Use of oral contraceptives in pregnancy and major structural birth defects in offspring
Dorothy Kim Waller, Michael Shayne Gallaway, Lockwood G Taylor
Tunu Ramadhani , Mark A Canfield, Angela E. Scheuerle, Sonia Hernández–Dı́az, Carol Louik, Adolfo Correa, National Birth Defects Prevention Study , Sonia Hernández-Diaz
Author affiliations (4)
The University of Texas Health Science Center at HoustonROR
Oral contraceptives (OCs) are the most commonly used reversible contraceptive method among US women. Although the majority of previous studies have reported no association between OC use during pregnancy and birth defects, some studies have reported increased occurrence of neural tube defects, limb reduction defects, and urinary tract anomalies.
Methods
We assessed OC use among mothers who participated in the multisite, case-control, National Birth Defects Prevention Study. Mothers of 9986 infants with 32 types of birth defects and 4000 infants without birth defects were included.
Results
Maternal OC use during the first 3 months of pregnancy was associated with an increased odds ratio for 2 of 32 birth defects: hypoplastic left heart syndrome (adjusted odds ratio = 2.3 [95% confidence interval = 1.3-4.3) and gastroschisis (1.8 [1.3-2.7]).
Conclusion
Previous reports of associations between OC use and specific types of anomalies were not corroborated. Given that associations were assessed for 32 types of birth defects, our findings of 2 increased associations between OC use and gastroschisis and hypoplastic left heart syndrome should be interpreted as hypotheses until they can be evaluated further. Overall, our findings are consistent with the majority of previous studies that found women who use OCs during early pregnancy have no increased risk for most types of major congenital malformations.
oral contraceptive use pregnancy birth defects risk, OC exposure first trimester congenital malformations, hypoplastic left heart syndrome oral contraceptive association, gastroschisis oral contraceptive early pregnancy exposure, National Birth Defects Prevention Study oral contraceptives, hormonal contraceptive teratogenicity case-control study, oral contraceptive neural tube defect limb reduction risk, inadvertent oral contraceptive use during pregnancy outcomes, Waller birth defects oral contraceptive epidemiology, contraceptive pill structural birth defects multisite study
PMID 20087193 20087193 DOI 10.1097/EDE.0b013e3181c9fbb3 10.1097/EDE.0b013e3181c9fbb3
Cite this article
Waller, D. K., Gallaway, M. S., Taylor, L. G., Ramadhani, T. A., Canfield, M. A., Scheuerle, A., Hernández-Diaz, S., Louik, C., Correa, A., & National Birth Defects Prevention Study (2010). Use of oral contraceptives in pregnancy and major structural birth defects in offspring. Epidemiology (Cambridge, Mass.), 21(2), 232-239. https://doi.org/10.1097/EDE.0b013e3181c9fbb3
Waller DK, Gallaway MS, Taylor LG, Ramadhani TA, Canfield MA, Scheuerle A, et al. Use of oral contraceptives in pregnancy and major structural birth defects in offspring. Epidemiology. 2010;21(2):232-239. doi:10.1097/EDE.0b013e3181c9fbb3
Waller, D. K., et al. "Use of oral contraceptives in pregnancy and major structural birth defects in offspring." Epidemiology (Cambridge, Mass.), vol. 21, no. 2, 2010, pp. 232-239.
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Women who experience pregnancy loss are especially prone to high stress, though the effects of stress on reproductive outcomes in this vulnerable population are unknown. We assessed relationships between perceived stress and hormones, anovulation, and fecundability among women with prior loss. One thousand two hundred fourteen women with 1-2 prior losses were followed for ≤6 cycles while attempting pregnancy and completed end-of-cycle stress assessments. For cycles 1 and 2, women also collected daily urine and completed daily perceived stress assessments. We assessed anovulation via. an algorithm based on human chorionic gonadotropin (hCG), pregnanediol-3-glucuronide (PdG), luteinizing hormone (LH), and fertility monitor readings. Pregnancy was determined via. hCG. Adjusted weighted linear mixed models estimated the effect of prospective phase-varying (menses, follicular, periovulatory, and luteal) perceived stress quartiles on estrone-1-glucuronide (E1G), PdG, and LH concentrations. Marginal structural models accounted for time-varying confounding by hormones and lifestyle factors affected by prior stress. Poisson and Cox regression estimated risk ratios and fecundability odds ratios of cycle-varying stress quartiles on anovulation and fecundability. Models were adjusted for age, race, body mass index (BMI), parity, and time-varying caffeine, alcohol, smoking, intercourse, and pelvic pain. Women in the highest versus lowest stress quartile had lower E1G and PdG concentrations, a marginally higher risk of anovulation [1.28; 95% confidence interval (CI) = 1.00, 1.63], and lower fecundability (0.71; 95% CI = 0.55, 0.90). Preconception perceived stress appears to adversely affect sex steroid synthesis and time to pregnancy. Mechanisms likely include the effects of stress on ovulatory function, but additional mechanisms, potentially during implantation, may also exist.
Environmental chemicals may be associated with endometriosis. No published research has focused on the possible role of perfluorochemicals (PFCs) despite their widespread presence in human tissues. We formulated two samples. The first was an operative sample comprising 495 women aged 18-44 years scheduled for laparoscopy/laparotomy at one of 14 participating clinical sites in the Salt Lake City or San Francisco area, 2007-2009. The second was a population-based sample comprising 131 women matched to the operative sample on age and residence within a 50-mile radius of participating clinics. Interviews and anthropometric assessments were conducted at enrollment, along with blood collection for the analysis of nine PFCs, which were quantified using liquid chromatography-tandem mass spectrometry. Endometriosis was defined based on surgical visualization (in the operative sample) or magnetic resonance imaging (in the population sample). Using logistic regression, we estimated odds ratios (ORs) and 95% confidence intervals (CIs) for each PFC (log-transformed), adjusting for age and body mass index, and then parity. Serum perfluorooctanoic acid (PFOA; OR = 1.89 [95% CI = 1.17-3.06]) and perfluorononanoic acid (2.20 [1.02-4.75]) were associated with endometriosis in the operative sample; findings were moderately attenuated with parity adjustment (1.62 [0.99-2.66] and 1.99 [0.91-4.33], respectively). Perfluorooctane sulfonic acid (1.86 [1.05-3.30]) and PFOA (2.58 [1.18-5.64]) increased the odds for moderate/severe endometriosis, although the odds were similarly attenuated with parity adjustment (OR = 1.50 and 1.86, respectively). Select PFCs were associated with an endometriosis diagnosis. These associations await corroboration.