Exogenous hormones and other drug exposures of children with congenital heart disease

Abstract

A history of oral contraceptive use, hormonal pregnancy tests, prescribed hormones and other drugs was obtained from 390 mothers of infants with congenital heart disease and 1254 mothers of normal infants in Massachusetts. The data show a small positive association between estrogen/progesterone exposure and cardiac malformation, the prevalence ratio estimate of exposed to non-exposed being 1.5 (90 per cent confidence limits are 1.0, 2.1). No association was evident, however, between hormones and trunco-conal or any other class of defect among the cases, an observation which casts doubt on a causal relationship betweem hormones and cardiovascular malformations. Several other drugs were reported more frequently by cases' mothers. These include: ampicillin; aspirin; a combined anti-nausea agent (doxylamine succinate, dicyclomine hydrochloride and pyridoxine hydrochloride); chlordiazopoxide, codeine, diazepam, diphenylhydantoin; insulin; phenobarbital; phenothiazine; phenylephrine; and tetracycline.

PIP: This study evaluated the effect of hormonal exposure before or during pregnancy on the risk of congenital heart disease to the child and assessed the cardiovascular teratogenicity of other drugs taken during early pregnancy. A total of 390 cases was ascertained from all infants with congenital heart disease born to Massachusetts women during the period of 1973-1975. 1254 randomly selected births were controls. A history of oral contraceptive (OC) use, hormonal pregnancy tests, prescribed hormones, and other drugs was obtained from both cases and controls. The proportion of mothers reporting any drug use during pregnancy was 54% for cases and 41% for controls. Among those reporting drugs, the mean number of drugs reported was 1.9 for cases and 1.8 for controls. Estimates of effects of specific drugs are provided tabularly. There was a small positive association with cardiac malformation for each of 3 categories of hormonal exposure (hormones prescribed during pregnancy, hormonal pregnancy tests, and OC use after conception). Combining the 3 types, the overall estimate for the rate ratio was 1.5; the overall exposure was compatible with no effect, the 90% confidence limit for the prevalence ratio ranging from 1-2.1. No association was evident between hormones and trunco-conal or any other class of defect among the cases, an observation which casts doubt on a causal relationship between hormones and cardiovascular malformations. Among the other drugs examined, insulin had the highest prevalence rate. Several other drugs were reported more frequently by mothers of cases, including: ampicillin, aspirin, a combined antinausea agent, chlordiazopoxide, codeine, diazepam, diphenylhydantoin, phenobarbital, phenothiazine, phenylephrine, and tetracycline.