Barbero Pablo, Liascovich Rosa, Valdez Rita, Moresco Angélica
Centro Nacional de Genética Médica, ANLIS, Ministerio de Salud, Argentina.
Arch Argent Pediatr. 2011 Jun;109(3):226-31. doi: 10.1590/S0325-00752011000300007.
Misoprostol is commonly used in Argentina to attempt abortion, although a certain proportion of pregnancies is not interrupted. On the other hand, various reports showed an association between misoprostol and congenital anomalies.
To estimate the risk of major congenital anomalies in children prenatally exposed to misoprostol, and to know their way of consumption during pregnancy.
A cohort study compared the frequency of abortion and major congenital abnormalities in offspring of pregnant women exposed to misoprostol (94) and an unexposed group of pregnant women (401), both groups consulting to a teratology information service.
Among women exposed to misoprostol only the 8.2% purchased it on prescription, 81.5% heard about its abortifacient effect by friends, neighbors or relatives, the average dose was 1.439 μg which was used both orally and vaginally by the 77.2%; the mean gestational age was 48.5 days and 35.2% used an additional abortive agent. Women exposed to misoprostol had a significantly higher frequency of abortions (exposed: 17/94= 18.1%, unexposed, 29/401= 7.2%, RR= 2.27, 95%: 1,30-3,98), and offspring with major congenital abnormalities (exposed: 5/77= 6.49%, unexposed: 8/372= 2.15%, RR= 3.02, 95%:1,02-8.98). The five malformed children prenatally exposed to misoprostol showed: 1) encephalocele and transverse limb defects; 2) porencephaly, 3) pulmonary adenomatous cystic malformation, 4) occipital encephalocele and, 5) intestinal malrotation.
The study found a significant association between prenatal exposure to misoprostol and the occurrence of major congenital anomalies.
在阿根廷，米索前列醇常用于尝试堕胎，尽管有一定比例的妊娠未被终止。另一方面，各种报告显示米索前列醇与先天性异常之间存在关联。
评估产前接触米索前列醇的儿童发生主要先天性异常的风险，并了解其在孕期的使用方式。
一项队列研究比较了接触米索前列醇的孕妇（94例）和未接触米索前列醇的孕妇（401例）后代的流产频率和主要先天性异常情况，两组均咨询了致畸信息服务机构。
在接触米索前列醇的女性中，只有8.2%是凭处方购买的，81.5%是通过朋友、邻居或亲戚听说其堕胎效果的，平均剂量为1.439微克，77.2%的人经口服和阴道使用；平均孕周为48.5天，35.2%的人使用了额外的堕胎剂。接触米索前列醇的女性流产频率显著更高（接触组：17/94 = 18.1%，未接触组：29/401 = 7.2%，相对危险度=2.27，95%可信区间：1.30 - 3.98），其后代发生主要先天性异常的频率也更高（接触组：5/77 = 6.49%，未接触组：8/372 = 2.15%，相对危险度=3.02，95%可信区间：1.02 - 8.98）。产前接触米索前列醇的5名畸形儿童表现为：1）脑膨出和四肢横断性缺损；2）脑穿通畸形；3）肺腺瘤样囊性畸形；4）枕部脑膨出；5）肠旋转不良。
该研究发现产前接触米索前列醇与主要先天性异常的发生之间存在显著关联。
