Over-the-counter Analgesics in Pregnancy and Offspring Neonatal Outcomes: A Retrospective Cohort Study
Over-the-counter Analgesics in Pregnancy and Offspring Neonatal Outcomes: A Retrospective Cohort Study
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非处方镇痛药对妊娠和后代新生儿结局的影响：一项回顾性队列研究
DOI：
10.1101/2020.09.24.20200188
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Zafeiri A
中科院分区：
文献类型：
--
作者：
Zafeiri A
为了确定子宫内暴露于五种非处方药之间的任何关联，（非处方）止痛药（扑热息痛、布洛芬、阿司匹林、双氯芬酸、萘普生）与新生儿不良结局的关系。使用Aberdeen孕产妇和新生儿数据库进行的回顾性队列研究。参与者：1985年至2015年期间的151，141例单胎妊娠。主要结局指标早产（<37周）、死产、新生儿死亡、出生体重、标准化出生体重评分、新生儿入院、1分钟和5分钟时的APGAR评分、神经管和羊膜带缺陷、腹裂，以及男性隐睾，83.7%的服用非处方止痛药的妇女在第一次产前门诊就诊时被特别询问使用情况时报告了妊娠早期使用止痛药的情况。妊娠期接触五种镇痛药中的至少一种与<37周早产风险增加显著独立相关（aOR=1.50，95%CI 1.43-1.58），死产（aOR=1.33，95%CI 1.15-1.54），新生儿死亡（aOR=1.56，95%CI 1.27-1.93），出生体重<2，500 g（aOR=1.28，95%CI 1.20-1.37），出生体重> 4,000 g（aOR=1.09，95%CI 1.05-1.13），入住新生儿病房（aOR=1.57，95%CI 1.51-1.64），1分钟时APGAR评分<7（aOR=1.18，95%CI 1.13-1.23）和5分钟（aOR=1.48，95%CI 1.35-1.62）、神经管缺陷（aOR=1.64，95%CI 1.08-2.47）和尿道下裂（aOR=1.27，95%CI 1.05-1.54，仅限男性）。怀孕期间使用非处方镇痛药的总体流行率为29.1%，但在30年的研究期间迅速增加，在研究的最后7年中包括超过60%的女性。这使得我们的研究结果高度相关的更广泛的怀孕population.CONCLUSIONSOver-the-counter（非处方）镇痛药消费在怀孕期间与一个显着更高的风险在后代的围产期健康不良后果。对乙酰氨基酚与其他非甾体类抗炎药联合使用的风险最高。与非处方，非处方，怀孕期间使用止痛药表明，孕妇关于止痛药使用的医疗保健指南需要紧急更新。（授权号1942576）给AZ和欧盟地平线2020项目FREIA（授权号825100）给PAF。RTM由MRC生殖健康中心资助MR/N 022556/1。
OBJECTIVESTo identify any associations betweenin uteroexposure to five over-the-counter (non-prescription) analgesics (paracetamol, ibuprofen, aspirin, diclofenac, naproxen) and adverse neonatal outcomes.DESIGNRetrospective cohort study using the Aberdeen Maternity and Neonatal Databank.PARTICIPANTS151,141 singleton pregnancies between 1985 and 2015.MAIN OUTCOME MEASURESPremature delivery (<37 weeks), stillbirth, neonatal death, birthweight, standardised birthweight score, neonatal unit admission, APGAR score at 1 and 5 minutes, neural tube and amniotic band defects, gastroschisis and, in males, cryptorchidism, and hypospadias.RESULTS83.7% of women taking over-the-counter analgesics reported first trimester use when specifically asked about use at their first antenatal clinic visit. Pregnancies exposed to at least one of the five analgesics were significantly independently associated with increased risks for premature delivery <37 weeks (aOR=1.50, 95%CI 1.43-1.58), stillbirth (aOR=1.33, 95%CI 1.15-1.54), neonatal death (aOR=1.56, 95%CI 1.27-1.93), birthweight <2,500g (aOR=1.28, 95%CI 1.20-1.37), birthweight >4,000g (aOR=1.09, 95%CI 1.05-1.13), admission to neonatal unit (aOR=1.57, 95%CI 1.51-1.64), APGAR score <7 at 1 minute (aOR=1.18, 95%CI 1.13-1.23) and 5 minutes (aOR=1.48, 95%CI 1.35-1.62), neural tube defects (aOR=1.64, 95%CI 1.08-2.47) and hypospadias (aOR=1.27, 95%CI 1.05-1.54 males only). The overall prevalence of over-the-counter analgesics use during pregnancy was 29.1%, however it rapidly increased over the 30-year study period, to include over 60% of women in the last seven years of the study. This makes our findings highly relevant to the wider pregnant population.CONCLUSIONSOver-the-counter (non-prescription) analgesics consumption during pregnancy was associated with a substantially higher risk for adverse perinatal health outcomes in the offspring. The use of paracetamol in combination with other non-steroidal anti-inflammatory drugs conferred the highest risk. The increased risks of adverse neonatal outcomes associated with non-prescribed, over-the-counter, analgesics use during pregnancy indicate that healthcare guidance for pregnant women regarding analgesic use need urgent updating.FundingBiotechnology and Biological Sciences Research council (BBSRC) funding under the EASTBIO doctoral training programme (grant number 1942576) to AZ and EU Horizon 2020 project FREIA (Grant Number 825100) to PAF. RTM is supported by MRC Centre for Reproductive Health Grant MR/N022556/1.
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影响因子：
7.7
作者：
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影响因子：
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DOI：
--
发表时间：
1992
期刊：
Teratology
影响因子：
--
作者：
M. Werler;A. Mitchell;S. Shapiro
通讯作者：
S. Shapiro
阿司匹林与先天性畸形
DOI：
10.1016/s0140-6736(76)93025-7
发表时间：
1976
期刊：
The Lancet
影响因子：
--
作者：
D. Slone;O. Heinonen;D. Kaufman;V. Siskind;RichardR. Monson;S. Shapiro
通讯作者：
S. Shapiro