Use of vasoactive medications in pregnancy and the risk of stillbirth among birth defect cases.
Use of vasoactive medications in pregnancy and the risk of stillbirth among birth defect cases.
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DOI：
10.1002/bdr2.1996
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发表时间：
2022-05
影响因子：
2.1
通讯作者：
Werler, Martha M.
中科院分区：
文献类型：
--
作者：
Kerr, Stephen;Heinke, Dominique;Yazdy, Mahsa M.;Mitchell, Allen A.;Darling, Anne Marie;Lin, Angela;Nestoridi, Eirini;Werler, Martha M.
许多先前的研究已经确定了死产的危险因素，但很少检查有出生缺陷的孕妇的死产。由于许多假设的死产病因是通过胎盘的血管病变起作用的，我们研究了孕妇使用血管活性药物与出生缺陷妊娠中死产的关系。数据分析来自国家出生缺陷预防研究（1997-2011）。我们研究了非甾体抗炎药（NSAIDs）、减充血药、短效或长效β受体激动剂（SABA/LABA）和降压药的使用情况，这些药物与出生缺陷导致死胎和活胎的妊娠相关。用妊娠早期用药的优势比（ORs）和随时间变化的妊娠晚期用药的危险比（hr）来衡量相关性。在所有出生缺陷（n = 12,394）中，死产风险与妊娠早期（优势比[OR]: 1.8； 95%可信区间[CI]: 1.0, 3.1）和妊娠晚期（优势比：2.0;95% CI: 1.1, 3.6）使用抗高血压药物相关。其他血管活性药物与死产风险增加无关。在27个特定缺陷组中，仅观察到一种药物/缺陷对的风险增加：与活产脊柱裂的母亲相比，死产母亲早期使用减充血剂更常见（OR: 2.4; 95% CI: 0.9, 6.5）。这项对血管活性药物使用的探索性分析表明，使用非甾体抗炎药、减充血药和SABA/LABA与有出生缺陷的孕妇死胎风险增加无关。我们发现抗高血压药物使用增加的风险引起了适应症混淆的问题，我们不能完全解决这个问题。
Many previous studies have identified risk factors for stillbirth, but few examine stillbirth among pregnancies affected with birth defects. Because many hypothesized etiologies of stillbirth work through vascular pathologies of the placenta, we examined maternal use of vasoactive medications in relation to stillbirth among pregnancies affected with birth defects. Data were analyzed from the National Birth Defects Prevention Study (1997–2011). We examined use of nonsteroidal anti-inflammatory drugs (NSAIDs), decongestants, short- or long-acting beta-agonists (SABA/LABA), and antihypertensive medications in relation to pregnancies affected by birth defects ending in stillbirth compared to live birth. Associations were measured with odds ratios (ORs) for early pregnancy use and hazard ratios (HRs) for time-varying late pregnancy use. Among all birth defects (n = 12,394), the risk of stillbirth was associated with use of antihypertensive medications in early (odds ratio [OR]: 1.8; 95% confidence interval [CI]: 1.0, 3.1) and late pregnancy (HR: 2.0; 95% CI: 1.1, 3.6). Other vasoactive medications were not associated with increased risk of stillbirth. Of 27 specific defect groups, increased risks were observed for only one medication/defect pair: early decongestant use was more common among mothers of stillbirth versus live birth cases with spina bifida (OR: 2.4; 95% CI: 0.9, 6.5). This exploratory analysis of vasoactive medication use suggests that use of NSAIDs, decongestants, and SABA/LABA is not associated with increased risk of stillbirth among pregnancies affected with birth defects. Our finding of increased risks associated with antihypertensive medication use raises questions of confounding by indication, which we were not able to fully address.
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影响因子：
7.2
作者：
Schechtman, KB;Gray, DL;Rothman, SM
通讯作者：
Rothman, SM
影响因子：
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作者：
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影响因子：
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DOI：
10.1111/j.1471-0528.2008.01844.x
发表时间：
2008-10-01
影响因子：
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作者：
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