Center for Environmental Health, New York State Department of Health, Troy, NY, USA.
Pediatrics. 2012 Feb;129(2):e317-24. doi: 10.1542/peds.2010-2660. Epub 2012 Jan 16.
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.
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).
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).
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.
大约有 4%至 12%的孕妇患有哮喘；很少有研究调查母亲使用哮喘药物是否会增加出生缺陷的风险。我们研究了妊娠早期母亲使用哮喘药物是否会增加某些出生缺陷的风险。
分析了 1997 年 10 月至 2005 年 12 月期间出生的 2853 名患有 1 种或多种特定出生缺陷（膈疝、食管闭锁、小肠闭锁、肛门直肠闭锁、神经管缺陷、脐膨出或肢体缺失）的婴儿和 6726 名无缺陷对照婴儿的国家出生缺陷预防研究数据。病例组和对照组的母亲均接受了电话采访，询问了药物使用情况和其他潜在的危险因素。将母亲在妊娠前 1 个月至妊娠第 3 个月期间使用的（支气管扩张剂或抗炎药）哮喘药物定义为暴露。使用调整后的优势比（aOR）和 95%置信区间（95%CI）来估计母亲在妊娠前使用哮喘药物与个别主要出生缺陷之间的关联。
在研究的大多数缺陷中，母亲在妊娠前使用哮喘药物与出生缺陷之间没有统计学上的显著关联；然而，在孤立性食管闭锁（支气管扩张剂使用：aOR=2.39，95%CI=1.23，4.66）、孤立性肛门直肠闭锁（抗炎药使用：aOR=2.12，95%CI=1.09，4.12）和脐膨出（支气管扩张剂和抗炎药使用：aOR=4.13，95%CI=1.43，11.95）中观察到阳性关联。
在孤立性肛门直肠闭锁、食管闭锁和脐膨出与母亲在妊娠前使用哮喘药物之间观察到了阳性关联，但在其他研究的缺陷中未观察到关联。观察到的关联可能是偶然发现，也可能是由于母亲哮喘的严重程度和相关的缺氧，而不是药物使用的结果。
