Folic acid antagonist use before and during pregnancy and risk for selected birth defects.
Folic acid antagonist use before and during pregnancy and risk for selected birth defects.
复制标题
怀孕前和怀孕期间使用叶酸拮抗剂以及特定出生缺陷的风险。
DOI：
10.1002/bdr2.1789
复制
发表时间：
2020
影响因子：
2.1
通讯作者：
Werler,MarthaM
中科院分区：
文献类型：
--
作者：
Kerr,StephenM;Parker,SamanthaE;Mitchell,AllenA;Tinker,SarahC;Werler,MarthaM
背景母亲在怀孕前和怀孕早期摄入叶酸（FA）可降低神经管缺陷（NTDs）的风险;有证据表明，它也可降低口腔裂、泌尿系统缺陷和心脏缺陷的风险。我们试图重新检查使用的药物，影响叶酸代谢，二氢叶酸还原酶抑制（DHFRI）药物，和抗癫痫药物（AED），在后FA强化时代（1998+）在Slone出生缺陷Study.MethodsWe收集的数据评估产妇DHFRI和AED使用和NTD，口腔裂，泌尿和心脏缺陷的风险。我们使用逻辑回归估计比值比（OR）和95%置信区间（CI）。我们评估了每日平均FA摄入量≥400微克作为一个潜在的影响modifier.ResultsWe从10,209对照组和9,625例母亲的数据进行了分析。在对照组中，暴露于DHFRI药物的患病率为0.3%，暴露于AED的患病率为0.5%。母亲使用抗癫痫药物与神经管缺陷风险增加相关（OR：3.4; 95% CI：1.5，7.5），唇裂（OR：2.3; 95% CI：1.3，4.0），泌尿系统缺陷（OR：1.6; 95% CI：1.0，2.7）和心脏缺陷（OR：1.6; 95% CI：1.1，2.3）;在FA摄入量≥400 mcg/天的患者中发现了相似或进一步增加的风险。DHFRI的使用是罕见的，相对风险估计是不精确的，一致的null.ConclusionsSimilar我们以前的分析，我们观察到AED的使用和这些缺陷之间的关联。对于DHFRI暴露，我们没有发现这些缺陷风险增加的证据。尽管检验FA效应改变的统计学把握度较低，但我们没有发现FA摄入量≥400 mcg的人群中存在进一步保护的证据，该组中的一些相关性更强。
BackgroundMaternal folic acid (FA) intake before and during early pregnancy reduces the risk for neural tube defects (NTDs); evidence suggests it may also reduce the risk for oral clefts, urinary defects, and cardiac defects. We sought to re‐examine the use of drugs, which affect folate metabolism, dihydrofolate reductase inhibiting (DHFRI) medications, and anti‐epileptic drugs (AEDs), in data collected in the post‐FA fortification era (1998+) in the Slone Birth Defects Study.MethodsWe assessed maternal DHFRI and AED use and risk for NTDs, oral clefts, and urinary and cardiac defects. We estimated odds ratios (ORs) and 95% confidence intervals (CIs) using logistic regression. We assessed daily average FA intake of ≥400 mcg as a potential effect modifier.ResultsWe analyzed data from 10,209 control and 9,625 case mothers. Among controls, the prevalence of exposure to DHFRI medications was 0.3% and to AEDs was 0.5%. Maternal use of AEDs was associated with increased risks for NTDs (OR: 3.4; 95% CI: 1.5, 7.5), oral clefts (OR: 2.3; 95% CI: 1.3, 4.0), urinary defects (OR: 1.6; 95% CI: 1.0, 2.7), and cardiac defects (OR: 1.6; 95% CI: 1.1, 2.3); similar or further increased risks were found among those with FA intake ≥400 mcg per day. DHFRI use was rare and relative risk estimates were imprecise and consistent with the null.ConclusionsSimilar to our previous analyses, we observed associations between AED use and these defects. For DHFRI exposure, we found no evidence for increased risk of these defects. Though statistical power to examine FA effect modification was low, we found no evidence of further protection among those with FA intake ≥400 mcg, with some associations somewhat stronger in this group.