RESUMEN
Importance: The incidence of gastroschisis, a birth defect involving the herniation of the small bowel through the abdominal wall, has increased in the US since the 1960s. The pesticide atrazine is a hypothesized cause of gastroschisis; however, examination of the association between atrazine and gastroschisis has been limited. Objective: To evaluate national trends in gastroschisis incidence, maternal and infant characteristics associated with gastroschisis, and whether county-level atrazine use is associated with gastroschisis. Design, Setting, and Participants: This retrospective, repeated cross-sectional study examined birth certificate data of all live births in the US and data on atrazine use from the US Geological Survey from January 1, 2009, through December 31, 2019. The data analysis was performed between August 5, 2021, and May 26, 2023. Exposures: County-level atrazine use. Main Outcomes and Measures: The primary outcome was gastroschisis incidence. Covariates included maternal age, race and ethnicity, body mass index (measured by weight in kilograms divided by height in meters squared), parity, insurance type, Chlamydia infection during pregnancy, smoking, and rurality. Mixed-effects logistic regression models (year fixed effects and county random effects) were constructed using different county-level atrazine exposure variables (1-, 5-, and 10-year means). Results: Between 2009 and 2019, 39â¯282â¯566 live births were identified, with 10â¯527 infant diagnoses of gastroschisis. Infants with gastroschisis were more likely to have mothers who identified as non-Hispanic White (61% vs 54%; P < .001), had a lower body mass index (median [IQR], 23.4 [20.8-27.2] vs 25.4 [22.0-30.8]; P < .001), were more likely to be nulliparous (median [IQR], 0 [0-1] vs 1 [0-2]; P < .001), and were more commonly covered by Medicaid (63% vs 43%; P < .001). During the study period, the rate (per 1000 live births) of gastroschisis decreased from 0.31 (95% CI, 0.29-0.33) to 0.22 (95% CI, 0.21-0.24). The median (IQR) county-level atrazine use estimates were higher among infants with gastroschisis (1 year, 1389 [IQR, 198-10 162] vs 1023 [IQR, 167-6960] kg; 5 years, 1425 [IQR, 273-9895] vs 1057 [IQR, 199-6926] kg; 10 years, 1508 [IQR, 286-10â¯271] vs 1113 [IQR, 200-6650] kg; P < .001). In adjusted models, higher county levels of atrazine (each 100â¯000-kg increase) were associated with a higher incidence of gastroschisis (1 year: adjusted odds ratio [AOR], 1.12 [95% CI, 1.01-1.24]; 5 years: AOR, 1.15 [95% CI, 1.02-1.30]; 10 years: AOR, 1.21 [95% CI, 1.07-1.38]). Conclusions and Relevance: In this cross-sectional study, higher county levels of atrazine were associated with infant diagnoses of gastroschisis. While atrazine is the second-most used herbicide in the US, numerous countries around the world have banned it out of concern for adverse effects on human health. These findings suggest that exploring alternatives to atrazine in the US may be warranted.
Asunto(s)
Atrazina , Gastrosquisis , Gastrosquisis/epidemiología , Gastrosquisis/inducido químicamente , Humanos , Atrazina/efectos adversos , Femenino , Estudios Transversales , Estudios Retrospectivos , Adulto , Embarazo , Incidencia , Estados Unidos/epidemiología , Recién Nacido , Herbicidas/efectos adversos , Masculino , Adulto JovenRESUMEN
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.
Asunto(s)
Gastrosquisis , Femenino , Humanos , Embarazo , Aspirina , Anticonceptivos Orales , Gastrosquisis/epidemiología , Gastrosquisis/inducido químicamente , Ibuprofeno , Fenilpropanolamina/efectos adversos , Seudoefedrina , Estudios Observacionales como AsuntoRESUMEN
OBJECTIVE: To describe the incidence and to analyze risk factors associated with cholestasis in neonates with gastroschisis. METHODS: This is a retrospective cohort study in a tertiary single center analyzing 181 newborns with gastroschisis between 2009 and 2020. The following risk factors associated with cholestasis were analyzed: gestational age, birth weight, type of gastroschisis, silo closure or immediate closure, days of parenteral nutrition, type of lipid emulsion, days of fasting, days to reach a full diet, days with central venous catheter, presence of infections, and outcomes. RESULTS: Among the 176 patients evaluated, 41 (23.3%) evolved with cholestasis. In the univariate analysis, low birth weight (p=0.023), prematurity (p<0.001), lipid emulsion with medium-chain triglycerides and long-chain triglycerides (p=0.001) and death (p<0.001) were associated with cholestasis. In the multivariate analysis, patients who received lipid emulsion with fish oil instead of medium chain triglycerides/long chain triglycerides (MCT/LCT) emulsion had a lower risk of cholestasis. CONCLUSIONS: Our study shows that lipid emulsion with fish oil is associated with a lower risk of cholestasis in neonates with gastroschisis. However, this is a retrospective study and a prospective study should be performed to confirm the results.
Asunto(s)
Colestasis , Gastrosquisis , Humanos , Recién Nacido , Peso al Nacer , Estudios Retrospectivos , Emulsiones , Gastrosquisis/epidemiología , Gastrosquisis/inducido químicamente , Gastrosquisis/complicaciones , Estudios Prospectivos , Aceite de Soja/efectos adversos , Aceites de Pescado , Colestasis/etiología , Colestasis/inducido químicamente , TriglicéridosRESUMEN
BACKGROUND: We had a case in which three consecutive pregnancies resulted in birth of three children with an orofacial cleft. Their mother suffered from bronchial asthma and was treated using symbicort (corticosteroid budesonide plus bronchodilator formoterol) during her pregnancies. A hypothesis was assessed: these anti-asthmatics can induce an orofacial cleft in experimental model. MATERIALS AND METHODS: A single administration of one of five increasing doses (including therapeutically used ones) of Symbicort, budesonide or formoterol was injected into the amnion of a chick embryo on day 4 or 5 of incubation. The teratogenic/lethal effects of the anti-asthmatics were assessed on a total of 600 embryos. RESULTS: For budesonide, the teratogenic/lethal effect started at a dose 0.003 µg per embryo, for formoterol at 0.3 µg and for Symbicort 0.03 µg. Orofacial clefts and gastroschisis after exposure were found for all three anti-asthmatics. Heart septum defects occurred after exposure to formoterol. CONCLUSION: The present results support those clinical/epidemiological studies pointing out that anti-asthmatics have the potential to induce orofacial clefts, gastroschisis and heart malformations during prenatal development in human.
Asunto(s)
Antiasmáticos , Labio Leporino , Fisura del Paladar , Gastrosquisis , Administración por Inhalación , Animales , Budesonida/efectos adversos , Combinación Budesonida y Fumarato de Formoterol , Embrión de Pollo , Niño , Labio Leporino/inducido químicamente , Fisura del Paladar/inducido químicamente , Método Doble Ciego , Etanolaminas/efectos adversos , Femenino , Fumarato de Formoterol/efectos adversos , Gastrosquisis/inducido químicamente , Tabiques Cardíacos , Humanos , Resultado del TratamientoRESUMEN
PURPOSE: To compare the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and/or opioids to the use of acetaminophen without NSAIDs or opioids with respect to associations with birth defects. METHODS: We used data from the National Birth Defects Prevention Study (1997-2011). Exposure was self-reported maternal analgesic use from the month before through the third month of pregnancy (periconceptional). Adjusted odds ratios (aORs) were calculated to examine associations with 16 birth defects. RESULTS: Compared to acetaminophen, mothers reporting NSAIDs were significantly more likely to have offspring with gastroschisis, hypospadias, cleft palate, cleft lip with cleft palate, cleft lip without cleft palate, anencephaly, spina bifida, hypoplastic left heart syndrome, pulmonary valve stenosis, and tetralogy of Fallot (aOR range, 1.2-1.6). Opioids were associated with tetralogy of Fallot, perimembranous ventricular septal defect, and ventricular septal defect with atrial septal defect (aOR range, 1.8-2.3), whereas use of both opioids and NSAIDs was associated with gastroschisis, cleft palate, spina bifida, hypoplastic left heart syndrome, and pulmonary valve stenosis (aOR range, 2.0-2.9). CONCLUSIONS: Compared to periconceptional use of acetaminophen, selected birth defects occurred more frequently among infants of women using NSAIDs and/or opioids. However, we could not definitely determine whether these risks relate to the drugs or to indications for treatment.
Asunto(s)
Anomalías Inducidas por Medicamentos/epidemiología , Acetaminofén/efectos adversos , Analgésicos no Narcóticos/efectos adversos , Analgésicos Opioides/efectos adversos , Analgésicos/efectos adversos , Antiinflamatorios no Esteroideos/efectos adversos , Labio Leporino/inducido químicamente , Fisura del Paladar/inducido químicamente , Anomalías Congénitas/etiología , Gastrosquisis/inducido químicamente , Acetaminofén/administración & dosificación , Adulto , Analgésicos/administración & dosificación , Analgésicos no Narcóticos/administración & dosificación , Analgésicos Opioides/administración & dosificación , Antiinflamatorios no Esteroideos/administración & dosificación , Estudios de Casos y Controles , Labio Leporino/epidemiología , Fisura del Paladar/epidemiología , Femenino , Gastrosquisis/epidemiología , Humanos , Hipospadias/inducido químicamente , Hipospadias/epidemiología , Masculino , Madres , Vigilancia de la Población , Adulto JovenRESUMEN
PURPOSE: Gastroschisis incidence has increased over the past decade nationally and in Hawaii. Pesticides have been implicated as potential causative factors for gastroschisis, and use of restricted use pesticides (RUPs) is widespread in Hawaii. This study was conducted to characterize gastroschisis cases in Hawaii and determine whether RUP application correlates with gastroschisis incidence. METHODS: Gastroschisis patients treated in Hawaii between September, 2008 and August, 2015 were mapped by zip code along with RUP use. Spatial analysis software was used to identify patients' homes located within the pesticide application zone and agricultural land use areas. RESULTS: 71 gastroschisis cases were identified. 2.8% of patients were from Kauai, 64.8% from Oahu, 16.9% from Hawaii, 14.1% from Maui, and 1.4% from Molokai. RUPs have been used on all of these islands. 78.9% of patients lived in zip codes overlapping agricultural land use areas. 85.9% of patients shared zip codes with RUP-use areas. CONCLUSION: The majority of gastroschisis patients were from RUP-use areas, supporting the idea that pesticides may contribute to the development of gastroschisis, although limited data on specific releases make it difficult to apply these findings. As more RUP-use data become available to the public, these important research questions can be investigated further.
Asunto(s)
Exposición a Riesgos Ambientales/efectos adversos , Etnicidad , Gastrosquisis/etnología , Plaguicidas/efectos adversos , Adolescente , Adulto , Exposición a Riesgos Ambientales/estadística & datos numéricos , Femenino , Gastrosquisis/inducido químicamente , Hawaii/epidemiología , Humanos , Incidencia , Masculino , Adulto JovenRESUMEN
OBJECTIVE: To follow up on previously reported associations between periconceptional use of selective serotonin reuptake inhibitors (SSRIs) and specific birth defects using an expanded dataset from the National Birth Defects Prevention Study. DESIGN: Bayesian analysis combining results from independent published analyses with data from a multicenter population based case-control study of birth defects. SETTING: 10 centers in the United States. PARTICIPANTS: 17,952 mothers of infants with birth defects and 9857 mothers of infants without birth defects, identified through birth certificates or birth hospitals, with estimated dates of delivery between 1997 and 2009. EXPOSURES: Citalopram, escitalopram, fluoxetine, paroxetine, or sertraline use in the month before through the third month of pregnancy. Posterior odds ratio estimates were adjusted to account for maternal race/ethnicity, education, smoking, and prepregnancy obesity. MAIN OUTCOME MEASURE: 14 birth defects categories that had associations with SSRIs reported in the literature. RESULTS: Sertraline was the most commonly reported SSRI, but none of the five previously reported birth defects associations with sertraline was confirmed. For nine previously reported associations between maternal SSRI use and birth defect in infants, findings were consistent with no association. High posterior odds ratios excluding the null value were observed for five birth defects with paroxetine (anencephaly 3.2, 95% credible interval 1.6 to 6.2; atrial septal defects 1.8, 1.1 to 3.0; right ventricular outflow tract obstruction defects 2.4, 1.4 to 3.9; gastroschisis 2.5, 1.2 to 4.8; and omphalocele 3.5, 1.3 to 8.0) and for two defects with fluoxetine (right ventricular outflow tract obstruction defects 2.0, 1.4 to 3.1 and craniosynostosis 1.9, 1.1 to 3.0). CONCLUSIONS: These data provide reassuring evidence for some SSRIs but suggest that some birth defects occur 2-3.5 times more frequently among the infants of women treated with paroxetine or fluoxetine early in pregnancy.
Asunto(s)
Anomalías Inducidas por Medicamentos/epidemiología , Anomalías Cardiovasculares/epidemiología , Depresión/tratamiento farmacológico , Gastrosquisis/epidemiología , Complicaciones del Embarazo/tratamiento farmacológico , Efectos Tardíos de la Exposición Prenatal/epidemiología , Inhibidores Selectivos de la Recaptación de Serotonina/efectos adversos , Anomalías Inducidas por Medicamentos/prevención & control , Adulto , Teorema de Bayes , Anomalías Cardiovasculares/inducido químicamente , Anomalías Cardiovasculares/prevención & control , Estudios de Casos y Controles , Femenino , Gastrosquisis/inducido químicamente , Gastrosquisis/prevención & control , Humanos , Recién Nacido , Oportunidad Relativa , Embarazo , Efectos Tardíos de la Exposición Prenatal/inducido químicamente , Inhibidores Selectivos de la Recaptación de Serotonina/administración & dosificación , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: Prevalence of gastroschisis has inexplicably been increasing over the past few decades. Our intent was to explore whether early gestational exposures to pesticides were associated with risk of gastroschisis. METHODS: We used population-based data, accompanied by detailed information from maternal interviews as well as information on residential proximity to a large number of commercial pesticide applications during early pregnancy. The study population derived from the San Joaquin Valley of California (). Cases were 156 infants/fetuses with gastroschisis and controls were 785 infants without birth defects. RESULTS: Among 22 chemical pesticide groups analyzed, none had an elevated odds ratio with an associated confidence interval that excluded 1.0, although exposure to the triazine group showed borderline significance. Among 36 specific pesticide chemicals analyzed, only exposure to petroleum distillates was associated with an elevated risk, odds ratio = 2.5 (1.1-5.6). In general, a substantially different inference was not derived when analyses were stratified by maternal age or when risk estimation included adjustment for race/ethnicity, body mass index, folic acid supplement use, and smoking. CONCLUSION: Our study rigorously adds to the scant literature on this topic. Our a priori expectation was that we would observe certain pesticide compounds to be particularly associated with young age owing to the disproportionate risk observed for young women to have offspring with gastroschisis. We did not observe an exposure profile unique to young women.
Asunto(s)
Gastrosquisis/epidemiología , Exposición Materna , Plaguicidas/toxicidad , Efectos Tardíos de la Exposición Prenatal/epidemiología , Triazinas/toxicidad , Adulto , Factores de Edad , Índice de Masa Corporal , California/epidemiología , Estudios de Casos y Controles , Femenino , Feto , Ácido Fólico/administración & dosificación , Gastrosquisis/inducido químicamente , Gastrosquisis/etnología , Gastrosquisis/patología , Humanos , Lactante , Recién Nacido , Edad Materna , Americanos Mexicanos , Oportunidad Relativa , Embarazo , Efectos Tardíos de la Exposición Prenatal/inducido químicamente , Efectos Tardíos de la Exposición Prenatal/etnología , Efectos Tardíos de la Exposición Prenatal/patología , Riesgo , Fumar , Factores de Tiempo , Población BlancaRESUMEN
BACKGROUND: Previous studies examining the teratogenic effects of antiherpetic medications have found no associations for birth defects overall but have not examined the risk of specific birth defects. METHODS: The National Birth Defects Prevention Study ascertains population-based cases with birth defects and live-born controls without birth defects in 10 states across the United States for the purpose of identifying potential teratogenic risk factors. Mothers of cases and controls are interviewed within 2 years of their estimated date of delivery about demographic, medical and behavioural factors before and during pregnancy. This analysis examined the possible association between use of antiherpetic medications (acyclovir, valacyclovir or famciclovir) during early pregnancy and gastroschisis, a birth defect of the abdominal wall. RESULTS: The mothers of 1.1% (n = 10) of 941 gastroschisis cases and 0.3% (n = 27) of 8339 controls reported antiherpetic medication use during the month before conception through the third month of pregnancy. The adjusted odds ratios for such use in relation to gastroschisis were 4.7 [95% confidence interval 1.7, 13.3] and 4.7 [95% CI 1.2, 19.0] among women with and without self-reported genital herpes, respectively, when compared with women without antiherpetic use or herpes. Among women reporting no antiherpetic medication use, the odds ratio for self-reported genital herpes in relation to gastroschisis was 3.0 [95% CI 1.6, 5.7]. CONCLUSIONS: Our study raises the possibility of an increased risk of gastroschisis because of either antiherpetic medication use during early pregnancy or the underlying genital herpes infection for which it was indicated.
Asunto(s)
Antivirales/efectos adversos , Gastrosquisis/epidemiología , Herpes Simple/tratamiento farmacológico , Exposición Materna/efectos adversos , 2-Aminopurina/efectos adversos , 2-Aminopurina/análogos & derivados , Aciclovir/efectos adversos , Aciclovir/análogos & derivados , Adolescente , Adulto , Estudios de Casos y Controles , Famciclovir , Femenino , Gastrosquisis/inducido químicamente , Humanos , Recién Nacido , Persona de Mediana Edad , Embarazo , Análisis de Regresión , Estados Unidos/epidemiología , Valaciclovir , Valina/efectos adversos , Valina/análogos & derivados , Adulto JovenRESUMEN
Previous literature has suggested a link between maternal exposure to atrazine (the most commonly used herbicide in the US) and risk for gastroschisis (a birth defect that involves incomplete closure of the abdominal wall). Our objective was to evaluate the relationship between maternal atrazine exposure and gastroschisis risk by maternal age. We analyzed data for 1,161 cases with isolated gastroschisis and 8,390 controls delivered in Texas from 1999 through 2008. We estimated atrazine exposure based on maternal county of residence and data from the United States Geological Survey. Logistic regression was conducted among all subjects, and separately among offspring of women <25 and ≥25 years. Risk for gastroschisis in offspring was significantly increased for women ≥25 years with high levels of residential atrazine exposure compared to low (adjusted odds ratio: 1.97, 95 % confidence interval 1.19-3.26). This association was not observed among women <25 years. Our results provide additional insight into the suspected relationship of gastroschisis with atrazine. This relationship appears to be different in older versus younger mothers, providing further evidence that the etiology of gastroschisis may vary based on maternal age.
Asunto(s)
Atrazina/efectos adversos , Gastrosquisis/epidemiología , Herbicidas/efectos adversos , Edad Materna , Exposición Materna/efectos adversos , Adulto , Femenino , Gastrosquisis/inducido químicamente , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Medición de Riesgo , Factores de Riesgo , Texas/epidemiología , Adulto JovenRESUMEN
BACKGROUND: Exposure to polycyclic aromatic hydrocarbons (PAHs) occurs in many occupational settings. There is evidence in animal models that maternal exposure to PAHs during pregnancy is associated with gastroschisis in offspring; however, to our knowledge, no human studies examining this association have been conducted. OBJECTIVE: Our goal was to conduct a case-control study assessing the association between estimated maternal occupational exposure to PAHs and gastroschisis in offspring. METHODS: Data from gastroschisis cases and control infants were obtained from the population-based National Birth Defects Prevention Study for the period 1997-2002. Exposure to PAHs was assigned by industrial hygienist consensus, based on self-reported maternal occupational histories from 1 month before conception through the third month of pregnancy. Logistic regression was used to determine the association between estimated occupational PAH exposure and gastroschisis among children whose mothers were employed for at least 1 month during the month before conception through the third month of pregnancy. RESULTS: The prevalence of estimated occupational PAH exposure was 9.0% in case mothers (27 of 299) and 3.6% in control mothers (107 of 2,993). Logistic regression analyses indicated a significant association between occupational PAHs and gastroschisis among mothers ≥ 20 years of age [odds ratio (OR) = 2.53; 95% confidence interval (CI): 1.27, 5.04] after adjusting for maternal body mass index, education, gestational diabetes, and smoking. This association was not seen in mothers < 20 years (OR = 1.14; 95% CI: 0.55, 2.33), which is notable because although young maternal age is the strongest known risk factor for gastroschisis, most cases are born to mothers ≥ 20 years. CONCLUSION: Our findings indicate an association between occupational exposure to PAHs among mothers who are ≥ 20 years and gastroschisis. These results contribute to a body of evidence that PAHs may be teratogenic.
Asunto(s)
Gastrosquisis/epidemiología , Exposición Materna/efectos adversos , Exposición Profesional/efectos adversos , Estudios de Casos y Controles , Femenino , Gastrosquisis/inducido químicamente , Humanos , Modelos Logísticos , Oportunidad Relativa , Hidrocarburos Policíclicos Aromáticos , Embarazo , Factores de Riesgo , Estados Unidos/epidemiologíaRESUMEN
Phthalates are industrial chemicals widely used in consumer products, plastics and children toys, and the risk of exposure to phthalates, especially prenatal exposure, is a growing concern justifying the development of an animal model to better understand their effect. The present study was designed to evaluate the suitability of a chick model for phthalate DEHP teratogenicity and neurobehavioral teratogenicity, a model which is simple and devoid of potential confounding factors such as maternal toxicity, maternal-fetal unit and maternal-neonatal interactions; major findings were confirmed in the DBP study. Prehatch exposure to DEHP in doses ranging from 20 to 100 mg/kg, reduced the percent hatching from 80% in control eggs to 65%, and increased late hatchings from 12.5% in control eggs to 29.4%. In addition it induced developmental defects characterized by an opening or weakening of abdominal muscles allowing internal organs to protrude externally with or without a sac, omphalocele or gastroschisis, respectively. The effect was dose dependent ranging from 8% with DEHP (20 mg/kg) to 22% (100 mg/kg). Similar treatment with DBP 100mg/kg has reduced percentage hatching to 57% and increased late hatching to 37.5%, with a 14% increase in gastroschisis. Biochemical evaluation revealed elevated levels of alkaline phosphatase, which reflects non-specific toxicity of DEHP at such a high dose. Behavioral evaluation using an imprinting test and locomotor activity on chicks pretreated with DEHP (100 mg/kg) has shown an abolishment of imprinting performance from the control (0.65) preference ratio. DNA damage measurements of the metabolite 8-hydroxydeoxyguanosine (8-OH-dG) in blood samples showed an increase of 39.7% after prehatch exposure to phthalates. This was statistically significant for DEHP and indicates genetic toxicity, since part of the teratogenic activity is associated with oxidative stress and DNA damage.
Asunto(s)
Déficit de la Atención y Trastornos de Conducta Disruptiva/inducido químicamente , Conducta Animal/efectos de los fármacos , Dibutil Ftalato/toxicidad , Dietilhexil Ftalato/toxicidad , Plastificantes/toxicidad , Teratógenos/toxicidad , Animales , Conducta Animal/fisiología , Embrión de Pollo , Pollos , Daño del ADN/efectos de los fármacos , Daño del ADN/fisiología , Modelos Animales de Enfermedad , Embrión no Mamífero/anomalías , Embrión no Mamífero/efectos de los fármacos , Gastrosquisis/inducido químicamente , Hernia Umbilical/inducido químicamenteRESUMEN
La artritis reumatoide es una enfermedad que tiene una alta prevalencia en mujeres en edad fértil. Se realiza una revisión de las características de la barrera placentaria, el paso de medicamentos a través de ella y del uso de fármacos durante el embarazo: los que son potencialmente seguros, los fármacos que sólo pueden ser usados si la vida materna se ve comprometida, los fármacos que están contraindicados y aquéllos con información insuficiente sobre seguridad y que por tanto deben ser evitados, en este último grupo se ubican los fármacos biológicos. También se realiza una revisión acerca del uso de fármacos durante la lactancia, periodo en el cual es frecuente un rebrote de la artritis reumatoide (AU)
Rheumatoid arthritis is a disease that is highly prevalent in women of childbearing age. A review is done about the characteristics of the placental barrier, the passage of drugs through it and the use of drugs during pregnancy: those which are potentially safe drugs, those drugs that can only be used if there is a life threatening condition for the mother, drugs that are contraindicated and those with insufficient data on safety and therefore should be avoided, the latter group comprises biological drugs. Also a review is done about the use of drugs during lactation, a period that a flare of rheumatoid arthritis can occur (AU)
Asunto(s)
Humanos , Femenino , Embarazo , Adulto , Educación Médica Continua/métodos , Artritis Reumatoide/complicaciones , Artritis Reumatoide/tratamiento farmacológico , Complicaciones del Embarazo/tratamiento farmacológico , Inmunosupresores/uso terapéutico , Lactancia Materna/efectos adversos , Gastrosquisis/inducido químicamente , Gastrosquisis/complicaciones , Antiinflamatorios no Esteroideos/uso terapéutico , Metotrexato , Educación Médica Continua/estadística & datos numéricos , Complicaciones del Embarazo/prevención & control , Educación Médica Continua/tendencias , Corticoesteroides/uso terapéutico , Sulfasalazina/uso terapéutico , Azatioprina/uso terapéutico , Ciclosporina/uso terapéutico , Tacrolimus/uso terapéutico , Inmunoglobulinas/uso terapéuticoRESUMEN
OBJECTIVE: We examined whether maternal opioid treatment between 1 month before pregnancy and the first trimester was associated with birth defects. STUDY DESIGN: The National Birth Defects Prevention Study (1997 through 2005) is an ongoing population-based case-control study. We estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIS) for birth defects categories with at least 200 case infants or at least 4 exposed case infants. RESULTS: Therapeutic opioid use was reported by 2.6% of 17,449 case mothers and 2.0% of 6701 control mothers. Treatment was statistically significantly associated with conoventricular septal defects (OR, 2.7; 95% CI, 1.1-6.3), atrioventricular septal defects (OR, 2.0; 95% CI, 1.2-3.6), hypoplastic left heart syndrome (OR, 2.4; 95% CI, 1.4-4.1), spina bifida (OR, 2.0; 95% CI, 1.3-3.2), or gastroschisis (OR, 1.8; 95% CI, 1.1-2.9) in infants. CONCLUSION: Consistent with some previous investigations, our study shows an association between early pregnancy maternal opioid analgesic treatment and certain birth defects. This information should be considered by women and their physicians who are making treatment decisions during pregnancy.
Asunto(s)
Anomalías Inducidas por Medicamentos , Analgésicos Opioides/efectos adversos , Efectos Tardíos de la Exposición Prenatal , Adulto , Analgésicos Opioides/administración & dosificación , Cámara Anterior/anomalías , Estudios de Casos y Controles , Codeína/administración & dosificación , Codeína/efectos adversos , Femenino , Gastrosquisis/inducido químicamente , Gastrosquisis/epidemiología , Glaucoma/inducido químicamente , Glaucoma/epidemiología , Cardiopatías Congénitas/inducido químicamente , Cardiopatías Congénitas/epidemiología , Humanos , Hidrocefalia/inducido químicamente , Hidrocefalia/epidemiología , Hidrocodona/administración & dosificación , Hidrocodona/efectos adversos , Recién Nacido , Meperidina/administración & dosificación , Meperidina/efectos adversos , Análisis Multivariante , Oxicodona/administración & dosificación , Oxicodona/efectos adversos , Embarazo , Primer Trimestre del Embarazo , Estenosis de la Válvula Pulmonar/inducido químicamente , Estenosis de la Válvula Pulmonar/epidemiología , Disrafia Espinal/inducido químicamente , Disrafia Espinal/epidemiologíaRESUMEN
Acetaminophen is commonly used during pregnancy. Experimental animal studies do not suggest increased malformations after therapeutic use of single-ingredient acetaminophen during pregnancy. Cohort studies in humans in which exposure is prospectively ascertained show no detectable increase in congenital malformation risk associated with single-ingredient acetaminophen use during pregnancy. A case-control study identified an association between acetaminophen use during pregnancy and risk of gastroschisis in the offspring, but the study was limited by recall bias, unblinded interviewers, possible misclassification of gastroschisis, confounding by indication, difficulty in separating out the effects of combination products, and possible selection bias. Two case-control studies failed to identify a statistically significant association between acetaminophen use during pregnancy and gastroschisis. No other malformation has been shown to be causally associated with single-ingredient acetaminophen. A reported association between pre-eclampsia, preterm birth, and acetaminophen may be explained by reverse causation. Concerns expressed about childhood asthma and prenatal acetaminophen use has been addressed in a separate review. The use of single-ingredient acetaminophen during pregnancy can be justified based on outcome data. Data on the effects of acetaminophen cannot necessarily be extended to acetaminophen combination products.
Asunto(s)
Acetaminofén/efectos adversos , Analgésicos no Narcóticos/efectos adversos , Antipiréticos/efectos adversos , Resultado del Embarazo , Anomalías Inducidas por Medicamentos , Animales , Femenino , Retardo del Crecimiento Fetal/inducido químicamente , Gastrosquisis/inducido químicamente , Humanos , Preeclampsia/inducido químicamente , Embarazo , Nacimiento Prematuro/inducido químicamenteRESUMEN
Gastroschisis is a rare birth defect that has increased in prevalence over the past several decades but the etiology of the disease is largely unknown. Using data from the North Carolina Birth Defects Monitoring Program, we estimated multilevel logistic regression models to evaluate the association between drinking water source and upstream textile mills and the risk of a gastroschisis birth. Results indicate that while prenatal exposure to upstream textile mill effluent does not have an impact on the risk of a gastroschisis birth, women relying on public water systems that draw from a surface water source have an elevated risk. These findings suggest the possibility of a contaminant found in higher levels in surface water compared to groundwater.
Asunto(s)
Gastrosquisis/inducido químicamente , Residuos Industriales/efectos adversos , Exposición Materna/efectos adversos , Contaminación Química del Agua/efectos adversos , Abastecimiento de Agua , Adulto , Femenino , Gastrosquisis/epidemiología , Humanos , Recién Nacido , North Carolina/epidemiología , Embarazo , Estudios Retrospectivos , Textiles , Adulto JovenRESUMEN
BACKGROUND: Oral contraceptives (OCs) are the most commonly used reversible contraceptive method among US women. Although the majority of previous studies have reported no association between OC use during pregnancy and birth defects, some studies have reported increased occurrence of neural tube defects, limb reduction defects, and urinary tract anomalies. METHODS: We assessed OC use among mothers who participated in the multisite, case-control, National Birth Defects Prevention Study. Mothers of 9986 infants with 32 types of birth defects and 4000 infants without birth defects were included. RESULTS: Maternal OC use during the first 3 months of pregnancy was associated with an increased odds ratio for 2 of 32 birth defects: hypoplastic left heart syndrome (adjusted odds ratio = 2.3 [95% confidence interval = 1.3-4.3) and gastroschisis (1.8 [1.3-2.7]). CONCLUSION: Previous reports of associations between OC use and specific types of anomalies were not corroborated. Given that associations were assessed for 32 types of birth defects, our findings of 2 increased associations between OC use and gastroschisis and hypoplastic left heart syndrome should be interpreted as hypotheses until they can be evaluated further. Overall, our findings are consistent with the majority of previous studies that found women who use OCs during early pregnancy have no increased risk for most types of major congenital malformations.
Asunto(s)
Anomalías Inducidas por Medicamentos/etiología , Anticonceptivos Orales/efectos adversos , Anomalías Inducidas por Medicamentos/epidemiología , Anomalías Múltiples/inducido químicamente , Anomalías Múltiples/epidemiología , Adolescente , Adulto , Estudios de Casos y Controles , Intervalos de Confianza , Anomalías Congénitas/epidemiología , Anomalías Congénitas/etiología , Femenino , Gastrosquisis/inducido químicamente , Gastrosquisis/epidemiología , Humanos , Síndrome del Corazón Izquierdo Hipoplásico/inducido químicamente , Síndrome del Corazón Izquierdo Hipoplásico/epidemiología , Oportunidad Relativa , Embarazo , Primer Trimestre del Embarazo/efectos de los fármacos , Factores de Riesgo , Estados Unidos/epidemiología , Sistema Urinario/anomalías , Adulto JovenRESUMEN
Therapy in newborn infants presents unique challenges. The consequences of exposure of the fetus to medications and environmental contaminants in utero (following the mother's exposure to these) may present, in the newborn, as congenital malformations or adverse drug reactions or have unknown long-term consequences. Risk is not uniformly distributed across a population. Rather, pharmacogenomic principles assert that an individual's unique clinical, genomic, and environmental information can be used to accurately predict predisposition to risk. The challenge is to identify the specific factors--genetic and nongenetic--that contribute to increased risk.