New York State Department of Health, Congenital Malformations Registry, Albany, New York.
Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York.
Birth Defects Res. 2018 Nov 15;110(19):1433-1442. doi: 10.1002/bdr2.1372. Epub 2018 Sep 10.
There are limited data on the relationship between antihypertensive medication use in early pregnancy and risk of birth defects.
Using data from the National Birth Defects Prevention Study, we examined associations between specific antihypertensive medication classes and 28 noncardiac birth defects. We analyzed self-reported data on 17,038 case and 11,477 control pregnancies with estimated delivery dates during 1997-2011. We used multivariable logistic regression to estimate odds ratios (ORs) and 95% confidence intervals, adjusted for maternal age, race/ethnicity, body mass index, parity, pregestational diabetes, and study site, for associations between individual birth defects and antihypertensive medication use during the first trimester of pregnancy. We compared risk among women reporting early pregnancy antihypertensive medication use to normotensive women.
Hypertensive women who reported early pregnancy antihypertensive medication use were more likely to be at least 35 years old, non-Hispanic Black, obese, multiparous, and to report pregestational diabetes than normotensive women. Compared to normotensive women, early pregnancy antihypertensive medication use was associated with increased risk of small intestinal atresia (adjusted OR 2.4, 95% CI 1.2-4.7) and anencephaly (adjusted OR 1.9, 95% CI 1.0-3.5). Risk of these defects was not specific to any particular medication class.
Maternal antihypertensive medication use was not associated with the majority of birth defects we analyzed, but was associated with an increased risk for some birth defects. Because we cannot entirely rule out confounding by the underlying hypertension and most ORs were based on small numbers, the increased risks observed should be interpreted with caution.
关于妊娠早期使用降压药物与出生缺陷风险之间的关系，数据有限。
利用全国出生缺陷预防研究的数据，我们研究了特定降压药物类别与 28 种非心脏出生缺陷之间的关系。我们分析了 1997 年至 2011 年间估计分娩日期在 17038 例病例和 11477 例对照妊娠中的自我报告数据。我们使用多变量逻辑回归估计了比值比（OR）和 95％置信区间，调整了母亲的年龄、种族/族裔、体重指数、产次、孕前糖尿病和研究地点，以评估个体出生缺陷与妊娠早期使用降压药物之间的关联。我们将报告妊娠早期使用降压药物的高血压女性与血压正常的女性进行了比较。
报告妊娠早期使用降压药物的高血压女性比血压正常的女性更有可能年龄在 35 岁以上、非西班牙裔黑人、肥胖、多产，并且更有可能报告孕前糖尿病。与血压正常的女性相比，妊娠早期使用降压药物与小肠闭锁（调整后的 OR 2.4，95％CI 1.2-4.7）和无脑畸形（调整后的 OR 1.9，95％CI 1.0-3.5）的风险增加相关。这些缺陷的风险与任何特定药物类别均无关。
母亲使用降压药物与我们分析的大多数出生缺陷无关，但与某些出生缺陷的风险增加有关。由于我们不能完全排除潜在高血压的混杂因素，并且大多数 OR 基于小数量，因此观察到的风险增加应谨慎解释。
