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Risk of congenital anomalies after exposure to asthma medication in the first trimester of pregnancy – a cohort linkage study
Author(s) -
Garne E,
Vinkel Hansen A,
Morris J,
Jordan S,
Klungsøyr K,
Engeland A,
Tucker D,
Thayer DS,
Davies GI,
Nybo Andersen AM,
Dolk H
Publication year - 2016
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.14026
Subject(s) - medicine , asthma , pregnancy , pediatrics , odds ratio , cohort , medical prescription , cohort study , confounding , record linkage , population , obstetrics , environmental health , genetics , pharmacology , biology
Objective To examine the effect of maternal exposure to asthma medications on the risk of congenital anomalies. Design Meta‐analysis of aggregated data from three cohort studies. Setting Linkage between healthcare databases and EUROCAT congenital anomaly registries. Population 519 242 pregnancies in Norway (2004–2010), Wales (2000–2010) and Funen, Denmark (2000–2010). Methods Exposure defined as having at least one prescription for asthma medications issued (Wales) or dispensed (Norway, Denmark) from 91 days before to 91 days after the pregnancy start date. Odds ratios ( OR s) were estimated separately for each register and combined in meta‐analyses. Main outcome measures OR s for all congenital anomalies and specific congenital anomalies. Results Overall exposure prevalence was 3.76%. For e xposure to asthma medication in general, the adjusted OR (adj OR ) for a major congenital anomaly was 1.21 (99% CI 1.09–1.34) after adjustment for maternal age and socioeconomic position. The OR of anal atresia was significantly increased in pregnancies exposed to inhaled corticosteroids (3.40; 99% CI 1.15–10.04). For severe congenital heart defects, an increased OR (1.97; 1.12–3.49) was associated with exposure to combination treatment with inhaled corticosteroids and long‐acting beta‐2‐agonists. Associations with renal dysplasia were driven by exposure to short‐acting beta‐2‐agonists (2.37; 1.20–4.67). Conclusion The increased risk of congenital anomalies for women taking asthma medication is small with little confounding by maternal age or socioeconomic status. The study confirmed the association of inhaled corticosteroids with anal atresia found in earlier research and found potential new associations with combination treatment. The potential new associations should be interpreted with caution due to the large number of comparisons undertaken. Tweetable abstract This cohort study found a small increased risk of congenital anomalies for women taking asthma medication.