Congenital anomalies in the offspring of women with total hip replacement: a nationwide register study in Finland

Abstract

Background: Few previous studies have analysed the possible teratogenic effect of maternal total hip replacement (THR) on congenital anomalies. The aim of this study was to estimate the risk of major congenital anomalies in the offspring of women with THR. Furthermore, we compared the risks based on type of implant (metal-on-metal [MoM]/non-MoM). Methods: The study population for this register-based cohort study was gathered from six Finnish national registers. All fertile-aged females who underwent THR from 1980 to 2007 and three reference females for each THR patient without THR were selected. THR operation day was the start of the follow-up for both groups. Information on pregnancies, induced abortions (IA) and congenital anomalies was gathered for the years 1987–2007 and the proportions of congenital anomalies were compared. Results: In the THR group, 2429 women had 256 pregnancies, 205 (80.1%) deliveries and 51 (19.9%) IAs. In the reference group, 7276 women had 1670 pregnancies, 1443 (86.4%) deliveries and 236 (13.6%) IAs. There was no difference in the incidence of major anomalies between the THR (3.5%, n = 9) and the reference group (3.6%, n = 60), p = 0.91. In the THR group, there was no difference in the risk of major anomalies between the patients with a MoM-THR (10.5%, 2/19) and those with a non-MoM (2.9%, 7/241) (OR 3.93, 95% confidence interval 0.76–20.2; p = 0.13). Conclusions: Reassuringly, maternal THR does not appear to increase the risk of major congenital anomalies or pregnancies ending due to suspected foetal anomalies. Studies with larger study populations are needed to further assess the risk of anomalies in the offspring of women having MoM-THR.

Assessing the Effects and Challenges of Total Hip Arthroplasty before Pregnancy and Childbirth: A Systematic Review

“…No teratogenic effects on the newborns were observed; yet, no concrete data existed in terms of the children’s later development [ 22 ]. Finally, a study by Kuitunen et al [ 23 ], utilizing data from the Finish nationwide registry based on 2429 women with THA history compared to 7276 women as a reference group, denoted that in the THA group, three (5.9%) out of the total number of IAs were executed owing to suspected fetal defects, while four (1.9%) stillbirths and eight (3.8%) newborns with one or more major abnormalities were noted. Regarding the control group, 13 (5.5%) out of the total number of IAs were performed due to suspected fetal defects, whilst eight (0.6%) stillbirths and 47 (3.3%) newborns with one or more major defects were recorded.…”

“…Regarding the control group, 13 (5.5%) out of the total number of IAs were performed due to suspected fetal defects, whilst eight (0.6%) stillbirths and 47 (3.3%) newborns with one or more major defects were recorded. No noteworthy discrepancies were descried in terms of the rates of defects between women who had undergone metal-on-metal THA and those with other types of hip prostheses [ 23 ].…”

“…It needs to be stressed that these women customarily suffer from diseases like RA, congenital hip dysplasia or hip osteonecrosis. These patients should be reassured that they can proceed with vaginal delivery without expecting complications, if hip flexion is maintained below 90° [ 23 ]. Furthermore, the lower probability of labor trial success can be ascribed to the fact that many women had already arranged an elective c-section and trial was undertaken due to early labor onset.…”

“…The study carried out by Kuitunen et al [ 23 ] denoted that pregnant women with a past medical history of THA with non-MoM implants did not feature higher rates of delivering offspring with congenital anomalies in comparison with the control group. Moreover, women with MoM hip implants demonstrated a comparable risk of having offspring with congenital defects when contrasted to the control group, as the discrepancies were not statistically significant.…”

Pregnancy, Hip Pain, and Total Hip Replacement

“…A population-based study in Finland demonstrated that the birth rate was 20% to 60% lower in patients with a THR than in a reference population 38 . The same group demonstrated that, reassuringly, THR did not increase the rate of congenital anomalies in the offspring of women with a THR 39 .…”