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Tao Q, Shen Y, Li Y, Luo H, Yuan M, Gan J. Prenatal exposure to antibiotics and risk of neurodevelopmental disorders in offspring: A systematic review and meta-analysis. Front Neurol 2022; 13:1045865. [PMID: 36504646 PMCID: PMC9732381 DOI: 10.3389/fneur.2022.1045865] [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: 09/16/2022] [Accepted: 11/07/2022] [Indexed: 11/27/2022] Open
Abstract
Background and purpose A growing body of research suggests that inflammation and maternal infections may lead to an increased risk of neurodevelopmental problems such as attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), cerebral palsy (CP), and epilepsy in offspring. The aim of this study was to observe the connection between prenatal antibiotic exposure and the risk of these neurodevelopmental disorders in offspring. Patients and methods A comprehensive search was conducted in the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Google Scholar, and Scopus databases for observational studies that looked into the link between prenatal exposure to antibiotics and the risk of neurodevelopmental problems in offspring, published from 1 January 1950 to 31 January 2022. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of the included studies. Data were analyzed using the STATA version 12 software, and an odds ratio (OR) with a 95% confidence interval (CI) was reported. Results A total of 15 studies were included in the meta-analysis. Prenatal antibiotic exposure was associated with the increased risk of ADHD (OR = 1.14; 95% CI = 1.13 to 1.15; I 2 = 0%) and epilepsy (OR = 1.34; 95% CI = 1.02 to 1.66; I 2 = 96.8%). The link between prenatal antibiotic exposure and the risk of ASD [OR = 1.09; 95 % CI = 0.88 to 1.31; I 2 = 78.9%] and CP [OR = 0.99; 95% CI = 0.56 to 1.43; I 2 = 91%] was found to be non-significant. In all of the included prospective cohort studies, subgroup analysis suggested a significant association between prenatal antibiotic exposure and the incidence of ASD [OR = 1.17; 95% CI = 1.03 to 1.31; I 2 = 48.1%] and CP [OR = 1.18; 95% CI = 1.02 to 1.34; I 2 = 0%]. Conclusion Prenatal antibiotic exposure during pregnancy is linked to a higher incidence of ADHD and epilepsy in the offspring. Further prospective studies that compare prenatal antibiotic use and are adjusted for various confounders are needed to further assess the association of prenatal antibiotic exposure and neurological disorders in offspring. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42022306248.
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Affiliation(s)
- Qiuji Tao
- Department of Pediatrics of Neurology Nursing, West China School of Nursing, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China,Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, China
| | - Yajun Shen
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China,Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, Sichuan, China,Key Laboratory of Development and Maternal and Child Diseases of Sichuan Province, Chengdu, Sichuan, China
| | - Yang Li
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huan Luo
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Meng Yuan
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jing Gan
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China,Key Laboratory of Obstetric and Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Sichuan University, Chengdu, Sichuan, China,Key Laboratory of Development and Maternal and Child Diseases of Sichuan Province, Chengdu, Sichuan, China,*Correspondence: Jing Gan ;
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Anderson RC, O'Keeffe GW, McDermott KW. Characterisation of the consequences of maternal immune activation on distinct cell populations in the developing rat spinal cord. J Anat 2022; 241:938-950. [PMID: 35808977 PMCID: PMC9482694 DOI: 10.1111/joa.13726] [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: 10/18/2021] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/30/2022] Open
Abstract
Maternal immune activation (MIA) during gestation has been implicated in the development of neurological disorders such as schizophrenia and autism. Epidemiological studies have suggested that the effect of MIA may depend on the gestational timing of the immune challenge and the region of the central nervous system (CNS) in question. This study investigated the effects of MIA with 100 μg/kg lipopolysaccharide at either Embryonic days (E)12 or E16 on the oligodendrocytes, microglia and astrocytes of the offspring spinal cord. At E16, MIA decreased the number of olig2+ and Iba‐1+ cells in multiple grey and white matter regions of the developing spinal cord 5 h after injection. These decreases were not observed at postnatal day 14. In contrast, MIA at E12 did not alter Olig2+ or Iba‐1+ cell number in the developing spinal cord 5 h after injection, however, Olig2+ cell number was decreased in the ventral grey matter of the P14 spinal cord. No changes were observed in glial fibrillary acidic protein (GFAP) expression at P14 following MIA at either E12 or E16. These data suggest that E16 may be a window of immediate vulnerability to MIA during spinal cord development, however, the findings also suggest that the developmental process may be capable of compensation over time. Potential changes in P14 animals following the challenge at E12 are indicative of the complexity of the effects of MIA during the developmental process.
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Affiliation(s)
| | - Gerard W O'Keeffe
- Department of Anatomy and Neuroscience, University College Cork, Cork, Ireland
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3
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Oakley LL, Regan AK, Fell DB, Spruin S, Bakken IJ, Kwong JC, Pereira G, Nassar N, Aaberg KM, Wilcox AJ, Håberg SE. Childhood seizures after prenatal exposure to maternal influenza infection: a population-based cohort study from Norway, Australia and Canada. Arch Dis Child 2022; 107:153-159. [PMID: 34187781 PMCID: PMC8908878 DOI: 10.1136/archdischild-2021-322210] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/10/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess whether clinical and/or laboratory-confirmed diagnosis of maternal influenza during pregnancy increases the risk of seizures in early childhood. DESIGN Analysis of prospectively collected registry data for children born between 2009 and 2013 in three high-income countries. We used Cox regression to estimate country-level adjusted HRs (aHRs); fixed-effects meta-analyses were used to pool adjusted estimates. SETTING Population-based. PARTICIPANTS 1 360 629 children born between 1 January 2009 and 31 December 2013 in Norway, Australia (New South Wales) and Canada (Ontario). EXPOSURE Clinical and/or laboratory-confirmed diagnosis of maternal influenza infection during pregnancy. MAIN OUTCOME MEASURES We extracted data on recorded seizure diagnosis in secondary/specialist healthcare between birth and up to 7 years of age; additional analyses were performed for the specific seizure outcomes 'epilepsy' and 'febrile seizures'. RESULTS Among 1 360 629 children in the study population, 14 280 (1.0%) were exposed to maternal influenza in utero. Exposed children were at increased risk of seizures (aHR 1.17, 95% CI 1.07 to 1.28), and also febrile seizures (aHR 1.20, 95% CI 1.07 to 1.34). There was no strong evidence of an increased risk of epilepsy (aHR 1.07, 95% CI 0.81 to 1.41). Risk estimates for seizures were higher after influenza infection during the second and third trimester than for first trimester. CONCLUSIONS In this large international study, prenatal exposure to influenza infection was associated with increased risk of childhood seizures.
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Affiliation(s)
- Laura L. Oakley
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK,Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Annette K. Regan
- School of Nursing and Health Professions, University of San Francisco, San Francisco CA, US,School of Public Health, Curtin University, Perth, Australia,Fielding School of Public Health, University of California Los Angeles, Los Angeles CA, US
| | - Deshayne B. Fell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada,ICES, Toronto, Ontario, Canada,Children’s Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Canada
| | - Sarah Spruin
- ICES, Toronto, Ontario, Canada,Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Inger Johanne Bakken
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Jeffrey C. Kwong
- ICES, Toronto, Ontario, Canada,Public Health Ontario, Toronto, Canada,Department of Family and Community Medicine, University of Toronto, Toronto, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada,University Health Network, Toronto, Canada
| | - Gavin Pereira
- School of Public Health, Curtin University, Perth, Australia
| | - Natasha Nassar
- Children’s Hospital at Westmead Clinical School, University of Sydney, NSW, Australia
| | - Kari M. Aaberg
- The National Center for Epilepsy, Oslo University Hospital, Oslo, Norway
| | - Allen J. Wilcox
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway,The National Institute of Environmental Health Sciences, Durham NC, US
| | - Siri E. Håberg
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
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4
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Sassonker-Joseph N, Gorodischer R, Atar-Vardi M, Noyman I, Novack L. Prenatal Exposure to Antibiotics and Development of Epilepsy in Children. J Clin Pharmacol 2020; 61:18-24. [PMID: 32578224 DOI: 10.1002/jcph.1674] [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: 03/06/2020] [Accepted: 05/21/2020] [Indexed: 11/09/2022]
Abstract
We aimed to confirm or reject previous reports on the association of prenatal antibiotic exposure and development of epilepsy in offspring by accounting for known and unidentified confounding factors. In a retrospective cohort investigation, we enrolled children aged 3-18 years born between 1998 and 2012 at a single regional hospital and their mothers. A computerized medication database was linked with hospital records. The exposed group included children whose mothers purchased 1 or more antibiotic medications for use during pregnancy. Epilepsy was defined by epilepsy diagnosis and/or by chronic dispensing of antiepileptic drugs. We analyzed maternal exposure to antibiotics 2 years after delivery (but not during pregnancy and/or the 2 years following delivery) as part of the specificity analysis. We enrolled 88 899 children and their 74 416 mothers. The group exposed prenatally to antibiotics comprised 36 622 children (41.2%). Of them, 326 (0.9%) developed epilepsy compared with 370 of 52 277 (0.7%) in the unexposed group (relative risk [RR], 1.24; 95% confidence interval [CI], 1.07-1.44: P = .004). Exposure during the first, second, and third trimesters was characterized by incidence of epilepsy in 0.8% (P = .943), 0.9% (P = .266), and 0.9% (P = .073) of children, respectively, compared with the unexposed group, with an RR of 1.01 (95%CI, 0.83-1.23), 1.12 (95%CI, 0.92-1.36), and 1.19 (95%CI, 0.98-1.45), respectively. Similarly, prenatal exposure by antibiotic class was associated with epilepsy. Nevertheless, the specificity analysis strongly suggested the possibility of confounding by indication. Our findings indicated that pregnant women should receive the indicated antibiotic treatment with no fear of the development of epilepsy in their children.
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Affiliation(s)
| | - Rafael Gorodischer
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Division of Pediatrics, Soroka Medical Center, Beer-Sheva, Israel
| | - Maya Atar-Vardi
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Clinical Research Center, Soroka Medical Center, Beer-Sheva, Israel
| | - Iris Noyman
- Pediatric Neurology Unit, Division of Pediatrics, Soroka Medical Center, Beer-Sheva, Israel
| | - Lena Novack
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.,Division of Pediatrics, Soroka Medical Center, Beer-Sheva, Israel
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5
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Mao Y, Pedersen LH, Christensen J, Vestergaard M, Zhou W, Olsen J, Sun Y. Prenatal exposure to antidepressants and risk of epilepsy in childhood. Pharmacoepidemiol Drug Saf 2016; 25:1320-1330. [PMID: 27477111 DOI: 10.1002/pds.4072] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 07/04/2016] [Accepted: 07/05/2016] [Indexed: 12/16/2022]
Abstract
PURPOSE This study aimed to estimate the association between prenatal exposure to antidepressants and risk of epilepsy in childhood, taking maternal depression into account. METHODS We conducted a population-based cohort study including all Danish singletons born alive between 1997 and 2008 (n = 734 237). Information on antidepressant medication and diagnosis of depression and epilepsy was obtained from Danish National Registers. The exposed group comprised children of mothers who used antidepressants from 30 days before pregnancy until the date of birth. The reference group comprised children of mothers who used no antidepressants from 6 months before pregnancy to birth. We estimated the hazard ratios (HR) of epilepsy and 95% confidence intervals (CI) using Cox proportional hazard models. RESULTS We identified 12 438 (1.7%) children exposed to antidepressants during pregnancy (including 30 days before pregnancy) and 5829 (0.8%) children diagnosed with epilepsy in the follow-up time (mean: 6.7 years). Children exposed to antidepressants during pregnancy had a 27% higher risk of epilepsy (aHR: 1.27; 95%CI: 1.05-1.54) than children in the reference group. The estimate of this association was 1.71 (95%CI: 1.10-2.66) if their mothers also had a registry-based hospital diagnosis of depression in the 6 months before pregnancy or during pregnancy and 1.14 (95%CI: 0.91-1.43) if their mothers had no registry-based hospital diagnosis of depression. Children of mothers who used antidepressants from 2 to 6 months before pregnancy (but not during pregnancy) had an increased risk of epilepsy (aHR: 1.36; 95%CI: 1.07-1.73). CONCLUSIONS Antidepressant use during pregnancy was associated with a higher risk of epilepsy among children whose mothers had also a registry-based hospital diagnosis of depression during pregnancy. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Yanyan Mao
- Key Laboratory of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai, China. .,School of Public Health, Fudan University, Shanghai, China. .,Department of Reproductive Epidemiology and Social Medicine, Shanghai Institute of Planned Parenthood Research, Shanghai, China.
| | - Lars Henning Pedersen
- Department of Clinical Medicine, Obstetrics and Gynecology, Aarhus University, Aarhus, Denmark
| | - Jakob Christensen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Mogens Vestergaard
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark.,Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Weijin Zhou
- Key Laboratory of Reproduction Regulation of NPFPC, SIPPR, IRD, Fudan University, Shanghai, China.,Department of Reproductive Epidemiology and Social Medicine, Shanghai Institute of Planned Parenthood Research, Shanghai, China
| | - Jørn Olsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Yuelian Sun
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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6
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Kazemier BM, Koningstein FN, Schneeberger C, Ott A, Bossuyt PM, de Miranda E, Vogelvang TE, Verhoeven CJM, Langenveld J, Woiski M, Oudijk MA, van der Ven JEM, Vlegels MTW, Kuiper PN, Feiertag N, Pajkrt E, de Groot CJM, Mol BWJ, Geerlings SE. Maternal and neonatal consequences of treated and untreated asymptomatic bacteriuria in pregnancy: a prospective cohort study with an embedded randomised controlled trial. THE LANCET. INFECTIOUS DISEASES 2015; 15:1324-33. [PMID: 26255208 DOI: 10.1016/s1473-3099(15)00070-5] [Citation(s) in RCA: 102] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 03/27/2015] [Accepted: 05/19/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Existing approaches for the screening and treatment of asymptomatic bacteriuria in pregnancy are based on trials that were done more than 30 years ago. In this study, we reassessed the consequences of treated and untreated asymptomatic bacteriuria in pregnancy. METHODS In this multicentre prospective cohort study with an embedded randomised controlled trial, we screened women (aged ≥18 years) at eight hospitals and five ultrasound centres in the Netherlands with a singleton pregnancy between 16 and 22 weeks' gestation for asymptomatic bacteriuria. Screening was done with a single dipslide and two culture media. Dipslides were judged positive when the colony concentration was at least 1×10(5) colony-forming units (CFU) per mL of a single microorganism or when two different colony types were present but one had a concentration of at least 1×10(5) CFU per mL. Asymptomatic bacteriuria-positive women were eligible to participate in the randomised controlled trial comparing nitrofurantoin with placebo treatment. In this trial, participants were randomly assigned 1:1 to receive either nitrofurantoin 100 mg or identical placebo tablets, and were instructed to self-administer these tablets twice daily for 5 consecutive days. Randomisation was done by a web-based application with a computer-generated list with random block sizes of two, four, or six participants rendered by an independent data manager. 1 week after the end of treatment, they provided us with a follow-up dipslide. Women, treating physicians, and researchers all remained unaware of the bacteriuria status and treatment allocation. Women who refused to participate in the randomised controlled trial did not receive any antibiotics, but their outcomes were collected for analysis in the cohort study. We compared untreated and placebo-treated asymptomatic bacteriuria-positive women with asymptomatic bacteriuria-negative women and nitrofurantoin-treated asymptomatic bacteriuria-positive women. The primary endpoint was a composite of pyelonephritis with or without preterm birth at less than 34 weeks, analysed by intention to treat at 6 weeks post-partum. This trial is registered with the Dutch Trial Registry, number NTR3068. FINDINGS Between Oct 11, 2011, and June 10, 2013, we enrolled 5621 women into our screening cohort, of whom 5132 were eligible for screening. After exclusions for contaminated dipslides and patients lost to follow-up, in our final cohort of 4283 women, 248 were asymptomatic bacteriuria positive, of whom 40 were randomly assigned to nitrofurantoin and 45 to placebo for the randomised controlled trial, whereas the other 163 asymptomatic bacteriuria-positive women were followed without treatment. The proportion of women with pyelonephritis, preterm birth, or both did not differ between untreated or placebo-treated asymptomatic bacteriuria-positive women and asymptomatic bacteriuria-negative women (6 [2·9%] of 208 vs 77 [1·9%] of 4035; adjusted odds ratio [OR] 1·5, 95% CI 0·6-3·5) nor between asymptomatic bacteriuria-positive women treated with nitrofurantoin versus those who were untreated or received placebo (1 [2·5%] of 40 vs 6 [2·9%] of 208; risk difference -0·4, 95% CI -3·6 to 9·4). Untreated or placebo-treated asymptomatic bacteriuria-positive women developed pyelonephritis in five [2·4%] of 208 cases, compared with 24 [0·6%] of 4035 asymptomatic bacteriuria-negative women (adjusted OR 3·9, 95% CI 1·4-11·4). INTERPRETATION In women with an uncomplicated singleton pregnancy, asymptomatic bacteriuria is not associated with preterm birth. Asymptomatic bacteriuria showed a significant association with pyelonephritis, but the absolute risk of pyelonephritis in untreated asymptomatic bacteriuria is low. These findings question a routine screen-treat-policy for asymptomatic bacteriuria in pregnancy. FUNDING ZonMw (the Netherlands Organisation for Health Research and Development).
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Affiliation(s)
- Brenda M Kazemier
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, Netherlands.
| | - Fiona N Koningstein
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, Netherlands
| | - Caroline Schneeberger
- Department of Infectious Diseases, Centre for Infection and Immunity Amsterdam, Academic Medical Centre, Amsterdam, Netherlands
| | - Alewijn Ott
- Certe Laboratory for Infectious Diseases, Groningen, Netherlands
| | - Patrick M Bossuyt
- Department of Clinical Epidemiology, University of Amsterdam, Amsterdam, Netherlands
| | - Esteriek de Miranda
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, Netherlands
| | - Tatjana E Vogelvang
- Department of Obstetrics and Gynecology, Diakonessenhuis Utrecht, Utrecht, Netherlands
| | - Corine J M Verhoeven
- Department of Midwifery Science, AVAG/EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, Netherlands
| | - Josje Langenveld
- Department of Obstetrics and Gynecology, Atrium Medical Centre, Heerlen, Netherlands
| | - Mallory Woiski
- Department of Obstetrics and Gynecology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Martijn A Oudijk
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | | | | | | | - Eva Pajkrt
- Department of Obstetrics and Gynecology, Academic Medical Centre, Amsterdam, Netherlands
| | | | - Ben W J Mol
- The Robinson Research Institute, School of Pediatrics and Reproductive Health, University of Adelaide, Adelaide, Australia
| | - Suzanne E Geerlings
- Department of Infectious Diseases, Centre for Infection and Immunity Amsterdam, Academic Medical Centre, Amsterdam, Netherlands
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Sun Y, Wu CS, Olsen J. Trimethoprim use before pregnancy and risk of congenital malformation: reanalyzed using a case-crossover design and a case-time-control design. Pharmacoepidemiol Drug Saf 2014; 23:1076-83. [PMID: 25111783 DOI: 10.1002/pds.3691] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 07/15/2014] [Accepted: 07/18/2014] [Indexed: 01/09/2023]
Abstract
PURPOSE Studies on the safety of drugs used during pregnancy are necessary and important but prone to bias. Using cases as their own controls can reduce bias. We used a case-crossover design and a case-time-control design to estimate the risk of congenital malformation (CM) for children born to mothers who redeemed a trimethoprim prescription shortly before pregnancy. METHODS The study was based on all live born singletons (N = 685 600) in Denmark whose mothers had available information on prescriptions in the Danish National Prescription Registry between 1996 and 2008. We defined 1-3 months before pregnancy as a potential risk period and 13-15 months before pregnancy as a reference period. Two other reference periods were used (7-9 months before pregnancy and months 4-6 of pregnancy). The case-crossover design is dependent on the assumption of a stable trimethoprim prescription over the study period in the source population. To estimate the trend of trimethoprim prescriptions, we used a control group comprising children without CMs. RESULTS Both study designs showed children had a higher risk of overall CM [odds ratio of 1.66, 95% confidence interval (CI): 1.10-2.53 and 1.50, 95%CI: 0.66-3.38, respectively] if their mothers had a trimethoprim prescription in the 3 months before pregnancy and subtypes of CM for example in the musculoskeletal system, which were consistent to the previous findings from a cohort study. CONCLUSIONS This study corroborates that trimethoprim is a potential teratogen when used 3 months before pregnancy and demonstrates the value of case-only approaches for studying, for example, adverse effects of antibiotics in reproductive epidemiology.
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Affiliation(s)
- Yuelian Sun
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
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Abbo LM, Hooton TM. Antimicrobial Stewardship and Urinary Tract Infections. Antibiotics (Basel) 2014; 3:174-92. [PMID: 27025743 PMCID: PMC4790395 DOI: 10.3390/antibiotics3020174] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 04/10/2014] [Accepted: 04/21/2014] [Indexed: 01/24/2023] Open
Abstract
Urinary tract infections are the most common bacterial infections encountered in ambulatory and long-term care settings in the United States. Urine samples are the largest single category of specimens received by most microbiology laboratories and many such cultures are collected from patients who have no or questionable urinary symptoms. Unfortunately, antimicrobials are often prescribed inappropriately in such patients. Antimicrobial use, whether appropriate or inappropriate, is associated with the selection for antimicrobial-resistant organisms colonizing or infecting the urinary tract. Infections caused by antimicrobial-resistant organisms are associated with higher rates of treatment failures, prolonged hospitalizations, increased costs and mortality. Antimicrobial stewardship consists of avoidance of antimicrobials when appropriate and, when antimicrobials are indicated, use of strategies to optimize the selection, dosing, route of administration, duration and timing of antimicrobial therapy to maximize clinical cure while limiting the unintended consequences of antimicrobial use, including toxicity and selection of resistant microorganisms. This article reviews successful antimicrobial stewardship strategies in the diagnosis and treatment of urinary tract infections.
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Affiliation(s)
- Lilian M Abbo
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 851, Miami, FL 33136, USA.
| | - Thomas M Hooton
- Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, 1120 NW 14th Street, Suite 851, Miami, FL 33136, USA.
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9
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Asymptomatic bacteriuria and urinary tract infections in special patient groups. Curr Opin Infect Dis 2014; 27:108-14. [DOI: 10.1097/qco.0000000000000028] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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10
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Miller JE, Pedersen LH, Streja E, Bech BH, Yeargin-Allsopp M, Van Naarden Braun K, Schendel DE, Christensen D, Uldall P, Olsen J. Maternal infections during pregnancy and cerebral palsy: a population-based cohort study. Paediatr Perinat Epidemiol 2013; 27:542-52. [PMID: 24117888 PMCID: PMC4997608 DOI: 10.1111/ppe.12082] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cerebral palsy (CP) is a common motor disability in childhood. We examined the association between maternal infections during pregnancy and the risk of congenital CP in the child. METHODS Liveborn singletons in Denmark between 1997 and 2003 were identified from the Danish National Birth Registry and followed from 1 year of life until 2008. Redemption of antibiotics from the National Register of Medicinal Product Statistics and maternal infections reported by the National Hospital Register were used as markers of maternal infection during pregnancy. CP diagnoses were obtained from the Danish Cerebral Palsy Registry. Adjusted hazard ratio (HR) and 95% confidence interval (CI) were estimated by Cox proportional hazard models. RESULTS Of the 440 564 singletons with follow-up data, 840 were diagnosed with congenital CP. Maternal genito-urinary tract infections (HR 2.1, 95% CI 1.4, 3.2) were associated with CP in all births, in term births (HR 1.9, 95% CI 1.1, 3.2), in children with spastic CP (HR 2.1, 95% CI 1.4, 3.3), and among first-born children (HR 1.9, 95% CI 1.4, 3.3). Overall, we found associations between redeemed nitrofurantoin (HR 1.7, 95% CI 1.1, 2.8) and CP. Among trimester-specific exposures, CP risk was associated with prescriptions redeemed in the first trimester for any antibacterials, beta-lactam antibacterials, and nitrofurantoin, an antibiotic commonly used to treat lower urinary tract infection, and genito-urinary tract infections in the third trimester. CONCLUSION Genito-urinary tract infections and antibiotic use during pregnancy were associated with increased risks of CP, indicating that some maternal infections or causes of maternal infections present in prenatal life may be part of a causal pathway leading to CP.
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Affiliation(s)
- Jessica E. Miller
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA
| | - Lars Henning Pedersen
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
,Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Elani Streja
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA
| | - Bodil H. Bech
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Marshalyn Yeargin-Allsopp
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kim Van Naarden Braun
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Diana E. Schendel
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Deborah Christensen
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Peter Uldall
- The Danish Cerebral Palsy Registry, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
,Pediatric Department, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jørn Olsen
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, CA
,Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
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Maternal thyroid dysfunction and risk of seizure in the child: a Danish nationwide cohort study. J Pregnancy 2013; 2013:636705. [PMID: 23984072 PMCID: PMC3745964 DOI: 10.1155/2013/636705] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 06/03/2013] [Accepted: 06/27/2013] [Indexed: 01/08/2023] Open
Abstract
Thyroid hormones are essential for brain development, and maternal thyroid disease may affect child neurocognitive development. Some types of seizures may also depend upon early exposure of the developing central nervous system, and we hypothesized that maternal thyroid dysfunction could increase the risk of seizure in the child. In a Danish population-based study we included 1,699,693 liveborn singletons, and from the Danish National Hospital Register we obtained information on maternal diagnosis of hyper- or hypothyroidism and neonatal seizure, febrile seizure, and epilepsy in the child. Maternal diagnosis of thyroid dysfunction before or after birth of the child was registered in two percent of the singleton births. In adjusted analyses, maternal hyperthyroidism and hypothyroidism first time diagnosed after birth of the child were associated with a significant increased risk of epilepsy in the child. Moreover, hypothyroidism diagnosed after birth of the child was associated with a significant increased risk of neonatal and febrile seizures. No significant association was seen for maternal diagnosis prior to birth of the child. We speculate if some degree of maternal thyroid dysfunction was already present during the pregnancy in mothers diagnosed after birth of the child and if this untreated condition may present a neurodevelopmental risk.
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Wu CS, Pedersen LH, Miller JE, Sun Y, Streja E, Uldall P, Olsen J. Risk of cerebral palsy and childhood epilepsy related to infections before or during pregnancy. PLoS One 2013; 8:e57552. [PMID: 23460873 PMCID: PMC3583873 DOI: 10.1371/journal.pone.0057552] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 01/22/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND AIM Maternal infections during pregnancy have been associated with several neurological disorders in the offspring. However, given the lack of specificity for both the exposures and the outcomes, other factors related to infection such as impaired maternal immune function may be involved in the causal pathway. If impaired maternal immune function plays a role, we would expect infection before pregnancy to be associated with these neurological outcomes. METHODS/PRINCIPAL FINDINGS The study population included all first-born singletons in Denmark between January 1 1982 and December 31 2004. We identified women who had hospital-recorded infections within the 5 year period before pregnancy, and women who had hospital-recorded infections during pregnancy. We grouped infections into either infections of the genitourinary system, or any other infections. Cox models were used to estimate adjusted hazard ratios (aHRs) with 95% confidence interval (CI). Maternal infection of the genitourinary system during pregnancy was associated with an increased risk of cerebral palsy (aHR = 1.63, 95% CI: 1.34-1.98) and epilepsy (aHR = 1.27, 95% CI: 1.13-1.42) in the children, compared to children of women without infections during pregnancy. Among women without hospital-recorded infections during pregnancy, maternal infection before pregnancy was associated with an increased risk of epilepsy (aHR = 1.35, 95% CI: 1.21-1.50 for infections of the genitourinary system, and HR = 1.12, 95% CI: 1.03-1.22 for any other infections) and a slightly higher risk of cerebral palsy (aHR = 1.20, 95% CI: 0.96-1.49 for infections of the genitourinary system, and HR = 1.23, 95% CI: 1.06-1.43 for any other infections) in the children, compared to children of women without infections before (and during) pregnancy. CONCLUSIONS These findings indicate that the maternal immune system, maternal infections, or factors related to maternal immune function play a role in the observed associations between maternal infections before pregnancy and cerebral diseases in the offspring.
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Affiliation(s)
- Chun S Wu
- Department of Public Health, Aarhus University, Aarhus, Denmark.
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