Maternal Medication Use and Risks of Gastroschisis and Small Intestinal Atresia

Abstract

Gastroschisis and small intestinal atresia (SIA) are birth defects that are thought to arise from vascular disruption of fetal mesenteric vessels. Previous studies of gastroschisis have suggested that risk is increased for maternal use of vasoactive over-the-counter medications, including specific analgesics and decongestants. This retrospective study evaluated the relation between maternal use of cough/cold/analgesic medications and risks of gastroschisis and SIA. From 1995 to 1999, the mothers of 206 gastroschisis cases, 126 SIA cases, and 798 controls in the United States and Canada were interviewed about medication use and illnesses. Risks of gastroschisis were elevated for use of aspirin (odds ratio = 2.7, 95% confidence interval: 1.2, 5.9), pseudoephedrine (odds ratio = 1.8, 95% confidence interval: 1.0, 3.2), acetaminophen (odds ratio = 1.5, 95% confidence interval: 1.1, 2.2), and pseudoephedrine combined with acetaminophen (odds ratio = 4.2, 95% confidence interval: 1.9, 9.2). Risks of SIA were increased for any use of pseudoephedrine (odds ratio = 2.0, 95% confidence interval: 1.0, 4.0) and for use of pseudoephedrine in combination with acetaminophen (odds ratio = 3.0, 95% confidence interval: 1.1, 8.0). Reported fever, upper respiratory infection, and allergy were not associated with risks of either defect. These findings add more evidence that aspirin use in early pregnancy increases risk of gastroschisis. Although pseudoephedrine has previously been shown to increase gastroschisis risk, findings of this study raise questions about interactions between medications and possible confounding by underlying illness. Am J Epidemiol 2002;155:26-31.

The incidence and maternal age distribution of abdominal wall defects in Norway and Arkhangelskaja Oblast in Russia

“…Still, this finding was unexpected, considering the relatively young pregnant population in AO compared to in Norway. Misclassifications of gastroschisis as omphalocele in AO could be an explanation for the ratio difference (7,8). Since our study only included cases registered as isolated, under-diagnosing of anomalies cooccurring with omphalocele, such as heart defects (4), could also be an explanation.…”

“…Thus, it was a strength of our study that information about induced and spontaneous abortions from as early as weeks' gestation was available. Reported studies concerning severe birth defects in relation to maternal age usually did not include spontaneous abortuses with less than 0 or 4 weeks' gestation (5,9,0,7,8); they only included medically induced abortuses (0), or abortuses were not included at all (8). Earlier studies of these defects in Norway did not include medical abortions and spontaneous abortuses with -6 weeks' gestation (9,7,).…”

“…An association between these defects and stillbirth/spontaneous abortion has been reported (4,5), but most of the affected liveborn survive (6). The aetiology and incidence of these defects differ (7); for gastroschisis, teratogens are implicated (8), whereas foetuses with omphalocele also tend to have other anomalies and abnormalities (4,5). A previous study of gastroschisis in Norway reported an increasing incidence at birth in the period 967-998 (9).…”

Rising Birth Prevalence of Gastroschisis

“…[10][11][12][13] Additional risk may occur when combinations of these medications are used. 14 Torfs et al 15 demonstrated that teenage diets, with lower intake of a-carotene, total glutathione, and high levels of nitrosamines, were associated with increased risk of gastroschisis.…”

Maternal nativity as a risk factor for gastroschisis: A population‐based study

“…Young maternal age is the most consistently reported risk factor (Baerg et al, 2003;Feldkamp et al, 2007;Hougland et al, 2005;Saada et al, 2005). Other maternal factors that have been suspected to increase gastroschisis risk include maternal smoking, maternal use of vasoactive substances, low socioeconomic status, low pregnancy body mass index, and Hispanic ethnicity (Haddow et al, 1993;Torfs et al, 1994;Lam et al, 1999;Werler et al, 2002;Salihu et al, 2003;Saada et al, 2005;Canfield et al, 2006;Feldkamp et al, 2007;Stothard et al, 2009). More recently, maternal birthplace (nativity) has been reported to affect the risk of congenital malformations, including gastroschisis; foreign-born women have a lower risk of delivering an infant with gastroschisis than U.S.-born women (Zhu et al, 2006;Vu et al, 2008).…”