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Vasoactive exposures during pregnancy and risk of microtia

Authors

  • Carla M. Van Bennekom,

    Corresponding author
    1. Slone Epidemiology Center at Boston University, Boston, Massachusetts
    • Slone Epidemiology Center at Boston University, 1010 Commonwealth Avenue, Boston, MA 02215
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  • Allen A. Mitchell,

    1. Slone Epidemiology Center at Boston University, Boston, Massachusetts
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  • Cynthia A. Moore,

    1. National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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  • Martha M. Werler,

    1. Slone Epidemiology Center at Boston University, Boston, Massachusetts
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    • This study was supported by a grant from the Centers for Disease Control and Prevention (U01DD000493). The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. Presented at the 28th International Conference on Pharmacoepidemiology, Barcelona, Spain, August 24–26, 2012; and the 33rd Annual David W. Smith Workshop on Malformations and Morphogenesis, Buford, Georgia, August 8–12, 2012.Dr. Werler serves on the advisory board of studies that evaluate the effects of medications taken in pregnancy for rheumatoid arthritis. It is possible that the manufacturers of these medications also make drugs that were examined in this article. Dr. Werler does not track manufacturer's product lines. Therefore, we believe there is no conflict of interest. Dr. Mitchell owns Johnson & Johnson stock valued at less than $20,000, and the company makes a number of the products under study; the company had no involvement in or knowledge of this analysis. Dr. Moore and Ms. Van Bennekom report no conflicts of interest.

  • and the National Birth Defects Prevention Study


Abstract

BACKGROUND

Little is known about the etiology of nonsyndromic microtia. This study investigated the hypothesis that microtia is caused by vascular disruption.

METHODS

The study analyzed data from the population-based National Birth Defects Prevention Study (NBDPS) for deliveries between 1997 and 2005. Four hundred eleven nonsyndromic cases of microtia, with or without additional defects, were compared to 6560 nonmalformed infants with respect to maternal exposures to vasoactive medications and smoking during the periconceptional period and conditions that have previously been associated with vascular events (multiple gestation, maternal history of type 1, type 2, or gestational diabetes, and hypertension). Odds ratios (ORs) were estimated with multivariable models, controlling for the effects of race/ethnicity, education, periconceptional folic acid use, and study center.

RESULTS

Risk estimates for vasoactive medications and smoking were not meaningfully increased. Maternal type 1/2 diabetes was diagnosed before or during the index pregnancy in 4% and 1% of cases, respectively, compared to 1% and 0.05% of controls; the adjusted OR for these two groups combined was 7.2 (95% confidence interval [CI], 3.9–13.1). Gestational diabetes was observed for 9% of cases and 6% of controls; the OR was moderately elevated (OR, 1.4; 95% CI, 0.9–2.0). ORs were also increased for multiple gestations (OR, 2.5; 95% CI, 1.5–4.2) and pre-existing hypertension (OR, 1.6; 95% CI, 1.0–2.5).

CONCLUSIONS

Because ORs were only elevated for diabetes and not for vasoactive exposures or other potential vascular events, findings suggest that some microtia occurrences may be part of the diabetic embryopathy rather than manifestations of vascular disruption. Birth Defects Research (Part A), 2013. © 2012 Wiley Periodicals, Inc.

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