Maternal antihypertensive medication use and selected birth defects in the National Birth Defects Prevention Study
Maternal antihypertensive medication use and selected birth defects in the National Birth Defects Prevention Study
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DOI：
10.1002/bdr2.1372
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发表时间：
2018-11-15
影响因子：
2.1
通讯作者：
Browne, Marilyn L.
中科院分区：
文献类型：
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作者：
Fisher, Sarah C.;Van Zutphen, Alissa R.;Browne, Marilyn L.
背景方法妊娠早期降压药使用与出生缺陷风险关系的研究资料有限。使用来自国家出生缺陷预防研究的数据，我们检查了特定抗高血压药物类别与28种非心脏性出生缺陷之间的关系。我们分析了1997-2011年期间估计分娩日期的17038例和11477例对照妊娠的自我报告数据。我们使用多变量logistic回归来估计优势比（ORs）和95%置信区间，调整了产妇年龄、种族/民族、体重指数、胎次、妊娠糖尿病和研究地点，以确定个体出生缺陷与妊娠前三个月抗高血压药物使用之间的关联。我们比较了报告妊娠早期使用降压药的妇女与正常妊娠妇女的风险。结论报告妊娠早期使用降压药的高血压妇女，年龄≥35岁、非西班牙裔黑人、肥胖、多胎和报告妊娠糖尿病的可能性高于正常妇女。与血压正常的妇女相比，妊娠早期使用降压药与小肠闭锁（校正OR为2.4,95% CI为1.2-4.7）和无脑畸形（校正OR为1.9,95% CI为1.0-3.5）的风险增加相关。这些缺陷的风险并不特定于任何特定的药物类别。母亲抗高血压药物的使用与我们分析的大多数出生缺陷无关，但与某些出生缺陷的风险增加有关。由于我们不能完全排除潜在高血压引起的混淆，而且大多数ORs是基于小数据，因此观察到的风险增加应谨慎解释。
Background Methods There are limited data on the relationship between antihypertensive medication use in early pregnancy and risk of birth defects. Using data from the National Birth Defects Prevention Study, we examined associations between specific antihypertensive medication classes and 28 noncardiac birth defects. We analyzed self-reported data on 17,038 case and 11,477 control pregnancies with estimated delivery dates during 1997-2011. We used multivariable logistic regression to estimate odds ratios (ORs) and 95% confidence intervals, adjusted for maternal age, race/ethnicity, body mass index, parity, pregestational diabetes, and study site, for associations between individual birth defects and antihypertensive medication use during the first trimester of pregnancy. We compared risk among women reporting early pregnancy antihypertensive medication use to normotensive women. Results Conclusions Hypertensive women who reported early pregnancy antihypertensive medication use were more likely to be at least 35 years old, non-Hispanic Black, obese, multiparous, and to report pregestational diabetes than normotensive women. Compared to normotensive women, early pregnancy antihypertensive medication use was associated with increased risk of small intestinal atresia (adjusted OR 2.4, 95% CI 1.2-4.7) and anencephaly (adjusted OR 1.9, 95% CI 1.0-3.5). Risk of these defects was not specific to any particular medication class. Maternal antihypertensive medication use was not associated with the majority of birth defects we analyzed, but was associated with an increased risk for some birth defects. Because we cannot entirely rule out confounding by the underlying hypertension and most ORs were based on small numbers, the increased risks observed should be interpreted with caution.