Shaw G M, Todoroff K, Velie E M, Lammer E J
March of Dimes Birth Defects Foundation, California Birth Defects Monitoring Program, Emeryville 94608, USA.
Teratology. 1998 Jan;57(1):1-7. doi: 10.1002/(SICI)1096-9926(199801)57:1<1::AID-TERA1>3.0.CO;2-6.
We investigated if selected maternal illnesses or medications used during the periconceptional period increased risk of having neural tube defect (NTD)-affected pregnancies. We used a population-based case-control study of fetuses and liveborn infants with NTDs among 1989-1991 California births. In-person interviews were conducted with mothers of 538 (88% of eligible) NTD cases and 539 (88%) nonmalformed controls, usually within 5 months of delivery. A maternal fever or febrile illness episode in the first trimester was associated with an increased risk for having a NTD-affected pregnancy, odds ratio (OR) = 1.91 (95% confidence interval, 1.35-2.72) for fever and OR = 2.02 (1.20-3.43) for febrile illness. Risk estimates were not substantially altered after adjustment for maternal age, race/ethnicity, education, vitamin use, and body mass index. Other reported illnesses were generally not associated with risks of 1.5 or greater, or were too infrequent to adequately estimate risk. An OR of 1.5 or greater was observed for maternal use of guaifenesin, OR = 2.04 (0.79-5.28), and an OR of 0.5 or less was observed for maternal use of calcium-containing medicines, OR = 0.38 (0.14-1.03). Our findings are consistent with previous reports that suggested elevated NTD risks from maternal fever. We could not discriminate, however, whether the increased risks observed for maternal fever were indicative of a causal relation or due to reporting bias. Our findings suggest that many of the illnesses common to reproductive-aged women and the medications commonly used to treat them during pregnancy, except, perhaps, for those illnesses that are febrile-related, do not appear to substantially contribute to the occurrence of NTDs in the population.
我们调查了孕期特定的母体疾病或药物使用是否会增加神经管缺陷（NTD）妊娠的风险。我们采用了一项基于人群的病例对照研究，研究对象为1989 - 1991年加利福尼亚州出生的患有NTD的胎儿和活产婴儿。对538例（88%符合条件）NTD病例的母亲和539例（88%）无畸形对照的母亲进行了面对面访谈，访谈通常在分娩后5个月内进行。孕早期母体发热或发热性疾病发作与NTD妊娠风险增加相关，发热的比值比（OR）= 1.91（95%置信区间，1.35 - 2.72），发热性疾病的OR = 2.02（1.20 - 3.43）。在对母体年龄、种族/民族、教育程度、维生素使用情况和体重指数进行调整后，风险估计值没有实质性改变。其他报告的疾病一般与1.5或更高的风险无关，或者发生频率过低，无法充分估计风险。母体使用愈创甘油醚的OR为1.5或更高，OR = 2.04（0.79 - 5.28），母体使用含钙药物的OR为0.5或更低，OR = 0.38（0.14 - 1.03）。我们的研究结果与之前提示母体发热会增加NTD风险的报告一致。然而，我们无法区分观察到的母体发热风险增加是表明存在因果关系还是由于报告偏倚。我们的研究结果表明，育龄妇女常见的许多疾病以及孕期常用的治疗这些疾病的药物，可能除了与发热相关的疾病外，似乎对人群中NTD的发生没有实质性影响。
