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Miller, Eric A.; Manning, Susan E.; Rasmussen, Sonja A.; Reefhuis, Jennita; Honein, Margaret A.; Honein, Margaret A.
doi: 10.1111/j.1365-3016.2008.00976.xpmid: 19228309
Summary Anorectal atresia is a congenital anomaly with mostly unknown risk factors. Studies have provided evidence of teratogenic effects of alcohol and tobacco, and animal studies have suggested that caffeine may potentiate their teratogenicity. However, it is unclear how these factors affect the risk of anorectal atresia. We analysed data from maternal telephone interviews in a multistate case‐control study with 464 infants with anorectal atresia and 4940 infants with no major birth defects. We used unconditional logistic regression to determine the association of exposure to smoking, environmental tobacco smoke (ETS), alcohol or caffeine with anorectal atresia. Effect modification by caffeine intake was assessed on additive and multiplicative scales. There was no association with alcohol intake in this analysis. However, there was some evidence of an association between anorectal atresia and maternal exposure to tobacco smoke and caffeine. Compared with non‐smokers not exposed to ETS, the crude odds ratio (OR) and 95% confidence interval (CI) for cigarette smoking was 1.2 (95% CI 1.0, 1.5). The association with anorectal atresia for non‐smokers exposed to ETS at home and work was OR = 2.3 (95% CI 1.2, 4.1). Compared with the lowest level of caffeine intake (<10 mg/day), the association for the highest caffeine intake (≥300 mg/day) was OR = 1.5 (95% CI 1.0, 2.2). Results did not change after adjustment for covariates. This study found evidence of associations between anorectal atresia and caffeine intake, cigarette smoking and exposure to ETS. Because there are currently few additional data to support these results, further study is needed.
Cooper, William O.; Hernandez‐Diaz, Sonia; Arbogast, Patrick G.; Dudley, Judith A.; Dyer, Shannon M.; Gideon, Patricia S.; Hall, Kathleen S.; Kaltenbach, Lisa A.; Ray, Wayne A.
doi: 10.1111/j.1365-3016.2008.00978.xpmid: 19228311
Materna‐Kiryluk, Anna; Wiśniewska, Katarzyna; Badura‐Stronka, Magdalena; Mejnartowicz, Jan; Wiȩckowska, Barbara; Balcar‐Boroń, Anna; Czerwionka‐Szaflarska, Mieczyslawa; Gajewska, Elzbieta; Godula‐Stuglik, Urszula; Krawczyński, Marian; Limon, Janusz; Rusin, Jozef; Sawulicka‐Oleszczuk, Henryka;
Canfield, Mark A.; Marengo, Lisa; Ramadhani, Tunu A.; Suarez, Lucina; Brender, Jean D.; Scheuerle, Angela
doi: 10.1111/j.1365-3016.2008.00975.xpmid: 19228313
Summary Texas shares a 1255‐miles border with Mexico and encompasses a variety of ecosystems, industries and other potential environmental exposures. The Texas Birth Defects Registry is an active surveillance system which covers all pregnancy outcomes (livebirths, fetal deaths and elective pregnancy terminations). This study describes the occurrence and the predictors of neural tube defects (anencephaly and spina bifida) in Texas between 1999 and 2003. Birth prevalence, crude and adjusted prevalence ratios and 95% confidence intervals were calculated using Poisson regression, for each defect, by fetal/infant sex, delivery year and maternal sociodemographic characteristics. Among approximately 1.8 million livebirths, a total of 1157 neural tube defects cases were ascertained by the Registry, resulting in an overall prevalence of 6.33 cases per 10 000 livebirths. The prevalences of anencephaly and spina bifida were 2.81 and 3.52 per 10 000 livebirths respectively. Prevalences of both defects were highest in Hispanics, among mothers living along the border with Mexico, among women of higher parity and among mothers who were 40+ years of age. In addition, the prevalence of each defect was higher among women with no record of prenatal care and among women with less than 7 years of education. Hispanic ethnicity was an important predictor for anencephaly, along with sex, maternal age, parity and border residence. However, only border residence and delivery year were significant predictors for spina bifida.
Siega‐Riz, Anna Maria; Herring, Amy H.; Olshan, Andrew F.; Smith, Joanna; Moore, Cynthia; Moore, Cynthia
doi: 10.1111/j.1365-3016.2008.00990.xpmid: 19228314
Summary Young maternal age has been associated with an increased risk of gastroschisis, while high maternal weight status has been associated with a decreased risk. We were interested in investigating the joint effect of these two risk factors to identify thresholds in risk associated with body mass index (BMI) for a given age. Data from the National Birth Defects Prevention Study included 464 case infants with gastroschisis and 4842 healthy controls. A generalised additive model with a bivariate spline for continuous maternal age and prepregnancy BMI was used to model the probability of gastroschisis. The bivariate spline in BMI and maternal age was significantly associated with gastroschisis (P = 0.0001) after adjustment for study centre, maternal race/ethnicity, education, income and number of persons supported by income, smoking, alcohol use, vitamin use, vasoconstrictor medication use and gestational diabetes. The data indicate that women who are younger and who have lower BMI are at the greatest risk; a woman with a BMI of 17 who gives birth at age 15 has 7 times the odds (adjusted odds ratio = 7.0 (95% CI 4.2, 11.5)) of having an offspring with gastroschisis compared with a woman of age 24 with a BMI of 23. Furthermore, there was an interaction between maternal age and BMI for this risk. The increased risk of low maternal age and prepregnancy BMI associated with gastroschisis appears to suggest an aetiological role related to biological immaturity for this particular birth defect.
Dadvand, Payam; Rankin, Judith; Shirley, Mark D. F.; Rushton, Stephen; Pless‐Mulloli, Tanja
doi: 10.1111/j.1365-3016.2008.00987.xpmid: 19228315
Summary Congenital heart disease (CHD) is the most prevalent group of congenital anomalies. There is considerable variation in the reported epidemiology of CHD, mainly attributable to methodological differences. Using register‐based data, the current study describes the epidemiology of CHD in a geographically well‐defined population of the North of England during 1985–2003. The total prevalence of CHD was 85.9 per 10 000 births and terminations of pregnancy for fetal anomaly. Livebirth prevalence was 79.7 per 10 000 livebirths. Both total and livebirth prevalence increased during the study period. Ninety‐two per cent of affected pregnancies resulted in a livebirth, 5% were terminated, 2% resulted in a stillbirth, and 1% in a late miscarriage. Almost a quarter (23%) of cases had one or more coincident anomalies of other organs, with chromosomal abnormalities the most frequent group. A total of 89.2% of cases survived to 1 year and the survival improved during the study period. This population‐based study has demonstrated an increasing trend in both prevalence and survival among children with CHD.
Petersen, Christina B.; Mortensen, Laust H.; Morgen, Camilla S.; Madsen, Mia; Schnor, Ole; Arntzen, Annett; Gissler, Mika; Cnattingius, Sven; Nybo Andersen, Anne‐Marie
doi: 10.1111/j.1365-3016.2008.00977.xpmid: 19228316
Showing 1 to 10 of 12 Articles
Summary This study was designed to assess the association between pregnancy‐related exposures to antibiotics recommended for use in the event of a bioterrorism attack and major congenital malformations. A retrospective cohort study included 30 049 infants from Tennessee Medicaid born between 1985 and 2000 identified from computerised state databases. Infants with fetal exposures to ciprofloxacin, azithromycin, doxycycline and amoxicillin (antibiotics recommended for potential bioterrorism attacks) (n = 24 521) and erythromycin (included as a positive control) (n = 2128) were compared with infants with no fetal exposure to any antibiotics (n = 3400). Major congenital malformations identified from computerised records were confirmed through medical record review. Overall, 869 (2.9%) of infants in the cohort had a confirmed major congenital malformation, with major malformations ranging from 2.5% to 3.0% among the antibiotic‐specific exposure groups. No increased risk was present in multivariable analyses for any malformations and for malformations of specific organ systems. In conclusion, these data suggest that ciprofloxacin, azithromycin, doxycycline or amoxicillin use by pregnant women should not result in a greater incidence of overall major congenital malformations in infants whose mothers take these medications, though a large increase in risk cannot be ruled out.
doi: 10.1111/j.1365-3016.2008.00979.xpmid: 19228312
Summary Currently available data on the relationship between the prevalence of isolated congenital malformations and parental age are inconsistent and frequently divergent. We utilised the data from the Polish Registry of Congenital Malformations (PRCM) to accurately assess the interplay between maternal and paternal age in the risk of isolated non‐syndromic congenital malformations. Out of 902 452 livebirths we studied 8683 children aged 0–2 years registered in the PRCM. Logistic regression was used to simultaneously adjust the risk estimates for maternal and paternal age. Our data indicated that paternal and maternal age were independently associated with several congenital malformations. Based on our data, young maternal and paternal ages were independently associated with gastroschisis. In addition, young maternal age, but not young paternal age, carried a higher risk of neural tube defects. Advanced maternal and paternal ages were both independently associated with congenital heart defects. Moreover, there was a positive association between advanced paternal age and hypospadias, cleft palate, and cleft lip (with or without cleft palate). No significant relationships between parental age and the following congenital malformations were detected: microcephaly, hydrocephaly, oesophageal atresia, atresia or stenosis of small and/or large intestine, ano‐rectal atresia or stenosis, renal agenesis or hypoplasia, cystic kidney disease, congenital hydronephrosis, diaphragmatic hernia and omphalocele.
Summary During the 1980s and 1990s, there were large social and structural changes within the Nordic countries. Here we examine time changes in risks of preterm birth by maternal educational attainment in Denmark, Finland, Norway and Sweden. Information on gestational age and maternal socio‐economic position was obtained from the NorCHASE database, which includes comparable population‐based register data of births from Denmark, Finland, Sweden and Norway from 1981 to 2000. The risks of very preterm birth (<32 gestational weeks) and moderately preterm birth (32–36 gestational weeks) were calculated by maternal educational attainment and analysed in 5‐year intervals from 1981 to 2000. Compared with mothers with >12 years of education, mothers with <10 years of education had similarly increased risks of very, and to a lesser extent moderately, preterm birth in all four countries. The educational gradient increased slightly over time in very preterm births in Denmark, while there was a slight narrowing of the gap in Sweden. In moderately preterm births, the educational inequality gap was constant over the study period in Denmark, Norway and Sweden, but narrowed in Finland. The educational gradient in preterm birth remained broadly stable from 1981 to 2000 in all four countries. Consequently, the socio‐economic inequalities in preterm birth were not strongly influenced by structural changes during the period.