A possible association between maternal otitis media and ear
defect in their offspring
Nándor Ács, PhD
, Ferenc Bánhidy, PhD
, Erzsébet H. Puhó, PhD
, Andrew E. Czeizel, PhD, DSc
Second Department of Obstetrics and Gynecology, Semmelweis University, School of Medicine, Budapest, Hungary
Foundation for the Community Control of Hereditary Diseases, Budapest, Hungary
Received 19 October 2009
Abstract Background: The possible association between otitis media in pregnancy (OMP) and structural birth
defects, that is, congenital abnormalities (CAs), in their offspring has not been studied.
Methods: The data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities,
1980 and 1996, was evaluated.
Results: There were 58 (0.25%) and 55 (0.14%) of 22 843 cases and 38 151 controls with mothers
who had OMP, respectively. There was association of OMP and a higher risk of ear CA.
Conclusions: A possible explanation for the association of OMP with higher risk of ear CA may be
some morphological deviation of the inner ear.
© 2011 Elsevier Inc. All rights reserved.
There are well-known infectious diseases such as rubella,
varicella, influenza, or localized inflammatory diseases, for
example, urinary tact infections/diseases or vulvovaginitis,
that have been frequently studied regarding their maternal
and fetal effect during pregnancy. However, otitis media is
not presented in handbooks , although 113 pregnant
women affected with otitis media were recorded in the data
set of the population-based Hungarian Case-Control Sur-
veillance of Congenital Abnormalities (HCCSCA) .
Otitis media is the inflammatory disease of the inner ear in
general related to acute respiratory diseases and caused by
bacterial or viral infections. Otitismediais common in children
but may occur in adult persons including pregnant women. We
did not find reports of previous controlled epidemiological
studies regarding the possible associations between otitis
media in pregnancy (OMP) and adverse birth outcomes
particularly structural birth defects, that is, congenital
abnormalities (CAs); therefore, the objective of our study
was to evaluate these 113 pregnant women from this aspect.
2. Materials and methods
The protocol of the HCCSCA includes 5 steps.
The first step was the selection of cases with CA from the
Hungarian Congenital Abnormality Registry (HCAR)  for
the HCCSCA. Notification of cases with CAs is mandatory
for physicians from birth until the first birthday to the HCAR,
and most CAs are reported by obstetricians (in Hungary,
practically all deliveries take place in inpatient obstetric
clinics, and birth attendants are obstetricians) or pediatricians
(working at neonatal units of inpatient obstetric clinics as well
as of various general and special surgical, cardiologic,
orthopedic, and others, of inpatient and outpatient pediatric
clinics). Autopsy during the study period was obligatory for
all infant deaths and was usually performed in stillborn
fetuses. Pathologists sent a copy of the autopsy report to the
HCAR if defects were identified in stillborn fetuses or infant
deaths. Fetal defects diagnosed by prenatal diagnostic centers
with or without elective termination of pregnancy have also
been reported to the HCAR since 1984. Thus, malformed
fetuses diagnosed during the second and third trimester of
pregnancy and electively terminated are also included in the
data set of the HCAR. The recorded total (birth and fetal)
prevalence of cases with CA diagnosed from the second
trimester of pregnancy to the end of the first postnatal year
was 35 per 1000 informative offspring (live-born infants,
Available online at www.sciencedirect.com
American Journal of Otolaryngology–Head and Neck Medicine and Surgery 32 (2011) 203 –209
Corresponding author. Foundation for the Community Control of
Hereditary Diseases, 1026 Budapest, Törökvész lejtő 32, Hungary. Tel.: +36
1 3944712; fax: +36 1 3944712.
E-mail address: firstname.lastname@example.org (A.E. Czeizel).
0196-0709/$ – see front matter © 2011 Elsevier Inc. All rights reserved.