Intrauterine exposure to carbamazepine and specific congenital malformations

Autor: Jentink, Janneke, Dolk, Helen, Loane, Maria A., Morris, Joan K., Wellesley, Diana, Garne, Ester, de Jong-van den Berg, Lolkje, Bakker, Marian
Přispěvatelé: EUROCAT Antiepileptic Study Working Group, Verellen-Dumoulin, C., Nelen, V., Barisic, I., Garne, E., Khoshnood, B., Doray, B., Poetzsch, S., Wiesel, A., O'Mahony, M., Pierini, A., Rivieri, F., Gatt, M., Bakker, M., Melve, K., Latos-Bielenska, A., Mejnartowicz, JP., Portillo, I., Addor, MC., Tucker, D., Reproductive Origins of Adult Health and Disease (ROAHD)
Jazyk: angličtina
Rok vydání: 2010
Předmět:
Pediatrics
Dentistry and Oral Medicine
Epilepsy
Pregnancy
Risk Factors
Drugs: Psychiatry
Prevalence
Medicine
EPILEPSY
General Environmental Science
TERATOGENESIS
RISK
General Engineering
Congenital Heart Disease
ANTIEPILEPTIC DRUGS
Abnormalities
Drug-Induced
General Medicine
Europe
Carbamazepine
PREGNANCY
Prenatal Exposure Delayed Effects
Anticonvulsants
Female
Abnormalities
Drug-Induced/epidemiology
Abnormalities
Drug-Induced/etiology
Anticonvulsants/adverse effects
Carbamazepine/adverse effects
Case-Control Studies
Epilepsy/drug therapy
Epilepsy/epidemiology
Europe/epidemiology
Humans
Infant
Newborn
Pregnancy Complications/drug therapy
Pregnancy Complications/epidemiology
Pregnancy Trimester
First
Prenatal Exposure Delayed Effects/epidemiology
Prenatal Exposure Delayed Effects/etiology
medicine.drug
Cohort study
medicine.medical_specialty
IN-UTERO
Lamotrigine
VALPROIC ACID
MAJOR MALFORMATIONS
Urological Surgery
FETAL
Internet
business.industry
Spina bifida
Research
Case-control study
Odds ratio
medicine.disease
Surgery
Pregnancy Complications
Oesophagus
Epidemiologic Studies
Reproductive Medicine
LAMOTRIGINE
General Earth and Planetary Sciences
carbamazepine
intrauterine
business
Zdroj: The BMJ
Jentink, J, Dolk, H, Loane, M A, Morris, J K, Wellesley, D, Garne, E, de Jong-van den Berg, L & EUROCAT Antiepileptic Study Working Group 2010, ' Intrauterine exposure to carbamazepine and specific congenital malformations: systematic review and case-control study ', B M J-Clinical Research Edition, vol. 341, pp. c6581 .
Bmj, vol. 341, pp. c6581
British Medical Journal, 341:6581. BMJ PUBLISHING GROUP
ISSN: 0959-535X
Popis: Objective To identify specific major congenital malformations associated with use of carbamazepine in the first trimester of pregnancy.Design A review of all published cohort studies to identify key indications and a population based case-control study to test these indications.Setting Review of PubMed, Web of Science, and Embase for papers about carbamazepine exposure in the first trimester of pregnancy and specific malformations, and the EUROCAT Antiepileptic Study Database, including data from 19 European population based congenital anomaly registries, 1995-2005.Participants The literature review covered eight cohort studies of 2680 pregnancies with carbamazepine monotherapy exposure, and the EUROCAT dataset included 98 075 registrations of malformations covering over 3.8 million births.Main outcome measures Overall prevalence for a major congenital malformation after exposure to carbamazepine monotherapy in the first trimester. Odds ratios for malformations with exposure to carbamazepine among cases (five types of malformation identified in the literature review) compared with two groups of controls: other non-chromosomal registrations of malformations and chromosomal syndromes.Results The literature review yielded an overall prevalence for a major congenital malformation of 3.3% (95% confidence interval 2.7 to 4.2) after exposure to carbamazepine monotherapy in the first trimester. In 131 registrations of malformations, the fetus had been exposed to carbamazepine monotherapy. Spina bifida was the only specific major congenital malformation significantly associated with exposure to carbamazepine monotherapy (odds ratio 2.6 (95% confidence interval 1.2 to 5.3) compared with no antiepileptic drug), but the risk was smaller for carbamazepine than for valproic acid (0.2, 0.1 to 0.6). There was no evidence for an association with total anomalous pulmonary venous return (no cases with carbamazepine exposure), cleft lip (with or without palate) (0.2, 0.0 to 1.3), diaphragmatic hernia (0.9, 0.1 to 6.6), or hypospadias (0.7, 0.3 to 1.6) compared with no exposure to antiepileptic drugs. Further exploratory analysis suggested a higher risk of single ventricle and atrioventricular septal defect.Conclusion Carbamazepine teratogenicity is relatively specific to spina bifida, though the risk is less than with valproic acid. Despite the large dataset, there was not enough power to detect moderate risks for some rare major congenital malformations.
Databáze: OpenAIRE
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