scholarly journals Exposure to Propylthiouracil in the First Trimester of Pregnancy and Birth Defects: A Study at a Single Institution

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Ai Yoshihara ◽  
Jaeduk Yoshimura Noh ◽  
Natsuko Watanabe ◽  
Miho Fukushita ◽  
Masako Matsumoto ◽  
...  
Keyword(s):  
Medical Treatment ◽  
Birth Defects ◽  
Antithyroid Drug ◽  
First Trimester ◽  
Control Group ◽  
Graves Disease ◽  
Increased Risk ◽  
Group A ◽  
First Trimester Of Pregnancy ◽  
Maternal Thyroid

Abstract Context Medical treatment of Graves disease during the first trimester has been the subject of controversy ever since treatment with an antithyroid drug during the first trimester was reported to possibly be associated with an increased risk of birth defects in newborns. Objective We investigated whether the incidence of birth defects among newborns born to mothers with Graves disease (GD) treated with propylthiouracil (PTU) during the first trimester of pregnancy was higher than in a control group that was not exposed to any medication. Methods We reviewed the cases of 1913 women with GD who gave birth between January 1, 2015, and May 31, 2019. Detailed information concerning the outcome of pregnancy and the presence of birth defects was collected at the first visit after the delivery and again 1 year after delivery. We classified the mothers and infants into 3 groups according to the treatment the mother had received for GD in the first trimester of pregnancy: a group in which the mothers had been treated with PTU alone (PTU group), a group in which the mothers had not been treated with any medication (control group), and a group in which the mothers had received some other medical treatment, such as thiamazole, potassium iodide, or 2 or more drugs (other treatment group). Results The incidence of malformed infant births was 5.5% (30/541 infants) in the PTU group and 5.7% (27/ 475 infants) in the control group. There were no specific birth defects in the PTU group, and there were no significant differences between PTU dosages or maternal thyroid function according to whether mothers had delivered a child with a birth defect. Conclusion The results of our retrospective study showed that treatment with PTU during the first trimester of pregnancy did not increase the incidence of birth defects among newborns.

scholarly journals Prospective, Controlled, Multicentre Study of Loperimide in Pregnancy

2000 ◽  
Vol 14 (3) ◽  
pp. 185-187 ◽  
Author(s):  
A Einarson ◽  
P Mastroiacovo ◽  
J Arnon ◽  
A Ornoy ◽  
A Addis ◽  
...  
Keyword(s):  
Birth Defects ◽  
Chronic Diarrhea ◽  
First Trimester ◽  
Control Group ◽  
Premature Births ◽  
End Points ◽  
Increased Risk ◽  
First Trimester Of Pregnancy ◽  
Cardiovascular Anomalies ◽  
In Pregnancy

BACKGROUND: Loperamide is a synthetic piperidine derivative used for the treatment of both acute and chronic diarrhea. Little is known about its safety and risk in pregnancy. Human data are limited to one surveillance study of Michigan Medicaid patients, with 108 women exposed in the first trimester. In this study there were six major birth defects, three of which were cardiovascular anomalies.OBJECTIVES: To determine whether loperamide use in pregnancy is associated with an increased risk of major malformations. The secondary end points were rates of minor malformations, spontaneous and therapeutic abortions, and premature births, and mean birth weights.PATIENTS AND METHODS: Women counselled by five teratogen information centres on the safety and risk of loperamide in pregnancy were followed after delivery and compared with a similar group of women matched for age, smoking, alcohol and other exposures.RESULTS: One hundred and five follow-ups were completed; 89 of the women were exposed to loperamide in the first trimester of pregnancy. There were no statistically significant differences between the study group and the control group in any of the end points that were analyzed. However, of women who took loperamide throughout their pregnancy, 21 of 105 had babies who were 200 g smaller than babies in the control group.CONCLUSIONS: The results of this study suggest that the use of loperamide during pregnancy is not associated with an increased risk of major malformations.

Maternal Thyroid Function, Use of Antithyroid Drugs in Early Pregnancy, and Birth Defects

2019 ◽  
Vol 104 (12) ◽  
pp. 6040-6048 ◽  
Author(s):  
Stine Linding Andersen ◽  
Louise Knøsgaard ◽  
Jørn Olsen ◽  
Peter Vestergaard ◽  
Stig Andersen
Keyword(s):  
Thyroid Function ◽  
Birth Defects ◽  
Early Pregnancy ◽  
Antithyroid Drug ◽  
Maternal Blood ◽  
Antithyroid Drugs ◽  
Birth Cohorts ◽  
Increased Risk ◽  
Maternal Thyroid

Abstract Context Antithyroid drug (ATD) therapy in early pregnancy is associated with birth defects, but more data are needed to substantiate the risk associated with different types of ATD. Furthermore, the role of abnormal maternal thyroid function per se remains unclarified. Objective To evaluate the risk of birth defects associated with the use of ATD in an extended nationwide cohort and the role of abnormal maternal thyroid function in birth cohorts including stored maternal blood samples from early pregnancy. Participants Danish pregnant women and their live-born children, including 1,243,353 children from a Nationwide Register-Based Cohort (NRBC), 1997 to 2016; 8830 children from the Danish National Birth Cohort (DNBC), 1997 to 2003; and 14,483 children from the North Denmark Region Pregnancy Cohort (NDRPC), 2011 to 2015. Main Outcome Measures Birth defects diagnosed before 2 years of age. Results In the NRBC, altogether 2718 (0.2%) children had been exposed to ATD in early pregnancy. The overall frequency of birth defects was 6.7% (95% CI, 6.7% to 6.8%) in nonexposed children and higher after exposure to methimazole/carbimazole (9.6%; 95% CI, 8.2% to 11.2%) and propylthiouracil (8.3%; 95% CI, 6.7% to 10.3%). On the other hand, the frequency of maternal thyroid dysfunction in early pregnancy was similar in the random cohort and in cases of birth defect in the DNBC (12.4 vs 12.6%, P = 0.8) and the NDRPC (15.1 vs 15.4%, P = 0.8). Conclusions Results corroborate an increased risk of birth defects associated with the use of ATD in early pregnancy and suggest that abnormal maternal thyroid function is not a major risk factor for birth defects.

scholarly journals Congenital Bands with Intestinal Malrotation after Propylthiouracil Exposure in Early Pregnancy

2015 ◽  
Vol 2015 ◽  
pp. 1-4 ◽  
Author(s):  
Alexander A. Leung ◽  
Jennifer Yamamoto ◽  
Paola Luca ◽  
Paul Beaudry ◽  
Julie McKeen
Keyword(s):  
Birth Defects ◽  
Early Pregnancy ◽  
First Trimester ◽  
Careful Consideration ◽  
Intestinal Malrotation ◽  
Graves Disease ◽  
Increased Risk ◽  
Acute Small Bowel Obstruction ◽  
Trimester Exposure ◽  
Duration Of Pregnancy

Exposure to propylthiouracil in early pregnancy may be associated with an increased risk of birth defects. But the spectrum of associated congenital anomalies is not yet well defined. While preliminary reports suggest that most cases of propylthiouracil-associated birth defects are restricted to the preauricular and urinary systems, careful consideration should be given to other possible manifestations of teratogenicity. We propose that congenital bands may potentially represent a rare yet serious complication of propylthiouracil exposure in early pregnancy, possibly arising from an early mesenteric developmental anomaly. We report a case of a 17-day-old girl that presented with acute small bowel obstruction associated with intestinal malrotation arising from several anomalous congenital bands. Her mother was treated for Graves’ disease during pregnancy with first trimester exposure to propylthiouracil but remained clinically and biochemically euthyroid at conception and throughout the duration of pregnancy. This case suggests that the use of propylthiouracil in early pregnancy may be associated with congenital bands and intestinal malrotation. More reports are needed to further support this association.

scholarly journals Could molecular assessment of calcium metabolism be a useful tool to early screen patients at risk for pre-eclampsia complicated pregnancy? Proposal and rationale

2015 ◽  
Vol 53 (7) ◽  
Author(s):  
Salvatore Gizzo ◽  
Marco Noventa ◽  
Stefania Di Gangi ◽  
Carlo Saccardi ◽  
Erich Cosmi ◽  
...  
Keyword(s):  
Calcium Intake ◽  
Calcium Metabolism ◽  
Large Scale ◽  
Calcium Supplementation ◽  
English Literature ◽  
First Trimester ◽  
Control Group ◽  
Hypertensive Disorders ◽  
Increased Risk ◽  
First Trimester Of Pregnancy

AbstractOne of the most frequent causes of maternal and perinatal morbidity is represented by hypertensive disorders during pregnancy. Women at high risk must be subjected to a more intensive antenatal surveillance and prophylactic treatments. Many genetic risk factors, clinical features and biomarkers have been proposed but none of these seems able to prevent pre-eclampsia onset. English literature review of manuscripts focused on calcium intake and hypertensive disorders during pregnancy was performed. We performed a critical analysis of evidences about maternal calcium metabolism pattern in pregnancy analyzing all possible bias affecting studies. Calcium supplementation seems to give beneficial effects on women with low calcium intake. Some evidence reported that calcium supplementation may drastically reduce the percentage of pre-eclampsia onset consequently improving the neonatal outcome. Starting from this evidence, it is intuitive that investigations on maternal calcium metabolism pattern in first trimester of pregnancy could represent a low cost, large scale tool to screen pregnant women and to identify those at increased risk of pre-eclampsia onset. We propose a biochemical screening of maternal calcium metabolism pattern in first trimester of pregnancy to discriminate patients who potentially may benefit from calcium supplementation. In a second step we propose to randomly allocate the sub-cohort of patients with calcium metabolism disorders in a treatment group (calcium supplementation) or in a control group (placebo) to define if calcium supplementation may represent a dietary mean to reduce pre-eclampsia onset and to improve pregnancy outcome.

Association of the Common Cold in the First Trimester of Pregnancy With Birth Defects

PEDIATRICS ◽  
1993 ◽  
Vol 92 (4) ◽  
pp. 559-563
Author(s):  
Jun Zhang ◽  
Wen-wei Cai
Keyword(s):  
Birth Defects ◽  
Common Cold ◽  
Cleft Lip ◽  
Monitoring Program ◽  
First Trimester ◽  
Relative Risks ◽  
Increased Risk ◽  
First Trimester Of Pregnancy ◽  
The Common ◽  
Pregnancy And Birth

Objective. To examine the association between the common cold with or without fever in the first 3 months of pregnancy and birth defects in offspring. Design. A case-control study. Setting. Data are from the Shanghai Birth Defects Monitoring Program, conducted in 29 hospitals in Shanghai, China from October 1, 1986 to September 30, 1987. Subjects. A total of 986 birth defects cases, 990 frequency-matched live birth controls, and 159 stillbirth controls. Results. Modestly elevated risk of birth defects was identified among women who reported having a cold with or without fever in the first trimester of pregnancy. Notably increased relative risks were observed for anencephalus (odds ratio [OR] = 3.9, 95% confidence interval [CI] = 2.0 to 7.7), spina bifida (OR = 4.1, 95% CI = 1.7 to 9.7), hydrocephalus (OR = 2.3, 95 % CI = 1.1 to 5.1), cleft lip (OR = 2.2, 95 % CI = 1.4 to 3.4), and undescended testicle (OR = 1.8, 95 % CI = 1.0 to 3.0). Our study further found that the overall relative risks were consistent by using two different control groups, suggesting that this association was unlikely to be due to recall or report bias. Conclusion. Common cold in the first trimester of pregnancy may be associated with an increased risk of birth defects in offspring. However, these findings should be interpreted cautiously.

scholarly journals Anti-thyroid drug use during the first trimester of pregnancy and the risk of birth defects in offspring: systematic review and meta-analysis of observational studies with methodological considerations

2020 ◽  
Author(s):  
Daniel R. Morales ◽  
Lionel Fonkwen ◽  
Hedvig M. Nordeng
Keyword(s):  
Systematic Review ◽  
Birth Defects ◽  
Observational Studies ◽  
Absolute Risk ◽  
Meta Analysis ◽  
First Trimester ◽  
Adjusted Risk ◽  
Increased Risk ◽  
Study Characteristics ◽  
First Trimester Of Pregnancy

ABSTRACTBackgroundMaternal anti-thyroid drug (ATD) use during the first trimester of pregnancy has been associated with an increased risk of birth defects in offspring. Uncertainty remains on the size of this risk and how it compares to untreated hyperthyroidism due to methodological limitations of previous studies.MethodsSystematic review of MEDLINE and EMBASE identifying observational studies examining ATD use during the first trimester of pregnancy and risk of birth defects. Data were extracted on study characteristics, adjusted effect estimates and comparator groups. Effect estimates were pooled using a random-effects generic inverse variance method of analysis and absolute risk calculated.ResultsSeven cohort studies and one case–control study (involving 6212322 pregnancies and 388976 birth defects) were identified. Compared to unexposed women without hyperthyroidism, the association between ATD first trimester use and birth defects in offspring was: adjusted risk ratio [aRR] 1.16 95% CI 1.08-1.25 for propylthyoruacil (PTU); aRR 1.28 95% CI 1.06-1.54 for methimazole/carbimazole (MMI/CMZ); aRR 1.51, 95% CI 1.16-1.97 for both MMI/CMZ and PTU; and aRR 1.15 95%CI 1.02-1.29 for untreated hyperthyroidism. The risk of major birth defects per 1000 live births was: 9.6 for PTU; 16.8 for MMI/CMZ; 30.6 for both MMI/CMZ and PTU; and 9.0 for untreated hyperthyroidism.ConclusionsWhen appropriately analysed this risk of birth defects associated with ATD use in the first trimester of pregnancy is attenuated. Although still elevated, the risk of birth defects is smallest with PTU compared to use of MMI/CMZ and may be similar to that of untreated hyperthyroidism.

HLA-DR3 and DRw6: prognostic factors for the incidence of hypothyroidism in Graves' disease after radioiodine treatment

1986 ◽  
Vol 113 (3) ◽  
pp. 323-328 ◽  
Author(s):  
B. Althaus ◽  
J.J. Staub ◽  
T. M. Neri ◽  
M. Hauenstein ◽  
J. Müller-Brand ◽  
...  
Keyword(s):  
Thyroid Function ◽  
Serum Levels ◽  
Normal Serum ◽  
Control Group ◽  
Overt Hypothyroidism ◽  
Graves Disease ◽  
Radioiodine Treatment ◽  
Increased Risk ◽  
Group A ◽  
Group B

Abstract. Several studies demonstrated a relationship between HLA-B8 and -DR3 and the early course of thyroid function after treatment of thyrotoxicosis. However, the association between certain DR antigens and the outcome of thyroid function years after radioiodine treatment for Graves' disease remains unclear. We therefore determined the HLA pattern in 2 groups of female patients with different severity of hypothyroidism. From a total of 45 patients, 27 had developed pre-clinical hypothyroidism (normal serum levels of T4, FT4 and T3, normal or elevated basal TSH levels, but an exaggerated TSH response to TRH, Group A). Mean follow-up was 111 months (range 36–360 months) for this group. Eighteen patients had become overtly hypothyroid (T4 and FT4 levels in the hypothyroid range and an elevated basal TSH concentration, group B) after a mean interval of 51 months (range: 4–132 months) following treatment. Eighty-seven healthy blood donors served a controls. Positive plasma antibody titres (tanned red cell haemagglutination technique) were observed in 67% of all patients with a preponderance in group B (83% versus 56% in group A, n.s.). The whole group of Graves' disease patients showed the antigens B8, DR3 and Drw6 in 37.8%, 33.3% and 35.6%, respectively (P < 0.02, < 0.05, and < 0.04 vs controls). In patients with pre-clinical hypothyroidism there was a significantly increased prevalence of antigen B8 (P < 0.01) and DR3 (P < 0.05) compared to the control group. In contrast, the overt hypothyroid group showed an augmented frequency of HLA-DRw6 (P < 0.04). Antibody positivity was related to the antigens B8 and DR3 (P < 0.005, < 0.03, respectively). Thus, the presence of B8/DR3 represents a genetic pattern possibly protecting against the development of overt hypothyroidism, at least over several years after 131I-treatment. The presence of DRw6 and the absence of DR3 were associated with an increased risk for overt post-irradiation hypothyroidism.

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