Use of asthma medication during pregnancy and risk of specific congenital anomalies: A European case-malformed control study
Use of asthma medication during pregnancy and risk of specific congenital anomalies: A European case-malformed control study
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DOI：
10.1016/j.jaci.2015.05.043
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发表时间：
2015-12-01
影响因子：
14.2
通讯作者：
Dolk, Helen
中科院分区：
文献类型：
--
作者：
Garne, Ester;Hansen, Anne Vinkel;Dolk, Helen
背景资料：孕妇哮喘需要服用药物在pregnancy.Objective：我们试图确定是否有特定的先天性异常的风险增加后，暴露于抗哮喘药物在怀孕的头三个月。方法：我们进行了一项基于人群的病例畸形对照研究测试信号中确定的文献综述。与非染色体、非信号异常登记作为对照登记相比，计算10个信号异常中每一个的主要哮喘药物组暴露的比值比（OR）。此外，对每种非信号异常进行了探索性分析。结果：腭裂（OR，1.63; 95%CI，1.05-2.52）和腹裂（OR，1.89; 95%CI，1.12-3.20）与非染色体对照登记相比，孕早期使用吸入性β 2受体激动剂的风险显著增加。接触沙丁胺醇的几率相似。在脊柱裂、唇裂、肛门闭锁、一般严重先天性心脏病或法洛四联症中，发现吸入β 2受体激动剂暴露的OR值不显著。4个暴露于吸入性类固醇的文献信号均未得到证实（腭裂、唇裂、肛门闭锁和尿道下裂）。探索性分析发现，肾发育不良与长效β 2受体激动剂和吸入性皮质类固醇联合使用之间存在相关性（OR，3.95; 95%CI，1.99-7.85）。这项研究证实了早期妊娠暴露于吸入性β 2受体激动剂治疗腭裂和腹裂的几率增加，并发现了一个潜在的新信号，即与长期妊娠相关的肾发育不良。作用β（2）-激动剂和吸入性皮质类固醇。在妊娠早期使用吸入性糖皮质激素似乎是安全的，与一系列特定的重大先天性畸形的风险有关。
Background: Pregnant women with asthma need to take medication during pregnancy.Objective: We sought to identify whether there is an increased risk of specific congenital anomalies after exposure to antiasthma medication in the first trimester of pregnancy.Methods: We performed a population-based case-malformed control study testing signals identified in a literature review. Odds ratios (ORs) of exposure to the main groups of asthma medication were calculated for each of the 10 signal anomalies compared with registrations with nonchromosomal, nonsignal anomalies as control registrations. In addition, exploratory analyses were done for each nonsignal anomaly. The data set included 76,249 registrations of congenital anomalies from 13 EUROmediCAT registries.Results: Cleft palate (OR, 1.63; 95% CI, 1.05-2.52) and gastroschisis (OR, 1.89; 95% CI, 1.12-3.20) had significantly increased odds of exposure to first-trimester use of inhaled beta(2)-agonists compared with nonchromosomal control registrations. Odds of exposure to salbutamol were similar. Nonsignificant ORs of exposure to inhaled beta(2)-agonists were found for spina bifida, cleft lip, anal atresia, severe congenital heart defects in general, or tetralogy of Fallot. None of the 4 literature signals of exposure to inhaled steroids were confirmed (cleft palate, cleft lip, anal atresia, and hypospadias). Exploratory analyses found an association between renal dysplasia and exposure to the combination of long-acting beta(2)-agonists and inhaled corticosteroids (OR, 3.95; 95% CI, 1.99-7.85).Conclusions: The study confirmed increased odds of first-trimester exposure to inhaled beta(2)-agonists for cleft palate and gastroschisis and found a potential new signal for renal dysplasia associated with combined long-acting beta(2)-agonists and inhaled corticosteroids. Use of inhaled corticosteroids during the first trimester of pregnancy seems to be safe in relation to the risk for a range of specific major congenital anomalies.