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de Castro CT, Leal LF, Ramos DDO, Santana JDM, Cordeiro RC, Rivemales MDCC, de Araújo EM, da Silva CAL, Pereira M, dos Santos DB. Racial Disparities in Medication Use During Pregnancy: Results from the NISAMI Cohort. J Multidiscip Healthc 2024; 17:2755-2775. [PMID: 38855020 PMCID: PMC11162620 DOI: 10.2147/jmdh.s455378] [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: 01/13/2024] [Accepted: 05/29/2024] [Indexed: 06/11/2024] Open
Abstract
Purpose This study aimed to evaluate racial disparities in medication use and associated factors among pregnant women receiving prenatal care at Brazilian Unified Health System primary care health units in the northeast region. Patients and Methods A total of 1058 pregnant women in the NISAMI Cohort were interviewed between June 2012 and February 2014. Medicines used during pregnancy were classified according to the Anatomical Therapeutic Chemical (ATC) classification system and ANVISA pregnancy risk categories. Prevalence ratios (crude and adjusted) and 95% confidence intervals (CIs) were estimated using Poisson regression with robust error variance. All analyses were stratified by race (Asian, black, brown/mixed, Brazilian indigenous, and white). Results Approximately 84% of the pregnant women used at least one medication, with a lower proportion among white women. The most reported medications were antianemic preparations (71.08%; 95% CI 68.27-73.72%), analgesics (21.74%; 95% CI 19.36-24.32%), and drugs for functional gastrointestinal disorders (18.81%; 95% CI 16.57-21.28%). Approximately 29% of women took potentially risky medications during pregnancy, with a higher prevalence among Asian and white women. Factors associated with medication use during pregnancy include a greater number of prenatal consultations, higher education levels, health problems, and smoking. In addition, maternal age above 25 years, smoking status, and two or more previous pregnancies were associated with potentially risky medication use during pregnancy. Conclusion A high prevalence of medication use during pregnancy was found; however, this prevalence was lower among white women. Nonetheless, black and brown women used antianemic preparations less frequently. This finding suggests that race is a factor of inequity in prenatal care, demanding public policies to mitigate it.
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Affiliation(s)
| | - Lisiane Freitas Leal
- Centre Hospitalier Universitaire Sainte-Justine Centre de Recherche, Montreal, Quebec, Canada
| | | | - Jerusa da Mota Santana
- Center for Health Sciences, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, Bahia, Brazil
| | - Rosa Cândida Cordeiro
- Center for Health Sciences, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, Bahia, Brazil
- Postgraduation Program in Health for the Black and Indigenous Population, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, Bahia, Brazil
| | - Maria da Conceição Costa Rivemales
- Center for Health Sciences, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, Bahia, Brazil
- Postgraduation Program in Health for the Black and Indigenous Population, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, Bahia, Brazil
| | | | | | - Marcos Pereira
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Djanilson Barbosa dos Santos
- Center for Health Sciences, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, Bahia, Brazil
- Postgraduation Program in Health for the Black and Indigenous Population, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, Bahia, Brazil
- State University of Feira de Santana, Feira de Santana, Bahia, Brazil
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Rezende GCD, Noronha RCR, Ortiz HC, do Nascimento LAS, das Neves SC, Ventura Said YL, Cardoso AL, de Mescouto VA, Vilela MLB, do Nascimento VA, Coelho HRS, Leite Kassuya CA, Pedroso TF, Salvador MJ, Oliveira RJ. Absence of maternal-fetal adverse effects of Alternanthera littoralis P. Beauv. following treatment during pregnancy in mice. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2023; 86:543-556. [PMID: 37340982 DOI: 10.1080/15287394.2023.2223624] [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: 06/22/2023]
Abstract
Alternanthera littoralis P. Beauv is a plant native to Brazil that exhibits various beneficial activities including antioxidant, antibacterial, antifungal, antiprotozoal, anti-hyperalgesic, and anti-inflammatory properties. The aim of this study was to assess the impact of the ethanol extract of Alternanthera littoralis (EEAl) on reproductive outcomes, embryofetal development, and DNA integrity of pregnant female mice. Pregnant Swiss female mice were randomly assigned to three experimental groups (n = 10): controls were administered either 1% Tween 80 (vehicle), EEAl 100 mg/kg or EEAl 1000 mg/kg. Treatment was administered through gavage during the gestational period until day 18. On gestational days 16, 17, and 18, a peripheral blood sample from the tail vein was obtained for DNA integrity analysis (micronucleus test). After the last collection, animals were euthanized by cervical dislocation. Maternal organs and fetuses were collected, weighed, and subsequently analyzed. Reproductive outcome parameters were assessed by measurement of number of implants, live fetuses, and resorptions. Embryonic development was determined by adequacy of weight for gestational age as well as determination of external, visceral, and skeletal malformations. Data demonstrated that EEAl did not produce maternal toxicity at either dose associated with no marked alterations in any of the reproductive outcome parameters including implantation sites, live/dead fetuses ratio, fetal viability, post-implantation losses, resorptions, and resorption rate. However, EEAl 1000 group reduced embryofetal development by lowering placental weight. In addition, there was an increase in the frequency of external and skeletal malformations in the EEAl 1000 group, which could not be attributed to extract exposure as these values were within control levels. Based upon our findings, evidence indicates that the EEAl at the concentrations employed in our study may be considered safe for use during pregnancy and extracts of this plant show potential for development of phytomedicines to be used in pregnancy.
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Affiliation(s)
- Giovana Corbucci Danti Rezende
- Centro de Estudos em Células-Tronco, Terapia Celular e Genética Toxicológica (CeTroGen), Faculdade de Medicina (FAMED), Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brasil
- Programa de Pós-Graduação em Saúde e Desenvolvimento na Região Centro-Oeste, Faculdade de Medicina (FAMED), Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brasil
| | - Renata Coelho Rodrigues Noronha
- Laboratório de Citogenética, Centro de Estudos Avançados da Biodiversidade, Instituto de Ciências Biológicas (ICB), Universidade Federal Do Pará (UFPA), Belém, Brasil
| | - Hudman Cunha Ortiz
- Centro de Estudos em Células-Tronco, Terapia Celular e Genética Toxicológica (CeTroGen), Faculdade de Medicina (FAMED), Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brasil
- Programa de Pós-Graduação em Saúde e Desenvolvimento na Região Centro-Oeste, Faculdade de Medicina (FAMED), Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brasil
| | | | - Silvia Cordeiro das Neves
- Centro de Estudos em Células-Tronco, Terapia Celular e Genética Toxicológica (CeTroGen), Faculdade de Medicina (FAMED), Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brasil
- Programa de Pós-Graduação em Saúde e Desenvolvimento na Região Centro-Oeste, Faculdade de Medicina (FAMED), Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brasil
| | - Yasmin Lany Ventura Said
- Centro de Estudos em Células-Tronco, Terapia Celular e Genética Toxicológica (CeTroGen), Faculdade de Medicina (FAMED), Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brasil
- Programa de Pós-Graduação em Saúde e Desenvolvimento na Região Centro-Oeste, Faculdade de Medicina (FAMED), Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brasil
| | - Adauto Lima Cardoso
- Laboratório de Citogenética, Centro de Estudos Avançados da Biodiversidade, Instituto de Ciências Biológicas (ICB), Universidade Federal Do Pará (UFPA), Belém, Brasil
- Programa de Pós-Graduação em Biotecnologia, Universidade Federal do Pará (UFPA), Belém, Brasil
- Laboratório Genômica Integrativa, Departamento de Biologia Estrutural e Funcional, Instituto de Biociências de Botucatu (IBB), Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brasil
| | | | - Marcelo Luiz Brandão Vilela
- Faculdade de Medicina (FAMED), Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brasil
| | - Valter Aragão do Nascimento
- Programa de Pós-Graduação em Saúde e Desenvolvimento na Região Centro-Oeste, Faculdade de Medicina (FAMED), Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brasil
| | - Henrique Rodrigues Scherer Coelho
- Centro de Estudos em Células-Tronco, Terapia Celular e Genética Toxicológica (CeTroGen), Faculdade de Medicina (FAMED), Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brasil
| | | | - Taise Fonseca Pedroso
- Departamento de Biologia Vegetal, Instituto de Biologia, Universidade Estadual de Campinas (UNICAMP), São Paulo, Brasil
| | - Marcos José Salvador
- Departamento de Biologia Vegetal, Instituto de Biologia, Universidade Estadual de Campinas (UNICAMP), São Paulo, Brasil
| | - Rodrigo Juliano Oliveira
- Centro de Estudos em Células-Tronco, Terapia Celular e Genética Toxicológica (CeTroGen), Faculdade de Medicina (FAMED), Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brasil
- Programa de Pós-Graduação em Saúde e Desenvolvimento na Região Centro-Oeste, Faculdade de Medicina (FAMED), Universidade Federal de Mato Grosso do Sul (UFMS), Campo Grande, Mato Grosso do Sul, Brasil
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Campos HMN, Mattos MP, Gomes DR. Use of medications by pregnant women in the Family Health Strategy in the Northeast of Brazil. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2022. [DOI: 10.1590/1806-9304202200040014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Abstract Objectives: To evaluate the medication use, exposure to potential risks, and associated factors before and during pregnancy of pregnant women receiving care at the Family Health Strategy in a municipality in the Northeast of Brazil. Methods: This is a cross-sectional study of pregnant women receiving care in the municipality of Barreiras, in Bahia, Brazil. In data analysis process, prevalence and frequency of medication use were estimated. To investigate the association between variables, the outcome measure was expressed by the prevalence ratio (crude and adjusted) with a 95% confidence interval via Poisson regression. Results: The prevalence of medication use before pregnancy was 35% and during pregnancy, it was 80.7%. Analgesics and antianemics were the prevalent groups of medications before and during pregnancy, respectively. Family income (≤1 minimum wage; PR=1.62; CI95%=1.02-2.55) showed an association with prior use; health problems (PR=2.3; CI95%=1.27-4.22) and complaints in pregnancy (PR=2.39; CI95%=1.28-4.47) had an association with use during pregnancy. Conclusion: The characterization of a high prevalence of use of medicines by pregnant women, combined with a trend of failures in family planning could demonstrate the exposure of the risks of using some harmful substances in periods close to conception and pregnancy.
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Guimarães FS, Cata-Preta BO, Barros AJD, Matijasevich A, Santos IS, Silveira MF, Silveira MPT, Bertoldi AD. [Use of anti-bacterial agents in pregnant women before and after regulation in Brazil: Pelotas (Brazil) birth cohorts of 2004 and 2015]. CAD SAUDE PUBLICA 2022; 38:e00168021. [PMID: 35976345 DOI: 10.1590/0102-311xpt168021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 06/01/2022] [Indexed: 11/22/2022] Open
Abstract
Indiscriminate use of anti-bacterial agents during pregnancy can increase antimicrobial resistance and endanger both the mother's and the children's health. Currently, Brazil has the Collegiate Directive Resolution n. 20/2011, which controls prescription and dispensation of anti-bacterial agents. Given this scenario, this study compared the use of anti-bacterial agents by pregnant women participating in the 2004 and 2015 Pelotas (Brazil) birth cohorts, in Rio Grande do Sul, Brazil, considering the regulation issued between the two cohorts. Data were collected in the perinatal period of the two studies. The main outcome was the use of anti-bacterial agents during pregnancy. Prevalence scans were described based on independent variables and differences in percentage points (p.p.) between the two cohorts. The prevalence of anti-bacterial use was 41.9% (95%CI: 40.4; 43.3) in 2004 and 39.2% (95%CI: 37.7; 40.6) in 2015. Considering the pregnant women who reported having infection during pregnancy, a greater reduction in use was observed in 2015, when compared to 2004, in poor women (-15.4p.p., 95%CI: 9.59; 21.20) and in those who had less consultations (-17.1p.p., 95%CI: 2.81; 31.36). Considering total medications, the proportion of anti-bacterial used dropped from 20.6% (95%CI: 19.9; 21.4) in 2004 to 12.6% (95%CI: 12.1; 13.1) in 2015. The reductions found in both the prevalence of use and the proportion of anti-bacterial agents over total medications used may be a reflection of the regulatory policy implemented in 2011.
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Affiliation(s)
| | | | - Aluísio J D Barros
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brasil
| | | | - Iná S Santos
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brasil
| | | | | | - Andréa Dâmaso Bertoldi
- Programa de Pós-graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brasil
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Nagai MM, Zanetti MOB, Lemos CA, Campos MSDA, Ayres LR, Duarte G, Pereira LRL. High-risk pregnancy: characterization of medication use profile and association with clinical and sociodemographic factors. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2022. [DOI: 10.1590/1806-9304202200030010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract Objectives: describe the profile of medication use and adherence, and the association with clinical and sociodemographic characteristics of high-risk pregnant women attended at a university hospital. Methods: cross-sectional study with data collected through a questionnaire applied on 386 pregnant women. Results: most participants were seen only by the gynecologist (75.1%), started prenatal in the first gestational trimester (86.8%), did not plan the pregnancy (61.9%), and performed an average of 8.2 (SD=4.4) prenatal consultations. The most frequent diagnoses were arterial hypertension (20.5%) and diabetes mellitus (19.7%). Prevalence of medication use was 99.7%, with an average of 5.1 (SD=2.1) medication per woman and 12.7% self-medication. Antianemics (88.9%) and analgesics (63.2%) were the most prevalent classes and 17.9% of the women reported the use of medication with significant gestational risk. Only 36.5% were considered adherent, 32.9% declared they were unaware of the indication of the medication in use and 42% did not receive guidance on the use of the medication during pregnancy. There is no evidence of association between the number of the medication used and clinical and sociodemographic aspects. Conclusions: there is a need to develop strategies to improve the care of this population, with emphasis on strengthening multi-professional care.
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de Castro CT, Pereira M, dos Santos DB. Association between paracetamol use during pregnancy and perinatal outcomes: Prospective NISAMI cohort. PLoS One 2022; 17:e0267270. [PMID: 35436308 PMCID: PMC9015137 DOI: 10.1371/journal.pone.0267270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/05/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Paracetamol is widely used to manage fever and pain during pregnancy worldwide. However, paracetamol may affect the pregnant woman and fetus, once this drug crosses the placental barrier after therapeutic doses and may impair fetal liver function, affecting fetus growth and development. Thus, this study aimed to investigate the association between paracetamol use during pregnancy and perinatal outcomes as preterm birth, low birth weight, and small for gestational age. METHODS AND FINDINGS Data from 760 pregnant women within the NISAMI Cohort between June 2012 and February 2014 were analyzed. Logistic regression was used to estimate the association among paracetamol use during pregnancy and preterm birth, low birth weight, and small for gestational age. Multivariate analyses were adjusted for socioeconomic, maternal, pregnancy, and newborn covariates. Around 14% of women were exposed to paracetamol during pregnancy. A decrease in paracetamol use throughout pregnancy was observed. Lower risk of low birth weight in infants born to women exposed to the drug (OR 0.21; IC 95% 0.01-0.99) was found. Paracetamol use during pregnancy was not statistically associated with preterm birth or small for gestational age. CONCLUSIONS The findings of this study do not suggest an increased risk of perinatal outcomes. However, it should not be assumed that paracetamol is a risk-free medication and its use must be rational.
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Affiliation(s)
| | - Marcos Pereira
- Institute of Collective Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Djanilson Barbosa dos Santos
- Multidisciplinary Health Institute, Federal University of Bahia, Vitória da Conquista, Bahia, Brazil
- Health Sciences Center, Federal University of Recôncavo da Bahia, Santo Antônio de Jesus, Bahia, Brazil
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EXAMINATION OF PREGNANT WOMEN’S KNOWLEDGE LEVEL AND ATTITUDES TOWARDS RATIONAL DRUG USE APPLYING TO HEALTHCARE FACILITY IN MARDİN. INTERNATIONAL JOURNAL OF HEALTH SERVICES RESEARCH AND POLICY 2020. [DOI: 10.33457/ijhsrp.793342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Lutz BH, Miranda VIA, Silveira MPT, Dal Pizzol TDS, Mengue SS, da Silveira MF, Domingues MR, Bertoldi AD. Medication Use among Pregnant Women from the 2015 Pelotas (Brazil) Birth Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E989. [PMID: 32033282 PMCID: PMC7037701 DOI: 10.3390/ijerph17030989] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 01/26/2020] [Accepted: 01/29/2020] [Indexed: 11/16/2022]
Abstract
Background: Medication use during pregnancy is a common practice that has been increasing in recent years. The aim of this study is to describe medication use among pregnant women from the 2015 Pelotas (Brazil) Birth Cohort Study. Methods: This paper relies on a population-based cohort study including 4270 women. Participants completed a questionnaire about the antenatal period, including information about medication use. We performed descriptive analyses of the sample and the medications used and adjusted analyses for the use of medications and self-medication. Results: The prevalence of medication use was 92.5% (95% CI 91.7-93.3), excluding iron salts, folic acid, vitamins, and other minerals. The prevalence of self-medication was 27.7% (95% CI 26.3-29.1). In the adjusted analysis, women who had three or more health problems during pregnancy demonstrated higher use of medicines. Self-medication was higher in lower income groups and among smokers and multiparous women (three pregnancies or more). Acetaminophen, scopolamine, and dimenhydrinate were the medications most commonly used. Conclusions: This study describes the pattern of drug use among pregnant women in a population-based cohort study, with a high prevalence of self-medication. Greater awareness of the risks of self-medication during pregnancy is required, focusing on groups more prone to this practice, as well as ensuring qualified multidisciplinary prenatal care.
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Affiliation(s)
- Bárbara Heather Lutz
- Faculty of Medicine, Department of Social Medicine & Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, Pelotas CEP 96020-220, RS, Brazil
| | - Vanessa Iribarrem Avena Miranda
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, Pelotas CEP 96020-220, RS, Brazil; (V.I.A.M.); (M.F.d.S.); (A.D.B.)
| | - Marysabel Pinto Telis Silveira
- Institute of Biology, Department of Physiology and Pharmacology & Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, Pelotas CEP 96020-220, RS, Brazil;
| | - Tatiane da Silva Dal Pizzol
- Post-Graduate Program in Epidemiology, Federal University of Porto Alegre, Av. Ipiranga, 2752, Sala 203, Porto Alegre CEP 90610-000, RS, Brazil; (T.d.S.D.P.); (S.S.M.)
| | - Sotero Serrate Mengue
- Post-Graduate Program in Epidemiology, Federal University of Porto Alegre, Av. Ipiranga, 2752, Sala 203, Porto Alegre CEP 90610-000, RS, Brazil; (T.d.S.D.P.); (S.S.M.)
| | - Mariângela Freitas da Silveira
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, Pelotas CEP 96020-220, RS, Brazil; (V.I.A.M.); (M.F.d.S.); (A.D.B.)
| | - Marlos Rodrigues Domingues
- Post Graduate Program in Physical Education & Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, Pelotas CEP 96020-220, RS, Brazil;
| | - Andréa Dâmaso Bertoldi
- Post-Graduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro, 1160, Pelotas CEP 96020-220, RS, Brazil; (V.I.A.M.); (M.F.d.S.); (A.D.B.)
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Tovo-Rodrigues L, Schneider BC, Martins-Silva T, Del-Ponte B, Loret de Mola C, Schuler-Faccini L, Vianna FSL, Munhoz TN, Entiauspe L, Silveira MF, Santos IS, Matijasevich A, Barros AJD, Rohde LA, Bertoldi AD. Is intrauterine exposure to acetaminophen associated with emotional and hyperactivity problems during childhood? Findings from the 2004 Pelotas birth cohort. BMC Psychiatry 2018; 18:368. [PMID: 30458756 PMCID: PMC6245767 DOI: 10.1186/s12888-018-1942-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Longitudinal studies have consistently reported that prenatal exposure to acetaminophen can to lead to an increased risk of attention deficit-hyperactivity disorder during childhood. This study aimed to investigate the association between intrauterine exposure to acetaminophen and the presence of emotional and behavioral problems at the ages of 6 and 11 years in a low-middle income country. METHODS We performed a prospective longitudinal population-based study using data from the 2004 Pelotas birth cohort. From the 4231 initial cohort participants, 3722 and 3566 children were assessed at 6 and 11 years of age, respectively. The outcomes were assessed using the parent version of Strengths and Difficulties Questionnaire (SDQ). The cut-off points established for the Brazilian population were used to categorize the outcomes. Crude and adjusted odds ratio were obtained through logistic regression. RESULTS Acetaminophen was used by 27.5% (95% confidence interval [CI]: 26.1-28.9) of the mothers at least once during pregnancy. The prevalence of emotional problems at 6 and 11 years was 13.6 and 19.9%, respectively. For hyperactivity problems, prevalence was 13.9 and 16.1%, respectively. Intrauterine exposure to acetaminophen increased the odds of having emotional (odds ratio [OR] = 1.47; 95% CI: 1.07-2.02) and hyperactivity/inattention (OR = 1.42; 95% CI: 1.06-1.92) problems in 6-year-old boys. At the age of 11, a small decrease in the effect was observed for both outcomes after adjustment: OR = 1.31 (95% CI: 0.99-1.73) for emotional problems and OR = 1.25 (95% CI: 0.95-1.65) for hyperactivity/inattention in boys. No association for any phenotypes at both ages was observed for girls. CONCLUSION The effect of intrauterine exposure to acetaminophen in emotional and hyperactivity symptoms was dependent on sex in a Brazilian cohort. While it seemed to be important for boys, mainly at 6 years of age, for girls, no association was observed.
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Affiliation(s)
- Luciana Tovo-Rodrigues
- Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 - 3° andar, Pelotas, RS, 96020-220, Brazil.
| | - Bruna Celestino Schneider
- 0000 0001 2134 6519grid.411221.5Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 - 3° andar, Pelotas, RS 96020-220 Brazil
| | - Thais Martins-Silva
- 0000 0001 2134 6519grid.411221.5Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 - 3° andar, Pelotas, RS 96020-220 Brazil
| | - Bianca Del-Ponte
- 0000 0001 2134 6519grid.411221.5Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 - 3° andar, Pelotas, RS 96020-220 Brazil
| | - Christian Loret de Mola
- 0000 0001 2134 6519grid.411221.5School of Nursing and Public Health, Universidade Federal de Pelotas, Pelotas, Brazil
| | | | - Fernanda Sales Luiz Vianna
- 0000 0001 2200 7498grid.8532.cPostgraduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande Do Sul, Porto Alegre, Brazil ,0000 0001 0125 3761grid.414449.8Genomic Medicine Laboratory, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil ,0000 0001 0125 3761grid.414449.8Laboratory of Research in Bioethics and Ethics in Research, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | - Tiago N. Munhoz
- 0000 0001 2134 6519grid.411221.5Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 - 3° andar, Pelotas, RS 96020-220 Brazil ,0000 0001 2134 6519grid.411221.5Department of Psychology, School of Medicine, Universidade Federal de Pelotas, Pelotas, Brazil
| | - Ludmila Entiauspe
- 0000 0001 2134 6519grid.411221.5Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 - 3° andar, Pelotas, RS 96020-220 Brazil
| | - Mariângela Freitas Silveira
- 0000 0001 2134 6519grid.411221.5Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 - 3° andar, Pelotas, RS 96020-220 Brazil
| | - Iná S. Santos
- 0000 0001 2134 6519grid.411221.5Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 - 3° andar, Pelotas, RS 96020-220 Brazil
| | - Alicia Matijasevich
- 0000 0004 1937 0722grid.11899.38Departamento de Medicina Preventiva, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Aluísio J. D. Barros
- 0000 0001 2134 6519grid.411221.5Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 - 3° andar, Pelotas, RS 96020-220 Brazil
| | - Luis Augusto Rohde
- 0000 0001 2200 7498grid.8532.cDepartment of Psychiatry, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil ,National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil
| | - Andréa Dâmaso Bertoldi
- 0000 0001 2134 6519grid.411221.5Postgraduate Program in Epidemiology, Universidade Federal de Pelotas, Rua Marechal Deodoro, 1160 - 3° andar, Pelotas, RS 96020-220 Brazil
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