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Maternal hypertension, antihypertensive medication use, and the risk of severe hypospadias

Authors

  • Alissa R. Caton,

    Corresponding author
    1. Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York
    2. Congenital Malformations Registry, Center for Environmental Health, New York State Department of Health, Troy, New York
    • New York State Department of Health, Bureau of Environmental and Occupational Epidemiology, Flanigan Square, 547 River St., Room 200, Troy, NY 12180-2216
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  • Erin M. Bell,

    1. Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York
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  • Charlotte M. Druschel,

    1. Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York
    2. Congenital Malformations Registry, Center for Environmental Health, New York State Department of Health, Troy, New York
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  • Martha M. Werler,

    1. Slone Epidemiology Center at Boston University, Boston, Massachusetts
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  • Allen A. Mitchell,

    1. Slone Epidemiology Center at Boston University, Boston, Massachusetts
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  • Marilyn L. Browne,

    1. Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York
    2. Congenital Malformations Registry, Center for Environmental Health, New York State Department of Health, Troy, New York
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  • Louise-Anne McNutt,

    1. Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York
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  • Paul A. Romitti,

    1. Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
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  • Richard S. Olney,

    1. National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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  • Adolfo Correa

    1. National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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  • This article is a US Government work and, as such, is in the public domain in the United States of America.

  • Presented at the 20th annual meeting of the Society for Paediatric and Perinatal Epidemiology, Boston, Massachusetts, June 18–19, 2007.

    The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the National Center for Birth Defects and Developmental Disabilities or the Centers for Disease Control and Prevention.

Abstract

BACKGROUND:

Hypertensive disorders occur in an estimated 5–10% of pregnancies, but few studies have examined birth defects in relation to high blood pressure and antihypertensive medication use. The objective of this study was to investigate the relationship between high blood pressure, antihypertensive medication use, and severe hypospadias.

METHODS:

We used data from the National Birth Defects Prevention Study, a population-based, multicenter, case-control study of birth defects to assess risks for severe hypospadias in relation to self-reported high blood pressure and prenatal exposures to antihypertensive drugs in 758 male infants with severe hypospadias and 2,058 male controls born between 1997 and 2002. Logistic regression analyses estimated ORs and 95% CIs, adjusted for potential confounders.

RESULTS:

We observed slight to moderate elevations in the risk of severe hypospadias for maternal untreated hypertension (adjusted OR 2.1; 95% CI: 1.6–2.9) and antihypertensive medication use during 1 month preconception through pregnancy month 4 (adjusted OR 1.4; 95% CI: 0.7–2.9). The association was strongest for subjects initiating medications after the fourth month (adjusted OR 5.0; 95% CI: 1.9–12.9).

CONCLUSIONS:

We observed an association between hypertension, antihypertensive medication use, and the risk of severe hypospadias, particularly when medication use began late in pregnancy. Because hypospadias occurs in early pregnancy, the data suggest that hypertension and its morphologic/physiologic precursors play an etiologic role, perhaps via compromised uteroplacental perfusion. Birth Defects Research (Part A) 2008. © 2007 Wiley-Liss, Inc.

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