Antibacterial Medication Use During Pregnancy and Risk of Birth Defects National Birth Defects Prevention Study
Antibacterial Medication Use During Pregnancy and Risk of Birth Defects National Birth Defects Prevention Study
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DOI：
10.1001/archpediatrics.2009.188
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发表时间：
2009-11-01
影响因子：
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通讯作者：
Hu, Dale J.
中科院分区：
文献类型：
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作者：
Crider, Krista S.;Cleves, Mario A.;Hu, Dale J.
目的：评估抗菌药物与选择的出生缺陷之间的关系。设计、设置和参与者：以人口为基础，多地点，对10个州出生缺陷监测项目确定的30多个合格的主要出生缺陷中的1个影响妊娠的妇女进行的病例对照研究（n = 13155）和对照组妇女随机选择从相同的地理区域（n = 4941）。主要暴露：报告的母亲使用抗菌药物（从怀孕前1个月到怀孕前三个月结束）。主要结果测量：比值比（OR）测量抗菌药物使用和选定的出生缺陷之间的关联，调整了潜在的混杂因素。报告的抗菌药物的使用在怀孕期间增加，在第三个月达到高峰。磺胺类药物与无脑畸形有关（校正OR [AOR] = 3.4; 95%置信区间[CI]，1.3-8.8），左心发育不良综合征（AOR = 3.2; 95% CI，1.3-7.6），主动脉缩窄（AOR = 2.7; 95% CI，1.3-5.6），后鼻孔闭锁（AOR = 8.0; 95% CI，2.7-23.5）、横肢缺损（AOR = 2.5; 95% CI，1.0-5.9）和腹股沟疝（AOR = 2.4; 95% CI，1.1-5.4）。呋喃妥因与无眼球或小眼球（AOR = 3.7; 95% CI，1.1-12.2）、左心发育不良综合征（AOR = 4.2; 95% CI，1.9-9.1）、房间隔缺损（AOR = 1.9; 95% CI，1.1-3.4）和唇裂伴腭裂（AOR = 2.1; 95% CI，1.2-3.9）相关。其他抗菌药物，显示协会包括红霉素（2缺陷），青霉素（1缺陷），头孢菌素（1缺陷），喹诺酮类（1缺陷）。结论：令人欣慰的是，青霉素，红霉素，头孢菌素，虽然常用的孕妇，与许多出生缺陷。磺胺类药物和呋喃妥因与几种出生缺陷有关，这表明需要进一步审查。
Objective: To estimate the association between antibacterial medications and selected birth defects.Design, Setting, and Participants: Population-based, multisite, case-control study of women who had pregnancies affected by 1 of more than 30 eligible major birth defects identified via birth defect surveillance programs in 10 states (n = 13 155) and control women randomly selected from the same geographical regions (n = 4941).Main Exposure: Reported maternal use of antibacterials (1 month before pregnancy through the end of the first trimester).Main Outcome Measure: Odds ratios (ORs) measuring the association between antibacterial use and selected birth defects adjusted for potential confounders.Results: The reported use of antibacterials increased during pregnancy, peaking during the third month. Sulfonamides were associated with anencephaly (adjusted OR [AOR] = 3.4; 95% confidence interval [CI], 1.3-8.8), hypoplastic left heart syndrome (AOR = 3.2; 95% CI, 1.3-7.6), coarctation of the aorta (AOR = 2.7; 95% CI, 1.3-5.6), choanal atresia (AOR = 8.0; 95% CI, 2.7-23.5), transverse limb deficiency (AOR = 2.5; 95% CI, 1.0-5.9), and diaphragmatic hernia (AOR = 2.4; 95% CI, 1.1-5.4). Nitrofurantoins were associated with anophthalmia or microphthalmos (AOR = 3.7; 95% CI, 1.1-12.2), hypoplastic left heart syndrome (AOR = 4.2; 95% CI, 1.9-9.1), atrial septal defects (AOR = 1.9; 95% CI, 1.1-3.4), and cleft lip with cleft palate (AOR = 2.1; 95% CI, 1.2-3.9). Other antibacterial agents that showed associations included erythromycins (2 defects), penicillins (1 defect), cephalosporins (1 defect), and quinolones (1 defect).Conclusions: Reassuringly, penicillins, erythromycins, and cephalosporins, although used commonly by pregnant women, were not associated with many birth defects. Sulfonamides and nitrofurantoins were associated with several birth defects, indicating a need for additional scrutiny.