Maternal Use Of Oral Contraceptives Research Articles

Maternal use of oral contraceptives and risk of birth defects in Denmark: prospective, nationwide cohort study

Study question Is oral contraceptive use around the time of pregnancy onset associated with an increased risk of major birth defects? Methods In a prospective observational cohort study, data on...

Oral contraceptive use and conotruncal congenital heart disease

Background Congenital heart disease (CHD) represents some of the more prevalent malformations among live births andremains the leading cause of death from congenital malformations.Conotruncal anomalies comprise a diverse group of CHDinvolving the outflow tracts of the heart and the great vessels.Oral contraceptive exposure before pregnancy may be one of therisk factors for conotruncal CHD.Objective To evaluate the effect of oral contraceptive use beforepregnancy on the risk of conotruncal CHD in children.Methods A case-control study was conducted from July 2010until July 2011 in Haji Adam Malik Hospital, Medan. Subjectswith CHD were divided into two groups: conotruncal CHD asthe case group and non-conotruncal CHD as the control group.Both groups had mothers with and without histories of oralcontraceptive use before pregnancy. Parents were interviewedusing questionnaires. Statistical analyses were performed usingChi-square test, student’s T-test, and Mann Whitney test.Results A total of 80 subjects were eligible, with 40 subjects ineach group. The percentages of subjects whose mothers used oralcontraceptives were 62% of the conotruncal CHD group and60% of the non-conotruncal CHD group (OR 0.82; 95%CI 0.33to 1.98). The mean duration of maternal oral contraceptive usebefore pregnancy was 19.1 months for the case group and 18.8months for the control group (P=0.87).Conclusion In children with CHD, maternal oral contraceptiveuse before pregnancy does not appear to increase the risk ofconotruncal CHD.

Maternal Use of Oral Contraceptives During Early Pregnancy and Risk of Hypospadias in Male Offspring

To examine the association between maternal use of oral contraceptives in early pregnancy and increased prevalence of hypospadias in male offspring. We conducted a nationwide population-based case-control study using data from nationwide medical databases. Among live male births between January 1, 1996, and December 31, 2005, we identified all cases of hypospadias recorded anytime postpartum (n = 1683) and randomly selected 10 controls per case without such a diagnosis (n = 15 650), matched by year and hospital of birth. We used conditional logistic regression to estimate prevalence ratios stratified according to time of diagnosis (within 6 months postpartum, >6 months postpartum), controlling for potential confounding factors including maternal age, birth order, maternal smoking, prescriptions for ovulation-inducing drugs, antiepileptics, and antidiabetics, and a maternal diagnosis of pre-eclampsia. We included 1683 cases of hypospadias and 15,650 population controls during 1996-2005. Among the 1186 boys who had their hypospadias diagnosis recorded within 6 months postpartum, 28 (2.4%) had been exposed to oral contraceptives between 30 days before conception until the end of the first trimester. Among the controls, 307 (2.8%) were similarly exposed, corresponding to a prevalence ratio of 0.85 (95% CI: 0.57-1.27) after adjusting for possible confounders. For a diagnosis registered >6 months postpartum, the adjusted prevalence ratio was 1.12 (95% CI: 0.61-2.06). Our data do not support the hypothesis that maternal use of oral contraceptives around conception is associated with an increased prevalence of hypospadias in the offspring.

Maternal use of oral contraceptives and risk of fetal death

Intrauterine exposure to artificial sex hormones such as oral contraceptives may be associated with an increased risk of fetal death. Between 1996 and 2002, a total of 92 719 women were recruited to The Danish National Birth Cohort and interviewed about exposures during pregnancy. Outcome of pregnancy was identified through linkage to the Civil Registration System and the National Discharge Registry. The authors analysed the risk of fetal death after recruitment to the cohort by using proportional hazards regression models with gestational age as the underlying time scale. In total, 1102 (1.2%) women took oral contraceptives during pregnancy. Use of combined oestrogen and progesterone oral contraceptives (COC) or progesterone-only oral contraceptives (POC) during pregnancy was not associated with increased hazard ratios of fetal death compared with non-users, HR 1.01 [95% CI 0.71, 1.45] and HR 1.37 [95% CI 0.65, 2.89] respectively. Neither use of COC nor POC prior to pregnancy was associated with fetal death. Stratification by maternal age and smoking showed elevated risks of fetal death for women <30 years and smokers using oral contraception during pregnancy, but the interactions were not significant. In conclusion, there was no evidence that oral contraceptive use before or during pregnancy is associated with an increased risk of fetal death.

Maternal use of oral contraceptives and risk of hypospadias – a population-based case-control study

The aim of this population-based case-control study was to examine the risk of isolated hypospadias in boys born to mothers who have used oral contraceptives in early pregnancy. The study was based on data from the Hungarian Case-Control Surveillance of Congenital Abnormalities from 1980 to 1996, and included 3,038 boys with hypospadias (cases), 24,799 boys without congenital abnormalities (CA-free controls), and 11,881 boys with abnormalities other than hypospadias. We used unconditional logistic regression to adjust for birth order, maternal age, maternal employment status, maternal diabetes, and pre-eclampsia. When comparing cases with CA-free controls the OR for maternal use of OC was 1.21 (95% CI: 0.67-2.17). When comparing cases with boys with other abnormalities, the OR for maternal use of OC was 0.83 (95% CI: 0.46-1.50). Our data showed that self-reported maternal use of oral contraceptives during pregnancy was not associated with an increased risk of hypospadias in the offspring.

Maternal oral contraceptive use and atopic diseases in the offspring.

This study examined the association of maternal oral contraceptive (OC) use - before and after birth - and atopic manifestations in the offspring. A total of 2754 East German children aged 5-14 years participated in a cross-sectional survey in 1998-99. The standardized parental questionnaire in 1998-99 included data on atopic diseases, socio-economic factors, parental atopy and maternal OC use. Specific immunoglobulin E against common inhalant allergens was measured by radioallergosorbent test (RAST). Maternal OC use before birth was associated with a higher risk of atopic diseases in the offspring compared with children of mothers who had never taken OC [asthma: odds ratio (OR) 1.6; 95% confidence interval (CI): 0.9-3.0; allergic rhinitis: OR 1.5; CI: 0.96-2.2; atopic eczema: OR 2.6; CI: 1.6-4.3; atopic sensitization: OR 1.5; CI: 0.97-2.2]. However, the effect estimates for maternal OC use after birth compared with the never users showed quite similar effects for these atopic conditions. No relations were observed between the prevalences of atopic diseases and maternal age at beginning of OC use, the duration of OC use, the type of contraceptive or maternal age at birth. This study raises doubts in a true biological association between OC use and atopic diseases.

Periconceptional exposure to contraceptive pills and risk for Down syndrome.

There are some studies which analyzed the relationship between prenatal exposure to oral contraceptives (OCs) and Down syndrome, with conflicting results even in women using OCs and conceiving at different intervals after discontinuing the use of contraceptive pills. We analyzed the risk for Down syndrome in infants of women who become pregnant while taking OC. We used the data from the Spanish Collaborative Study of Congenital Malformations (ECEMC). The ECEMC is a case-control study and surveillance system. For each malformed infant (case), the next non-malformed infant of the same sex born in the same hospital is selected as a control subject, from whom the collaborating physicians collected the same data as for the malformed infant. For the present study, we used two different approaches. First, the pair-matching analysis. Second, a case-control using the rest of the total of 17,183 controls from the ECEMC database with specified data on maternal use of OCs and maternal age. To control for maternal age, we used a logistic regression analysis. The results show an increased risk of 2.8-fold for infants with Down syndrome in women younger than 35 years of age if the mother became pregnant while she was taking OCs. We did not observe this result for women older than 34 years of age. Our results showed that the risk for Down syndrome in infants born to mothers with less than 35 years of age (as a group) who became pregnant while taking OCs is near the risk for Down syndrome of mothers with more than 34 years of age, women who are candidates for prenatal diagnosis. Thus, based on our results, one may consider the possibility of offering prenatal diagnosis for Down syndrome to young women who became pregnant while taking OCs.

Risk factors for neuroblastoma at different stages of disease. Results from a population-based case-control study in Germany

Neuroblastoma is one of the childhood cancers included in two recent population-based case-control studies in West Germany. Altogether, 183 children under the age of 8 with neuroblastoma diagnosed in 1988–1994 and 1785 control children sampled from population registration files participated. Information on potential risk factors was obtained from the children's parents by a self-administered questionnaire and subsequent telephone interview. We observed positive associations with the use of oral contraceptives or other sex hormones during pregnancy (particularly with male offspring), a shorter gestational duration, lower birth weight, and maternal alcohol consumption during pregnancy. While the association with maternal use of oral contraceptives or sex hormones was strong for stages I/II (odds ratio 4.5, 95% confidence interval 1.2–16.5), the associations with shorter gestation duration (odds ratio 3.4, 95% confidence interval 1.7–6.7) as well as maternal alcohol consumption during pregnancy (>7 glasses/week odds ratio 5.2, 95% confidence interval 1.3–20.6) were observed only for the unfavourable advanced stages. It is notable that the associations in our study were either observed only for the advanced stages of disease or only for the less advanced stages, but not for both subgroups. This adds to evidence for the hypothesis that neuroblastoma consists of at least two distinct disease entities, which differ in clinical stage at the time of diagnosis.

Oral contraceptives in the etiology of isolated hypospadias

With the objective of identifying whether hypospadias in infants is associated with maternal use of oral contraceptives before pregnancy or in early pregnancy, 846 case-control pairs were collected from eight different malformation monitoring programs around the world and mothers were interviewed using structured questionnaires administered after the birth of the infants. There was no difference in the preconceptional use of oral contraceptives between cases and controls, neither with respect to the number of years of oral contraceptive usage nor the time betwen stopping oral contraceptives and the present pregnancy. To this material was added data on oral contraceptive usage in early pregnancy from two other sources: an ongoing case-control study in Spain (725 infants with hypospadias) and a population-based study in Sweden (631 infants with hypospadias). There was no statistically significant difference in oral contraceptive exposure in early pregnancy between cases and controls. There is no demonstrable association between oral contraceptive use and infant hypospadias.

Maternal use of oral contraceptives and Down syndrome

The date of stopping oral contraceptives (OC) in relation to the last menstrual period was studied in 458 women with Down syndrome infants born in 1983–1986 and compared with the expected distribution estimated from the total population of births for these years, after stratification for year of birth, maternal age, and parity. No deviations were seen for the total group, for women < 30 or 30+ years old, or for Down syndrome infants with known trisomy 21. This is the third study showing no effect and in contrast to the only study which indicates an association between OC use and the birth of an infant with Down syndrome.

Role of oral contraception in congenital malformations of offspring.

In a case control study we examined the relationship between congenital malformations in offspring and maternal exposure to oral contraceptives around the time of conception. There were 1 370 with congenital malformations and 2 968 healthy control infants. Maternal oral contraceptive use was unrelated to malformations considered as a whole whether exposure last occurred in the year before conception [odds ratio = 0.9, p=0.25] or during pregnancy [odds ratio = 1.3, p=0.30]. Exposure during pregnancy doubled the risk for some specific diagnoses, including certain cardiovascular defects, but these increases were not statistically significant. Exposure to specific oestrogens or progestogens was also unrelated to the occurrence of malformations. There was a suggestion that women who both smoked more than 20 cigarettes per day and used oral contraceptives during pregnancy were more likely to deliver a malformed infant than were women who neither used oral contraceptives nor smoked during pregnancy.

Origin of triploidy and tetraploidy in man: 11 cases with chromosomes markers.

Sixteen triploid and one tetraploid human abortuses were studied for the origin of polyploidy using a sequential Q- and R-banding technique. Ten triploid abortuses provided informative data: one originated in the maternal first meiotic division; five apparently resulted from dispermy; two derived from an error during either the paternal second meiotic division or the first mitotic division; and the last two were of paternal origin. The results indicate that paternal factors, especially dispermy, are the predominant sources of triploidy in man. The tetraploid abortus showed duplication of both the maternal and paternal haploid sets, suggesting normal division of chromosomes and suppression of cytoplasmic cleavage at the first mitotic division. No correlation was found between the origin of polyploidy and the phenotype of the triploid abortuses, nor between the origin of polyploidy and the maternal use of oral contraceptives.