Despite warnings to abstain from alcohol, American women who are or could become pregnant still drink. This study evaluates whether women who consume alcohol are at an increased risk of recognizing pregnancy later than women who do not, adjusting for confounding factors that have been associated with alcohol consumption during pregnancy.
The sample included 863 control women from a multisite case-control study conducted from 1996 to 2002 in the United States and Canada. Telephone interviews were conducted with mothers by trained nurse interviewers who administered standardized questionnaires on demographic and reproductive factors, and pregnancy exposures.
Alcohol consumption was classified as none (42.0%), occasional (31.9%), regular (15.6%), and heavy (10.5%). Time to recognition of pregnancy was calculated as the date pregnancy was suspected minus the last menstrual period date (median: 31 days; range: 7-227 days). Unadjusted Cox proportional hazard models found that regular drinkers, but not heavy drinkers, had a significantly higher risk of recognizing pregnancy later than non-drinkers. However, this association went away after adjustment for demographic factors. Among women with unplanned pregnancies, heavy alcohol intake was associated with a 45% increased hazard ratio, compared to 0.80 for women with planned pregnancies; however, this finding was not statistically significant.
While time to pregnancy recognition did not vary among drinkers and non-drinkers, results from this study reiterate previous findings that pregnant women consume alcohol, and that drinkers share social and demographic characteristics that could be used to target public health interventions.
BACKGROUND: Endosulfan has been used for over 50 years. Although most analogs have been discontinued, endosulfan has less environmental persistence. Nevertheless, pressure groups are lobbying for a worldwide ban. The reasons are: possible rodent male reproductive toxicity, other endocrine effects and cancer; human epidemiology, and exposure studies; residues appearing in remote areas of the world, e.g., the Arctic. METHODS: The endosulfan toxicology database is described and risks of its use assessed. RESULTS: Endosulfan is an antagonist at the GABA(A) receptor Cl(-) ionophore in mammalian CNS. Rat acute toxicity is moderate, LD(50)=48 (M) or 10 mg/kg/d (F), oral gavage; 130 (M), 70 mg/kg/d (F) dermal; LC(50)=34.5 microg/L (M), 12.6 microg/L (F), inhalation. Critical NOELs for risk assessment: acute oral (gavage)=0.7 mg/kg/d (rabbit developmental); Subchronic oral (diet)=1.2 mg/kg/d (rat reproduction); Chronic oral (diet)=0.6 mg/kg/d. There were no acceptable dermal toxicity studies. The critical acute and subchronic inhalation NOELs=0.001 mg/L, chronic inhalation=0.0001 mg/L (estimated). Toxicity to rat sperm occurred at doses causing neurotoxicity. Endocrine effects, resulting from P450 oxygenase(s) induction, were reversible. Increased cancer, genotoxicity, or histopathology in rodents was not observed in any organ. Possible effects on brain biogenic amine levels were probably secondary. CONCLUSIONS: Epidemiology and rodent studies suggesting autism and male reproductive toxicity are open to other interpretations. Developmental/ reproductive toxicity or endocrine disruption occurs only at doses causing neurotoxicity. Toxicity to the fetus or young animals is not more severe than that shown by adults.
Concerns have been raised as to the safety of using pivaloyl-conjugated beta-lactam antibiotics during pregnancy as they cause carnitine depletion. Restrictions have been recommended in some Scandinavian countries as drug-induced carnitine depletion could constitute a risk to the developing foetus. One of these drugs, pivmecillinam, is widely used against urinary tract infections but few data exist concerning its safety in pregnancy. In a cohort study, we compared the prevalences of congenital abnormalities, pre-term delivery, low birth weight, low Apgar score and neonatal hypoglycaemia in the offspring of 414 women who had at least 1 prescription for pivmecillinam redeemed during pregnancy with those of the offspring of 7472 pregnant women for whom no drugs were prescribed during pregnancy. The prevalence of congenital abnormalities was 1.7% among 119 infants exposed in the first trimester and 3.7% among the reference group [odds ratio (OR) 0.46; 95% confidence interval (CI) 0.11-1.86]. We found no significantly increased risks in either pre-term delivery (OR 0.91, 95% CI 0.11-1.86), low birth weight (OR 0.57, 95%, CI 0.23-1.41), low Apgar score (OR 2.32, 95% CI 0.30-18.16) or hypoglycaemia (OR 0.73, 95% CI 0.18-3.00) that were induced by carnitine depletion. No significantly increased risk in adverse birth outcome was therefore found in women treated with pivmecillinam.
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 (
It seems to me that cancer is occurring or being diagnosed more frequently among young women who are or might become pregnant. In the past year, I have seen several such women in my practice and I have had difficulty finding appropriate information in order to counsel them. Is there somewhere I can go for information about cancer during pregnancy so that I can better educate and inform these patients?
The Motherisk Program at the Hospital for Sick Children supports an on-line Cancer in Pregnancy Forum where physicians and other health care professionals can submit questions or details of experiences that they have had with patients who had cancer during pregnancy. Questions about the safety of chemotherapeutic drugs before and during pregnancy and about possible exacerbation of previous cancer by pregnancy are most common.
In two Copenhagen University hospitals 12,885 pregnant women, seen during the period 1.8.1992 to 30.04.1995, answered questionnaires regarding consumption of alcohol, tobacco, cannabis and other drugs. The prevalence of cannabis use was 0.8%. Women using cannabis but no other illicit drugs were each retrospectively matched with four randomly chosen pregnant women in the same period and the same age group and with same parity. Eighty-four cannabis users were included. These women were socioeconomically disadvantaged and had a higher prevalence of present and past use of alcohol, tobacco and other drugs. No significant difference in pregnancy, delivery or puerperal outcome was found. Children of women using cannabis were 150 g lighter, 1.2 cm shorter and had 0.2 cm smaller head circumference than the control infants. Controlling for the child's sex and maternal use of alcohol did not eliminate the significant differences in birthweight and length; however, they were eliminated by controlling for maternal tobacco smoking. It is concluded, that the use of cannabis is not a major prognostic factor regarding the outcome of pregnancy, but is an indicator of low socioeconomic status and use of other substances.
Although the impact of environmental contaminants on human health has been widely studied, few reports in the Canadian literature have focussed on the specific vulnerability of children. Because of their rapid growth, physiologic and metabolic immaturity, the fetus and child are often at increased risk from toxic substances in their environments. Furthermore, greater air, food and fluid intakes relative to body weight compared with the adult, increase the child's potential for excessive exposures. The crawling stage of infancy, the play patterns and short stature of toddlers also serve to increase their exposure to dust and heavy and volatile substances which accumulate near the floor. This article provides an overview of some of the developmental physiologic, anatomic and behavioural features of the fetus, infant and child which increase their vulnerability to environmental contaminants in comparison with adults. Specific examples are given.
OBJECTIVES: To examine the risk of malformations and fetal growth in the children of women treated with anticonvulsant drugs in North Jutland County, Denmark. MATERIAL AND METHODS: All women treated with anticonvulsant drugs in the county were identified in a Pharmaco-Epidemiological Prescription Database and linked to the Danish Medical Birth Registry and the Regional Hospital Information system. RESULTS: We identified 235 pregnancies where the mothers had used prescriptions for anticonvulsants around conception and/or during pregnancy, and 17,259 unexposed pregnancies where the mothers had not used prescriptions. One case of neural tube defect was found among 15 malformations in the exposed cohort. The overall odds ratio for malformations was 2.2 (95% confidence intervals 1.3-3.8). The odds ratios for low birth weight and preterm delivery were respectively 1.5 (95% confidence intervals 0.6-3.7) and 1.6 (95% confidence intervals 1.0-2.5). CONCLUSION: We found an increased risk of congenital malformations and a tendency to growth retardation in the children of women taking anticonvulsants.
Developmental origins of environmentally induced disease and dysfunction. Proceedings of the International Conference on Foetal Programming and Developmental Toxicity. Tórshavn, Faroe Islands. May, 20-24, 2007.