Exposure to misoprostol and hormones during pregnancy and risk of congenital anomalies / Exposição ao misoprostol e hormônios durante a gravidez e risco de anomalia congênita

This study evaluated the association between use of misoprostol and other drugs to induce menstruation, and congenital anomalies. A sample of 4,856 pregnant women 20 years and older were enrolled consecutively in prenatal services in the Unified National Health System, in six Brazilian State capitals. Data on socio-demographics and use of medicines were obtained using an interview from the 21st to 28th week of pregnancy. Other data, including information on delivery and diagnosis of congenital anomalies by the attending neonatal physician were obtained from patient charts. Potential confounders were adjusted by logistic regression. Use of drugs to induce menstruation was reported by 707 women (14.6 percent), of whom 120 (17 percent) reported use of misoprostol. After adjusting for the study center, a positive association was observed between misoprostol and congenital anomalies (OR = 2.64; 95 percentCI: 1.03-6.75); a positive association was also observed for sex hormones (OR = 2.24; 95 percentCI: 1.06-4.74). The results suggest that the use of misoprostol or sex hormones during pregnancy increases the risk of congenital anomalies.

Este estudo avalia a associação do uso do misoprostol e de outros produtos utilizados para induzir a menstruação com anomalia congênita. Foram arroladas consecutivamente 4.856 mulheres com vinte anos de idade ou mais, procedentes de serviços de pré-natal do Sistema Único de Saúde em seis capitais brasileiras. Dados sócio-demográficos e o uso de medicamentos foram obtidos por meio de entrevista, entre a 21ª e a 28ª semanas de gestação. Outros dados, incluindo informações sobre o parto e o diagnóstico de anomalia congênita, realizado pelo médico que assistiu o recém-nascido, foram obtidos no prontuário. Potenciais confundidores foram ajustados por meio de regressão logística. O uso de produtos para induzir a menstruação foi relatado por 707 gestantes (14,6 por cento), das quais 120 (17 por cento) referiram-se ao misoprostol. Após ajustamento para o centro de realização da pesquisa, foi verificada uma associação positiva entre misoprostol e anomalias congênitas (RC = 2,64; IC95 por cento: 1,03-6,75); para hormônios sexuais também foi verificada uma associação positiva (RC = 2,24; IC95 por cento: 1,06-4,74). Os resultados sugerem que o uso de misoprostol ou hormônios sexuais durante a gravidez aumenta o risco de anomalia congênita.

Drogadicción embriofetal por abuso de pasta base de cocaína durante el embarazo / Fetal drug addiction as a consequence of maternal cocaine base paste abuse during pregnancy

Background: Fetal drug addiction is a serious public health problem. In the United States 10 to 15 percent of children have been exposed "in utero" to cocaine. In a Chilean public health service, more than 200 offspring of cocaine free base abuser have been detected. Aim: To analyze the clinical and social features of 100 children exposed to cocaine free base during fetal development. Patients and methods: Clinical features of children born from cocaine free base consume mothers were described at birth. During subsequent follow up, growth and development, disease episodes, developmental alterations and social situation were recorded. Data was compared with other newborns from the same health service. Results: Compared to their normal counterparts, exposed children has a lower birth weight, the frequency of premature babies was thrice higher, and small-for-gestational age children were four times more common. There was also a higher prevalence of cardiac malformations, seizures and apnea. Hospital admissions were more frequent, prolonged and required more complex facilities. During follow up, undernutrition and stunting were more prevalent. Psychomotor retardation was present in 67 percent of children and behavioral disturbances in 93 percent. Most of these children are governmental protection. Conclusions: Strategies to prevent drug abuse during pregnancy and its devastating medical and social consequences should be urgently developed