (aOR=1.27, 95% CI 1.05 to 1.54 males only). The overall prevalence of over-the-counter analgesics use during pregnancy was 29.1%, however it rapidly increased over the 30-year study period, to include over 60% of women in the last 7 years of the study. This makes our findings highly relevant to the wider pregnant population. CONCLUSIONS Over-the-counter (non-prescription) analgesics consumption during pregnancy was associated with a substantially higher risk for adverse perinatal health outcomes in the offspring. The use of paracetamol in combination with other non-steroidal anti-inflammatory drugs conferred the highest risk. The increased risks of adverse neonatal outcomes associated with non-prescribed, over-the-counter, analgesics use during pregnancy indicate that healthcare guidance for pregnant women regarding analgesic use need urgent updating.
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Affiliation(s)
- Aikaterini Zafeiri
- Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Edwin Amalraj Raja
- Medical Statistics Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Rod Thomas Mitchell
- MRC Centre for Reproductive Health, The Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - David C Hay
- MRC Centre for Regenerative Medicine, University of Edinburgh, Edinburgh, UK
| | - Sohinee Bhattacharya
- Aberdeen Centre for Women's Health Research, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Paul A Fowler
- Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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20
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Isaković J, Šimunić I, Jagečić D, Hribljan V, Mitrečić D. Overview of Neural Tube Defects: Gene–Environment Interactions, Preventative Approaches and Future Perspectives. Biomedicines 2022; 10:biomedicines10050965. [PMID: 35625701 PMCID: PMC9138472 DOI: 10.3390/biomedicines10050965] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 11/16/2022] Open
Abstract
Neural tube defects (NTDs) are the second most common congenital malformations of humans, characterized by impaired development of the central nervous system. Even though the etiology of most birth defects remains undetermined, genetic and environmental risk factors in the background of NTDs have been identified and extensively reported. On top of genetic and nutritional risks which include mutations in both coding and non-coding regions and maternal folate status, respectively, recent years have seen a rise in the identification of a variety of teratogens that could be implicated in NTD development. These include polycyclic aromatic hydrocarbons, arsenic, pesticides, maternal hyperthermia and antibiotics as well as pain and seizure medication. With an increase in understanding of teratogens leading to NTD formation, preventative and treatment approaches have witnessed great advances throughout the years. While the most common preventative approach includes folic acid food fortification as well as suggested inositol supplementation, treatment and management approaches differ greatly depending on the developmental stage and the site of the lesion and include prenatal surgery, stem cell transplantation and postnatal surgery. Because NTDs still represent a large health and financial burden for the patient and society as a whole, it is crucial to investigate potential risk factors and develop novel approaches in order to fully prevent this category of disorders.
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Affiliation(s)
- Jasmina Isaković
- Omnion Research International Ltd., Heinzelova 4, 10000 Zagreb, Croatia
- Department of Histology and Embryology, University of Zagreb School of Medicine, 10000 Zagreb, Croatia; (D.J.); (V.H.); (D.M.)
- Correspondence:
| | - Iva Šimunić
- Laboratory for Stem Cells, Croatian Institute for Brain Research, University of Zagreb School of Medicine, 10000 Zagreb, Croatia;
| | - Denis Jagečić
- Department of Histology and Embryology, University of Zagreb School of Medicine, 10000 Zagreb, Croatia; (D.J.); (V.H.); (D.M.)
- Laboratory for Stem Cells, Croatian Institute for Brain Research, University of Zagreb School of Medicine, 10000 Zagreb, Croatia;
| | - Valentina Hribljan
- Department of Histology and Embryology, University of Zagreb School of Medicine, 10000 Zagreb, Croatia; (D.J.); (V.H.); (D.M.)
- Laboratory for Stem Cells, Croatian Institute for Brain Research, University of Zagreb School of Medicine, 10000 Zagreb, Croatia;
| | - Dinko Mitrečić
- Department of Histology and Embryology, University of Zagreb School of Medicine, 10000 Zagreb, Croatia; (D.J.); (V.H.); (D.M.)
- Laboratory for Stem Cells, Croatian Institute for Brain Research, University of Zagreb School of Medicine, 10000 Zagreb, Croatia;
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21
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Tadokoro-Cuccaro R, Fisher BG, Thankamony A, Ong KK, Hughes IA. Maternal Paracetamol Intake During Pregnancy-Impacts on Offspring Reproductive Development. FRONTIERS IN TOXICOLOGY 2022; 4:884704. [PMID: 35499038 PMCID: PMC9047911 DOI: 10.3389/ftox.2022.884704] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 03/22/2022] [Indexed: 02/02/2023] Open
Abstract
Paracetamol (acetaminophen) is the preferred antipyretic/analgesic for pregnant women as it is believed there are no adverse fetal effects at the recommended dose. However, emerging evidence suggests that intrauterine paracetamol exposure may be associated with certain urogenital/reproductive disorders in the offspring. In this mini-review, we describe human fetal sex development and possible pharmacological mechanisms by which paracetamol may disrupt this process, including reduced testicular production of testosterone and/or insulin-like peptide 3. We then review the available epidemiological literature on associations between maternal paracetamol exposure and offspring sexual development. Three epidemiological studies have reported associations between maternal paracetamol intake and increased risk of cryptorchidism, although five others have not. None have found associations with hypospadias or penile length. Two out of three studies have reported a shorter anogenital distance (a marker of androgen action during the masculinisation programming window, ∼8-14 weeks of gestation) in male infants antenatally exposed to paracetamol. One study has described a dose-dependent relationship between maternal paracetamol consumption and earlier female (but not male) attainment of puberty. Such epidemiological analyses are complicated by various factors, including method of paracetamol exposure assessment (usually retrospective self-report), variation in diagnostic accuracy, selection bias, confounding by clinical indication, and demographic/genetic differences between geographically separated populations. There is an urgent need for stronger evidence in this area, from both relevant experimental studies and large, carefully-designed prospective studies. In the meantime, a precautionary attitude to gestational paracetamol usage should be considered as the evidence for clinically significant reproductive effects in humans is limited.
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Affiliation(s)
| | - Benjamin G. Fisher
- Wellcome/Cancer Research UK Gurdon Institute, University of Cambridge, Cambridge, United Kingdom
| | - Ajay Thankamony
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Ken K. Ong
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
- Wellcome-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- MRC Epidemiology Unit, University of Cambridge, Cambridge, United Kingdom
| | - Ieuan A. Hughes
- Department of Paediatrics, University of Cambridge, Cambridge, United Kingdom
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22
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Boizet-Bonhoure B, Déjardin S, Rossitto M, Poulat F, Philibert P. Using Experimental Models to Decipher the Effects of Acetaminophen and NSAIDs on Reproductive Development and Health. FRONTIERS IN TOXICOLOGY 2022; 4:835360. [PMID: 35295217 PMCID: PMC8915900 DOI: 10.3389/ftox.2022.835360] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/07/2022] [Indexed: 01/04/2023] Open
Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin (acetylsalicylic acid), diclofenac and ibuprofen (IBU), and analgesic drugs, such as acetaminophen (APAP, or paracetamol), are widely used to treat inflammation and pain. APAP and IBU are over-the-counter drugs and are among the most commonly taken drugs in the first trimester of pregnancy, even in combination. Furthermore, these drugs and their metabolites are released in the environment, and can be frequently detected in wastewater, surface water, and importantly in drinking water. Although their environmental concentrations are much lower than the therapeutics doses, this suggests an uncontrolled low-dose exposure of the general population, including pregnant women and young children, two particularly at risk populations. Epidemiological studies show that exposure to these molecules in the first and second trimester of gestation can favor genital malformations in new-born boys. To investigate the cellular, molecular and mechanistic effects of exposure to these molecules, ex vivo studies with human or rodent gonadal explants and in vivo experiments in rodents have been performed in the past years. This review recapitulates recent data obtained in rodent models after in utero or postnatal exposure to these drugs. The first part of this review discusses the mechanisms by which NSAIDs and analgesics may impair gonadal development and maturation, puberty development, sex hormone production, maturation and function of adult organs, and ultimately fertility in the exposed animals and their offspring. Like other endocrine disruptors, NSAIDs and APAP interfere with endocrine gland function and may have inter/transgenerational adverse effects. Particularly, they may target germ cells, resulting in reduced quality of male and female gametes, and decreased fertility of exposed individuals and their descendants. Then, this review discusses the effects of exposure to a single drug (APAP, aspirin, or IBU) or to combinations of drugs during early embryogenesis, and the consequences on postnatal gonadal development and adult reproductive health. Altogether, these data may increase medical and public awareness about these reproductive health concerns, particularly in women of childbearing age, pregnant women, and parents of young children.
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Affiliation(s)
- Brigitte Boizet-Bonhoure
- Institute of Human Genetics, CNRS, University of Montpellier, Montpellier, France
- *Correspondence: Brigitte Boizet-Bonhoure,
| | - Stéphanie Déjardin
- Institute of Human Genetics, CNRS, University of Montpellier, Montpellier, France
| | | | - Francis Poulat
- Institute of Human Genetics, CNRS, University of Montpellier, Montpellier, France
| | - Pascal Philibert
- Institute of Human Genetics, CNRS, University of Montpellier, Montpellier, France
- Laboratory of Biochemistry and Molecular Biology, Carèmeau Hospital, Nîmes University Hospital, Nîmes, France
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23
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Tran-Guzman A, Culty M. Eicosanoid Biosynthesis in Male Reproductive Development: Effects of Perinatal Exposure to NSAIDs and Analgesic Drugs. FRONTIERS IN TOXICOLOGY 2022; 4:842565. [PMID: 35295224 PMCID: PMC8915844 DOI: 10.3389/ftox.2022.842565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/09/2022] [Indexed: 11/13/2022] Open
Abstract
Increasing rates of infertility associated with declining sperm counts and quality, as well as increasing rates of testicular cancer are contemporary issues in the United States and abroad. These conditions are part of the Testicular Dysgenesis Syndrome, which includes a variety of male reproductive disorders hypothesized to share a common origin based on disrupted testicular development during fetal and neonatal stages of life. Male reproductive development is a highly regulated and complex process that relies on an intricate coordination between germ, Leydig, and Sertoli cells as well as other supporting cell types, to ensure proper spermatogenesis, testicular immune privilege, and endocrine function. The eicosanoid system has been reported to be involved in the regulation of fetal and neonatal germ cell development as well as overall testicular homeostasis. Moreover, non-steroidal anti-inflammatory drugs (NSAIDs) and analgesics with abilities to block eicosanoid synthesis by targeting either or both isoforms of cyclooxygenase enzymes, have been found to adversely affect male reproductive development. This review will explore the current body of knowledge on the involvement of the eicosanoid system in male reproductive development, as well as discuss adverse effects of NSAIDs and analgesic drugs administered perinatally, focusing on toxicities reported in the testis and on major testicular cell types. Rodent and epidemiological studies will be corroborated by findings in invertebrate models for a comprehensive report of the state of the field, and to add to our understanding of the potential long-term effects of NSAID and analgesic drug administration in infants.
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24
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Varney B, Zoega H, Gillies MB, Brett J, Pearson SA, Havard A. Prescription opioid use in Australian women of reproductive age: Implications for unplanned pregnancies. Br J Clin Pharmacol 2022; 88:1298-1320. [PMID: 34505707 DOI: 10.1111/bcp.15074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/20/2021] [Accepted: 08/29/2021] [Indexed: 11/29/2022] Open
Abstract
AIMS To examine trends in the prevalence and incidence of prescription opioid analgesic use in Australian women of reproductive age and to estimate the number of calendar months each year that women were dispensed opioids. METHODS We conducted a retrospective cross-sectional study involving women aged 15-44 years using pharmaceutical dispensing claims for a 10% random sample of Australians. For the period 2013-2020, we calculated the annual prevalence and incidence of opioid analgesic dispensing per 100 (%) population by opioid type and age group. We also estimated the total number of calendar months that women were dispensed at least 1 opioid each year. RESULTS The prevalence of opioid use decreased from 12.8% in 2013 to 11.3% in 2020, representing a relative decrease of 11.6% (95% confidence interval 10.7, 12.6%). The incidence of opioid use decreased from 10.3% in 2014 to 8.3% in 2020, representing a relative decrease of 18.6% (95% confidence interval 17.6, 19.6%). Codeine in combination products, followed by oxycodone and tramadol, were the most prevalent opioids. Prevalence and incidence of opioid use were lowest in women aged 15-19 years and the highest in women 30 years and above. Among all women dispensed opioids, 72.7% were dispensed an opioid in only 1 month each year. CONCLUSION Prescription opioid use remains common, although decreasing, among women of reproductive age in Australia. However, it is reassuring that the majority of opioid use in this population is short term.
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Affiliation(s)
- Bianca Varney
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Helga Zoega
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Malcolm Bjørn Gillies
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Jonathan Brett
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Sallie-Anne Pearson
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Alys Havard
- Centre for Big Data Research in Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
- National Drug and Alcohol Research Centre, Faculty of Medicine, University of New South Wales, Sydney, Australia
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25
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Zhao JP, Berthod C, Sheehy O, Kassaï B, Gorgui J, Bérard A. Prevalence and duration of prescribed opioid use during pregnancy: a cohort study from the Quebec Pregnancy Cohort. BMC Pregnancy Childbirth 2021; 21:800. [PMID: 34847870 PMCID: PMC8638412 DOI: 10.1186/s12884-021-04270-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 11/08/2021] [Indexed: 11/13/2022] Open
Abstract
Background Recent studies show a rapid growth among pregnant women using high potency opioids for common pain management during their pregnancy. No study has examined the duration of treatment among strong opioid users and weak opioid users during pregnancy. We aimed to investigate the prevalence of prescribed opioid use during pregnancy, in Quebec; and to compare the duration of opioid treatment between strong opioid users and weak opioid users. Methods Using the Quebec Pregnancy Cohort (1998–2015), we included all pregnancies covered by the Quebec Public Prescription Drug Insurance Program. Opioid exposure was defined as filled at least one prescription for any opioid during pregnancy or before pregnancy but with a duration that overlapped the beginning of pregnancy. Prevalence of opioids use was calculated for all pregnancies, according to pregnancy outcome, trimester of exposure, and individual opioids. The duration of opioid use during pregnancy was analyzed according to 8 categories based on cumulative duration (< 90 days vs. ≥90 days), duration of action (short-acting vs. long-acting) and strength of the opioid (weak vs. strong). Results Of 442,079 eligible pregnancies, 20,921 (4.7%) were exposed to opioids. Among pregnancies ending with deliveries (n = 249,234), 5.4% were exposed to opioids; the prevalence increased by 40.3% from 3.9% in 1998 to 5.5% in 2015, more specifically a significant increase in the second and third trimesters of pregnancy. Weak opioid, codeine was the most commonly dispensed opioid (70% of all dispensed opioids), followed by strong opioid, hydromorphone (11%), morphine (10%), and oxycodone (5%). The prevalence of codeine use decreased by 47% from 4.3% in 2005 to 2.3% in 2015, accompanied by an increased use of strong opioid, morphine (0.029 to 1.41%), hydromorphone (0.115 to 1.08%) and oxycodone (0.022 to 0.44%), from 1998 to 2015. The average durations of opioid exposure were significantly longer among pregnancies exposed to strong opioid as compared to weak opioid regardless of the cumulative duration or duration of action (P < 0.05). Conclusions Given the differences in the safety profile between strong opioids and the major weak opioid codeine, the increased use of strong opioids during pregnancy with longer treatment duration raises public health concerns. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04270-x.
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Affiliation(s)
- Jin-Ping Zhao
- Research Center, CHU Sainte-Justine, 3175, Chemin de la Côte-Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada
| | - Christelle Berthod
- Research Center, CHU Sainte-Justine, 3175, Chemin de la Côte-Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada.,Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada.,University of Lyon 1, 69008, Lyon, France.,Laboratoire de Biométrie et Biologie Evolutive, University of Lyon 1; CNRS, UMR 5558, 69622, Villeurbanne, France
| | - Odile Sheehy
- Research Center, CHU Sainte-Justine, 3175, Chemin de la Côte-Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada
| | - Behrouz Kassaï
- EPICIME-CIC 1407 Lyon, Inserm, Pharmacotoxicology Department, CHU-Lyon, 69677, Bron, France.,University of Lyon 1, 69008, Lyon, France.,Laboratoire de Biométrie et Biologie Evolutive, University of Lyon 1; CNRS, UMR 5558, 69622, Villeurbanne, France
| | - Jessica Gorgui
- Research Center, CHU Sainte-Justine, 3175, Chemin de la Côte-Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada.,Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada
| | - Anick Bérard
- Research Center, CHU Sainte-Justine, 3175, Chemin de la Côte-Sainte-Catherine, Montreal, Quebec, H3T 1C5, Canada. .,Faculty of Pharmacy, University of Montreal, Montreal, Quebec, Canada. .,EPICIME-CIC 1407 Lyon, Inserm, Pharmacotoxicology Department, CHU-Lyon, 69677, Bron, France. .,University of Lyon 1, 69008, Lyon, France. .,Laboratoire de Biométrie et Biologie Evolutive, University of Lyon 1; CNRS, UMR 5558, 69622, Villeurbanne, France.
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26
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Bauer AZ, Swan SH, Kriebel D, Liew Z, Taylor HS, Bornehag CG, Andrade AM, Olsen J, Jensen RH, Mitchell RT, Skakkebaek NE, Jégou B, Kristensen DM. Paracetamol use during pregnancy - a call for precautionary action. Nat Rev Endocrinol 2021; 17:757-766. [PMID: 34556849 PMCID: PMC8580820 DOI: 10.1038/s41574-021-00553-7] [Citation(s) in RCA: 85] [Impact Index Per Article: 28.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 02/07/2023]
Abstract
Paracetamol (N-acetyl-p-aminophenol (APAP), otherwise known as acetaminophen) is the active ingredient in more than 600 medications used to relieve mild to moderate pain and reduce fever. APAP is widely used by pregnant women as governmental agencies, including the FDA and EMA, have long considered APAP appropriate for use during pregnancy when used as directed. However, increasing experimental and epidemiological research suggests that prenatal exposure to APAP might alter fetal development, which could increase the risks of some neurodevelopmental, reproductive and urogenital disorders. Here we summarize this evidence and call for precautionary action through a focused research effort and by increasing awareness among health professionals and pregnant women. APAP is an important medication and alternatives for treatment of high fever and severe pain are limited. We recommend that pregnant women should be cautioned at the beginning of pregnancy to: forego APAP unless its use is medically indicated; consult with a physician or pharmacist if they are uncertain whether use is indicated and before using on a long-term basis; and minimize exposure by using the lowest effective dose for the shortest possible time. We suggest specific actions to implement these recommendations. This Consensus Statement reflects our concerns and is currently supported by 91 scientists, clinicians and public health professionals from across the globe.
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Affiliation(s)
- Ann Z Bauer
- Department of Public Health, University of Massachusetts School of Health Sciences, Lowell, MA, USA
| | - Shanna H Swan
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - David Kriebel
- Department of Public Health, University of Massachusetts School of Health Sciences, Lowell, MA, USA
| | - Zeyan Liew
- Yale Center for Perinatal, Paediatric, and Environmental Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Hugh S Taylor
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, Yale-New Haven Hospital, New Haven, CT, USA
| | - Carl-Gustaf Bornehag
- Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
- Department of Health Sciences, Karlstad University, Karlstad, Sweden
| | - Anderson M Andrade
- Departamento de Fisiologia, Setor de Ciências Biológicas, Universidade Federal do Paraná (UFPR), Curitiba, Brazil
| | - Jørn Olsen
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Rigmor H Jensen
- Department of Neurology, Danish Headache Center, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Rod T Mitchell
- MRC Centre for Reproductive Health, Queens Medical Research Institute, Edinburgh, Scotland
| | - Niels E Skakkebaek
- Department of Growth & Reproduction and EDMaRC, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Bernard Jégou
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) UMR_S, 1085, Rennes, France
| | - David M Kristensen
- Department of Neurology, Danish Headache Center, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark.
- Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) UMR_S, 1085, Rennes, France.
- Department of Biology, University of Copenhagen, Copenhagen, Denmark.
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27
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Abstract
In recent years, there has been an increased incidence in several of the most common reproductive disorders, including hypospadias and cryptorchidism in newborns, and testicular cancer and lower sperm quality in young adult males. In addition, the timing of puberty has also changed over time. Although the cause of these reproductive effects is a matter of intense debate, a link with the presence of ubiquitous compounds in the environment, or the exposure to specific groups of medications during foetal life, has been suggested. Results from epidemiological and experimental studies, as well as clinical observations in humans indicate that endocrine-disrupting chemicals may be associated with those disorders. In this review, we will summarize the results of epidemiological studies and experimental studies utilising human testicular cells or tissue. Due to increasing public interest and the recently published data, the main focus will be on the effects of prenatal exposure to mild analgesics.
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Affiliation(s)
- Jan-Bernd Stukenborg
- NORDFERTIL Research Lab Stockholm, Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, and Karolinska University Hospital, 17164 Solna, Sweden.
| | - Rod T Mitchell
- MRC Centre for Reproductive Health, The Queen's Medical Research Institute, The University of Edinburgh, and the Royal Hospital for Children and Young People, Edinburgh, UK.
| | - Olle Söder
- NORDFERTIL Research Lab Stockholm, Childhood Cancer Research Unit, Department of Women's and Children's Health, Karolinska Institutet, and Karolinska University Hospital, 17164 Solna, Sweden.
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28
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Esposito DB, Parker SE, Mitchell AA, Tinker SC, Werler MM. Periconceptional nonsteroidal anti-inflammatory drug use, folic acid intake, and the risk of spina bifida. Birth Defects Res 2021; 113:1257-1266. [PMID: 34346174 DOI: 10.1002/bdr2.1944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/02/2021] [Accepted: 07/12/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Use of nonsteroidal anti-inflammatory drugs (NSAIDs) during pregnancy may increase risk for neural tube defects (NTDs), including spina bifida. Folic acid intake can prevent NTDs, but it is not known whether it modifies any risks associated with NSAID use. OBJECTIVES To assess the impact of periconceptional NSAID use on the risk of spina bifida overall and stratified by folic acid intake. STUDY DESIGN We analyzed 1998-2015 data from the Slone Epidemiology Center Birth Defects Study, a multi-site, case-control study. Mothers were interviewed to identify sociodemographic factors, behaviors, and exposures during pregnancy. Periconceptional NSAID use was defined as use of aspirin, ibuprofen, naproxen, or COX2 inhibitors within the month before or after the last menstrual period. Logistic regression models were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for NSAID use, adjusted for study center and race/ethnicity stratified by average daily folic acid intake above ("high FA") or below ("low FA") 400 mcg/day. RESULTS We compared mothers of 267 infants with spina bifida to mothers of 6,233 nonmalformed controls. Among control mothers, 20% used NSAIDS periconceptionally (16% ibuprofen, 4% aspirin, 3% naproxen, and <1% COX-2 inhibitors). For any NSAID use, the aORs among low FA and high FA women were 1.70 (95% CI [1.13, 2.57]) and 1.09 (95% CI [0.69, 1.71]), respectively. CONCLUSIONS We observed a small increase in the risk for spina bifida among infants born to women who used NSAIDs periconceptionally, but this risk was limited to those who had inadequate folic acid intake.
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Affiliation(s)
- Daina B Esposito
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Samantha E Parker
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA.,Slone Epidemiology Center at Boston University, Boston, Massachusetts, USA
| | - Allen A Mitchell
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA.,Slone Epidemiology Center at Boston University, Boston, Massachusetts, USA
| | - Sarah C Tinker
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Martha M Werler
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA.,Slone Epidemiology Center at Boston University, Boston, Massachusetts, USA
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29
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Regional variation in gastroschisis: a nationwide database review of demographics and outcomes. Pediatr Surg Int 2021; 37:911-917. [PMID: 33787981 DOI: 10.1007/s00383-021-04894-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/23/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Gastroschisis is an index neonatal malformation with an increasing incidence from earlier decades. The aim of this study was to investigate regional variations in patient demographics, outcomes, and costs in gastroschisis. MATERIALS AND METHODS The 2016 kid's inpatient database (KID) obtained from the Healthcare Cost and Utilization Project (HCUP) was used to obtain gastroschisis birth, demographic, and outcome data across four U.S. geographical regions: Northeast, Midwest, South, and West. Categorical variables were analyzed with Pearson's Chi-squared test. Odds ratios (OR) with 95% confidence intervals (CI) were reported for variables with significance (p < 0.05). Appropriate logistic regressions were used for comparing categorical, cardinal, and continuous data. RESULTS 2043 gastroschisis cases were obtained from the 2016 KID database with a weighted incidence of 5.1 per 10,000 live births. Incidence of gastroschisis across regions was similar when controlling for a number of hospitals reporting to KID. Prematurity was common, with 59% (1204) of neonates with gastroschisis born at less than 37 weeks. 52% (N = 1067) of gastroschisis infants were male. 46% (955) were White, 9% (178) African American, 22% (450) Hispanic, and 8% (155) other. The overall mortality of gastroschisis in this database was 3.6% (75). The average length of stay was 39 days and average cost of treatment was $357,436. Though without significant differences in mortality, there were significant differences in demographics, costs, and lengths of stay between regions. CONCLUSIONS There has been a significant increase in gastroschisis incidence over the last three decades. This significant increase appears to be related to an increase in socioeconomic inequality and an alteration in the population demographics in the United States. Further study of regional variations will facilitate the development of best practice guidelines that benefit all.
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Tan J, Xiong Y, Qi Y, Liu C, Huang S, Yao G, Sun W, Qian Y, Ye L, Xu Q, Liu H, Lee AH, Thabane L, Sun X. Data Resource Profile: Xiamen registry of pregnant women and offspring (REPRESENT): a population-based, long-term follow-up database linking four major healthcare data platforms. Int J Epidemiol 2021; 50:27-28. [PMID: 33367681 PMCID: PMC7938502 DOI: 10.1093/ije/dyaa161] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2020] [Indexed: 02/05/2023] Open
Affiliation(s)
- Jing Tan
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China.,Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Biostatistics Unit, St Joseph's Healthcare-Hamilton, Hamilton, Canada
| | - Yiquan Xiong
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Yana Qi
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Chunrong Liu
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | - Shiyao Huang
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
| | | | - Wei Sun
- Xiamen Health Commission, Xiamen, China
| | | | - Lishan Ye
- Xiamen Health and Medical Big Data Center, Xiamen, China
| | - Qiushi Xu
- Xiamen Health and Medical Big Data Center, Xiamen, China
| | - Hui Liu
- Xiamen Health and Medical Big Data Center, Xiamen, China
| | - Andy H Lee
- School of Public Health, Curtin University, Perth, Australia
| | - Lehana Thabane
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Biostatistics Unit, St Joseph's Healthcare-Hamilton, Hamilton, Canada
| | - Xin Sun
- Chinese Evidence-based Medicine Center, West China Hospital, Sichuan University, Chengdu, China
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Hultzsch S, Paulus W, Padberg S, Fietz AK, Schaefer C, Dathe K. First trimester naproxen exposure and outcome of pregnancy - A German case series. Reprod Toxicol 2021; 103:51-57. [PMID: 34015472 DOI: 10.1016/j.reprotox.2021.05.006] [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: 12/09/2020] [Revised: 05/12/2021] [Accepted: 05/16/2021] [Indexed: 12/11/2022]
Abstract
In contrast to other non-steroidal anti-inflammatory drugs (NSAIDs), naproxen use during pregnancy is not well studied. The objective of this analysis was to assess negative effects on pregnancy outcomes following naproxen exposure in the first trimester of pregnancy. Out of 121 exposed pregnancies prospectively recorded by two German teratology information services (TIS) 15 ended as spontaneous abortion and ten were electively terminated; in one case for prenatal diagnosis of anencephaly. Four pregnancies were stillborn, in these cases naproxen was discontinued more than two months before the event. Of 95 live-born infants, including three pairs of twins, two were born with major birth defects: one with dysmelia of the left hand and foot and another with a complex congenital heart defect, esophageal atresia with tracheoesophageal fistula, and choanal stenosis. The results of this case series do not suggest that naproxen has a significant teratogenic effect. However, due to the limited cohort size and lack of comparable reference group results should be interpreted with caution and better studied NSAIDs such as ibuprofen should be preferred in the first and second trimester of pregnancy. This work was supported by the German Federal Institute for Drugs and Medical Devices (BfArM).
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Affiliation(s)
- Stefanie Hultzsch
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institut für Klinische Pharmakologie und Toxikologie, Pharmakovigilanz- und Beratungszentrum für Embryonaltoxikologie, Germany.
| | - Wolfgang Paulus
- Universitätsfrauenklinik Ulm, Beratungsstelle für Reproduktionstoxikologie, Ulm, Germany
| | - Stephanie Padberg
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institut für Klinische Pharmakologie und Toxikologie, Pharmakovigilanz- und Beratungszentrum für Embryonaltoxikologie, Germany
| | - Anne-Katrin Fietz
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institut für Klinische Pharmakologie und Toxikologie, Pharmakovigilanz- und Beratungszentrum für Embryonaltoxikologie, Germany
| | - Christof Schaefer
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institut für Klinische Pharmakologie und Toxikologie, Pharmakovigilanz- und Beratungszentrum für Embryonaltoxikologie, Germany
| | - Katarina Dathe
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institut für Klinische Pharmakologie und Toxikologie, Pharmakovigilanz- und Beratungszentrum für Embryonaltoxikologie, Germany
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Sebastian N, Czuzoj-Shulman N, Spence AR, Abenhaim HA. Maternal and fetal outcomes of urolithiasis: A retrospective cohort study. J Gynecol Obstet Hum Reprod 2021; 50:102161. [PMID: 33984541 DOI: 10.1016/j.jogoh.2021.102161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/22/2021] [Accepted: 05/04/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Although urolithiasis is relatively common in the general population, there is limited information on this condition available in the pregnant population. The objectives of this study are to identify the incidence of urolithiasis in pregnancy, as well as to compare maternal and fetal outcomes associated with urolithiasis in pregnancy. METHODS Using the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample database from the United States, a population-based retrospective cohort study consisting of pregnant women who delivered between 1999 and 2015 was conducted. ICD-9-CM code 592.X was used to identify pregnant women with urolithiasis within the cohort, with pregnant women without urolithiasis forming the comparison group. Unconditional logistic regression models were used to estimate the associations between urolithiasis in pregnancy and maternal and neonatal outcomes, while adjusting for baseline maternal characteristics. RESULTS A cohort of 13,792,544 pregnant women was identified, of which 11,528 had a urolithiasis-related admission during pregnancy, for an overall incidence of 8.3 per 10,000 pregnancies. Women with urolithiasis had a greater risk of developing preeclampsia/eclampsia, OR 1.35(95% CI 1.24-1.47), gestational diabetes, 1.29(1.20-1.30), abruptio placenta, 1.41(1.22-1.64), placenta previa, 1.55(1.27-1.90), pyelonephritis, 88.87(81.69-96.69), venous thromboembolism, 1.65(1.23-2.22), and more likely to deliver by cesarean, 1.20(1.15-1.25). As well, maternal death was more common among these women, 2.85(1.07-7.60). Congenital anomalies, 2.84(2.43-3.31) and prematurity, 1.92(1.82-2.03) were more commonly found among babies born to women with urolithiasis. CONCLUSION Although the mechanism is unclear, women with urolithiasis in pregnancy have an increased risk of adverse pregnancy and newborn outcomes.
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Affiliation(s)
- Natasha Sebastian
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Nicholas Czuzoj-Shulman
- Center for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Quebec, Canada
| | - Andrea R Spence
- Center for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Quebec, Canada
| | - Haim Arie Abenhaim
- Department of Obstetrics and Gynecology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Center for Clinical Epidemiology and Community Studies, Jewish General Hospital, Montreal, Quebec, Canada.
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Signal Detection in EUROmediCAT: Identification and Evaluation of Medication-Congenital Anomaly Associations and Use of VigiBase as a Complementary Source of Reference. Drug Saf 2021; 44:765-785. [PMID: 33966183 DOI: 10.1007/s40264-021-01073-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Knowledge on the safety of medication use during pregnancy is often sparse. Pregnant women are generally excluded from clinical trials, and there is a dependence on post-marketing surveillance to identify teratogenic medications. AIMS This study aimed to identify signals of potentially teratogenic medications using EUROmediCAT registry data on medication exposure in pregnancies with a congenital anomaly, and to investigate the use of VigiBase reports of adverse events of medications in the evaluation of these signals. METHODS Signals of medication-congenital anomaly associations were identified in EUROmediCAT (21,636 congenital anomaly cases with 32,619 medication exposures), then investigated in a subset of VigiBase (45,749 cases and 165,121 exposures), by reviewing statistical reporting patterns and VigiBase case reports. Evidence from the literature and quantitative and qualitative aspects of both datasets were considered before recommending signals as warranting further independent investigation. RESULTS EUROmediCAT analysis identified 49 signals of medication-congenital anomaly associations. Incorporating investigation in VigiBase and the literature, these were categorised as follows: four non-specific medications; 11 likely due to maternal disease; 11 well-established teratogens; two reviewed in previous EUROmediCAT studies with limited additional evidence; and 13 with insufficient basis for recommending follow-up. Independent investigations are recommended for eight signals: pregnen (4) derivatives with limb reduction; nitrofuran derivatives with cleft palate and patent ductus arteriosus; salicylic acid and derivatives with atresia or stenosis of other parts of the small intestine and tetralogy of Fallot; carbamazepine with atrioventricular septal defect and severe congenital heart defect; and selective beta-2-adrenoreceptor agonists with posterior urethral valve and/or prune belly. CONCLUSION EUROmediCAT data should continue to be used for signal detection, accompanied by information from VigiBase and review of the existing literature to prioritise signals for further independent evaluation.
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Blecharz-Klin K, Sznejder-Pachołek A, Wawer A, Pyrzanowska J, Piechal A, Joniec-Maciejak I, Mirowska-Guzel D, Widy-Tyszkiewicz E. Early exposure to paracetamol reduces level of testicular testosterone and changes gonadal expression of genes relevant for steroidogenesis in rats offspring. Drug Chem Toxicol 2021; 45:1862-1869. [PMID: 33657953 DOI: 10.1080/01480545.2021.1892941] [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] [Indexed: 10/22/2022]
Abstract
In this study, we investigated the effects of early paracetamol treatment on the testicular level of testosterone and expression of genes important for steroid biosynthesis and reproduction in male rats offspring. Rats were continuously exposed to paracetamol at doses of 5 or 15 mg/kg b.w. during pregnancy and the first two months of the postpartum development. Testosterone level was determined by ELISA. Profile of gene expression for the testicular steroidogenic factors were evaluated using the Real-Time PCR. Our results showed that paracetamol reduces testicular testosterone level and causes compensatory transactivation of genes important for steroidogenesis and reproductive capacity. We have observed significant over-expression of several genes involved in cholesterol transport and steroid biosynthesis e.g., genes for steroidogenic acute regulatory protein, hydroxysteroid dehydrogenases, luteinizing hormone subunit beta, gonadotropin and androgen receptors. Up-regulation of these genes with parallel testosterone reduction in the testicles could be the possible mechanism that maintains and prevents the loss of the steroidogenic function.
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Affiliation(s)
- Kamilla Blecharz-Klin
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Centre for Preclinical Research and Technology CePT, Warsaw, Poland
| | - Anna Sznejder-Pachołek
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Centre for Preclinical Research and Technology CePT, Warsaw, Poland
| | - Adriana Wawer
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Centre for Preclinical Research and Technology CePT, Warsaw, Poland
| | - Justyna Pyrzanowska
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Centre for Preclinical Research and Technology CePT, Warsaw, Poland
| | - Agnieszka Piechal
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Centre for Preclinical Research and Technology CePT, Warsaw, Poland
| | - Ilona Joniec-Maciejak
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Centre for Preclinical Research and Technology CePT, Warsaw, Poland
| | - Dagmara Mirowska-Guzel
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Centre for Preclinical Research and Technology CePT, Warsaw, Poland
| | - Ewa Widy-Tyszkiewicz
- Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Centre for Preclinical Research and Technology CePT, Warsaw, Poland
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Straub L, Huybrechts KF, Hernandez-Diaz S, Zhu Y, Vine S, Desai RJ, Gray KJ, Bateman BT. Chronic prescription opioid use in pregnancy in the United States. Pharmacoepidemiol Drug Saf 2021; 30:504-513. [PMID: 33428239 DOI: 10.1002/pds.5194] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 01/05/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE To evaluate chronic opioid utilization patterns during pregnancy using nationwide data from publicly and commercially insured women. METHODS Pregnancy cohorts were identified using data from the Medicaid Analytic eXtract 2008-2014 and the IBM Health MarketScan Research Database 2008-2015. Opioid dispensing was evaluated using claims from filled prescriptions. Two different definitions of chronic opioid use were employed: ≥90 days' supply and ≥180 days' supply of prescription opioids during pregnancy. Patient characteristics were assessed and variations in the prevalence of chronic opioid therapy were described by geographic region and over time. RESULTS 1.50% of 975 169 Medicaid-insured and 0.32% of 1 037 599 commercially insured beneficiaries filled opioid prescriptions for ≥90 days' supply; 0.78% (Medicaid) and 0.17% (commercially insured) filled prescriptions for ≥180 days' supply. Prevalence approximately doubled in Medicaid beneficiaries during the study period, while it remained relatively stable for commercial insurance beneficiaries. The most commonly prescribed opioid for chronic therapy was hydrocodone, followed by oxycodone and tramadol. Indications commonly associated with chronic use were back/neck pain, abdominal/pelvic pain, musculoskeletal pain and migraine/headache. Substantial regional variation was observed, with several states reporting a frequency of ≥90 days' supply in excess of 3% in Medicaid-insured patients. CONCLUSIONS Despite growing awareness of the risks associated with chronic opioid use and emphasis on improving opioid prescription patterns, prevalence of chronic use in pregnancy among publicly insured women nearly doubled from 2008-2014 and was 5-fold more common when compared to commercially insured women. Findings call for the development of guidelines on chronic pain management during pregnancy.
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Affiliation(s)
- Loreen Straub
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Krista F Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Sonia Hernandez-Diaz
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Yanmin Zhu
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Seanna Vine
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Rishi J Desai
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Kathryn J Gray
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Brian T Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA.,Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Intrauterine Exposure to Acetaminophen and Adverse Developmental Outcomes: Epidemiological Findings and Methodological Issues. Curr Environ Health Rep 2021; 8:23-33. [PMID: 33398668 DOI: 10.1007/s40572-020-00301-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE OF REVIEW Acetaminophen (or paracetamol) is one of the most commonly used medications during pregnancy. We reviewed recent epidemiological evidence regarding intrauterine exposure to acetaminophen and risk for asthma, neurodevelopment disorders, and reproductive health in childhood. RECENT FINDINGS An increasing number of cohort studies have suggested that maternal use of acetaminophen during pregnancy was associated with increased risk for asthma; neurodevelopmental disorders, especially ADHD and behavioral problems; and genital malformations in the offspring. Oxidative stress and inflammation or endocrine effects are plausible shared biological mechanisms for the exposure to influence multiple developmental outcomes. We discussed methodological challenges that can threaten the validity of these observational data, including confounding and measurement errors. Novel statistical methods and research designs that can be used to mitigate these issues were introduced. Given the high prevalence of use, findings regarding intrauterine exposure to acetaminophen on multiple child health outcomes raise concerns. Research on causal and non-causal mechanisms that might explain these associations should be a priority.
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Zafeiri A, Mitchell RT, Hay DC, Fowler PA. Over-the-counter analgesics during pregnancy: a comprehensive review of global prevalence and offspring safety. Hum Reprod Update 2020; 27:67-95. [PMID: 33118024 DOI: 10.1093/humupd/dmaa042] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/16/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Analgesia during pregnancy is often necessary. Due to their widespread availability, many mothers opt to use over-the-counter (OTC) analgesics. Those analgesic compounds and their metabolites can readily cross the placenta and reach the developing foetus. Evidence for safety or associations with adverse health outcomes is conflicting, limiting definitive decision-making for healthcare professionals. OBJECTIVE AND RATIONALE This review provides a detailed and objective overview of research in this field. We consider the global prevalence of OTC analgesia during pregnancy, explain the current mechanistic understanding of how analgesic compounds cross the placenta and reach the foetus, and review current research on exposure associations with offspring health outcomes. SEARCH METHODS A comprehensive English language literature search was conducted using PubMed and Scopus databases. Different combinations of key search terms were used including 'over-the-counter/non-prescription analgesics', 'pregnancy', 'self-medication', 'paracetamol', 'acetaminophen', 'diclofenac', 'aspirin', 'ibuprofen', 'in utero exposure', 'placenta drug transport', 'placental transporters', 'placenta drug metabolism' and 'offspring outcomes'. OUTCOMES This article examines the evidence of foetal exposure to OTC analgesia, starting from different routes of exposure to evidence, or the lack thereof, linking maternal consumption to offspring ill health. There is a very high prevalence of maternal consumption of OTC analgesics globally, which is increasing sharply. The choice of analgesia selected by pregnant women differs across populations. Location was also observed to have an effect on prevalence of use, with more developed countries reporting the highest consumption rates. Some of the literature focuses on the association of in utero exposure at different pregnancy trimesters and the development of neurodevelopmental, cardiovascular, respiratory and reproductive defects. This is in contrast to other studies which report no associations. WIDER IMPLICATIONS The high prevalence and the challenges of reporting exact consumption rates make OTC analgesia during pregnancy a pressing reproductive health issue globally. Even though some healthcare policy-making authorities have declared the consumption of some OTC analgesics for most stages of pregnancy to be safe, such decisions are often based on partial review of literature. Our comprehensive review of current evidence highlights that important knowledge gaps still exist. Those areas require further research in order to provide pregnant mothers with clear guidance with regard to OTC analgesic use during pregnancy.
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Affiliation(s)
- Aikaterini Zafeiri
- Institute of Medical Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Rod T Mitchell
- MRC Centre for Reproductive Health, University of Edinburgh, The Queen's Medical Research Institute, Edinburgh, UK
| | - David C Hay
- MRC Centre for Regenerative Medicine, Institute of Regeneration and Repair, University of Edinburgh, Edinburgh, UK
| | - Paul A Fowler
- Institute of Medical Sciences, School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
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Xia J, Huang YH, Li J, Liu S, Chen YL, Li LL, Jiang CZ, Chen ZJ, Wang Y, Liu XM, Wang XM, Wang J. Maternal exposure to ambient particulate matter 10 μm or less in diameter before and after pregnancy, and anencephaly risk: A population-based case-control study in China. ENVIRONMENTAL RESEARCH 2020; 188:109757. [PMID: 32535358 DOI: 10.1016/j.envres.2020.109757] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/27/2020] [Accepted: 05/27/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND There is no epidemiological evidence on the effects of maternal exposure to ambient particulate matter 10 μm or less in diameter (PM10) and anencephaly risk in offspring. METHODS We conducted a population-based case-control study in Liaoning Province, China. The case group consisted of 663 cases with anencephaly and the control group consisted of 7950 healthy infants from the Maternal and Child Health Certificate Registry of Liaoning Province that were born between 2010 and 2015. Daily PM10 concentrations were obtained from 77 monitoring stations located within the study area. A multivariable logistic regression model was established to calculate the adjusted odds ratios (ORs) and 95% confidence intervals (CIs). RESULTS Maternal PM10 exposure was significantly associated with an increased risk of anencephaly at three months before conception (highest versus lowest tertile: OR = 1.74, 95% CI: 1.29-2.34; per 10 μg/m3 increment: OR = 1.13, 95% CI: 1.06-1.20) and three months after conception (highest versus lowest tertile: OR = 1.93, 95% CI: 1.44-2.60; per 10 μg/m3 increment: OR = 1.01, 95% CI: 0.95-1.08). The evaluation of shorter exposure windows revealed similar associations for PM10 exposure from the third month before pregnancy to the third month after pregnancy. CONCLUSIONS Maternal PM10 exposure is positively associated with anencephaly risk during the critical period of neural system development.
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Affiliation(s)
- Jing Xia
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yan-Hong Huang
- Department of Ophthalmology, Shenyang Women's and Children's Hospital, Shenyang, China.
| | - Jing Li
- Department of Science and Education, Shenyang Maternity and Child Health Hospital, Shenyang, China
| | - Shu Liu
- Department of Atmospheric Environment Monitoring, Liaoning Eco-environmental Monitoring Center, China
| | - Yan-Ling Chen
- Liaoning Women and Children's Health Hospital, Shenyang, China
| | - Li-Li Li
- Department of Children's Health Prevention, Shenyang Maternity and Child Health Hospital, Shenyang, China
| | - Cheng-Zhi Jiang
- School of Environmental and Chemical Engineering, Shenyang Ligong University, Shenyang, China
| | - Zong-Jiao Chen
- Department of Atmospheric Environment Monitoring, Liaoning Eco-environmental Monitoring Center, China
| | - Ying Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xue-Min Liu
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Xiao-Ming Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Jun Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang, China.
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Adrien N, Petersen JM, Parker SE, Werler MM. Vasoactive exposures and risk of amniotic band syndrome and terminal transverse limb deficiencies. Birth Defects Res 2020; 112:1074-1084. [PMID: 32573119 DOI: 10.1002/bdr2.1740] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Amniotic band syndrome (ABS) includes limb deficiencies accompanied by fibrous strands originating from the amniotic lining. Terminal transverse limb deficiencies (TTLD) appear to be similar but lack fibrous strands. Both are hypothesized to result from vascular disruption. For ABS, limb deficiencies are considered secondary to amnion rupture. We explored an alternative possibility-that TTLD is the primary defect and ABS is secondary. METHODS Using data from the National Birth Defects Prevention Study, we expanded on a previous study. We examined smoking, alcohol, and medications categorized by indicated vasoactivity as markers of vascular disruption. Logistic regression models with Firth's penalized likelihood were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs). RESULTS Use of bronchodilators and aspirin appeared to increase the risk of ABS, while decongestants and nonaspirin NSAIDs increased the risk of TTLD. The risk of ABS was markedly increased in cases reporting combinations of vasoactive exposures, particularly alcohol and aspirin (aOR 3.7, 95% CI 1.6, 7.8), and alcohol and bronchodilators (aOR 3.4, 95% CI 1.4, 7.5). Increased risk of TTLD due to combinations of vasoactive exposures was only observed for smoking and decongestants (aOR 2.3, 95% CI 1.4, 3.6). CONCLUSIONS Exposures associated with increased risk of ABS had no apparent association with TTLD, supporting previous evidence that these may be distinct phenotypes. ABS appears to be associated with combined exposures with vasodilation properties, such as alcohol and bronchodilators, while increased risk of TTLD may be associated with smoking and decongestants, both vasoconstrictive exposures.
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Affiliation(s)
- Nedghie Adrien
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Julie M Petersen
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Samantha E Parker
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Martha M Werler
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
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Taylor WM, Lu Y, Wang S, Sun LS, Li G, Ing C. Long-term Healthcare Utilization by Medicaid Enrolled Children with Neonatal Abstinence Syndrome. J Pediatr 2020; 221:55-63.e6. [PMID: 32446493 PMCID: PMC9112831 DOI: 10.1016/j.jpeds.2020.02.077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 02/07/2020] [Accepted: 02/27/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To evaluate healthcare utilization in Medicaid enrolled children with neonatal abstinence syndrome (NAS) in the first 2 years of life. STUDY DESIGN A retrospective, longitudinal cohort study evaluating Medicaid enrolled children born in New York (1999-2011) and Texas (1999-2010) was performed. Healthcare utilization, including inpatient days, emergency department and outpatient visits, and filled prescriptions in children after birth hospitalization was assessed. A tapered propensity-matching methodology was used, matching each child with NAS with 5 children without NAS, first on demographics, then on both demographics and clinical covariates (clinical diagnoses and congenital anomalies at birth). Poisson and negative binomial regression were used to calculate healthcare utilization ratios (HUR). RESULTS In the first 2 years of life, children with NAS (n = 3799) had increased healthcare utilization with more inpatient days and emergency department visits than demographically similar children without NAS. This increased utilization however did not persist after matching on clinical covariates and performing multiple comparisons adjustment (inpatient days [HUR, 1.01; 95% CI, 0.88-1.16; P = .89], total emergency department visits [HUR, 1.06; 95% CI, 1.01-1.11; P = .02]). Children with NAS conversely had 9% fewer outpatient office visits (HUR, 0.91; 95% CI, 0.87-0.95; P < .0001). CONCLUSIONS A diagnosis of NAS does not appear to be an independent predictor of increased healthcare utilization in the first 2 years of life. These results differ from some other published studies, but may suggest that the increased healthcare utilization observed in children with NAS is due to higher incidences of perinatal complications and congenital anomalies in children with prenatal drug exposures.
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Affiliation(s)
- Walter M Taylor
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY; University of Colorado School of Medicine, Aurora, CO
| | - Yewei Lu
- University of Colorado School of Medicine, Aurora, CO
| | - Shuang Wang
- Department of Biostatistics, Mailman School of Public Health, New York, NY
| | - Lena S Sun
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY; Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY
| | - Guohua Li
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY
| | - Caleb Ing
- Department of Anesthesiology, Columbia University College of Physicians and Surgeons, New York, NY; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY.
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Masarwa R, Platt RW, Filion KB. Acetaminophen use during pregnancy and the risk of attention deficit hyperactivity disorder: A causal association or bias? Paediatr Perinat Epidemiol 2020; 34:309-317. [PMID: 31916282 DOI: 10.1111/ppe.12615] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/23/2019] [Accepted: 10/06/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND The association between acetaminophen use during pregnancy and the development of attention deficit hyperactivity disorder (ADHD) in the offspring may be due to bias. OBJECTIVES The primary objective was to assess the role of potential unmeasured confounding in the estimation of the association between acetaminophen use during pregnancy and the risk of ADHD, through bias analysis. The secondary objective was to assess the roles of selection bias and exposure misclassification. DATA SOURCES We searched MEDLINE, Embase, Scopus, and the Cochrane Library up to December 2018. STUDY SELECTION AND DATA EXTRACTION We included observational studies examining the association between acetaminophen use during pregnancy and the risk of ADHD. SYNTHESIS We meta-analysed data across studies, using random-effects model. We conducted a bias analysis to studies that did not adjust for important confounders, to explore systematic errors related to unmeasured confounding, selection bias, and exposure misclassification. RESULTS The search resulted in seven studies included in our meta-analysis. When adjusted estimates were pooled across all studies, the risk ratio (RR) for ADHD was 1.35 (95% confidence interval [CI] 1.25, 1.46; I2 = 48%). Sensitivity analysis for unmeasured confounding in this meta-analysis showed that a confounder of 1.69 on the RR scale would reduce to 10% the proportion of studies with a true effect size of RR >1.10. Unmeasured confounding bias analysis decreased the point estimate in five of the seven studies and increased in two studies, suggesting that the observed association could be confounded by parental ADHD. Unadjusted and bias-corrected risk ratios (bcRRs) were: RR = 1.34, bcRR = 1.13; RR = 1.51, bcRR = 1.17; RR = 1.63, bcRR = 1.38; RR = 1.44, bcRR = 1.17; RR = 1.16, bcRR = 1.18; RR = 1.25, bcRR = 1.05; and RR = 0.99, bcRR = 1.18. CONCLUSIONS Bias analysis suggests that the previously reported association between acetaminophen use during pregnancy and an increased risk of ADHD in the offspring may be due to unmeasured confounding. Our ability to conclude a causal association is limited.
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Affiliation(s)
- Reem Masarwa
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Robert W Platt
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.,Research Institute of the McGill University Health Centre, McGill University, Montreal, Canada.,Department of Pediatrics, McGill University, Montreal, Canada
| | - Kristian B Filion
- Centre for Clinical Epidemiology, Lady Davis Institute, Jewish General Hospital, Montreal, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada.,Department of Medicine, McGill University, Montreal, Canada
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Madsen C, Banaag A, Koehlmoos TP. Trends in Use of Acupuncture During Pregnancy for the Military Health System, 2006-2016. Med Acupunct 2019; 31:366-371. [PMID: 31871524 DOI: 10.1089/acu.2019.1376] [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: 11/13/2022] Open
Abstract
Objective: Acupuncture is recognized as safe for use in pregnancy when correctly performed and has been provided at military healthcare facilities since 2005. Previous research identified a number of pregnant patients receiving acupuncture within the Military Health System (MHS). This study was conducted to describe trends in usage from 2006 to 2016 including patient and provider characteristics. Materials and Methods: This study utilized TRICARE claims from the MHS Data Repository (MDR). Analysis was performed through the MDR for women ages 18 years and older, who had acupuncture treatments at military treatment facilities related to pregnancy, from 2006 to 2016. Descriptive statistics were collected on patient demographics, clinic types and provider specialties, major diagnostic categories associated with acupuncture, number of visits per patient, and utilization over time. Results: Less than 0.3% of pregnant women in the MHS received acupuncture. The greatest usage was among patients who were white, ages 25-34, dependents of active duty personnel, and in the Army service. The most common diagnoses were for musculoskeletal system and connective tissue disorders (41.9%). Approximately 79% of care was delivered by physicians. The trend over time rose from 11 visits in 2006 to 130 visits in 2016. Conclusions: Provision of acupuncture in pregnancy grew ∼12-fold between 2006 and 2016, although usage remains low overall. This greater proportion of physician-provided care in pregnant women versus the general patient population may reflect a cautionary attitude toward use in pregnancy. This research is expected to inform discussions for people seeking to increase access to acupuncture during pregnancy.
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Affiliation(s)
- Cathaleen Madsen
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
| | - Amanda Banaag
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD
| | - Tracey Pérez Koehlmoos
- Uniformed Services University of the Health Sciences, F. Edward Hebert School of Medicine; Bethesda, MD
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Kolding L, Pedersen LH, Petersen OB, Uldbjerg N, Sandager P. Sertraline use during pregnancy and effect on fetal cardiac function. J Matern Fetal Neonatal Med 2019; 34:3631-3638. [PMID: 31718339 DOI: 10.1080/14767058.2019.1688297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Objectives: The objective of this study was to evaluate the fetal cardiac function in human pregnancies exposed to sertraline (a selective serotonin reuptake inhibitor) compared to unexposed pregnancies.Method: We included 44 women in gestational week 25 + 0 days to week 26 + 6 days. Fifteen women used sertraline (50-150 mg per day), and 29 women used no daily medication. We assessed fetal cardiac function by Myocardial Performance Index (MPI), E/A ratios and by tricuspid and mitral annular plane systolic excursion (TAPSE and MAPSE) measured by 2D M-mode and by 4D eSTIC M-mode.Results: There were no differences between the sertraline exposed and the unexposed. The mean difference of MPI was 0.03 (95% CI -0.08-0.03), of tricuspid and mitral E/A ratios 0.00 (95% CI -0.03-0.05) and 0.03 (95% CI -0.07-0.01), respectively. The mean difference of TAPSE, by 2D and eSTIC, was 0.07 mm (95% CI -0.56-0.41) and 0.10 mm (95% CI -0.55-0.34). Mean difference of MAPSE, by 2D and eSTIC was 0.16 mm (95% CI -0.22-0.53) and 0.24 mm (95% CI -0.16-0.65), respectively. Serum levels of sertraline in exposed participants ranged from 33-266, median 92 nmol/L.Conclusions: We found no significant differences in fetal cardiac function, assessed by TAPSE, MAPSE, MPI and E/A ratios, in pregnancies exposed to sertraline compared to the unexposed.
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Affiliation(s)
- Line Kolding
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lars Henning Pedersen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Olav Bjørn Petersen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Centre for Fetal Diagnostics, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
| | - Niels Uldbjerg
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Puk Sandager
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark.,Centre for Fetal Diagnostics, Aarhus University and Aarhus University Hospital, Aarhus, Denmark
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Weber KA, Yang W, Carmichael SL, Padula AM, Shaw GM. A machine learning approach to investigate potential risk factors for gastroschisis in California. Birth Defects Res 2019; 111:212-221. [PMID: 30588769 PMCID: PMC6397054 DOI: 10.1002/bdr2.1441] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/30/2018] [Accepted: 11/21/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND To generate new leads about risk factors for gastroschisis, a birth defect that has been increasing in prevalence over time, we performed an untargeted data mining statistical approach. METHODS Using data exclusively from the California Center of the National Birth Defects Prevention Study, we compared 286 cases of gastroschisis and 1,263 non-malformed, live-born controls. All infants had delivery dates between October 1997 and December 2011 and were stratified by maternal age at birth (<20 and ≥ 20 years). Cases and controls were compared by maternal responses to 183 questions (219 variables) using random forest, a data mining procedure. Variables deemed important by random forest were included in logistic regression models to estimate odds ratios and 95% confidence intervals. RESULTS Among women younger than 20, of variables deemed important, there were higher odds observed for higher consumption of chocolate, low intake of iron, acetaminophen use, and urinary tract infections during the beginning of pregnancy. After adjustment, the higher odds remained for low iron intake and a urinary tract infection in the first month of pregnancy. Among women aged 20 or older, of variables deemed important, higher odds were observed for US-born women of Hispanic ethnicity and for parental substance abuse. There were lower odds observed for obese women, women who ate any cereal the month before pregnancy, and those with higher parity. CONCLUSIONS We did not discover many previously unreported associations, despite our novel approach to generate new hypotheses. However, our results do add evidence to some previously proposed risk factors.
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Affiliation(s)
- Kari A. Weber
- Department of Pediatrics, Division of Neonatology, Stanford University School of Medicine, Stanford, CA
| | - Wei Yang
- Department of Pediatrics, Division of Neonatology, Stanford University School of Medicine, Stanford, CA
| | - Suzan L. Carmichael
- Department of Pediatrics, Division of Neonatology, Stanford University School of Medicine, Stanford, CA
| | - Amy M. Padula
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, CA
| | - Gary M. Shaw
- Department of Pediatrics, Division of Neonatology, Stanford University School of Medicine, Stanford, CA
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d’Arby Toledano R, Madden HE, Leffert L. Anesthetic Management of Nonobstetric Surgery during Pregnancy. CURRENT ANESTHESIOLOGY REPORTS 2019. [DOI: 10.1007/s40140-019-00314-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Anderson JE, Galganski LA, Cheng Y, Stark RA, Saadai P, Stephenson JT, Hirose S. Epidemiology of gastroschisis: A population-based study in California from 1995 to 2012. J Pediatr Surg 2018; 53:2399-2403. [PMID: 30266482 PMCID: PMC6327946 DOI: 10.1016/j.jpedsurg.2018.08.035] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 08/25/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Although the incidence of gastroschisis is increasing, risk factors are not clearly identified. METHODS Using the Linked Birth Database from the California Office of Statewide Health Planning and Development from 1995 to 2012, patients with gastroschisis were identified by ICD-9 diagnosis/procedure code or birth certificate designation. Logistic regressions examined demographics, birth factors, and maternal exposures on risk of gastroschisis. RESULTS The prevalence of gastroschisis was 2.7 cases per 10,000 live births. Patients with gastroschisis had no difference in fetal exposure to alcohol (p = 0.609), narcotics (p = 0.072), hallucinogenics (p = 0.239), or cocaine (p = 0.777), but had higher exposure to unspecified/other noxious substances (OR 3.27, p = 0.040; OR 2.02, p = 0.002). Gastroschisis was associated with low/very low birthweight (OR 5.08-16.21, p < 0.001) and preterm birth (OR 3.26-10.0, p < 0.001). Multivariable analysis showed lower risk in black (OR 0.44, p < 0.001), Asian/Pacific Islander (OR 0.76, p = 0.003), and Hispanic patients (OR 0.72, p < 0.001) compared to white patients. Risk was higher in rural areas (OR 1.24-1.76, p = 0.001). Compared to women age < 20, risk decreased with advancing maternal age (OR 0.49-OR 0.03, p < 0.001). Patients with gastroschisis had increased total charges ($336,270 vs. $9012, p < 0.001) and length of stay (38.1 vs. 2.9 days, p < 0.001). Mortality was 4.6%. CONCLUSIONS This is the largest population-based study summarizing current epidemiology of gastroschisis in California. TYPE OF STUDY Retrospective comparative cohort study. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jamie E Anderson
- Division of Pediatric General, Thoracic, and Fetal Surgery, University of California, Davis Medical Center, Sacramento, CA.
| | - Laura A Galganski
- Division of Pediatric General, Thoracic, and Fetal Surgery, University of California, Davis Medical Center, Sacramento, CA
| | - Yvonne Cheng
- Division of Pediatric General, Thoracic, and Fetal Surgery, University of California, Davis Medical Center, Sacramento, CA
| | - Rebecca A Stark
- Division of Pediatric General, Thoracic, and Fetal Surgery, University of California, Davis Medical Center, Sacramento, CA
| | - Payam Saadai
- Division of Pediatric General, Thoracic, and Fetal Surgery, University of California, Davis Medical Center, Sacramento, CA
| | - Jacob T Stephenson
- Division of Pediatric General, Thoracic, and Fetal Surgery, University of California, Davis Medical Center, Sacramento, CA
| | - Shinjiro Hirose
- Division of Pediatric General, Thoracic, and Fetal Surgery, University of California, Davis Medical Center, Sacramento, CA
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Abstract
The development of gastroschisis has long remained an area of interest and controversy. Successive theories about its pathogenesis are herein reviewed and discussed. Two historical assumptions, that omphalocele results from a persistent umbilical hernia, and that gastroschisis does not involve the umbilical cord, are dismissed. Therefore, one can envision gastroschisis for what it is, i.e. a ruptured physiological hernia. The causal agents for this intrauterine accident to occur are yet to be determined. Further bowel damage and complications can be explained by the mesenteric insult.
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Affiliation(s)
- Sylvie Beaudoin
- Service de Chirurgie Pédiatrique, Hôpital Universitaire Necker Enfants Malades, APHP, Paris, France; Département d'Anatomie et Morphogenèse, Université Paris Descartes, Paris, France.
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49
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No evidence of adverse pregnancy outcome after exposure to ibuprofen in the first trimester – Evaluation of the national Embryotox cohort. Reprod Toxicol 2018; 79:32-38. [DOI: 10.1016/j.reprotox.2018.05.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/26/2018] [Accepted: 05/08/2018] [Indexed: 01/29/2023]
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50
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Gilardi F, Augsburger M, Thomas A. Will Widespread Synthetic Opioid Consumption Induce Epigenetic Consequences in Future Generations? Front Pharmacol 2018; 9:702. [PMID: 30018553 PMCID: PMC6037745 DOI: 10.3389/fphar.2018.00702] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 06/11/2018] [Indexed: 11/13/2022] Open
Abstract
A growing number of evidence demonstrates that ancestral exposure to xenobiotics (pollutants, drugs of abuse, etc.) can perturb the physiology and behavior of descendants. Both maternal and paternal transmission of phenotype across generations has been proved, demonstrating that parental drug history may have significant implications for subsequent generations. In the last years, the burden of novel synthetic opioid (NSO) consumption, due to increased medical prescription of pain medications and to easier accessibility of these substances on illegal market, is raising new questions first in term of public health, but also about the consequences of the parental use of these drugs on future generations. Besides being associated to the neonatal abstinence syndrome, in utero exposure to opioids has an impact on neuronal development with long-term repercussions that are potentially transmitted to subsequent generations. In addition, recent reports suggest that opioid use even before conception influences the reactivity to opioids of the progeny and the following generations, likely through epigenetic mechanisms. This review describes the current knowledge about the transgenerational effects of opioid consumption. We summarize the preclinical and clinical findings showing the implications for the subsequent generations of parental exposure to opioids earlier in life. Limitations of the existing data on NSOs and new perspectives of the research are also discussed, as well as clinical and forensic consequences.
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Affiliation(s)
- Federica Gilardi
- Forensic Toxicology and Chemistry Unit, University Center of Legal Medicine, Lausanne University Hospital - Geneva University Hospitals, Geneva, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Marc Augsburger
- Forensic Toxicology and Chemistry Unit, University Center of Legal Medicine, Lausanne University Hospital - Geneva University Hospitals, Geneva, Switzerland
| | - Aurelien Thomas
- Forensic Toxicology and Chemistry Unit, University Center of Legal Medicine, Lausanne University Hospital - Geneva University Hospitals, Geneva, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
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