PURPOSE: To investigate the influence of maternal antiepileptic drug (AED) treatment on pregnancy duration, birth weight, body length, head circumference, and intrauterine growth in infants exposed in utero to antiepileptic drugs in Sweden between 1973-1997, with 963 singleton infants. METHODS: Data collected from (a) 1973-1981 (record linkage between a hospital discharge register and a medical birth register); (b) 1984-1995 (prospectively collected information in one defined catchment area with two delivery hospitals); and (c) 1995-1997 (medical birth register data). Observed numbers of infants below a defined size for body measurements compared with expected numbers calculated from all births in Sweden after stratification for year of birth, maternal age, parity, and education or smoking habits in early pregnancy. Standard deviation scores estimated with same stratification procedures. RESULTS: Fraction of monotherapy exposures increased from approximately 40% to approximately 90% from 1973 to 1997. Significantly increased numbers of infants with small body measurements found in exposed group. Negative influence on body dimensions decreased over time. More marked effects found in infants exposed to polytherapy. In monotherapy, only infants exposed to carbamazepine consistently showed reduction in body dimensions. Significant effect on gestational age in girls and on number of small for gestational age (
Concerns have been expressed about possible adverse effects of the use of antidepressant medication during pregnancy, including risk for neonatal pathology and the presence of congenital malformations.
Data from the Swedish Medical Birth Register (MBR) from 1 July 1995 up to 2007 were used to identify women who reported the use of antidepressants in early pregnancy or were prescribed antidepressants during pregnancy by antenatal care: a total of 14 821 women with 15 017 infants. Maternal characteristics, maternal delivery diagnoses, infant neonatal diagnoses and the presence of congenital malformations were compared with all other women who gave birth, using the Mantel-Haenszel technique and with adjustments for certain characteristics.
There was an association between antidepressant treatment and pre-existing diabetes and chronic hypertension but also with many pregnancy complications. Rates of induced delivery and caesarean section were increased. The preterm birth rate was increased but not that of intrauterine growth retardation. Neonatal complications were common, notably after tricyclic antidepressant (TCA) use. An increased risk of persistent pulmonary hypertension of the newborn (PPHN) was verified. The congenital malformation rate was increased after TCAs. An association between use of paroxetine and congenital heart defects was verified and a similar effect on hypospadias was seen.
Women using antidepressants during pregnancy and their newborns have increased pathology. It is not clear how much of this is due to drug use or underlying pathology. Use of TCAs was found to carry a higher risk than other antidepressants and paroxetine seems to be associated with a specific teratogenic property.
PURPOSE: To investigate whether blue-collar employment in the Swedish rubber industry from 1973 onwards had a negative impact on reproductive health. METHODS: Pairs of mother and child, and triads of father-mother-child were obtained through linkage of a cohort of 18,518 rubber factory employees with the Swedish Population Registry. Birth outcomes were obtained from the Medical Birth Register for 17,918 children. For each child, parental employment as blue-collar rubber worker during the pregnancy and sperm maturation period was obtained from work-place records. Children to female food industry workers, in all 33,256, constituted an external reference group. RESULTS: The sex ratio was reversed, with odds ratio (OR) for having a girl was 1.15 (95% CI 1.02, 1.31) when the mother was exposed. When both parents were exposed, the OR was even higher, 1.28 (95% CI 1.02, 1.62). An increased risk of multiple births was observed when both parents were exposed, with OR 2.42 (95% CI 1.17, 5.01). Children with both maternal and paternal exposure had a reduced birth weight compared to the external reference cohort. After adjustment for smoking (available for births from 1983 onwards), ethnicity and sex, the difference between children (singletons, live births) with maternal and paternal exposure and external referents was -142 g (95% CI -229, -54). The adjusted OR for having a small-for-gestational-age child was 2.15 (95% CI 1.45, 3.18) when the mother was a rubber worker during the pregnancy. CONCLUSION: There were clear indications that reproductive outcome was adversely affected in rubber workers. The findings warrant further investigation with refinement of exposure indices and inclusion of other endpoints of reproductive health.
Cohorts comprising fishermen's families on the east coast of Sweden have been found to have a high consumption of contaminated fish as well as high body burdens of persistent organochlorine pollutants (POPs). Their west coast correspondents are socio-economically similar, but with considerably lower POP exposure since the fish caught on the west coast is far less contaminated. The rationale for this was that the cohorts residing on the east coast of Sweden have been found to have a high consumption of contaminated fish as well as high body burdens of POPs, whereas their west coast correspondents are socio-economically similar, but with considerably lower POP exposure since the fish caught on the west coast is far less contaminated. Among the reproductive outcomes investigated are included both male and female parameters, as well as couple fertility and effects on the fetus. A range of exposure measures, including both questionnaire assessments of fish consumption and biomarkers, have been used. The most consistent findings of the studies are those related to the fetus, where a decreased birth weight was found across all measures of exposure, which is in agreement with studies from other populations. Some markers for male reproduction function, i.e. sperm motility, sperm chromatin integrity, and Y:X chromosome ratio, were associated with POP exposure, whereas others, such as sperm concentration and semen volume, were not. With respect to couple fertility and female reproductive parameters, no support was given for associations with POP exposure. Although some associations may have been affected by beneficial effects of essential nutrients in seafood, the overall findings are meaningful in the context of reproductive toxicity and support the usefulness of the epidemiological design.