JAMA:孕早期暴露于昂丹司琼会导致胎儿先天畸形吗?

2019-02-13 王淳 环球医学

2018年12月,发表于《JAMA》上的一项研究,考察了孕早期暴露于昂丹司琼与胎儿心脏畸形和唇腭裂的相关性。

2018年12月,发表于《JAMA》上的一项研究,考察了孕早期暴露于昂丹司琼与胎儿心脏畸形和唇腭裂的相关性。

重要性:昂丹司琼是一种5-HT3受体拮抗剂,通常用于孕期恶心和呕吐,其胎儿安全性的证据有限且相互矛盾。

目的:评估妊娠期暴露于昂丹司琼与胎儿先天畸形风险之间的相关性。

设计、环境和受试者:使用2000~2013年Medicaid医保数据开展回顾性队列研究。这个队列包括1502895名女性,1816414例妊娠,记录了这些女性从末次月经前3个月直到分娩后1个月或更长时间的医疗记录;同时纳入了至少3个月大的婴儿。随访最终日期是2013年12月31日。数据分析开展于2017年11月1日至2018年6月30日间。采用倾向评分分层控制混杂因素。

暴露:在孕早期即器官形成期内使用昂丹司琼。

主要结局指标:主要结局是胎儿出生后前90日内被诊断为心脏畸形和唇腭裂。次要结局包括所有的先天畸形以及心脏畸形和唇腭裂的疾病亚型。

结果:在1816414例妊娠(母亲平均年龄,24.3[5.8]岁)中,88467(4.9%)例在孕早期暴露于昂丹司琼。

总体上,未暴露组1727947例中有14577例婴儿诊断为心脏畸形,暴露组88467例中有835例,绝对风险分别为每10000例婴儿有84.4例(95%CI,83.0~85.7)和94.4例(95%CI,88.0~100.8)。

唇腭裂的绝对风险分别是非暴露组每10000例婴儿中有11.1例(95%CI,10.6~11.6;1921名未暴露的婴儿)和暴露组每10000例婴儿中有14.0例(95%CI,11.6~16.5;124名暴露的婴儿)。

任何先天畸形风险分别是非暴露组每10000例婴儿中有313.5例(95%CI,310.9~316.1;54174名未暴露的婴儿)和暴露组每10000例婴儿中370.4例(95%CI,358.0~382.9;3277例暴露的婴儿)。

心脏畸形的调整后相对风险(RR)是0.99(95%CI,0.93~1.06),调整后风险差(RD)是-0.8(95%CI,每10000例婴儿中有-7.3~5.7);唇腭裂的调整后RR是1.24(95%CI,1.03~1.48),RD是2.7(95%CI,每10000例婴儿中有0.2~5.2)。

总的先天畸形的调整后RR为1.01(95%CI,0.98~1.05),RD为5.4(95%CI,每10000例婴儿中有-7.3~18.2)。

结论和意义:在考虑了已测量的混杂因素后,孕早期暴露于昂丹司琼与心脏畸形或总体的先天畸形无关,但可能小幅增加唇腭裂的风险。

原始出处:

Huybrechts KF, Hernández-Díaz S, Straub L, et.al. Association of Maternal First-Trimester Ondansetron Use With Cardiac Malformations and Oral Clefts in Offspring. JAMA. 2018 Dec 18;320(23):2429-2437. doi: 10.1001/jama.2018.18307.

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (4)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1362266, encodeId=d3241362266e6, content=<a href='/topic/show?id=9857e03444b' target=_blank style='color:#2F92EE;'>#畸形#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70344, encryptionId=9857e03444b, topicName=畸形)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=395f25, createdName=爆笑小医, createdTime=Fri Feb 15 03:50:00 CST 2019, time=2019-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1394201, encodeId=87271394201a0, content=<a href='/topic/show?id=1646452e771' target=_blank style='color:#2F92EE;'>#孕早期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45277, encryptionId=1646452e771, topicName=孕早期)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdqq.qlogo.cn/qqapp/101173734/0EDD6BA8A8C6A0C23E8ABC8BA5331A25/100, createdBy=d37d2500154, createdName=ms5106640509429053, createdTime=Fri Feb 15 03:50:00 CST 2019, time=2019-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1604913, encodeId=ff141604913f0, content=<a href='/topic/show?id=84dd286962f' target=_blank style='color:#2F92EE;'>#先天畸形#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=28696, encryptionId=84dd286962f, topicName=先天畸形)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6c5d19291935, createdName=12498484m52(暂无昵称), createdTime=Fri Feb 15 03:50:00 CST 2019, time=2019-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1630921, encodeId=8fd81630921af, content=<a href='/topic/show?id=8ef5595e72d' target=_blank style='color:#2F92EE;'>#昂丹司琼#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59577, encryptionId=8ef5595e72d, topicName=昂丹司琼)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f8e421606376, createdName=zhucaizhong7773, createdTime=Fri Feb 15 03:50:00 CST 2019, time=2019-02-15, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=1362266, encodeId=d3241362266e6, content=<a href='/topic/show?id=9857e03444b' target=_blank style='color:#2F92EE;'>#畸形#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70344, encryptionId=9857e03444b, topicName=畸形)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=395f25, createdName=爆笑小医, createdTime=Fri Feb 15 03:50:00 CST 2019, time=2019-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1394201, encodeId=87271394201a0, content=<a href='/topic/show?id=1646452e771' target=_blank style='color:#2F92EE;'>#孕早期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45277, encryptionId=1646452e771, topicName=孕早期)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdqq.qlogo.cn/qqapp/101173734/0EDD6BA8A8C6A0C23E8ABC8BA5331A25/100, createdBy=d37d2500154, createdName=ms5106640509429053, createdTime=Fri Feb 15 03:50:00 CST 2019, time=2019-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1604913, encodeId=ff141604913f0, content=<a href='/topic/show?id=84dd286962f' target=_blank style='color:#2F92EE;'>#先天畸形#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=28696, encryptionId=84dd286962f, topicName=先天畸形)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6c5d19291935, createdName=12498484m52(暂无昵称), createdTime=Fri Feb 15 03:50:00 CST 2019, time=2019-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1630921, encodeId=8fd81630921af, content=<a href='/topic/show?id=8ef5595e72d' target=_blank style='color:#2F92EE;'>#昂丹司琼#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59577, encryptionId=8ef5595e72d, topicName=昂丹司琼)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f8e421606376, createdName=zhucaizhong7773, createdTime=Fri Feb 15 03:50:00 CST 2019, time=2019-02-15, status=1, ipAttribution=)]
  3. [GetPortalCommentsPageByObjectIdResponse(id=1362266, encodeId=d3241362266e6, content=<a href='/topic/show?id=9857e03444b' target=_blank style='color:#2F92EE;'>#畸形#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70344, encryptionId=9857e03444b, topicName=畸形)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=395f25, createdName=爆笑小医, createdTime=Fri Feb 15 03:50:00 CST 2019, time=2019-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1394201, encodeId=87271394201a0, content=<a href='/topic/show?id=1646452e771' target=_blank style='color:#2F92EE;'>#孕早期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45277, encryptionId=1646452e771, topicName=孕早期)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdqq.qlogo.cn/qqapp/101173734/0EDD6BA8A8C6A0C23E8ABC8BA5331A25/100, createdBy=d37d2500154, createdName=ms5106640509429053, createdTime=Fri Feb 15 03:50:00 CST 2019, time=2019-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1604913, encodeId=ff141604913f0, content=<a href='/topic/show?id=84dd286962f' target=_blank style='color:#2F92EE;'>#先天畸形#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=28696, encryptionId=84dd286962f, topicName=先天畸形)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6c5d19291935, createdName=12498484m52(暂无昵称), createdTime=Fri Feb 15 03:50:00 CST 2019, time=2019-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1630921, encodeId=8fd81630921af, content=<a href='/topic/show?id=8ef5595e72d' target=_blank style='color:#2F92EE;'>#昂丹司琼#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59577, encryptionId=8ef5595e72d, topicName=昂丹司琼)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f8e421606376, createdName=zhucaizhong7773, createdTime=Fri Feb 15 03:50:00 CST 2019, time=2019-02-15, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=1362266, encodeId=d3241362266e6, content=<a href='/topic/show?id=9857e03444b' target=_blank style='color:#2F92EE;'>#畸形#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70344, encryptionId=9857e03444b, topicName=畸形)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=395f25, createdName=爆笑小医, createdTime=Fri Feb 15 03:50:00 CST 2019, time=2019-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1394201, encodeId=87271394201a0, content=<a href='/topic/show?id=1646452e771' target=_blank style='color:#2F92EE;'>#孕早期#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=45277, encryptionId=1646452e771, topicName=孕早期)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdqq.qlogo.cn/qqapp/101173734/0EDD6BA8A8C6A0C23E8ABC8BA5331A25/100, createdBy=d37d2500154, createdName=ms5106640509429053, createdTime=Fri Feb 15 03:50:00 CST 2019, time=2019-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1604913, encodeId=ff141604913f0, content=<a href='/topic/show?id=84dd286962f' target=_blank style='color:#2F92EE;'>#先天畸形#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=28696, encryptionId=84dd286962f, topicName=先天畸形)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=6c5d19291935, createdName=12498484m52(暂无昵称), createdTime=Fri Feb 15 03:50:00 CST 2019, time=2019-02-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1630921, encodeId=8fd81630921af, content=<a href='/topic/show?id=8ef5595e72d' target=_blank style='color:#2F92EE;'>#昂丹司琼#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=59577, encryptionId=8ef5595e72d, topicName=昂丹司琼)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f8e421606376, createdName=zhucaizhong7773, createdTime=Fri Feb 15 03:50:00 CST 2019, time=2019-02-15, status=1, ipAttribution=)]

相关资讯

Eur Respir J:孕早期胎儿大小和15岁时配发哮喘药物之间的相关性分析!

由此可见,孕早期激活的产前因素可能与整个儿童期的呼吸道健康有关。

JAHA:孕早期热量暴露的增加会增加子代先心病风险!

由于气候变化,预计美国将发生更为强烈和持久的热事件。本研究的目的旨在评估孕早期(3-8周)对热量暴露的变化与子代先天性心脏病发生的相关性。本研究是全国性病例对照研究,评估了春天和夏天的孕早期热量暴露与子代先心病发生的关系。在美国,孕早期在夏天对热量的暴露时间和强度更大,中西部夏天的热量暴露增幅最大,平均每个孕期暴露时间增加3.42天,热事件频率增加0.52。在子代先心病的发生中,美国南部的圆锥动脉

Hypertension:美国研究称,孕前和孕早期血压升高与反复流产有关

美国国立卫生研究院尤妮斯甘乃迪施莱佛国家儿童健康与人类发展研究所发表的一项新的研究结果表明,孕前以及孕早期血压升高与反复流产有关。

JCEM:孕早期高甘油三酯水平与早产风险

由此可见,妊娠早期的高mTG水平不仅增加了OWO女性的早产风险,而且增加了BMI正常女性的早产风险。

BMJ:孕早期服用二甲双胍不会增加新生儿先天畸形风险

研究认为孕早期服用二甲双胍是安全的

早孕期超声诊断人体鱼序列综合征1例

患者女,27岁,孕1产0,孕12周。平素身体健康。曾服左旋18-甲基炔诺酮避孕,受孕后14~19d因尿路感染服用过磺胺类药物。