Periconceptional nonsteroidal anti-inflammatory drug use, folic acid intake, and the risk of spina bifida.
Periconceptional nonsteroidal anti-inflammatory drug use, folic acid intake, and the risk of spina bifida.
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DOI：
10.1002/bdr2.1944
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发表时间：
2021-10-15
影响因子：
2.1
通讯作者：
Werler, Martha M.
中科院分区：
文献类型：
--
作者：
Esposito, Daina B.;Parker, Samantha E.;Mitchell, Allen A.;Tinker, Sarah C.;Werler, Martha M.
怀孕期间使用非甾体抗炎药 (NSAID) 可能会增加神经管缺陷 (NTD) 的风险，包括脊柱裂。摄入叶酸可以预防 NTD，但尚不清楚它是否会改变与使用 NSAID 相关的任何风险。评估围孕期使用非甾体抗炎药对脊柱裂总体风险的影响，并按叶酸摄入量分层。我们分析了斯隆流行病学中心出生缺陷研究 1998 年至 2015 年的数据，这是一项多中心病例对照研究。对母亲进行采访，以确定怀孕期间的社会人口因素、行为和暴露情况。围孕期 NSAID 使用定义为在末次月经前后一个月内使用阿司匹林、布洛芬、萘普生或 COX2 抑制剂。使用逻辑回归模型来估计 NSAID 使用的调整比值比 (aOR) 和 95% 置信区间 (CI)，并根据研究中心和种族/民族进行调整，按平均每日叶酸摄入量高于（“高 FA”）或低于（“低 FA”）400 微克/天进行分层。我们将 267 名脊柱裂婴儿的母亲与 6,233 名正常对照婴儿的母亲进行了比较。在对照母亲中，20% 在围孕期使用 NSAIDS（16% 布洛芬、4% 阿司匹林、3% 萘普生和 <1% COX-2 抑制剂）。对于任何 NSAID 的使用，低 FA 和高 FA 女性的 aOR 分别为 1.70 (95% CI [1.13, 2.57]) 和 1.09 (95% CI [0.69, 1.71])。我们观察到围孕期使用非甾体抗炎药的女性所生婴儿的脊柱裂风险略有增加，但这种风险仅限于叶酸摄入不足的女性。
Use of nonsteroidal anti-inflammatory drugs (NSAIDs) during pregnancy may increase risk for neural tube defects (NTDs), including spina bifida. Folic acid intake can prevent NTDs, but it is not known whether it modifies any risks associated with NSAID use. To assess the impact of periconceptional NSAID use on the risk of spina bifida overall and stratified by folic acid intake. We analyzed 1998–2015 data from the Slone Epidemiology Center Birth Defects Study, a multi-site, case–control study. Mothers were interviewed to identify sociodemographic factors, behaviors, and exposures during pregnancy. Periconceptional NSAID use was defined as use of aspirin, ibuprofen, naproxen, or COX2 inhibitors within the month before or after the last menstrual period. Logistic regression models were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for NSAID use, adjusted for study center and race/ethnicity stratified by average daily folic acid intake above (“high FA”) or below (“low FA”) 400 mcg/day. We compared mothers of 267 infants with spina bifida to mothers of 6,233 nonmalformed controls. Among control mothers, 20% used NSAIDS periconceptionally (16% ibuprofen, 4% aspirin, 3% naproxen, and <1% COX-2 inhibitors). For any NSAID use, the aORs among low FA and high FA women were 1.70 (95% CI [1.13, 2.57]) and 1.09 (95% CI [0.69, 1.71]), respectively. We observed a small increase in the risk for spina bifida among infants born to women who used NSAIDs periconceptionally, but this risk was limited to those who had inadequate folic acid intake.
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