Teratogenicity of Drugs Most Commonly Used in Pregnancy

扑热息痛、阿司匹林、布洛芬和阿莫西林是妊娠期间最常用的药物，但这些药物对于出生缺陷的安全性尚未确定。鉴于这些药物的广泛使用，即使出生缺陷风险略有增加，也可能对临床和公共卫生产生相当大的影响。我们建议评估这些药物与1)先前假设与每种药物相关的特定畸形和2)在普通人群中最常见的特定畸形之间的关联。此外，我们建议通过系统地筛选与特定畸形风险有关的每一种暴露来评估其他常用药物。这些目标可以通过利用北美现有的大型正在进行的多中心出生缺陷病例对照监测计划-斯隆流行病学中心出生缺陷研究(BDS)-以相对较低的成本实现。BDS涉及四个大都市地区(波士顿、费城、多伦多和圣地亚哥)的大约95家机构，25年来采访了20,000多名畸形婴儿的母亲和4,000多名非畸形婴儿的母亲。BDS在三级医院和产科医院发现出生后5个月内有各种畸形的婴儿，在分娩后6个月内，研究护士就人口统计、生殖和医疗因素、药物和维生素使用、吸烟和酒精消费以及饮食摄入量采访母亲。这项研究发现了可能的致畸作用，随后得到了其他人的证实(例如，与腹裂有关的纤毛虫)。在拟议的分析中，我们将使用Logistic回归来估计优势比和95%的可信区间，并将针对潜在的混杂因素对结果进行调整。这些发现将检验一些药物的假说，并为其他药物的进一步研究提供线索；这两个目标都寻求提高我们对孕妇常用药物相关风险的理解。

Acetaminophen, aspirin, ibuprofen, and amoxicillin are among the most commonly used drugs during pregnancy, but the safety of these medications with respect to birth defects is not established. Given the wide use of these drugs, even a small increase in the risk of birth defects may have considerable clinical and public health implications. We propose to evaluate the association between these drugs and 1) specific malformations previously hypothesized to be associated with each of them, and 2) specific malformations that occur most commonly in the general population. In addition, we propose to evaluate other commonly used medications by systematically screening each exposure in relation to the risk of specific malformations. These goals can be achieved at relatively modest cost by taking advantage of a large existing ongoing multicenter case-control surveillance program of birth defects in North America, the Slone Epidemiology Center Birth Defects Study (BDS). The BDS involves approximately 95 institutions in four metropolitan areas (Boston, Philadelphia, Toronto, and San Diego), and for over 25 years has interviewed over 20,000 mothers of malformed infants and over 4,000 mothers of non-malformed infants. The BDS identifies infants with a wide range of malformations within 5 months after birth at tertiary and birth hospitals, and within 6 months of delivery, study nurses interview mothers about demographic, reproductive, and medical factors; medication and vitamin use; cigarette smoking and alcohol consumption; and dietary intake. The study has discovered likely teratogenic effects that have subsequently been confirmed by others (e.g., salycilates in relation to gastroschisis). In the proposed analyses, we will estimate odds ratios and 95% confidence intervals using logistic regression, and results will be adjusted for potential confounders. Findings will test hypotheses about some drugs and provide leads for further research for others; both objectives seek to improve our understanding of risks associated with drugs commonly used by pregnant women.