Ella Segal, Daniella Landau, Lior Hassan, Adir Israeli, Rafael Gorodischer
{"title":"产前接触抑酸药物与足月新生儿动脉导管未闭的发生。","authors":"Ella Segal, Daniella Landau, Lior Hassan, Adir Israeli, Rafael Gorodischer","doi":"10.1055/a-2295-6339","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong> The ductus arteriosus normally closes after birth. Histamine 2 receptor antagonist (H<sub>2</sub>RA) has been associated with patent ductus arteriosus (PDA). We aimed to study the characteristics of term infants with PDA and their possible association with prenatal exposure to antacids-proton pump inhibitors (PPIs) and H<sub>2</sub>RA.</p><p><strong>Study design: </strong> This was a population-based matched case-control study of mothers registered at \"Clalit\" Health Maintenance Organization (HMO) and their infants born at \"Soroka\" University Medical Center (SUMC) between 2001 and 2018. Cases are defined as term infants born with PDA diagnosed by echocardiography and registered in the postdelivery discharge form. Each case was matched with four term newborns without PDA diagnosis. Exposure window was defined by the timing of first purchase of H<sub>2</sub>RA or PPI during pregnancy and based on information from a computerized medication database (Clalit HMO, SUMC).</p><p><strong>Results: </strong> PDA was diagnosed in 1,884 term infants (4.9%). Characteristics included a significantly higher percentage of lack of prenatal care, cesarean section, in vitro fertilization, polyhydramnios, oligohydramnios, Apgar 1 minute <5, and prenatal exposure to H<sub>2</sub>RA (odds ratio [OR] 4.18) and PPIs (OR 3.50; all <i>p</i> < 0.001). PDA association with exposure window was similar in each trimester (1.5-2%) for both H<sub>2</sub>RA and PPI.</p><p><strong>Conclusion: </strong> PDA incidence in term infants in our population was greater than previously reported. PPI and H<sub>2</sub>RA are both antiacids with different mechanisms of action. The similar OR for exposure to one as well as the other, and the lack of influence of the initial exposure period, are compatible with bias.</p><p><strong>Key points: </strong>· Term newborns with PDA have different characteristics than newborns without PDA.. · Prenatal exposure to PPIs or H2RA is associated with greater risk of PDA in term newborns.. · The possible effect mechanism of PPIs on the ductus is unclear and understudied..</p>","PeriodicalId":7584,"journal":{"name":"American journal of perinatology","volume":" ","pages":"2091-2097"},"PeriodicalIF":1.5000,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prenatal Exposure to Acid Suppressor Medications and Development of Ductus Arteriosus in Term Newborns.\",\"authors\":\"Ella Segal, Daniella Landau, Lior Hassan, Adir Israeli, Rafael Gorodischer\",\"doi\":\"10.1055/a-2295-6339\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objective: </strong> The ductus arteriosus normally closes after birth. Histamine 2 receptor antagonist (H<sub>2</sub>RA) has been associated with patent ductus arteriosus (PDA). We aimed to study the characteristics of term infants with PDA and their possible association with prenatal exposure to antacids-proton pump inhibitors (PPIs) and H<sub>2</sub>RA.</p><p><strong>Study design: </strong> This was a population-based matched case-control study of mothers registered at \\\"Clalit\\\" Health Maintenance Organization (HMO) and their infants born at \\\"Soroka\\\" University Medical Center (SUMC) between 2001 and 2018. Cases are defined as term infants born with PDA diagnosed by echocardiography and registered in the postdelivery discharge form. Each case was matched with four term newborns without PDA diagnosis. Exposure window was defined by the timing of first purchase of H<sub>2</sub>RA or PPI during pregnancy and based on information from a computerized medication database (Clalit HMO, SUMC).</p><p><strong>Results: </strong> PDA was diagnosed in 1,884 term infants (4.9%). Characteristics included a significantly higher percentage of lack of prenatal care, cesarean section, in vitro fertilization, polyhydramnios, oligohydramnios, Apgar 1 minute <5, and prenatal exposure to H<sub>2</sub>RA (odds ratio [OR] 4.18) and PPIs (OR 3.50; all <i>p</i> < 0.001). PDA association with exposure window was similar in each trimester (1.5-2%) for both H<sub>2</sub>RA and PPI.</p><p><strong>Conclusion: </strong> PDA incidence in term infants in our population was greater than previously reported. PPI and H<sub>2</sub>RA are both antiacids with different mechanisms of action. The similar OR for exposure to one as well as the other, and the lack of influence of the initial exposure period, are compatible with bias.</p><p><strong>Key points: </strong>· Term newborns with PDA have different characteristics than newborns without PDA.. · Prenatal exposure to PPIs or H2RA is associated with greater risk of PDA in term newborns.. · The possible effect mechanism of PPIs on the ductus is unclear and understudied..</p>\",\"PeriodicalId\":7584,\"journal\":{\"name\":\"American journal of perinatology\",\"volume\":\" \",\"pages\":\"2091-2097\"},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2024-11-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"American journal of perinatology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1055/a-2295-6339\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/3/27 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"OBSTETRICS & GYNECOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"American journal of perinatology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1055/a-2295-6339","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/3/27 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"OBSTETRICS & GYNECOLOGY","Score":null,"Total":0}
Prenatal Exposure to Acid Suppressor Medications and Development of Ductus Arteriosus in Term Newborns.
Objective: The ductus arteriosus normally closes after birth. Histamine 2 receptor antagonist (H2RA) has been associated with patent ductus arteriosus (PDA). We aimed to study the characteristics of term infants with PDA and their possible association with prenatal exposure to antacids-proton pump inhibitors (PPIs) and H2RA.
Study design: This was a population-based matched case-control study of mothers registered at "Clalit" Health Maintenance Organization (HMO) and their infants born at "Soroka" University Medical Center (SUMC) between 2001 and 2018. Cases are defined as term infants born with PDA diagnosed by echocardiography and registered in the postdelivery discharge form. Each case was matched with four term newborns without PDA diagnosis. Exposure window was defined by the timing of first purchase of H2RA or PPI during pregnancy and based on information from a computerized medication database (Clalit HMO, SUMC).
Results: PDA was diagnosed in 1,884 term infants (4.9%). Characteristics included a significantly higher percentage of lack of prenatal care, cesarean section, in vitro fertilization, polyhydramnios, oligohydramnios, Apgar 1 minute <5, and prenatal exposure to H2RA (odds ratio [OR] 4.18) and PPIs (OR 3.50; all p < 0.001). PDA association with exposure window was similar in each trimester (1.5-2%) for both H2RA and PPI.
Conclusion: PDA incidence in term infants in our population was greater than previously reported. PPI and H2RA are both antiacids with different mechanisms of action. The similar OR for exposure to one as well as the other, and the lack of influence of the initial exposure period, are compatible with bias.
Key points: · Term newborns with PDA have different characteristics than newborns without PDA.. · Prenatal exposure to PPIs or H2RA is associated with greater risk of PDA in term newborns.. · The possible effect mechanism of PPIs on the ductus is unclear and understudied..
期刊介绍：
The American Journal of Perinatology is an international, peer-reviewed, and indexed journal publishing 14 issues a year dealing with original research and topical reviews. It is the definitive forum for specialists in obstetrics, neonatology, perinatology, and maternal/fetal medicine, with emphasis on bridging the different fields.
The focus is primarily on clinical and translational research, clinical and technical advances in diagnosis, monitoring, and treatment as well as evidence-based reviews. Topics of interest include epidemiology, diagnosis, prevention, and management of maternal, fetal, and neonatal diseases. Manuscripts on new technology, NICU set-ups, and nursing topics are published to provide a broad survey of important issues in this field.
All articles undergo rigorous peer review, with web-based submission, expedited turn-around, and availability of electronic publication.
The American Journal of Perinatology is accompanied by AJP Reports - an Open Access journal for case reports in neonatology and maternal/fetal medicine.
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