Associations between maternal reports of periconceptional fever from miscellaneous causes and structural birth defects

Maternal Diarrhea During the Periconceptional Period and the Risk of Birth Defects, National Birth Defects Prevention Study, 2006-2011

BACKGROUND

The primary objective of this study was to assess associations between maternal reports of diarrhea during early pregnancy and a range of different birth defects, most of which have not been assessed in previous studies. The secondary objective was to determine whether associations were modified by maternal use of multivitamins.

METHODS

We analyzed data on 16,675 mothers who participated in the National Birth Defects Prevention Study (NBDPS) and delivered between 2006 and 2011. Logistic regression was used to evaluate associations between maternal report of diarrhea during the periconceptional period and 32 categories of birth defects. Odds ratios were adjusted for nine covariates.

RESULTS

Eleven percent of women reported having diarrhea during the periconceptional period. We observed elevated associations (p < 0.10) between maternal report of diarrhea lasting 1-5 days and 9 of 32 independent categories of birth defects (hypoplastic left heart, muscular ventricular septal defect, single ventricle complex, secundum atrial septal defect, esophageal atresia, diaphragmatic hernia, omphalocele, gastroschisis, and amniotic band syndrome). The elevated adjusted odds ratios (aORs) ranged from 1.45 to 2.62. There were no decreased associations between maternal report of diarrhea lasting 1-5 days and any of the 32 birth defects. There was no evidence for a significant linear trend of stronger associations between maternal diarrhea and birth defects among mothers who had inadequate or suboptimal use of multivitamins.

CONCLUSION

Our results are consistent with modest associations between shorter, but not longer, bouts of maternal diarrhea and specific categories of birth defects. These results add to existing evidence, suggesting maternal diarrhea and gastrointestinal infections during early pregnancy are associated with a higher frequency of some birth defects.

Fever and antibiotic use in maternal urinary tract infections during pregnancy and risk of congenital heart defects: Findings from the National Birth Defects Prevention Study

BACKGROUND

Previous studies report an association between prenatal maternal urinary tract infections (UTI) and specific congenital heart defects (CHDs); however, the role of fever and antibiotic use on this association is poorly understood. Using data from the National Birth Defects Prevention Study, we examined whether the relationship between maternal UTIs during the periconceptional period and occurrence of CHDs is modified by the presence of fever due to UTI and corresponding antibiotic use among 11,704 CHD case infants and 11,636 live-born control infants.

METHODS

Information on UTIs, fever associated with UTI and antibiotic use (sulfonamides, nitrofurantoin, cephalosporins, penicillin, macrolides, and quinolones) during pregnancy were obtained using a computer-assisted telephone interview. Using unconditional multivariable logistic regression, we calculated adjusted odds ratios (ORs) to determine the association between maternal UTIs and subtypes of CHDs. Analyses were stratified by the presence of fever and medication use associated with UTI.

RESULTS

The prevalence of UTIs during the periconceptional period was 7.6% in control mothers, and 8.7% in case mothers. In the absence of fever, UTI was associated with secundum atrial septal defects (ASD) (OR 1.3; 95% confidence interval [CI] 1.1-1.5) and in the absence of antibiotics, UTI was associated with conotruncal defects as a group and for four specific CHDs. When fever and UTI occurred concomitantly, no significantly elevated odds ratios were noticed for any subtypes of CHD. Among women with UTIs who used antibiotics, an elevated but statistically non-significant estimate was observed for secundum ASD (OR 1.4; 95% CI 1.0-2.0).

CONCLUSION

Findings in the present study suggest that fever due to UTI and corresponding maternal antibiotic use do not substantially modify the association between maternal UTIs and specific CHDs in offspring. Further studies with larger sample sizes are warranted to guide clinical management of UTIs during the periconceptional period.