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American Academy of Pediatrics
Article

Maternal Asthma Medication Use and the Risk of Selected Birth Defects

Shao Lin, Jean Pierre W. Munsie, Michele L. Herdt-Losavio, Charlotte M. Druschel, Kimberly Campbell, Marilyn L. Browne, Paul A. Romitti, Richard S. Olney, Erin M. Bell and the National Birth Defects Prevention Study
Pediatrics February 2012, 129 (2) e317-e324; DOI: https://doi.org/10.1542/peds.2010-2660
Shao Lin
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Jean Pierre W. Munsie
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Michele L. Herdt-Losavio
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Charlotte M. Druschel
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Kimberly Campbell
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Marilyn L. Browne
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Paul A. Romitti
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Richard S. Olney
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Erin M. Bell
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Abstract

OBJECTIVES: Approximately 4% to 12% of pregnant women have asthma; few studies have examined the effects of maternal asthma medication use on birth defects. We examined whether maternal asthma medication use during early pregnancy increased the risk of selected birth defects.

METHODS: National Birth Defects Prevention Study data for 2853 infants with 1 or more selected birth defects (diaphragmatic hernia, esophageal atresia, small intestinal atresia, anorectal atresia, neural tube defects, omphalocele, or limb deficiencies) and 6726 unaffected control infants delivered from October 1997 through December 2005 were analyzed. Mothers of cases and controls provided telephone interviews of medication use and additional potential risk factors. Exposure was defined as maternal periconceptional (1 month prior through the third month of pregnancy) asthma medication use (bronchodilator or anti-inflammatory). Associations between maternal periconceptional asthma medication use and individual major birth defects were estimated by using adjusted odds ratios (aOR) and 95% confidence intervals (95%CI).

RESULTS: No statistically significant associations were observed for maternal periconceptional asthma medication use and most defects studied; however, positive associations were observed between maternal asthma medication use and isolated esophageal atresia (bronchodilator use: aOR = 2.39, 95%CI = 1.23, 4.66), isolated anorectal atresia (anti-inflammatory use: aOR = 2.12, 95%CI = 1.09, 4.12), and omphalocele (bronchodilator and anti-inflammatory use: aOR = 4.13, 95%CI = 1.43, 11.95).

CONCLUSIONS: Positive associations were observed for anorectal atresia, esophageal atresia, and omphalocele and maternal periconceptional asthma medication use, but not for other defects studied. It is possible that observed associations may be chance findings or may be a result of maternal asthma severity and related hypoxia rather than medication use.

KEY WORDS
  • anti-inflammatory
  • asthma
  • birth defects
  • bronchodilator
  • medication
  • Abbreviations:
    aOR —
    adjusted odds ratio
    CI —
    confidence interval
    EDD —
    estimated dates of delivery
    NBDPS —
    National Birth Defects Prevention Study
    VACTERL —
    an association of defects that includes Vertebral defects, Anorectal atresia, Cardiac defects, Tracheo-esophageal fistula, Esophageal atresia, Renal defects, and Limb defects
    VATER —
    an association that includes Vertebral defects, Anorectal atresia, Tracheo-esophageal fistula, Esophageal atresia, and Renal defects
    • Accepted October 13, 2011.
    • Copyright © 2012 by the American Academy of Pediatrics

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    Pediatrics
    Vol. 129, Issue 2
    1 Feb 2012
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    Maternal Asthma Medication Use and the Risk of Selected Birth Defects
    Shao Lin, Jean Pierre W. Munsie, Michele L. Herdt-Losavio, Charlotte M. Druschel, Kimberly Campbell, Marilyn L. Browne, Paul A. Romitti, Richard S. Olney, Erin M. Bell, the National Birth Defects Prevention Study
    Pediatrics Feb 2012, 129 (2) e317-e324; DOI: 10.1542/peds.2010-2660

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    Maternal Asthma Medication Use and the Risk of Selected Birth Defects
    Shao Lin, Jean Pierre W. Munsie, Michele L. Herdt-Losavio, Charlotte M. Druschel, Kimberly Campbell, Marilyn L. Browne, Paul A. Romitti, Richard S. Olney, Erin M. Bell, the National Birth Defects Prevention Study
    Pediatrics Feb 2012, 129 (2) e317-e324; DOI: 10.1542/peds.2010-2660
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