Thyroid Medication Use and Birth Defects in the National Birth Defects Prevention Study.
Thyroid Medication Use and Birth Defects in the National Birth Defects Prevention Study.
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国家出生缺陷预防研究中的甲状腺药物使用和出生缺陷。
DOI：
10.1002/bdr2.1095
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发表时间：
2017
影响因子：
2.1
通讯作者：
NationalBirthDefectsPreventionStudy
中科院分区：
文献类型：
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作者：
Howley,MeredithM;Fisher,SarahC;VanZutphen,AlissaR;Waller,DorothyK;Carmichael,SuzanL;Browne,MarilynL;NationalBirthDefectsPreventionStudy
甲状腺疾病在育龄妇女中很常见，甲状腺功能减退症影响2 - 3%的妊娠，甲状腺功能亢进症影响另外0.1 - 1%。我们使用国家出生缺陷预防研究（NBDPS）的数据检查甲状腺药物和个体出生缺陷之间的关联。方法NBDPS是一项多地点，基于人群的病例对照研究，包括1997年至2011年估计分娩日期的妊娠。我们分析了31，409例出生缺陷病例和11，536例未受影响对照的母亲自我报告的甲状腺药物使用情况。使用logistic回归估计5例或5例以上暴露病例的出生缺陷的校正比值比（OR）和95%置信区间（CI），控制母亲年龄、人种/种族和研究中心。估计3 ~ 4例暴露病例的缺陷的粗OR和精确95%CI。（2.3%）例，237例（2.1%）对照组母亲，并与无脑畸形（OR = 1.68; 95%CI，1.03-2.73），前脑无裂畸形（OR = 2.48; 95% CI，1.13-5.44）、脑积水（1.77; 95% CI，1.07-2.95）和小肠闭锁（OR = 1.81; 95% CI，1.04-3.15）。34例（0.1%）病例和10例（<0.1%）对照母亲使用抗甲状腺药物，与主动脉瓣狭窄相关（OR = 6.91; 95%CI，1.21-27.0）。结论虽然发现了新的关联，但我们的研究结果与以前的NBDPS分析相对一致。我们的研究结果表明，甲状腺药物的使用与NBDPS研究的大多数出生缺陷无关，但可能与某些特定的出生缺陷有关。这些结果不应解释为用于治疗甲状腺疾病的药物是致畸剂，因为观察到的相关性可能反映了潜在甲状腺疾病的影响。出生缺陷研究109：1471-1481，2017.© 2017 Wiley Periodicals，Inc.
BackgroundThyroid disorders are common among reproductive‐aged women, with hypothyroidism affecting 2 to 3% of pregnancies, and hyperthyroidism affecting an additional 0.1 to 1%. We examined associations between thyroid medications and individual birth defects using data from the National Birth Defects Prevention Study (NBDPS).MethodsThe NBDPS is a multisite, population‐based, case–control study that included pregnancies with estimated delivery dates from 1997 to 2011. We analyzed self‐reported thyroid medication use from mothers of 31,409 birth defect cases and 11,536 unaffected controls. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression for birth defects with five or more exposed cases, controlling for maternal age, race/ethnicity, and study center. Crude ORs and exact 95% CIs were estimated for defects with 3 to 4 exposed cases.ResultsThyroid hormone was used by 738 (2.3%) case and 237 (2.1%) control mothers, and was associated with anencephaly (OR = 1.68; 95% CI, 1.03–2.73), holoprosencephaly (OR = 2.48; 95% CI, 1.13–5.44), hydrocephaly (1.77; 95% CI, 1.07–2.95) and small intestinal atresia (OR = 1.81; 95% CI, 1.04–3.15). Anti‐thyroid medication was used by 34 (0.1%) case and 10 (<0.1%) control mothers, and was associated with aortic valve stenosis (OR = 6.91; 95% CI, 1.21–27.0).ConclusionWhile new associations were identified, our findings are relatively consistent with previous NBDPS analyses. Our findings suggest thyroid medication use is not associated with most birth defects studied in the NBDPS, but may be associated with some specific birth defects. These results should not be interpreted to suggest that medications used to treat thyroid disease are teratogens, as the observed associations may reflect effects of the underlying thyroid disease. Birth Defects Research 109:1471–1481, 2017.© 2017 Wiley Periodicals, Inc.