Antifungal medication use during early pregnancy and the risk of congenital heart defects in the National Birth Defects Prevention Study, 1997–2011

IF 1.6 4区 医学 Q4 DEVELOPMENTAL BIOLOGY
Eleni A. Papadopoulos, Meredith M. Howley, Sarah C. Fisher, Alissa R. Van Zutphen, Martha M. Werler, Paul A. Romitti, Marilyn L. Browne, for the National Birth Defects Prevention Study
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引用次数: 0

Abstract

Background

Fungal infections are common among pregnant people. Recent studies suggest positive associations between oral antifungals used to treat fungal infections and congenital heart defects (CHDs).

Methods

We estimated associations between first trimester antifungal use and 20 major, specific CHDs using data from the National Birth Defects Prevention Study (NBDPS), a multi-site, case–control study that included pregnancies with estimated delivery dates from October 1997 through December 2011. Infants with CHDs (“cases”) were ascertained from 10 birth defect surveillance programs. Live born infants without major birth defects (“controls”) were randomly selected from birth records or hospital discharge lists. First trimester antifungal use was self-reported via maternal interview. We estimated adjusted odds ratios (AORs) and 95% confidence intervals (CIs) using logistic regression with Firth's penalized likelihood.

Results

First trimester antifungal use was reported by 148/11,653 (1.3%) case and 123/11,427 (1.1%) control participants. We estimated AORs for 12 CHDs; six had AORs >1.5 (tetralogy of Fallot, double outlet right ventricle with transposition of the great arteries [DORV-TGA], atrioventricular septal defect, hypoplastic left heart syndrome, pulmonary atresia, muscular ventricular septal defect), and one (pulmonary valve stenosis) had an AOR <0.7. All CIs included the null, except for DORV-TGA.

Conclusions

First trimester antifungal use was rare. We observed some positive associations for several specific CHDs in our analysis, although the CIs largely included the null. Results do not support a large increase in risk, but smaller increases in risk for certain CHD cannot be ruled out.

1997-2011年全国出生缺陷预防研究中孕早期抗真菌药物的使用与先天性心脏缺陷的风险
背景 真菌感染在孕妇中很常见。最近的研究表明,用于治疗真菌感染的口服抗真菌药与先天性心脏缺陷(CHD)之间存在正相关。 方法 我们利用全国出生缺陷预防研究(NBDPS)的数据估算了怀孕头三个月使用抗真菌药物与 20 种主要的特定先天性心脏病之间的关系,NBDPS 是一项多地点病例对照研究,研究对象包括估计分娩日期为 1997 年 10 月至 2011 年 12 月的孕妇。患有先天性心脏病的婴儿("病例")来自 10 个出生缺陷监测项目。无重大出生缺陷的活产婴儿("对照组")从出生记录或出院名单中随机抽取。孕期前三个月使用抗真菌药物的情况是通过产妇访谈自我报告的。我们使用逻辑回归和 Firth 惩罚似然法估算了调整后的几率比(AOR)和 95% 的置信区间(CI)。 结果 148/11,653 例病例(1.3%)和 123/11,427 例对照组病例(1.1%)报告了孕期前三个月使用抗真菌药物的情况。我们估计了 12 种先天性心脏病的 AOR,其中 6 种的 AOR 为 1.5(法洛氏四联症、双出口右心室伴大动脉转位 [DORV-TGA]、房室间隔缺损、左心发育不全综合征、肺动脉闭锁、肌性室间隔缺损),1 种(肺动脉瓣狭窄)的 AOR 为 0.7。除 DORV-TGA 外,所有 CI 均包括 null。 结论 怀孕头三个月使用抗真菌药物的情况很少见。在我们的分析中,我们观察到与几种特定的先天性心脏病存在一些正相关关系,尽管 CIs 大多包含空值。结果不支持风险的大幅增加,但不能排除某些先心病风险的小幅增加。
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来源期刊
Birth Defects Research
Birth Defects Research Medicine-Embryology
CiteScore
3.60
自引率
9.50%
发文量
153
期刊介绍: The journal Birth Defects Research publishes original research and reviews in areas related to the etiology of adverse developmental and reproductive outcome. In particular the journal is devoted to the publication of original scientific research that contributes to the understanding of the biology of embryonic development and the prenatal causative factors and mechanisms leading to adverse pregnancy outcomes, namely structural and functional birth defects, pregnancy loss, postnatal functional defects in the human population, and to the identification of prenatal factors and biological mechanisms that reduce these risks. Adverse reproductive and developmental outcomes may have genetic, environmental, nutritional or epigenetic causes. Accordingly, the journal Birth Defects Research takes an integrated, multidisciplinary approach in its organization and publication strategy. The journal Birth Defects Research contains separate sections for clinical and molecular teratology, developmental and reproductive toxicology, and reviews in developmental biology to acknowledge and accommodate the integrative nature of research in this field. Each section has a dedicated editor who is a leader in his/her field and who has full editorial authority in his/her area.
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