Stress of 911 Linked To Decrease In Male Babies Born With Birth Defects

MedicalResearch.com Interview with:
Parvati Singh B. Tech, MBA, MPA
PhD student, Department of Public Health,
University of California, Irvine and
Dr. Tim Bruckner, first author

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: This study builds upon earlier research by our group which showed that male fetal deaths rose and the number of liveborn males fell after the 9/11 attacks. Here we show that, in California, the number of live born males with birth defects fell after 9/11.

This finding appears consistent with the notion that frail male gestations, such as those with defects, may have been lost in utero as a result of the stress induced by the 9/11 attacks.

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Maternal Obesity Linked To Increased Risk of Congenital Malformations in Offspring

MedicalResearch.com Interview with:
Dr. Martina Persson

Clinical Epidemiology Unit
Department of Medicine Solna
Karolinska University Hospita

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: It is well known that obesity increases risks of several maternal, fetal and neonatal complications including congenital malformations. However, it has not been clear if risks of malformations are increased also in offspring of normal weight mothers or if risks increase with degree of maternal obesity.

In this study, we found progressively increasing risks of major congenital malformations in the offspring with a mother’s overweight and obesity severity.

MedicalResearch.com: What should readers take away from your report?

Response: The most sensitive period of fetal organ development is the first eight weeks of gestation and it is during this time a mother´s BMI may influence risks of malformations. Thus, it is important to try to obtain a normal bodyweight before conception.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Our results should be confirmed in other populations and mechanisms behind the increased risks of malformations associated with maternal obesity should be further explored.

MedicalResearch.com: Is there anything else you would like to add?

Response: Obesity is a major health problem in many countries in the world. Preventive measures to halt the obesity epidemic should be implemented at all levels of society.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Lithium Use in Pregnancy and Risk of Fetal Cardiac Malformations

MedicalResearch.com Interview with:

Elisabetta Patorno, MD, DrPH Assistant Professor of Medicine, Harvard Medical School Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital

Dr. Patorno

Elisabetta Patorno, MD, DrPH
Assistant Professor of Medicine, Harvard Medical School
Division of Pharmacoepidemiology and Pharmacoeconomics,
Department of Medicine, Brigham and Women’s Hospital

MedicalResearch.com: What is the background for this study?

Response: Lithium, a widely used medicine to treat bipolar disorder, has been associated with a 400 fold increased risk of Ebstein’s anomaly, a congenital malformation of the heart, and a 5 fold increased risk of cardiac defects overall in infants when taken early in pregnancy, based on the results from the International Register of Lithium Babies in the 1970’s. Beyond this data, most of the information on the safety of lithium during pregnancy accumulated in the last 40 years is based on case reports and small studies with conflicting results. Despite these concerns and the limited information, lithium remains a first-line treatment for the 1% of women of reproductive age with bipolar disorder in the U.S. population, due to its recognized efficacy during pregnancy and the postpartum period, and due to the presence of a larger body of evidence showing increased risk of congenital malformations for other mood stabilizers, such as valproate.

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No Increased Risk of Congenital Abnormalities Found With Paternal Use of Immunosuppressant Therapies

MedicalResearch.com Interview with:

Alexander Egeberg, MD PhD National Allergy Research Centre, Departments of Dermato-Allergology and Cardiology Herlev and Gentofte University Hospital, University of Copenhagen Hellerup, Denmark

Dr. Alexander Egeberg

Alexander Egeberg, MD PhD
Gentofte Hospital
Department of Dermatology and Allergy
Denmark

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: An issue that frequently arise in clinical practice is the question from patients whether they should discontinue their therapy if they want to have children. Since immunosuppressant agents are frequently used for a number of conditions, and discontinuation could lead to disease flaring, assessment of the potential impact of such drugs on birth outcomes is important.

In our study, we examined birth outcomes in children whose father had received treatment with methotrexate, azathioprine, cyclosporine, and mycophenolate mofetil in the time leading up to conception.

Importantly, we found no increased risk of congenital abnormalities, low birth weight, or preterm birth associated with paternal treatment with these drugs.

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Neural Tube Defects in Infants Share Molecular Processes With Neurodegenerative Diseases

MedicalResearch.com Interview with:

Zhiyong Zhao, Ph.D. Associate Professor Department of Obstetrics, Gynecology & Reproductive Sciences University of Maryland School of Medicine Baltimore, MD

Dr. Zhiyong Zhao

Zhiyong Zhao, Ph.D.
Associate Professor
Department of Obstetrics, Gynecology & Reproductive Sciences
University of Maryland School of Medicine
Baltimore, MD

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Diabetes in early pregnancy can cause neural tube defects in fetus. The defects are a result of failure in neural tube closure, due to excess cell death. The aim of this study was to delineate molecular processes that induce cell death.

The main findings of this study are:
(1) Hyperglycemia disrupts protein folding. The misfolded proteins, including the ones that are associated with neurodegenerative diseases, form aggregates, indicating similar molecular processes in both fetal neural tube defects and adult neurodegenerative diseases.
(2) Protein aggregation leads to formation of a neurodegenerative disease-related cell death inducting mechanism.

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Flu Treatment With Neuraminidase Inhibitors During Pregnancy Not Linked To Birth Defects

MedicalResearch.com Interview with:

Dr. Sophie Graner Department of Women's and Childrens Health Karolinska Institute, Stockholm, Sweden

Dr. Graner

Dr. Sophie Graner
Department of Women’s and Childrens Health
Karolinska Institute, Stockholm, Sweden

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Pregnant women are at increased risks of severe disease and death due to influensa infection, as well as hospitalization. Also influenza and fever increase the risk of adverse pregnancy outcomes for their infants such as intrauterine death and preterm birth. Due to this, the regulatory agencies in Europe and the US recommended post exposure prophylaxis and treatment for pregnant women with neuraminidase inhibitors during the last influenza pandemic 2009-10. Despite the recommendations, the knowledge on the effect of neuraminidase inhibitors on the infant has been limited. Previously published studies have not shown any increased risk, but they have had limited power to assess specific neonatal outcomes such as stillbirth, neonatal mortality, preterm birth, low Agar score, neonatal morbidity and congenital malformations.
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Reduced Stem Cells Link Congenital Heart Disease To Impaired Brain Growth

MedicalResearch.com Interview with:

Childrens National Research Team

Children’s National Research Team

Paul D. Morton, Ph.D.
Research PostDoc and lead study author of “Abnormal Neurogenesis and Cortical Growth in Congenital Heart Disease.”
Children’s National Health System Washington, DC

Nobuyuki Ishibashi, M.D.
Director of the Cardiac Surgery Research Laboratory at Children’s National Health System and co-senior study author.

Vittorio Gallo, Ph.D.
Director of the Center for Neuroscience Research at Children’s National Health System and co-senior study author.

 

 

Richard A. Jonas, M.D.
Chief of the Division of Cardiac Surgery at Children’s National Health System and co-senior study author.

MedicalResearch.com: What is the background for this study?

Response: Congenital heart disease (CHD) is the leading birth defect in the United States and often results in an array of long-term neurological deficits including motor, cognitive and behavioral abnormalities. It has become increasingly clear that children with CHD often have underdeveloped brains. In many cases of complex CHD, blood flow to the brain is both reduced and less oxygenated, which has been associated with developmental abnormalities and delay. The cellular mechanisms underlying the impact of CHD on brain development remain largely unknown. We developed a preclinical chronic hypoxia model to define these mechanisms.

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Link Between Antidepressants During Pregnancy and Birth Defects

MedicalResearch.com Interview with:
Anick Bérard PhD FISPE

Research chair FRQ-S on Medications and Pregnancy and
Director, Réseau Québécois de recherche sur le médicament (RQRM)
and Professor, Research Chair on Medications, Pregnancy and Lactation
Faculty of Pharmacy University of Montreal and
Director, Research Unit on Medications and Pregnancy
Research Center CHU Ste-Justine 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We have over 20 years of research showing that antidepressant use during the first trimester of pregnancy increases the risk of major congenital malformations. However, it still remains that controversies exist because we are not sure which of this increased risk is due to maternal depression. Therefore, we have only studied depressed pregnant women – some of them did not take antidepressant during pregnancy.

We were able to show that among depressed pregnant women, those who took antidepressants were at increased risk of having children with malformations – especially those taking citalopram. We were also able to show that many SSRIs, SNRI and tricyclic antidepressants put women at increased risk of having children with various malformations due to their similar mechanism of action (serotonin inhibition in utero).

MedicalResearch.com: What should readers take away from your report?

Response: Depression is a serious condition that requires medical attention during pregnancy. However, given that up to 85% of depressed pregnant women have mild to moderate depression – other treatment (other than antidepressants) options need to be considered. If a woman finds out she is pregnant and is taking antidepressants however, no abrupt discontinuation is suggested and a discussion with a health care provider is advised.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Very few data on the benefits of antidepressant use during pregnancy is available within depressed pregnant women with mild to moderate depression. Our study results taken together with all the body of literature on this topic should lead to other research on the benefits and risks of other forms of treatment for depression such as psychotherapy.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Anick Bérard, Jinping Zhao and Odile Sheehy. Antidepressant use during pregnancy and the risk of major congenital malformations in a cohort of depressed pregnant women: An updated analysis of the Quebec Pregnancy Cohort. BMJ Open, January 2017 DOI: 10.1136/bmjopen-2016-01337

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Women Who Can Become Pregnant Should Take Folic Acid

MedicalResearch.com Interview with:

Dr. Alex Kemper, MD, MPH, MS Member,US Preventive Services Task Force Professor of Pediatrics and Professor in Community Medicine Department of Pediatrics Duke University School of Medicine

Dr. Alex Kemper

Dr. Alex Kemper, MD, MPH, MS
Member,US Preventive Services Task Force
Professor of Pediatrics and Professor in Community Medicine
Department of Pediatrics
Duke University School of Medicine

MedicalResearch.com: What is the background for this study?

Response: Neural tube defects, where the brain or spinal cord do not develop properly in a baby, can occur early in pregnancy, even before a woman knows she is pregnant. Taking folic acid before and during pregnancy can help protect against neural tube defects. Most women do not get enough folic acid in their diets, so most clinicians recommend that any woman who could become pregnant take a daily folic acid supplement.

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High Outdoor Heat Early in Pregnancy May Raise Risk of Congenital Heart Defects

MedicalResearch.com Interview with:

Nathalie Auger MD MSc FRCPC Montréal, Québec

Dr. Nathalie Auger

Nathalie Auger MD MSc FRCPC
Montréal, Québec

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: We carried out this study because congenital heart defects take a large share of birth defects, but not much is known on its risk factors.

In previous research, we found that very high temperatures in the summer were associated with a greater risk of stillbirth. We sought to determine whether elevated outdoor heat could also be linked with congenital heart defects in a sample of about 700,000 pregnancies.

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Maternal Risk of Death Elevated After Birth of Child With Major Congenital Abnormalities

MedicalResearch.com Interview with:

Eyal Cohen, MD, MSc, FRCP(C) Staff Physician, Paediatrics The Hospital for Sick Children Associate Scientist, Research Institute Child Health Evaluative Sciences Associate Professor, University of Toronto

Dr. Eyal Cohen

Eyal Cohen, MD, MSc, FRCP(C)
Staff Physician, Paediatrics
The Hospital for Sick Children
Associate Scientist, Research Institute
Child Health Evaluative Sciences
Associate Professor, University of Toronto  

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Major structural or genetic congenital anomalies affect approximately 2 percent to 5 percent of all births in the United States and Europe. Mothers of children born with major congenital anomalies face serious challenges such as high financial pressures, as well as the burden of providing care to a child with complex needs within the home setting, which can impair a mother’s health. Little is known about the long-term health consequences for the mother. We assessed whether the birth of an infant with a major congenital anomaly was subsequently associated with an increased risk of death of the infant’s mother.

The population-based study (n = 455,250 women) used individual-level linked Danish registry data for mothers who gave birth to an infant with a major congenital anomaly between 1979 and 2010, with follow-up until December 31, 2014. A comparison group was constructed by randomly sampling, for each mother with an affected infant, up to 10 mothers matched on maternal age, parity (the number of children a woman has given birth to), and year of infant’s birth. Mothers in both groups were an average age of 29 years at delivery. After a median follow-up of 21 years, there were 1,275 deaths (1.60 per 1,000 person-years) among 41,508 mothers of a child with a major congenital anomaly vs 10,112 deaths (1.27 per 1,000 person-years) among 413,742 mothers in the comparison group. Mothers with affected infants were more likely to die of cardiovascular disease, respiratory disease, and other natural causes.

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Prediction of Congenital CMV Infection in High-Risk Pregnant Women

MedicalResearch.com Interview with:

Dr. Kenji Tanimura M.D., Ph.D. Assistant professor Division of Obstetrics and Gynecology Graduate School of Medicine and Hideto Yamada M.D., Ph.D. Professor and Chairman Department of Obstetrics and Gynecology Kobe University Graduate School of Medicine

Dr. Kenji Tanimura

Dr. Kenji Tanimura M.D., Ph.D.
Assistant professor
Division of Obstetrics and Gynecology
Graduate School of Medicine and
Hideto Yamada M.D., Ph.D.
Professor and Chairman Department of Obstetrics and Gynecology
Kobe University Graduate School of Medicine

MedicalResearch.com: What is the background for this study?

Response: Congenital cytomegalovirus (CMV) infection can cause long-term neurological sequelae, such as hearing difficulties and mental retardations, in affected children. Some investigators reported that early diagnosis and antiviral therapy can improve neurological outcomes in symptomatic congenital infected infants. However, universal screening of newborns for congenital CMV infection is not yet available. Therefore, the development of non-invasive methods for prenatal detection of mothers and newborns at high risk for congenital CMV infection has been desired.

We aimed to determine maternal clinical, laboratory, and ultrasound findings that effectively predict the occurrence of congenital CMV infection in high-risk pregnant women, who were positive for CMV IgM.

We performed maternal blood screening for CMV IgG and IgM, and 300 IgM-positive pregnant women, including 22 with congenital CMV infection, received series of examinations. We evaluated maternal clinical and laboratory findings, including serum CMV IgM and IgG, IgG avidity index, antigenemia testing, and CMV-DNA PCR for the maternal serum, urine, and uterine cervical secretion, and prenatal ultrasound findings.

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Maternal Chronic Disease Linked to Increased Risk of Cardiac Birth Defects in Offspring

MedicalResearch.com Interview with:
Prof. Chung-Yi Li
Department of Public Health College of Medicine
National Cheng Kung University
Tainan Taiwan

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Congenital heart disease is the leading congenital malformation that causes perinatal and infant deaths. However, little information is available about the risk factors, especially modifiable environmental and behavioral factors that may have posed adverse effects on fetal cardiac development. We conducted a nationwide population-based study in Taiwan to further evaluate the potential role of maternal chronic diseases in the risk of developing congenital heart disease in offspring.

We found that children of women with several kinds of chronic disease were at elevated risk for congenital heart disease; these diseases included type 1 and type 2 diabetes, hypertension, congenital heart defects, anemia, connective tissue disorders, epilepsy, and mood disorders.

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Maternal Use of SSRIs May Be Related to Speech and Language Disorders in Offspring

MedicalResearch.com Interview with:

Alan S. Brown, M.D., M.P.H. Professor of Psychiatry and Epidemiology Columbia University Medical Center Director, Program in Birth Cohort Studies, Division of Epidemiology New York State Psychiatric Institute

Dr. Alan Brown

Alan S. Brown, M.D., M.P.H.
Professor of Psychiatry and Epidemiology
Columbia University Medical Center
Director, Program in Birth Cohort Studies, Division of Epidemiology
New York State Psychiatric Institute 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Maternal use of antidepressants during pregnancy has been increasing.  A previous study from a team that I led in a national birth cohort in Finland showed that mother’s use of a serotonin reuptake inhibitor antidepressant is related to an increased risk of depression in offspring.  We sought to evaluate whether these medications also increased risk of speech/language, scholastic, and motor outcomes in offspring.  We found an increased risk (37% higher risk) of speech/language disorders in offspring of mothers exposed to SSRIs in pregnancy compared to mothers who were depressed during pregnancy but did not take an SSRI during pregnancy.

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Isolated Cleft Palate, But Not Cleft Lip, Linked to Increased Health Risks

MedicalResearch.com Interview with:
Erik Berg, MD

Department of Global Public Health and Primary Care
University of Bergen
Bergen, Norway

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Parents regularly express concern about long term health outcomes for children born with oral cleft.

In this study we used population-based long-term follow-up data from multiple national registries to focus on the future health outcomes of cleft cases without additional chronic medical conditions or congenital anomalies.
The study cohort consisted of all individuals born in Norway between 1967 and 1992. All patients treated for clefts in Norway during the study period were invited to participate. 2 337 cases with isolated clefts and 1 413 819 unaffected individuals were followed until 2010.

The main outcome variables were conditions diagnosed in childhood or early adulthood, need for social security benefits, and risk of death.

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More Birth Defects In Children Born Through Assisted Reproductive Technology

MedicalResearch.com Interview with:

Sheree L. Boulet, DrPH, MPH Division of Reproductive Health Centers for Disease Control and Prevention Atlanta, Georgia

Dr. Sheree Boulet

Sheree L. Boulet, DrPH, MPH
Division of Reproductive Health
Centers for Disease Control and Prevention
Atlanta, Georgia

MedicalResearch.com: What is the background for this study?

Dr. Boulet: Findings from some studies have suggested that children conceived with assisted reproductive technology (ART) have increased risks of birth defects compared with spontaneously conceived children. Many of these studies were limited by a small sample size and were unable to assess risks associated with specific ART procedures.

MedicalResearch.com: What are the main findings?

Dr. Boulet: We found that singleton infants conceived using assisted reproductive technology were 1.4 times more likely to have a non-chromosomal birth defect compared with other infants, and the risks were highest for gastrointestinal and musculoskeletal defects. However, when our study was restricted to only ART-conceived infants, no single procedure substantially increased the risk for birth defects. This suggests that the higher risk of birth defects may be due to underlying issues related to infertility, rather than to ART itself.

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First Trimester Use of Rhinocort Linked To Respiratory Defects in Newborns

MedicalResearch.com Interview with:
Anick Bérard PhD FISPE
Research chair FRQ-S on Medications and Pregnancy and
Director Réseau Québécois de recherche sur le médicament (RQRM) and
Professor, Research Chair on Medications, Pregnancy and Lactation
Faculty of Pharmacy,University of Montreal
and Director, Research Unit on Medications and Pregnancy
Research Center
CHU Ste-Justine

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Intranasal corticosteroid (Nasacort) use during pregnancy for the treatment of seasonal allergies has increased over the past decade. Nasacort is now available over the counter since October 2013 in the US and January 2015 in Canada. Given that seasonal allergies are prevalent during pregnancy and that a medication available over-the-counter is likely to be used frequently, we aimed to study the risk of using Nasacort during gestation. Furthermore, given the potential public health impact, the objectives of our study were to assess the safety of intranasal triamcinolone exposure during pregnancy on the occurrence of major congenital malformations, small-for-gestational-age (SGA) newborn, and spontaneous abortions.

Use of intranasal triamcinolone during the first trimester of pregnancy was not significantly associated with the risk of overall congenital malformations (OR 0.88, 95%CI 0.60-1.28; 31 exposed cases) compared to non-exposure; it was however associated with the risk of respiratory defects (OR 2.71, 95%CI 1.11-6.64; 5 exposed cases). This is important given that a medication given for the treatment of respiratory diseases is associated with respiratory defects in newborns.

Pregnancy exposure to intranasal triamcinolone was not significantly associated with the risk of spontaneous abortions (OR 1.04, 95%CI 0.76-1.43; 50 exposed cases). No association was found between 2nd or 3rd trimester exposure to intranasal triamcinolone and the risk of SGA (OR 1.06, 95%CI 0.79-1.43; 50 exposed cases).

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Most Cerebral Palsy Not Due To Poor Delivery Technique

Jonathan Muraskas M.D. Professor of Pediatrics and OB/Gyne Neonatal and Maternal Fetal Medicine Director Neonatal-Perinatal Research Loyola University Stritch School of Medicine Loyola University Medical Center

Dr. Muraskas

MedicalResearch.com Interview with:
Jonathan Muraskas M.D
.
Professor of Pediatrics and OB/Gyne
Neonatal and Maternal Fetal Medicine
Director Neonatal-Perinatal Research
Loyola University Stritch School of Medicine
Loyola University Medical Center

Medical Research: What is the background for this study? What are the main findings?

 Dr. Muraskas: Multiple studies over the years have demonstrated that only 15% of cerebral palsy is due to the birthing process.

In other words, a normal pregnancy is 7000 hours and lawyers frequently only focus on the last 2 hours.

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Study Finds No Increased Risk of Birth Defects With Birth Control Pill Exposure

Brittany M. Charlton, ScD Instructor Boston Children's Hospital and Harvard Medical School Researcher, Harvard Chan School Department of Epidemiology Boston, MA 02115

Dr. Charlton

MedicalResearch.com Interview with:
Brittany M. Charlton, ScD
Instructor
Boston Children’s Hospital and Harvard Medical School
Researcher, Harvard Chan School Department of Epidemiology
Boston, MA 02115  

Medical Research: What is the background for this study? What are the main findings?

Dr. Charlton: Even though oral contraceptives can be over 99% effective with perfect use, almost 10% of women become pregnant within their first year of use. Many more women will stop using oral contraceptives when planning a pregnancy and conceive within just a few months. In both of those examples, a woman may inadvertently expose her offspring during pregnancy to exogenous sex hormones. We conducted a nationwide cohort study in Denmark in order to investigate whether oral contraceptive use shortly before or during pregnancy was associated with an increased risk of major birth defects in the offspring. Our main finding was that there was no increased risk of having a birth defect associated with oral contraceptive exposure. These results were also consistent when we broke down the birth defects into different subgroups, like limb defects.

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Paroxetine – Paxil – Linked To Increase in Cardiac Birth Defects

Anick Bérard PhD FISPE Research chair FRQ-S on Medications and Pregnancy and Director, Réseau Québécois de recherche sur le médicament (RQRM) and Professor, Research Chair on Medications, Pregnancy and Lactation Faculty of Pharmacy University of Montreal and Director, Research Unit on Medications and Pregnancy Research Center CHU Ste-Justine

Dr. Anick Bérard

MedicalResearch.com Interview with:
Anick Bérard PhD FISPE
Research chair FRQ-S on Medications and Pregnancy
and Director, Réseau Québécois de recherche sur le médicament (RQRM)
and Professor, Research Chair on Medications, Pregnancy and Lactation
Faculty of Pharmacy University of Montreal
and Director, Research Unit on Medications and Pregnancy
Research Center
CHU Ste-Justine 

Medical Research: What is the background for this study? What are the main findings?

Dr. Bérard: Paroxetine (one of the most used antidepressant during pregnancy) has been studied extensively over the past 10-12 years. In 2005, a black box warning was put on the Paxil label to caution against use during pregnancy due to the increased risk of cardiac defects. The ACOG 2010 guidelines also suggested switching to other antidepressants during pregnancy. Over the past decade, many studies, including meta-analyses, were performed on on paroxetine use during pregnancy and the risk of cardiac malformations – but results were sometimes statistically significant or not, although a consistent increased risk was observed. It was thought that these variations could be explained by different study designs, patient populations, and because maternal depression was not always taken into account correctly. Hence, we undertook another meta-analysis (the most recent and updated) to quantify the risk of cardiac defects overall as well as specific cardiac defects associated with paoxetine use during pregnancy and to assess the impact of study designs, maternal depression and patient population on the effect of the risk.

We found that women using paroxetine during the first trimester of pregnancy (critical time-window for malformations) were 23% more at risk of having a child with malformations (15 studies combined) – baseline risk of malformation is 3-5% and thus a 23% increased risk is 3.69-6.15% absolute risk; women using paroxetine during the first trimester of pregnancy were 28% more at risk of having a child with cardiac malformations (18 studies combined) – baseline risk of cardiac malformation is 1% and thus a 28% increased risk is 1.28% absolute risk. We found that paroxetine was increasing the risk of many specific cardiac defects as well. Although the estimates varied depending on the comparator group, study design, and malformation detection period, a trend towards increased risk was observed.

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Large Racial and Ethnic Gaps Exist In US For Premature Births

Edward R. B. McCabe, MD, PhD Senior Vice President and Chief Medical Officer Professor Adjunct of Pediatrics, Yale University School of Medicine Distinguished Professor Emeritus, Department of Pediatrics & Inaugural Mattel Executive Endowed Chair of Pediatrics, UCLA School of Medicine Inaugural Physician-in-Chief, Mattel Children's Hospital UCLA Professor Adjunct of Pediatrics, Yale School of Medicine Chief Medical Officer March of Dimes

Dr. McCabe

MedicalResearch.com Interview with:
Edward R. B. McCabe, MD, PhD
Senior Vice President and Chief Medical Officer
Professor Adjunct of Pediatrics
Yale University School of Medicine
Distinguished Professor Emeritus, Department of Pediatrics & Inaugural Mattel Executive Endowed Chair of Pediatrics, UCLA School of Medicine
Inaugural Physician-in-Chief, Mattel Children’s Hospital
Chief Medical Officer March of Dimes

Medical Research: What is the background for this study? What are the main findings?

Dr. McCabe: The March of Dimes Prematurity Campaign was launched in 2003. The goal of the campaign is to lower the rate of premature birth to 8.1 percent of live births by 2020 and to 5.5 percent by 2030.

Premature birth is the leading cause of death for newborns, and a major cause of childhood disabilities. Worldwide, 15 million babies are born preterm, and nearly one million die due to complications of an early birth. The U.S. preterm birth rate ranks among the worst of high-resource nations. Babies who survive an early birth often face serious and lifelong health problems, including breathing problems, jaundice, vision loss, cerebral palsy and intellectual delays.

The US earned a “C” on the 8th annual March of Dimes Premature Birth Report Card which revealed persistent racial, ethnic and geographic disparities within states. The report card provided preterm rates and grades for each state and the largest cities. The report card showed that although some progress is being made in reducing preterm births, not all families are sharing in the success.

State specific information is available at marchofdimes.org/reportcard

Portland, Oregon has the best preterm birth rate of the top 100 cities with the most births nationwide, while Shreveport, Louisiana has the worst, according to the 2015 Report Card. The U.S. preterm birth rate was 9.6 percent in 2014. The report card shows more than 380,000 babies were born too soon last year.

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No Link Found Between Macrolide Antibiotics and Birth Defects

Anick Bérard PhD FISPE Research chair FRQ-S on Medications and Pregnancy Director, Réseau Québécois de recherche sur le médicament (RQRM) Professor, Research Chair on Medications, Pregnancy and Lactation Faculty of Pharmacy, University of Montreal Director, Research Unit on Medications and Pregnancy Research Center CHU Ste-JustineMedicalResearch.com Interview with:
Anick Bérard PhD FISPE
Research chair FRQ-S on Medications and Pregnancy
Director, Réseau Québécois de recherche sur le médicament (RQRM)
Professor, Research Chair on Medications, Pregnancy and Lactation
Faculty of Pharmacy, University of Montreal
Director, Research Unit on Medications and Pregnancy
Research Center CHU Ste-Justine

Medical Research:  Should we have any reservations about prescribing these macrolides during pregnancy?

Dr. Bérard: With penicillin, macrolides are amongst the most used medications in the general population and in pregnancy. However, debate remained on whether it is the infections or in fact the macrolides used to treat them that put women and their unborn child at greater risk of adverse pregnancy outcomes, including birth defects.
Our study was performed within the Quebec Pregnancy Cohort, one of the largest pregnancy cohorts in the World, and did not find a statistically significant association between macrolide use (a widely used class of antibiotics) during pregnancy and the risk of malformations. When looking at specific types of macrolides, no association was found between azithromycin, clarithromycin or erythromycin use during the first trimester of pregnancy and the risk of major malformations or cardiac malformations. This is reassuring when treating infections during pregnancy.

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CDC Study Finds Variable Risk of Antidepressants During Pregnancy and Birth Defects

Jennita Reefhuis, PhD Epidemiologist with CDC National Center on Birth Defects and Developmental DisabilitiesMedicalResearch.com Interview with:
Jennita Reefhuis, PhD
Epidemiologist with CDC
National Center on Birth Defects and Developmental Disabilities

Medical Research: What is the background for this study?

Dr. Reefhuis: There are previous reports on the link between birth defects and SSRIs. However, the results across some of these studies conflicted. It is not clear whether one SSRI might be safer than other SSRIs.

Medical Research: What are the main findings?

Dr. Reefhuis: Reassuringly, we found that the five earlier reported links between specific birth defects and sertraline were not found again. We did find that some birth defects occur two to three times more frequently among babies born to mothers who took paroxetine and fluoxetine in early pregnancy. Continue reading

Prenatal Exposure To Air Pollutants May Produce Structural Brain Abnormalities

Dr. Bradley S. Peterson, M.D Director of the Institute for the Developing Mind The Saban Research Institute of Children’s Hospital Los Angeles Children’s Hospital Los AngelesMedicalResearch.com Interview with:
Dr. Bradley S. Peterson, M.D
Director of the Institute for the Developing Mind
The Saban Research Institute of Children’s Hospital
Los Angeles Children’s Hospital Los Angeles

Medical Research: What is the background for this study?

Dr. Peterson: Neurotoxic PAH (polycyclic aromatic hydrocarbons) are ubiquitous in the environment, in the home and in the workplace. Emissions from motor vehicles, oil and coal burning for home heating or power generation, wildfires and agricultural burning, hazardous waste sites, tobacco smoke and charred foods are all sources of exposure. PAH readily crosses the placenta and affects an unborn child’s brain; earlier animal studies showed that prenatal exposure impaired the development of behavior, learning and memory. Our group previously reported that exposure to airborne PAH during gestation was associated with multiple neurodevelopmental disturbances, including development delay by age 3, reduced verbal IQ at age 5, and symptoms of anxiety and depression at age 7.

Medical Research: What are the main findings?

Dr. Peterson: Together with Virginia Rauh, ScD and Frederica Perera, DrPH, PhD of Columbia University’s Mailman School of Public Health, we conducted a brain imaging study to test the effects on brain structure of PAH exposure during the final trimester of pregnancy.  We used magnetic resonance imaging (MRI) to measure the brains of 40 children from a cohort of more than 600 mother-baby pairs from minority communities in New York City. These 40 children were carefully selected to have no other exposures that would affect brain development. Our findings showed that prenatal PAH exposure led to reductions in nearly the entire white matter surface of the brain’s left hemisphere – losses that were associated with slower processing of information during intelligence testing and more severe behavioral problems, including ADHD and aggression.  Postnatal PAH exposure – measured at age 5 – was found to contribute to additional disturbances in development of white matter in the dorsal prefrontal region of the brain, a portion of the brain that supports concentration, reasoning, judgment, and problem-solving ability. Continue reading

High DNA Mutation Rate In Teenage Dads May Lead To More Birth Defects

Dr. Peter Forster PhD Fellow of Murray Edwards College and McDonald Institute at the University of CambridgeMedicalResearch.com Interview with:
Dr. Peter Forster PhD
Fellow of Murray Edwards College and
McDonald Institute at the University of Cambridge

 

Medical Research: What is the background for this study? What are the main findings?

 

Dr. Forster: As a result of our paternity testing work at the Institute for Forensic Genetics in Munster (Germany), we have accumulated a pool of over 24,000
parents and their children, of whom we know for certain that they are
biologically related. Occasionally we observe a new mutation in these
children, which must have come either from the sperm or the egg of one
of the parents. As we analyse highly variable microsatellite DNA (a
repetitive type of DNA, also know as STR DNA, which stands for “short
tandem repeat” DNA), we can fairly easily find out whether the mutation
has come from the mother or the father. It turns out that the fathers
contribute 6-7 times more mutations to the children than the mothers do.
This has long been known. What is new is that we have observed that the
male and female teenagers at puberty do NOT set out with the same low
mutation load, but instead, the teenage boys already have a sixfold
higher mutation load in their sperm than the girls in their oocytes. Continue reading

For Most Birth Defects Survival Poorer Among Minorities

MedicalResearch.com Interview with:
Ying Wang, PhD, MPH

Data Management, Analysis & Research
Office of Primary Care and Health System Management
New York State Department of Health
Empire State Plaza  Albany, NY  12237

Medical Research: What is the background for this study? What are the main findings?

Dr. Wang: The purpose of the study was to examine the survival of children with one or more of 21 major birth defects in the United States.  We used data from 12 population-based birth defects surveillance programs that participate in the National Birth Defects Prevention Network.  The study included nearly 100,000 infants born with birth defects between 1997 and 2007.

We found that children who were born with hypoplastic left heart syndrome (a severe congenital heart defect) had the lowest chance of survival across multiple ages (up to 28 days of life, 1 year, 2 years, and 8 years of life), compared to children with any other birth defects studied.  We also found that the chances of survival up to 1 year of life was greater than 90% for babies born with spina bifida, cleft palate, cleft lip with or without cleft palate, pyloric stenosis, gastroschisis, or Down syndrome. For most birth defects, survival was poorer among non-Hispanic black mothers and Hispanic mothers compared to non-Hispanic white mothers.
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More Women Of Reproductive Age Need Folic Acid To Prevent Birth Defects

Jennifer Williams MSN, MPH, FNP-BC National Center on Birth Defects and Developmental Disabilities CDC, Atlanta, Georgia MedicalResearch.com Interview with:
Jennifer Williams MSN, MPH, FNP-BC

National Center on Birth Defects and Developmental Disabilities
CDC, Atlanta, Georgia

Medical Research: What is the background for this study? What are the main findings?

Response: Neural tube defects are serious birth defects of the brain and spine that can cause significant disability and death. Studies have shown that taking 400 mcg of folic acid daily before and during pregnancy can reduce the prevalence of neural tube defects. Therefore, in 1992, the US Public Health Service (USPHS) recommended that all women of childbearing age in the United States who are capable of becoming pregnant consume 400mcg of folic acid per day to reduce the risk of neural tube defects. To help women meet this requirement, in 1998 the US Food and Drug Administration (FDA) mandated that folic acid be added to enriched grain products for the prevention of neural tube defects.

This study looks at how many neural tube defects have been prevented annually since folic acid fortification. Using data from birth defects tracking systems, researchers found that since folic acid fortification, the birth prevalence of neural tube defects has decreased by 35% in the United States, which translates to about 1,300 babies that are born each year without a neural tube defect who might otherwise have been affected.  This study also reports that the number of babies born with a neural tube defect annually differs by the mother’s race/ethnicity. Hispanic mothers continue to be at the highest risk for having a baby with a neural tube defect.

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Maternal Obesity Increases Congenital Kidney/Urinary Anomalies in Offspring

MedicalResearch.com Interview with:
Ian R. Macumber MD
Pediatric Nephrology, Seattle Children’s Hospital
Seattle, Washington

Medical Research: What are the main findings of the study?

Dr. Macumber: The main finding is that there is a strong association between maternal obesity and odds of congenital anomalies of the kidney and urinary tract (CAKUT) in offspring.  This relationship remains strong when looking at offspring with renal malformation (excluding non-renal congenital anomalies of the kidney and urinary tract), or in offspring with isolated congenital anomalies of the kidney and urinary tract (no congenital anomalies elsewhere in the body).  There is a dose-response relationship to this association, with the offspring of extremely obese mothers have even higher odds of having congenital anomalies of the kidney and urinary tract.

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Do Antidepressants During Pregnancy Promote Cardiac Birth Defects?

Dr. Krista Huybrechts MD PhD Brigham & Women’s Hospital Department of Medicine Division of Pharmacoepidemiology & Pharmacoeconomics Boston, MA 02120MedicalResearch.com Interview Invitation
Dr. Krista Huybrechts MD PhD
Brigham & Women’s Hospital
Department of Medicine
Division of Pharmacoepidemiology & Pharmacoeconomics
Boston, MA 02120

MedicalResearch: What are the main findings of the study?

Dr. Huybrechts: In this cohort study including 949,504 pregnant women enrolled in Medicaid, we examined whether the use of selective serotonin reuptake inhibitors (SSRIs) and other antidepressants during the first trimester of pregnancy is associated with increased risks for congenital cardiac defects. In order to control for potential confounding by depression and associated factors, we restricted the cohort to women with a depression diagnosis and used propensity score adjustment to control for depression severity and other potential confounders. We found no substantial increased risk of cardiac malformations attributable to SSRIs. Relative risks for any cardiac defect were 1.25 (95%CI, 1.13-1.38) unadjusted, 1.12 (1.00-1.26) depression-restricted, and 1.06 (0.93-1.22) depression-restricted and fully-adjusted. We found no significant associations between the use of paroxetine and right ventricular outflow tract obstruction (1.07, 0.59-1.93), or the use of sertraline and ventricular septal defects (1.04, 0.76-1.41); two potential associations that had been of particular concern based on previous research findings.
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Many Pregnant Women Have Not Taken Folic Acid to Reduce Neural Tube Defects

Prof. Nicholas J. Wald Wolfson Institute of Preventive Medicine Barts and the London School of Medicine and Dentistry Queen Mary University of London London, United KingdomMedicalResearch.com Interview with:
Prof. Nicholas J. Wald
Wolfson Institute of Preventive Medicine
Barts and the London School of Medicine and Dentistry
Queen Mary University of London
London, United Kingdom

MedicalResearch.com: What are the main findings of the study?

Prof Wald: The percentage of women who become pregnant without having taken folic acid supplements to reduce the risk of a neural tube defect declined from a relatively low proportion (35%) to an even lower one (31%) between 1999 and 2012.

Moreover such use of folic acid in some groups of the population is much lower for example 17% in Afro-Caribbean women and 6% in women aged under 20.
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Pregnancy: Birth Defects Risks with Oral Fluconazole

MedicalResearch.com Interview with:
Ms. Mølgaard-Nielsen

Statens Serum Institut
Artillerivej 5, 2300
Copenhagen S, Denmark

MedicalResearch.com: What are the main findings of the study?

Answer: Use of oral fluconazole during early pregnancy did not increase the risk of birth defects overall in common therapeutic doses. We also looked at 15 individual birth defects of previous concern and oral fluconazole was not associated with an increased risk for 14 of these birth defects.  However, we did see an increase in the risk of tetralogy of Fallot, an uncommon congenital heart defect, but the number of exposed cases was few.
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