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Clemmensen PJ, Brix N, Schullehner J, Ernst A, Harrits Lunddorf LL, Bjerregaard AA, Halldorsson TI, Olsen SF, Hansen B, Stayner LT, Kolstad HA, Sigsgaard T, Ramlau-Hansen CH. Prenatal exposure to nitrosatable drugs and timing of puberty in sons and daughters: A nationwide cohort study. Int J Hyg Environ Health 2023; 254:114271. [PMID: 37820420 DOI: 10.1016/j.ijheh.2023.114271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 09/12/2023] [Accepted: 10/03/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND N-nitroso compounds (NOCs) can be formed by endogenous reactions between nitrosatable drugs and nitrite. Animal studies have found that several NOCs are teratogenic, and epidemiological studies report associations between prenatal exposure to nitrosatable drugs and adverse birth outcomes. It is unknown whether prenatal exposure to nitrosatable drugs is harmful to the child's reproductive health, including pubertal development. OBJECTIVES We investigated whether prenatal exposure to nitrosatable drugs was associated with timing of puberty and whether nitrate, nitrite and antioxidant intake modified any association. METHODS The population-based Danish National Birth Cohort (DNBC) Puberty Cohort, which includes 15,819 children, was used to investigate the association between prenatal exposure to nitrosatable drugs and timing of puberty. Around gestational week 11 and gestational week 18, mothers provided information about drug use during pregnancy. The children's self-reported information on onset of pubertal milestones was collected every six months from 11 years of age and throughout puberty. To investigate potential effect modification by nitrite, nitrate and antioxidant intake, information on these factors was obtained from a food frequency questionnaire completed by the mothers in gestational week 25, and information on nitrate concentration in maternal drinking water at her residential address was obtained from monitoring data from public waterworks. Data were analysed using a multivariable regression model for interval-censored data estimating difference in months in timing of puberty between exposure groups. RESULTS A total of 2,715 children were prenatally exposed to nitrosatable drugs. We did not find an association between prenatal exposure to nitrosatable drugs and timing of puberty. This finding was supported by null-findings in the following sub-analyses investigating: 1. subtypes of nitrosatable drugs (secondary and tertiary amines and amides), 2. dose-dependency (duration of drug intake), 3. effect modification by maternal intake of nitrate, nitrite, and antioxidants. 4. confounding by indication. CONCLUSIONS Prenatal exposure to nitrosatable drugs was not associated with timing of puberty. Nitrosatable drugs are commonly used drugs in pregnancy, and further research is needed to allow firm conclusions on the potential effect of prenatal exposure to nitrosatable drugs on the child's reproductive health.
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Affiliation(s)
| | - Nis Brix
- Department of Public Health, Aarhus University, Aarhus, Denmark; Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
| | - Jörg Schullehner
- Department of Public Health, Aarhus University, Aarhus, Denmark; Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus, Denmark
| | - Andreas Ernst
- Department of Public Health, Aarhus University, Aarhus, Denmark; Department of Urology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Anne Ahrendt Bjerregaard
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark; Center for Clinical Research and Prevention, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Thorhallur Ingi Halldorsson
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark; Faculty of Food Science and Nutrition, School of Health Sciences, University of Iceland, Iceland
| | - Sjurdur Frodi Olsen
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark; Section of Epidemiology, Institute of Public Health, University of Copenhagen, Denmark
| | | | - Leslie Thomas Stayner
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago, School of Public Health, Chicago, United States
| | - Henrik Albert Kolstad
- Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Torben Sigsgaard
- Department of Public Health, Aarhus University, Aarhus, Denmark; Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus, Denmark; Cirrau -Centre for Integrated Register-based Research at Aarhus University, Aarhus, Denmark
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2
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Clemmensen PJ, Schullehner J, Brix N, Sigsgaard T, Stayner LT, Kolstad HA, Ramlau-Hansen CH. Prenatal Exposure to Nitrate in Drinking Water and Adverse Health Outcomes in the Offspring: a Review of Current Epidemiological Research. Curr Environ Health Rep 2023; 10:250-263. [PMID: 37453984 PMCID: PMC10504112 DOI: 10.1007/s40572-023-00404-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE OF REVIEW Recently, several epidemiological studies have investigated whether prenatal exposure to nitrate from drinking water may be harmful to the fetus, even at nitrate levels below the current World Health Organization drinking water standard. The purpose of this review was to give an overview of the newest knowledge on potential health effects of prenatal exposure to nitrate. RECENT FINDINGS We included 13 epidemiological studies conducted since 2017. Nine studies investigated outcomes appearing around birth, and four studies investigated health outcomes appearing in childhood and young adulthood. The reviewed studies showed some indications of higher risk of preterm delivery, lower birth weight, birth defects, and childhood cancer related to prenatal exposure to nitrate. However, the numbers of studies for each outcome were sparse, and some of the results were conflicting. We suggest that there is a need for additional studies and particularly for studies that include information on water consumption patterns, intake of nitrate from diet, and intake of nitrosatable drugs.
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Affiliation(s)
| | - Jörg Schullehner
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus, Denmark
| | - Nis Brix
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
| | - Torben Sigsgaard
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus, Denmark
- Cirrau - Centre for Integrated Register-based Research at Aarhus University, Aarhus, Denmark
| | - Leslie Thomas Stayner
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago, School of Public Health, Chicago, IL, USA
| | - Henrik Albert Kolstad
- Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Sirirungreung A, Hansen J, He D, Huang X, Ritz B, Heck JE. Exposure to nitrosatable drugs during pregnancy and childhood cancer: A matched case-control study in Denmark, 1996-2016. Pharmacoepidemiol Drug Saf 2023; 32:496-505. [PMID: 36300575 PMCID: PMC10038857 DOI: 10.1002/pds.5557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 08/19/2022] [Accepted: 10/14/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Nitrosatable drugs can be synthesized to N-nitroso compounds in human stomach. In a pregnant woman, N-nitroso compounds can be translocated to the fetus through the placenta. Maternal exposure of nitrosatable compounds during pregnancy has been associated with childhood brain tumors and leukemia. However, few studies have investigated an association between nitrosatable drug exposure during pregnancy and childhood cancer. We examined if maternal prescriptions of nitrosatable drugs received during pregnancy are associated with childhood cancer. METHODS A matched case-control study was conducted using Danish nationwide registry data from 1995 to 2016. Each childhood cancer case was matched with twenty-five controls. Maternal exposure of nitrosatable drugs during pregnancy was identified from the Danish National Prescription Register. A multivariable conditional logistic regression model was used to estimate adjusted odds ratios (adj.OR) with 95% confidence intervals (CI) for each childhood cancer type. RESULTS Maternal prescriptions of nitrosatable drugs positively associate with central nervous system tumors (adj.OR = 1.25; 95% CI = 1.04-1.51) and neuroblastoma (adj.OR = 1.96; 95% CI = 1.34-2.85) in offspring. We also observed a positive association between perinatal exposure of nitrosatable drugs and acute lymphoblastic leukemia (adj.OR = 1.31; 95% CI = 1.07-1.59), however, it appeared to be due to confounding by indication, i.e., maternal infections. CONCLUSION Nitrosatable drug use during pregnancy potentially increased risk of central nervous system tumors and neuroblastoma. While a positive association between maternal prescriptions of nitrosatable drugs and acute lymphoblastic leukemia should be interpreted cautiously because of confounding by indication.
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Affiliation(s)
- Anupong Sirirungreung
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Johnni Hansen
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Di He
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Xiwen Huang
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Beate Ritz
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - Julia E Heck
- Department of Epidemiology, Fielding School of Public Health, University of California, Los Angeles, California, USA
- College of Health and Public Service, University of North Texas, Denton, Texas, USA
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Jul Clemmensen P, Brix N, Schullehner J, Lunddorf LLH, Ernst A, Ebdrup NH, Bjerregaard AA, Hansen B, Thomas Stayner L, Ingi Halldorsson T, Frodi Olsen S, Sigsgaard T, Kolstad HA, Ramlau-Hansen CH. Prenatal nitrate exposure from diet and drinking water and timing of puberty in sons and daughters: A nationwide cohort study. ENVIRONMENT INTERNATIONAL 2022; 170:107659. [PMID: 36651653 DOI: 10.1016/j.envint.2022.107659] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/31/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND In Western countries, age at pubertal development has declined during the last century in girls, and probably also in boys. No studies have investigated whether nitrate, a widespread environmental exposure with teratogenic and hormone disrupting properties, might affect timing of puberty. OBJECTIVES We investigated if prenatal exposure to nitrate from drinking water and diet was associated with timing of puberty. METHODS This cohort study included 15,819 children born from 2000 to 2003 within the Danish National Birth Cohort. Self-reported information on current status of various pubertal milestones was provided every six months by a questionnaire from 11 years of age until 18 years or full maturity, whichever came first. Maternal nitrate intake from diet (mg/day) was derived from a mid-pregnancy food frequency questionnaire and individual level nitrate exposure from drinking water (mg/L) was derived using measurements from Danish public waterworks. Adjusted average differences in months in age at attaining several pubertal milestones as well as the average age difference in age at attaining all the milestones were estimated separately for diet and water using a regression model for interval-censored data. C- and E-vitamin, red meat and processed meat intake were explored as potential effect modifiers in sub-analyses. RESULTS No strong associations were observed between prenatal exposure to nitrate and timing of puberty in children. However, sons born of mothers with a nitrate concentration in drinking water at their residential address of > 25 mg/L (half of the World Health Organisation (WHO) guideline value) compared with ≤ 1 mg/L showed a tendency towards earlier age at pubertal development with an average age difference of -1.2 months (95 % confidence interval,-3.0;0.6) for all the pubertal milestones combined. DISCUSSION Studies including more highly exposed children are needed before the current WHO drinking water guideline value for nitrate can be considered safe concerning pubertal development.
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Affiliation(s)
| | - Nis Brix
- Department of Public Health, Aarhus University, Aarhus, Denmark; Department of Clinical Genetics, Aarhus University Hospital, Aarhus, Denmark
| | - Jörg Schullehner
- Department of Public Health, Aarhus University, Aarhus, Denmark; Geological Survey of Denmark and Greenland, Aarhus, Denmark; Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus, Denmark
| | | | - Andreas Ernst
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Ninna Hinchely Ebdrup
- Department of Public Health, Aarhus University, Aarhus, Denmark; Fertility Clinic, Horsens Regional Hospital, Horsens, Denmark
| | - Anne Ahrendt Bjerregaard
- Department of Epidemiology Research, Center for Fetal Programming, Statens Serum Institut, Copenhagen, Denmark; Centre for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | | | - Leslie Thomas Stayner
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago, School of Public Health, Chicago, United States
| | - Thorhallur Ingi Halldorsson
- Department of Epidemiology Research, Center for Fetal Programming, Statens Serum Institut, Copenhagen, Denmark; Faculty of Food Science and Nutrition, School of Health Sciences, University of Iceland, Iceland
| | - Sjurdur Frodi Olsen
- Department of Epidemiology Research, Center for Fetal Programming, Statens Serum Institut, Copenhagen, Denmark; Section of Epidemiology, Institute of Public Health, University of Copenhagen, Denmark
| | - Torben Sigsgaard
- Department of Public Health, Aarhus University, Aarhus, Denmark; Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus, Denmark; Cirrau -Centre for Integrated Register-based Research at Aarhus University, Aarhus, Denmark
| | - Henrik Albert Kolstad
- Department of Occupational Medicine, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Ebdrup NH, Schullehner J, Knudsen UB, Liew Z, Thomsen AML, Lyngsø J, Bay B, Arendt LH, Clemmensen PJ, Sigsgaard T, Hansen B, Ramlau-Hansen CH. Drinking water nitrate and risk of pregnancy loss: a nationwide cohort study. Environ Health 2022; 21:87. [PMID: 36114546 PMCID: PMC9479399 DOI: 10.1186/s12940-022-00897-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 09/01/2022] [Indexed: 05/12/2023]
Abstract
BACKGROUND Nitrate contamination is seen in drinking water worldwide. Nitrate may pass the placental barrier. Despite suggestive evidence of fetal harm, the potential association between nitrate exposure from drinking water and pregnancy loss remains to be studied. We aimed to investigate if nitrate in drinking water was associated with the risk of pregnancy loss. METHODS We conducted a nationwide cohort study of 100,410 pregnancies (enrolled around gestational week 11) in the Danish National Birth Cohort (DNBC) during 1996-2002. Spontaneous pregnancy losses before gestational week 22 were ascertained from the Danish National Patient Registry and DNBC pregnancy interviews. Using the national drinking water quality-monitoring database Jupiter, we estimated the individual and time-specific nitrate exposure by linking geocoded maternal residential addresses with water supply areas. The nitrate exposure was analyzed in spline models using a log-transformed continuous level or classified into five categories. We used Cox proportional hazards models to estimate associations between nitrate and pregnancy loss and used gestational age (days) as the time scale, adjusting for demographic, health, and lifestyle variables. RESULTS No consistent associations were found when investigating the exposure as a categorical variable and null findings were also found in trimester specific analyses. In the spline model using the continuous exposure variable, a modestly increased hazard of pregnancy loss was observed for the first trimester at nitrate exposures between 1 and 10 mg/L, with the highest. adjusted hazard ratio at 5 mg/L of nitrate of 1.16 (95% CI: 1.01, 1.34). This trend was attenuated in the higher exposure ranges. CONCLUSION No association was seen between drinking water nitrate and the risk of pregnancy loss when investigating the exposure as a categorical variable. When we modelled the exposure as a continuous variable, a dose-dependent association was found between drinking water nitrate exposure in the first trimester and the risk of pregnancy loss. Very early pregnancy losses were not considered in this study, and whether survival bias influenced the results should be further explored.
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Affiliation(s)
- Ninna Hinchely Ebdrup
- Department of Obstetrics and Gynecology, Horsens Fertility Clinic, Horsens, Denmark.
- Department of Public Health, Aarhus University, Aarhus, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Jörg Schullehner
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Geological Survey of Denmark and Greenland, Aarhus, Denmark
| | - Ulla Breth Knudsen
- Department of Obstetrics and Gynecology, Horsens Fertility Clinic, Horsens, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Zeyan Liew
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
- Yale Center for Perinatal, Pediatric, and Environmental Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | - Anne Marie Ladehoff Thomsen
- Department of Public Health, Aarhus University, Aarhus, Denmark
- DEFACTUM - Public Health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - Julie Lyngsø
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - Bjørn Bay
- Department of Obstetrics and Gynecology, Horsens Fertility Clinic, Horsens, Denmark
- Maigaard Fertility Clinic, Aarhus, Denmark
| | - Linn Håkonsen Arendt
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Torben Sigsgaard
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Centre for Integrated Register-Based Research Aarhus University, Aarhus, Denmark
- Danish Big Data Centre for Environment and Health (BERTHA), Aarhus University, Aarhus, Denmark
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Thomsen AML, Ramlau-Hansen CH, Schullehner J, Ebdrup NH, Liew Z, Coffman V, Stayner L, Hansen B, Olsen J. Prenatal nitrosatable prescription drug intake, drinking water nitrate, and the risk of stillbirth: a register- and population-based cohort of Danish pregnancies, 1997-2017. Environ Health 2021; 20:118. [PMID: 34781958 PMCID: PMC8594235 DOI: 10.1186/s12940-021-00805-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 11/08/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Nitrosatable drugs commonly prescribed during pregnancy can react with nitrite to form N-nitroso compounds which have been associated with an increased risk of stillbirth. Whether maternal residential drinking water nitrate modifies this association is unknown. We investigated, if household drinking water nitrate was associated with stillbirth, and if it modified the association between nitrosatable prescription drug intake and the risk of stillbirth. METHODS We conducted an individual-level register- and population-based cohort study using 652,810 women with the first recorded singleton pregnancy in the Danish Medical Birth Registry between 1997 and 2017. Nitrosatable drug exposure was recorded by use of the Danish National Patient Registry defined as women with a first redeemed prescription of a nitrosatable drug the first 22 weeks of pregnancy. The reference group was women with no redeemed prescription of a nitrosatable drug in this period. The average individual drinking water nitrate concentration level (mg/L) was calculated in the same period. We categorized nitrosatable drugs as secondary amines, tertiary amines, and amides. Cox hazard regression was used to estimate crude and adjusted hazard ratios with 95% confidence intervals for stillbirth stratified into five categories of nitrate concentrations: ≤1 mg/L, > 1- ≤ 2 mg/L, > 2- ≤ 5 mg/L, > 5- ≤ 25 mg/L, and > 25 mg/L. RESULTS Drinking water nitrate exposure in the population was not associated with the risk of stillbirth. Among 100,244 women who had a nitrosatable prescription drug redeemed ≤22 weeks of pregnancy of pregnancy, 418 (0.42%) had a stillbirth compared to 1993 stillbirths (0.36%) among 552,566 referent women. Women with any nitrosatable prescription drug intake and > 1- ≤ 2 mg/L nitrate concentration had an increased risk of stillbirth [adjusted hazard ratio 1.55 (95% confidence interval, 1.15-2.09)] compared with referent women. In the stratified analyses, the highest risk of stillbirth was found among women with secondary amine intake and > 25 mg/L nitrate concentrations [adjusted hazard ratio 3.11 (95% CI, 1.08-8.94)]. CONCLUSIONS The association between nitrosatable prescription drug intake and the risk of stillbirth may depend on the level of nitrate in household drinking water. Evaluations of the effect of nitrosatable drug intake on perinatal outcomes might consider nitrate exposure from drinking water.
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Affiliation(s)
- Anne Marie Ladehoff Thomsen
- DEFACTUM, Public Health & Health Services Research, Central Denmark Region, Olof Palmes Allé 15, 8200, Aarhus N, Denmark.
- Department of Public Health, Aarhus University, Aarhus, Denmark.
| | | | - Jörg Schullehner
- Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Groundwater and Quaternary Geology Mapping, Geological Survey of Denmark and Greenland, Aarhus, Denmark
- Center for Integrated Research-based Research, Aarhus University, Aarhus, Denmark
| | | | - Zeyan Liew
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
- Yale Center for Perinatal, Pediatric, and Environmental Epidemiology, Yale School of Public Health, New Haven, USA
| | - Vanessa Coffman
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Leslie Stayner
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | - Birgitte Hansen
- Department of Groundwater and Quaternary Geology Mapping, Geological Survey of Denmark and Greenland, Aarhus, Denmark
| | - Jørn Olsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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Materna-Kiryluk A, Wisniewska K, Wieckowska B, Wierzba J, Jazdzewska A, Jaroszewska-Swiatek B, Skotnicka K, Latos-Bielenska A. Maternal Risk Factors Associated with Limb Reduction Defects: Data from the Polish Registry of Congenital Malformations (PRCM). CHILDREN-BASEL 2021; 8:children8020138. [PMID: 33673226 PMCID: PMC7918052 DOI: 10.3390/children8020138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/05/2021] [Accepted: 02/05/2021] [Indexed: 11/16/2022]
Abstract
Data from the Polish Registry of Congenital Malformations (PRCM) suggest that the prevalence of limb reduction defects (LRDs) in some Polish regions is significantly higher in comparison to that reported in the European Surveillance of Congenital Anomalies (EUROCAT) registry, but specific risk factors are still unknown. The objectives of this study were two-fold: to detect risk factors linked to isolated LRDs among Polish natives and to search for geospatial clusters of isolated LRDs to identify high-risk areas across the country. Among the 2,939,001 births accounted for in the PRCM, we determined that there were 852 children with distinct LRDs. Our data demonstrate that lower birth weight, prematurity, and maternal smoking history are strongly associated with isolated LRDs. Furthermore, our investigation pointed to various additional risk factors for isolated LRDs, including paternal education, gestational hypertension, upper respiratory tract infections, and exposure to anti-inflammatory drugs in the first trimester of pregnancy. We did not recognize statistically significant spatial or spatiotemporal clusters over the area of Poland using Kulldorff’s scan. Our study strengthens the hypothesis that maternal factors have an integral role in the etiology of isolated LRDs.
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Affiliation(s)
- Anna Materna-Kiryluk
- Polish Registry of Congenital Malformations, Chair and Department of Medical Genetics, University of Medical Sciences, 61-701 Poznan, Poland; (K.S.); (A.L.-B.)
- Correspondence: ; Tel.: +48-608-393-490
| | - Katarzyna Wisniewska
- Epidemiology Unit, Department of Preventive Medicine Poznan, University of Medical Sciences, 61-701 Poznan, Poland;
| | - Barbara Wieckowska
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, 61-701 Poznan, Poland;
| | - Jolanta Wierzba
- Department of Internal and Pediatric Nursing, Medical University of Gdansk, 80-952 Gdansk, Poland;
| | - Anna Jazdzewska
- Surgery and Burn Treatment Unit, Specialist Mother and Child Healthcare Centre in Poznan, 61-825 Poznan, Poland;
| | - Beata Jaroszewska-Swiatek
- Department of Clinical Pediatrics, University of Warmia and Mazury in Olsztyn, Children’s Hospital in Olsztyn, 10-561 Olsztyn, Poland;
| | - Kinga Skotnicka
- Polish Registry of Congenital Malformations, Chair and Department of Medical Genetics, University of Medical Sciences, 61-701 Poznan, Poland; (K.S.); (A.L.-B.)
| | - Anna Latos-Bielenska
- Polish Registry of Congenital Malformations, Chair and Department of Medical Genetics, University of Medical Sciences, 61-701 Poznan, Poland; (K.S.); (A.L.-B.)
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Martinelli M, Palmieri A, Carinci F, Scapoli L. Non-syndromic Cleft Palate: An Overview on Human Genetic and Environmental Risk Factors. Front Cell Dev Biol 2020; 8:592271. [PMID: 33195260 PMCID: PMC7606870 DOI: 10.3389/fcell.2020.592271] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 09/28/2020] [Indexed: 12/27/2022] Open
Abstract
The epithelial and mesenchymal cells involved in early embryonic facial development are guided by complex regulatory mechanisms. Any factor perturbing the growth, approach and fusion of the frontonasal and maxillary processes could result in orofacial clefts that represent the most common craniofacial malformations in humans. The rarest and, probably for this reason, the least studied form of cleft involves only the secondary palate, which is posterior to the incisive foramen. The etiology of cleft palate only is multifactorial and involves both genetic and environmental risk factors. The intention of this review is to give the reader an overview of the efforts made by researchers to shed light on the underlying causes of this birth defect. Most of the scientific papers suggesting potential environmental and genetic causes of non-syndromic cleft palate are summarized in this review, including genome-wide association and gene–environment interaction studies.
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Affiliation(s)
- Marcella Martinelli
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Annalisa Palmieri
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Francesco Carinci
- Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Ferrara, Italy
| | - Luca Scapoli
- Department of Experimental, Diagnostic and Specialty Medicine, Alma Mater Studiorum - University of Bologna, Bologna, Italy
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9
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Thomsen AML, Liew Z, Riis AH, Stayner LT, Ramlau-Hansen CH, Sigsgaard T, Olsen J. Nitrosatable drug exposure during pregnancy and risk of stillbirth. Pharmacoepidemiol Drug Saf 2019; 28:1204-1210. [PMID: 31348585 DOI: 10.1002/pds.4867] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 05/19/2019] [Accepted: 07/03/2019] [Indexed: 11/06/2022]
Abstract
PURPOSE Nitrosatable drugs can react with nitrite in the stomach and form N-nitroso compounds. Exposure to nitrosatable drugs has been associated with congenital malformations and preterm birth, but use during pregnancy as a cause of fetal death is not well-known. We examined if prenatally nitrosatable drug use is associated with risk of stillbirth. METHODS A nationwide cohort was conducted using 554 844 women with singleton and first recorded pregnancies regardless of previous pregnancy history from the Danish Medical Birth Register from 1996 to 2015. Exposure was recorded by use of the Danish National Prescription Register and defined as women who had redeemed a prescribed nitrosatable drug in the first 22 weeks of pregnancy. The reference group was women with no redeemed prescribed nitrosatable drug in this time period. We categorized nitrosatable drugs as secondary amines, tertiary amines, and amides. Cox hazard regression was used to estimate crude and adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) for stillbirth. RESULTS Among the 84 720 exposed women, 348 had a stillbirth compared with 1690 stillbirths among the 470 124 unexposed women. Women who used any prescribed nitrosatable drug were more likely to have a stillbirth compared with unexposed women (aHRs 1.24; 95% CI, 1.03-1.49). CONCLUSION Nitrosatable drug use during the first 22 weeks of pregnancy might increase risk of stillbirth. The findings should be interpreted cautiously because of important unmeasured factors that might influence the observed association, including maternal vitamin C intake, dietary, and other sources of nitrate/nitrite intake.
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Affiliation(s)
- Anne Marie L Thomsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Zeyan Liew
- Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA.,Yale Center for Perinatal, Pediatric, and Environmental Epidemiology, Yale School of Public Health, New Haven, CT, USA
| | | | - Leslie Thomas Stayner
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA
| | | | - Torben Sigsgaard
- Department of Public Health, Section for Environment, Occupation, and Health, Aarhus University, Aarhus, Denmark
| | - Jørn Olsen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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11
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Ward MH, Jones RR, Brender JD, de Kok TM, Weyer PJ, Nolan BT, Villanueva CM, van Breda SG. Drinking Water Nitrate and Human Health: An Updated Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1557. [PMID: 30041450 PMCID: PMC6068531 DOI: 10.3390/ijerph15071557] [Citation(s) in RCA: 395] [Impact Index Per Article: 65.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 07/10/2018] [Accepted: 07/14/2018] [Indexed: 02/07/2023]
Abstract
Nitrate levels in our water resources have increased in many areas of the world largely due to applications of inorganic fertilizer and animal manure in agricultural areas. The regulatory limit for nitrate in public drinking water supplies was set to protect against infant methemoglobinemia, but other health effects were not considered. Risk of specific cancers and birth defects may be increased when nitrate is ingested under conditions that increase formation of N-nitroso compounds. We previously reviewed epidemiologic studies before 2005 of nitrate intake from drinking water and cancer, adverse reproductive outcomes and other health effects. Since that review, more than 30 epidemiologic studies have evaluated drinking water nitrate and these outcomes. The most common endpoints studied were colorectal cancer, bladder, and breast cancer (three studies each), and thyroid disease (four studies). Considering all studies, the strongest evidence for a relationship between drinking water nitrate ingestion and adverse health outcomes (besides methemoglobinemia) is for colorectal cancer, thyroid disease, and neural tube defects. Many studies observed increased risk with ingestion of water nitrate levels that were below regulatory limits. Future studies of these and other health outcomes should include improved exposure assessment and accurate characterization of individual factors that affect endogenous nitrosation.
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Affiliation(s)
- Mary H Ward
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr. Room 6E138, Rockville, MD 20850, USA.
| | - Rena R Jones
- Occupational and Environmental Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, 9609 Medical Center Dr. Room 6E138, Rockville, MD 20850, USA.
| | - Jean D Brender
- Department of Epidemiology and Biostatistics, Texas A&M University, School of Public Health, College Station, TX 77843, USA.
| | - Theo M de Kok
- Department of Toxicogenomics, GROW-school for Oncology and Developmental Biology, Maastricht University Medical Center, P.O Box 616, 6200 MD Maastricht, The Netherlands.
| | - Peter J Weyer
- The Center for Health Effects of Environmental Contamination, The University of Iowa, 455 Van Allen Hall, Iowa City, IA 52242, USA.
| | - Bernard T Nolan
- U.S. Geological Survey, Water Mission Area, National Water Quality Program, 12201 Sunrise Valley Drive, Reston, VA 20192, USA.
| | - Cristina M Villanueva
- ISGlobal, 08003 Barcelona, Spain.
- IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain.
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), 08003 Barcelona, Spain.
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain.
| | - Simone G van Breda
- Department of Toxicogenomics, GROW-school for Oncology and Developmental Biology, Maastricht University Medical Center, P.O Box 616, 6200 MD Maastricht, The Netherlands.
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12
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Trindade-Suedam IK, Kostrisch LMV, Pimenta LAF, Negrato CA, Franzolin SB, Trindade AS. Diabetes mellitus and drug abuse during pregnancy and the risk for orofacial clefts and related abnormalities. Rev Lat Am Enfermagem 2017; 24:e2701. [PMID: 27508899 PMCID: PMC4990026 DOI: 10.1590/1518-8345.0815.2701] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 08/18/2015] [Indexed: 11/23/2022] Open
Abstract
Objective: to assessed the prevalence of diabetes mellitus (DM) and drug abuse in mothers of
children with orofacial clefts (OFC). Methods: 325 women who had children (0-3y) with clefts were interviewed. Data regarding
type of diabetes, use of legal/illegal drugs during pregnancy, waist girth and
fasting blood sugar at the first prenatal consult were collected. Results: twenty seven percent of the women had DM, out of these, 89% had gestational DM,
5,5% type 1 DM and 5,5% type 2 DM. The prevalence of DM in mothers of children
with OFC was 27%, it is significantly higher than the average Brazilian population
which is 7.6% (p<0.01) (OR=4.5, 95%CI=3.5-5.8). Regarding drug abuse during
pregnancy, 32% of the mothers used drugs and a significant positive correlation
was observed between drug abuse and the occurrence of clefts and other
craniofacial anomalies (p=0.028) (OR=2.87; 95%CI=1.1-7.4). Conclusions: DM and drug abuse during pregnancy increases the risk for OFC and related
anomalies and early diagnosis of DM and prevention of drug abuse, especially in
pregnant women, should be emphasized.
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Affiliation(s)
- Ivy Kiemle Trindade-Suedam
- PhD, Associate Professor, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, SP, Brazil
| | - Lília Maria von Kostrisch
- RN, Hospital de Messejana Dr. José Alberto Studart Gomes, Secretaria de Municipal de Saúde de Fortaleza, Fortaleza, CE, Brazil. Doctoral student, Hospital de Reabilitação de Anomalias Craniofaciais, Universidade de São Paulo, Bauru, SP, Brazil
| | - Luiz André Freire Pimenta
- Clinical Professor, School of Dentistry, University of North Carolina, Chapel Hill, NC, United States
| | | | | | - Alceu Sergio Trindade
- PhD, Full Professor, Faculdade de Odontologia de Bauru, Universidade de São Paulo, Bauru, SP, Brazil
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Muanda FT, Sheehy O, Bérard A. Use of antibiotics during pregnancy and the risk of major congenital malformations: a population based cohort study. Br J Clin Pharmacol 2017; 83:2557-2571. [PMID: 28722171 DOI: 10.1111/bcp.13364] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 06/12/2017] [Accepted: 06/14/2017] [Indexed: 02/01/2023] Open
Abstract
AIMS Few studies have investigated the link between individual antibiotics and major congenital malformations (MCMs) including specific malformations owing to small sample size. We aimed to quantify the association between exposure to gestational antibiotic and the risk of MCMs. METHODS Using the Quebec pregnancy cohort (1998-2008), we included a total of 139 938 liveborn singleton alive whose mothers were covered by the "Régie de l'assurance maladie du Québec" drug plan for at least 12 months before and during pregnancy. Antibiotic exposure was assessed in the first trimester and MCMs were identified within the first year of life. RESULTS After adjusting for potential confounders, clindamycin exposure was associated with an increased risk of MCMs (aOR 1.34, 95% CI 1.02-1.77, 60 exposed cases), musculoskeletal system malformations (aOR 1.67, 95% CI 1.12-2.48, 29 exposed cases) and ventricular/atrial septal defect (aOR 1.81, 95% CI 1.04-3.16, 13 exposed cases). Doxycycline exposure increased the risk of circulatory system malformation, cardiac malformations and ventricular/atrial septal defect (aOR 2.38, 95% CI 1.21-4.67, 9 exposed cases; aOR 2.46, 95% CI 1.21-4.99, 8 exposed cases; aOR 3.19, 95% CI 1.57-6.48, 8 exposed cases, respectively). Additional associations were seen with quinolone (1 defect), moxifloxacin (1 defect), ofloxacin (1 defect), macrolide (1 defect), erythromycin (1 defect) and phenoxymethylpenicillin (1 defect). No link was observed with amoxicillin, cephalosporins and nitrofurantoin. Similar results were found when penicillins were used as the comparator group. CONCLUSIONS Clindamycin, doxycycline, quinolones, macrolides and phenoxymethylpenicillin in utero exposure were linked to organ-specific malformations. Amoxicillin, cephalosporins and nitrofurantoin were not associated with MCMs.
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Affiliation(s)
- Flory T Muanda
- Faculty of Pharmacy, University of Montreal, Montréal, Québec, Canada.,Research Center, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Odile Sheehy
- Research Center, CHU Sainte-Justine, Montréal, Québec, Canada
| | - Anick Bérard
- Faculty of Pharmacy, University of Montreal, Montréal, Québec, Canada.,Research Center, CHU Sainte-Justine, Montréal, Québec, Canada
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Feng Y, Chen R, Li X, Mo X. Environmental factors in the etiology of isolated and nonisolated esophageal atresia in a Chinese population: A case-control study. ACTA ACUST UNITED AC 2016; 106:840-846. [PMID: 27494675 DOI: 10.1002/bdra.23550] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 07/07/2016] [Accepted: 07/08/2016] [Indexed: 11/05/2022]
Abstract
BACKGROUND Esophageal atresia (EA) is a common birth defect that occurs with tracheoesophageal fistula (TEF), although etiological studies on EA/TEF have produced inconsistent results. METHODS The aim of this study was to examine the association between environmental factors during pregnancy and the risk of EA/TEF in a Chinese population. Cases of isolated EA and nonisolated EA and unaffected controls were identified between July 2005 and November 2015, and face-to-face questionnaires concerning exposure to environmental factors were administered to the birth mothers of 130 cases and 400 controls. The adjusted odds ratio (OR) and 95% confidence interval (CI) were calculated to assess the association between environmental factors and the risk of EA/TEF. RESULTS The results of this case-control study suggest that lower maternal education (p < 0.0001), maternal binge drinking (OR = 2.63; 95% CI, 1.05-6.6) and pickled food consumption (OR = 2.04; 95% CI, 1.31-3.71) during pregnancy increase the risk of EA in offspring, while maternal folic acid supplementation (OR = 0.45; 95% CI, 0.29-0.71) is significantly associated with a decreased risk of EA. CONCLUSION These results suggest a role for environmental exposures in the etiology of EA/TEF; however, further studies are needed to replicate the observed associations. Birth Defects Research (Part A) 106:840-846, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Yu Feng
- Department of Cardiothoracic Surgery, The Affiliated Nanjing Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Runsen Chen
- Department of Cardiothoracic Surgery, The Affiliated Nanjing Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiaonan Li
- Children's Health Care, The Affiliated Nanjing Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xuming Mo
- Department of Cardiothoracic Surgery, The Affiliated Nanjing Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
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15
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Vuong AM, Shinde MU, Brender JD, Shipp EM, Huber JC, Sharkey JR, McDonald TJ, Werler MM, Kelley KE, Griesenbeck JS, Langlois PH, Canfield MA. Prenatal Exposure to Nitrosatable Drugs, Dietary Intake of Nitrites, and Preterm Birth. Am J Epidemiol 2016; 183:634-42. [PMID: 26953287 DOI: 10.1093/aje/kwv250] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Accepted: 09/08/2015] [Indexed: 02/01/2023] Open
Abstract
Prenatal exposure to nitrosatable drugs, including secondary or tertiary amines, has been associated with preterm birth. Associations may be accentuated by higher intakes of dietary nitrites because of the increased formation of N-nitroso compounds. Using data from mothers of babies without major birth defects (controls) from the National Birth Defects Prevention Study, we examined the relationship between nitrosatable drug exposure in conjunction with dietary nitrite intake and preterm birth among 496 mothers of preterm infants and 5,398 mothers with full-term deliveries in 1997-2005. A protective association was observed with a high intake of plant nitrites (adjusted hazard ratio (AHR) = 0.72, 95% confidence interval (CI): 0.53, 0.97). Secondary amines in conjunction with high nitrite intake were associated with preterm birth during the first (AHR = 1.84, 95% CI: 1.14, 2.98), second (AHR = 1.89, 95% CI: 1.17, 3.07), and third (AHR = 2.00, 95% CI: 1.22, 3.29) trimesters. The adjusted hazard ratios for tertiary amine use in the third trimester by increasing tertiles of nitrite intake were 0.67 (95% CI: 0.35, 1.31), 1.25 (95% CI: 0.71, 2.19), and 2.02 (95% CI: 1.17, 3.49). Prenatal exposure to nitrosatable drugs, particularly secondary and tertiary amines, in conjunction with higher levels of dietary nitrite intake may increase the risk of preterm birth.
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16
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Guidelines for the Management of Pregnant Women With Substance Use Disorders. PSYCHOSOMATICS 2016; 57:115-30. [DOI: 10.1016/j.psym.2015.12.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 11/29/2015] [Accepted: 11/30/2015] [Indexed: 11/21/2022]
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17
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Benedum CM, Yazdy MM, Mitchell AA, Werler MM. Impact of Periconceptional Use of Nitrosatable Drugs on the Risk of Neural Tube Defects. Am J Epidemiol 2015; 182:675-84. [PMID: 26424074 DOI: 10.1093/aje/kwv126] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 05/01/2015] [Indexed: 01/17/2023] Open
Abstract
Nitrosatable drugs (NSDs) can, in the presence of nitrosating agents and highly acidic conditions, form N-nitroso compounds that have been found to be teratogenic in animal models. Using data from the Slone Epidemiology Center Birth Defects Study collected from 1998 to 2012, we compared maternal periconceptional NSD use between 334 neural tube defect cases and 7,619 nonmalformed controls. We categorized NSDs according to their functional group (secondary amine, tertiary amine, and amide). With logistic regression models, we estimated adjusted odds ratios and 95% confidence intervals. Neural tube defect risk was associated with maternal periconceptional use of secondary (adjusted odds ratio (aOR) = 1.7, 95% confidence interval (CI): 1.1, 2.4) and tertiary (aOR = 1.7, 95% CI: 1.2, 2.5) amines; an association was observed for amides, but the 95% confidence interval included the null (aOR = 1.4, 95% CI: 0.7, 2.5). Within the secondary amine group, elevated adjusted odds ratios were observed for 3 drugs but were null for the remaining medications. Increases in risk were observed for both strata of folic acid intake (<400 µg/day, ≥400 µg/day), with a slightly higher risk in the ≥400-µg/day stratum. Our findings support previously reported positive associations between neural tube defects and periconceptional exposure to NSDs containing a secondary or tertiary amine or amide.
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Pistollato F, Sumalla Cano S, Elio I, Masias Vergara M, Giampieri F, Battino M. Plant-Based and Plant-Rich Diet Patterns during Gestation: Beneficial Effects and Possible Shortcomings. Adv Nutr 2015; 6:581-91. [PMID: 26374180 PMCID: PMC4561836 DOI: 10.3945/an.115.009126] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Environmental and lifestyle factors are known to play an important role during gestation, determining newborns' health status and influencing their risk of being subject to certain noncommunicable diseases later in life. In particular, maternal nutritional patterns characterized by a low intake of plant-derived foods could increase the risk of gestation-related issues, such as preeclampsia and pregravid obesity, increase genotoxicant susceptibility, and contribute to the onset of pediatric diseases. In particular, the risk of pediatric wheeze, diabetes, neural tube defects, orofacial clefts, and some pediatric tumors seems to be reduced by maternal intake of adequate amounts of vegetables, fruits, and selected antioxidants. Nevertheless, plant-based diets, like any other diet, if improperly balanced, could be deficient in some specific nutrients that are particularly relevant during gestation, such as n-3 (ω-3) fatty acids, vitamin B-12, iron, zinc, and iodine, possibly affecting the offspring's health state. Here we review the scientific literature in this field, focusing specifically on observational studies in humans, and highlight protective effects elicited by maternal diets enriched in plant-derived foods and possible issues related to maternal plant-based diets.
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Affiliation(s)
- Francesca Pistollato
- Center for Nutrition and Health, European University of the Atlantic, Santander, Spain
| | - Sandra Sumalla Cano
- Center for Nutrition and Health, European University of the Atlantic, Santander, Spain;,International Ibero-American University, Campeche, Mexico;,Ibero-American University Foundation, Barcelona, Spain
| | - Iñaki Elio
- Center for Nutrition and Health, European University of the Atlantic, Santander, Spain;,International Ibero-American University, Campeche, Mexico;,Ibero-American University Foundation, Barcelona, Spain
| | - Manuel Masias Vergara
- Center for Nutrition and Health, European University of the Atlantic, Santander, Spain;,International Ibero-American University, Arecibo, Puerto Rico
| | - Francesca Giampieri
- Umberto Veronesi Foundation, Milan, Italy; and Department of Specialized Clinical Sciences and Dentistry, Marche Polytechnic University, Ancona, Italy
| | - Maurizio Battino
- Center for Nutrition and Health, European University of the Atlantic, Santander, Spain; Department of Specialized Clinical Sciences and Dentistry, Marche Polytechnic University, Ancona, Italy
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Oberholzer HM, Van Der Schoor C, Taute H, Bester MJ. A descriptive study to provide evidence of the teratogenic and cellular effects of sibutramine and ephedrine on cardiac- and liver-tissue of chick embryos. Microsc Res Tech 2015; 78:737-46. [PMID: 26138360 DOI: 10.1002/jemt.22539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 05/29/2015] [Accepted: 06/14/2015] [Indexed: 11/07/2022]
Abstract
Exposure to drugs during pregnancy is a major concern, as some teratogenic compounds can influence normal foetal development. Although the use of drugs during pregnancy should generally be avoided, exposure of the developing foetus to teratogens may occur unknowingly since these compounds may be hidden in products that are being marketed as "all natural." The aim of the current study was to investigate the possible teratogenic and cellular effects of sibutramine-a serotonin-norepinephrine reuptake inhibitor used in the treatment of obesity-on the heart and liver tissue of chick embryos. Ephedrine was used as a positive control. The chick embryo model was chosen because it has been used in studying developmental and experimental biology and teratology with great success. The embryos were exposed to three different concentrations of sibutramine and ephedrine respectively. The results obtained revealed that both compounds exhibited embryotoxicity when compared to the control groups. Liver and heart tissue of the exposed embryos was severely affected by these compounds in a dose-related manner. Morphology similar to that of muscle dystrophy was observed in the heart, where the muscle tissue was infiltrated by adipose and connective tissue. Severe liver steatosis was also noted. A more in-depth investigation into the molecular pathways involved might provide more information on the exact mechanism of toxicity of these products influencing embryonic development.
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Affiliation(s)
| | - Ciska Van Der Schoor
- Department of Anatomy, Faculty of Health Sciences, University of Pretoria, Arcadia, South Africa
| | - Helena Taute
- Department of Anatomy, Faculty of Health Sciences, University of Pretoria, Arcadia, South Africa
| | - Megan Jean Bester
- Department of Anatomy, Faculty of Health Sciences, University of Pretoria, Arcadia, South Africa
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Vuong AM, Shinde MU, Brender JD, Shipp EM, Huber JC, Zheng Q, McDonald TJ, Sharkey JR, Hoyt AT, Werler MM, Kelley KE, Langlois PH, Canfield MA. Nitrosatable Drug Exposure during Pregnancy and Preterm and Small-for-Gestational-Age Births. Paediatr Perinat Epidemiol 2015; 29:60-71. [PMID: 25492517 DOI: 10.1111/ppe.12169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Nitrosatable drugs react with nitrite in the stomach to form N-nitroso compounds, observed in animal models to result in adverse pregnancy outcomes, such as birth defects and reduced fetal weight. Previous studies examining prenatal exposure to medications classified as nitrosatable have reported an increased risk of preterm births (PTBs) and small-for-gestational-age (SGA) infants. METHODS Using data from mothers (controls) of babies without major birth defects from the National Birth Defects Prevention Study, prenatal nitrosatable drug usage by trimester and month of gestation was examined in relation to PTBs and SGA infants. RESULTS Positive associations were observed with nitrosatable drug use and PTBs, with the strongest relationship with second trimester exposure (adjusted hazard ratio [aHR] 1.37, [95% confidence interval (CI) 1.10, 1.70]). Of the nitrosatable functional groups, secondary amines were the most notable, with a higher association among women with second (aHR 1.37, [95% CI 1.05, 1.79]) and third (aHR 1.34, [95% CI 1.02, 1.76]) trimester exposure compared with women with no prenatal nitrosatable drug use. Among SGA infants, a borderline association was noted with amide exposure during the third trimester (adjusted odds ratio 1.43 [95% confidence interval [CI] 1.00, 2.05]). CONCLUSIONS Prenatal exposure to nitrosatable drugs during the second and third trimester of pregnancy, particularly secondary amines, might increase the risk of PTBs. However, prenatal exposure to nitrosatable drugs was not associated with SGA infants, with the exception of amide drugs.
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Affiliation(s)
- Ann M Vuong
- Division of Epidemiology, Department of Environmental Health, University of Cincinnati College of Medicine, Cincinnati, OH
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Habermeyer M, Roth A, Guth S, Diel P, Engel KH, Epe B, Fürst P, Heinz V, Humpf HU, Joost HG, Knorr D, de Kok T, Kulling S, Lampen A, Marko D, Rechkemmer G, Rietjens I, Stadler RH, Vieths S, Vogel R, Steinberg P, Eisenbrand G. Nitrate and nitrite in the diet: how to assess their benefit and risk for human health. Mol Nutr Food Res 2014; 59:106-28. [PMID: 25164923 DOI: 10.1002/mnfr.201400286] [Citation(s) in RCA: 144] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 07/29/2014] [Accepted: 08/04/2014] [Indexed: 12/15/2022]
Abstract
Nitrate is a natural constituent of the human diet and an approved food additive. It can be partially converted to nitrogen monoxide, which induces vasodilation and thereby decreases blood pressure. This effect is associated with a reduced risk regarding cardiovascular disease, myocardial infarction, and stroke. Moreover, dietary nitrate has been associated with beneficial effects in patients with gastric ulcer, renal failure, or metabolic syndrome. Recent studies indicate that such beneficial health effects due to dietary nitrate may be achievable at intake levels resulting from the daily consumption of nitrate-rich vegetables. N-nitroso compounds are endogenously formed in humans. However, their relevance for human health has not been adequately explored up to now. Nitrate and nitrite are per se not carcinogenic, but under conditions that result in endogenous nitrosation, it cannot be excluded that ingested nitrate and nitrite may lead to an increased cancer risk and may probably be carcinogenic to humans. In this review, the known beneficial and detrimental health effects related to dietary nitrate/nitrite intake are described and the identified gaps in knowledge as well as the research needs required to perform a reliable benefit/risk assessment in terms of long-term human health consequences due to dietary nitrate/nitrite intake are presented.
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Affiliation(s)
- Michael Habermeyer
- Department of Food Chemistry and Toxicology, University of Kaiserslautern, Kaiserslautern, Germany**
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Novel study on N-nitrosamines as risk factors of cardiovascular diseases. BIOMED RESEARCH INTERNATIONAL 2014; 2014:817019. [PMID: 25243185 PMCID: PMC4160646 DOI: 10.1155/2014/817019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 07/28/2014] [Indexed: 11/18/2022]
Abstract
Millions of people are exposed daily to N-nitrosamines from different environmental sources. The present study aims at investigating the role of N-nitrosamines in the alteration of homocysteine, lipid profile, oxidative stress, paraoxonase activity, antioxidant enzymes, and free radicals which are important risk factors for CVD. In addition, biomarkers of cardiovascular diseases such as creatine kinase MB activity (CK-MB) and lactate dehydrogenase (LDH) as well as protein expression of both glutathione peroxidase and glutathione S-transferase π isozyme were assayed after treatment of rats with 0.2 mg/kg body weight of N-nitrosodibutylamine (NDBA), N-nitrosoethylbutylamine (NEBA), N-nitrosobutylpropylamine (NBPA), N-nitrosodiethylamine (NDEA), N-nitrosodimethylamine (NDMA), and N-nitrosodiphenylamine (NDPA) as a daily dose for two weeks. LDL levels, paraoxonase activity, reduced glutathione levels, and glutathione reductase activities were increased, whereas HDL levels decreased after treatment of rats with most of N-nitrosamines compared to control group. Moreover, levels of free radicals and catalase activity increased, whereas protein expression of both glutathione peroxidase and glutathione S-transferase decreased after treatment of rats with some N-nitrosamines. The data showed that most N-nitrosamines increased CK-MB and LDH activities. It is concluded that N-nitrosamines increased levels of free radicals, and decreased the activity of antioxidant enzymes which may consequently increase the incidence of CVDs.
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23
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Brender JD, Weyer PJ, Romitti PA, Mohanty BP, Shinde MU, Vuong AM, Sharkey JR, Dwivedi D, Horel SA, Kantamneni J, Huber JC, Zheng Q, Werler MM, Kelley KE, Griesenbeck JS, Zhan FB, Langlois PH, Suarez L, Canfield MA. Prenatal nitrate intake from drinking water and selected birth defects in offspring of participants in the national birth defects prevention study. ENVIRONMENTAL HEALTH PERSPECTIVES 2013; 121:1083-9. [PMID: 23771435 PMCID: PMC3764078 DOI: 10.1289/ehp.1206249] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2012] [Accepted: 06/11/2013] [Indexed: 05/18/2023]
Abstract
BACKGROUND Previous studies of prenatal exposure to drinking-water nitrate and birth defects in offspring have not accounted for water consumption patterns or potential interaction with nitrosatable drugs. OBJECTIVES We examined the relation between prenatal exposure to drinking-water nitrate and selected birth defects, accounting for maternal water consumption patterns and nitrosatable drug exposure. METHODS With data from the National Birth Defects Prevention Study, we linked addresses of 3,300 case mothers and 1,121 control mothers from the Iowa and Texas sites to public water supplies and respective nitrate measurements. We assigned nitrate levels for bottled water from collection of representative samples and standard laboratory testing. Daily nitrate consumption was estimated from self-reported water consumption at home and work. RESULTS With the lowest tertile of nitrate intake around conception as the referent group, mothers of babies with spina bifida were 2.0 times more likely (95% CI: 1.3, 3.2) to ingest ≥ 5 mg nitrate daily from drinking water (vs. < 0.91 mg) than control mothers. During 1 month preconception through the first trimester, mothers of limb deficiency, cleft palate, and cleft lip cases were, respectively, 1.8 (95% CI: 1.1, 3.1), 1.9 (95% CI: 1.2, 3.1), and 1.8 (95% CI: 1.1, 3.1) times more likely than control mothers to ingest ≥ 5.42 mg of nitrate daily (vs. < 1.0 mg). Higher water nitrate intake did not increase associations between prenatal nitrosatable drug use and birth defects. CONCLUSIONS Higher water nitrate intake was associated with several birth defects in offspring, but did not strengthen associations between nitrosatable drugs and birth defects.
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Affiliation(s)
- Jean D Brender
- Department of Epidemiology and Biostatistics, School of Rural Public Health, Texas A&M Health Science Center, College Station, Texas 77843, USA.
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24
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Shinde MU, Vuong AM, Brender JD, Werler MM, Kelley KE, Huber JC, Sharkey JR, Zheng Q, Suarez L, Langlois PH, Canfield MA, Romitti PA, Malik S. Prenatal exposure to nitrosatable drugs, vitamin C, and risk of selected birth defects. BIRTH DEFECTS RESEARCH. PART A, CLINICAL AND MOLECULAR TERATOLOGY 2013; 97:515-31. [PMID: 23716465 PMCID: PMC5893146 DOI: 10.1002/bdra.23137] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 03/01/2013] [Accepted: 03/17/2013] [Indexed: 11/08/2022]
Abstract
UNLABELLED Nitrosatable drugs, such as secondary or tertiary amines and amides react with nitrite in an acidic environment to form N-nitroso compounds, teratogens in animal models. Vitamin C is a known nitrosation inhibitor. METHODS Using data from the National Birth Defects Prevention Study, we assessed nitrosatable drug exposure and vitamin C intake during the first trimester among 11,606 case-mothers of infants with oral clefts, limb deficiencies (LDs), or congenital heart defects and 6807 control-mothers of infants without major birth defects during 1997-2005. Daily intake of vitamin C was estimated from maternal interviews that elicited information about supplement use and dietary intake. RESULTS With no reported use of nitrosatable drugs as the referent group, a lower odds ratio (OR) was observed for transverse LDs among births to mothers exposed to secondary amine drugs and daily vitamin C supplementation (adjusted odds ratio [aOR] 1.2, 95% confidence interval [CI] 0.83-1.8) compared with women taking these drugs and no supplementation (aOR 2.7, 95% CI 1.5-4.6). The OR for longitudinal LDs associated with secondary amine exposure was lower with daily dietary vitamin C intake ≥85 mg (aOR 1.2, 95% CI 0.68-2.0) compared with <85 mg (aOR 1.9, 95% CI 1.2-3.1). Daily vitamin C supplementation in combination with higher dietary vitamin C intake reduced associations between nitrosatable drug exposures and limb deficiencies and atrial septal defects not otherwise specified. CONCLUSION Prenatal dietary and vitamin C supplement intake may diminish the association between nitrosatable drug exposure during pregnancy and selected birth defects.
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Affiliation(s)
- Mayura U Shinde
- Texas A&M Health Science Center, School of Rural Public Health, College Station, Texas 77843-1266, USA.
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25
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Huber JC, Brender JD, Zheng Q, Sharkey JR, Vuong AM, Shinde MU, Griesenbeck JS, Suarez L, Langlois PH, Canfield MA, Romitti PA, Weyer PJ. Maternal dietary intake of nitrates, nitrites and nitrosamines and selected birth defects in offspring: a case-control study. Nutr J 2013; 12:34. [PMID: 23514444 PMCID: PMC3607976 DOI: 10.1186/1475-2891-12-34] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Accepted: 03/14/2013] [Indexed: 11/10/2022] Open
Abstract
Background Dietary intake of nitrates, nitrites, and nitrosamines can increase the endogenous formation of N-nitroso compounds in the stomach. Results from animal studies suggest that these compounds might be teratogenic. We examined the relationship between maternal dietary intake of nitrates, nitrites (including plant and animal sources as separate groups), and nitrosamines and several types of birth defects in offspring. Methods For this population-based case–control study, data from a 58-question food frequency questionnaire, adapted from the short Willett Food Frequency Questionnaire and administered as part of the National Birth Defects Prevention Study (NBDPS), were used to estimate daily intake of dietary nitrates, nitrites, and nitrosamines in a sample of 6544 mothers of infants with neural tube defects (NTD)s, oral clefts (OC)s, or limb deficiencies (LD)s and 6807 mothers of unaffected control infants. Total daily intake of these compounds was divided into quartiles based on the control mother distributions. Odds ratios (OR)s and 95% confidence intervals (CI)s were estimated using logistic regression; estimates were adjusted for maternal daily caloric intake, maternal race-ethnicity, education, dietary folate intake, high fat diet (> 30% of calories from fat), and state of residence. Results While some unadjusted ORs for NTDS had 95% (CI)s that excluded the null value, none remained significant after adjustment for covariates, and the effect sizes were small (adjusted odds ratios [aOR] <1.12). Similar results were found for OCs and LDs with the exception of animal nitrites and cleft lip with/without cleft palate (aORs and CIs for quartile 4 compared to quartile 1 =1.24; CI=1.05-1.48), animal nitrites and cleft lip (4th quartile aOR=1.32; CI=1.01-1.72), and total nitrite and intercalary LD (4th quartile aOR=4.70; CI=1.23-17.93). Conclusions Overall, odds of NTDs, OCs or LDs did not appear to be significantly associated with estimated dietary intake of nitrate, nitrite, and nitrosamines.
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Affiliation(s)
- John C Huber
- Department of Epidemiology and Biostatistics, The Texas A&M Health Science Center School of Rural Public Health, MS 1266 TAMU, College Station, TX 77843-1266, USA.
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Joshi N, Rhoades MG, Bennett GD, Wells SM, Mirvish SS, Breitbach MJ, Shea PJ. Developmental abnormalities in chicken embryos exposed to N-nitrosoatrazine. JOURNAL OF TOXICOLOGY AND ENVIRONMENTAL HEALTH. PART A 2013; 76:1015-1022. [PMID: 24168037 DOI: 10.1080/15287394.2013.831721] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Nitrate and atrazine (ATR) occur in combination in some drinking-water supplies and might react to form N-nitrosoatrazine (NNAT), which is reportedly more toxic than nitrate, nitrite, or ATR. Current evidence from population-based studies indicates that exposure to nitrate, nitrite, and nitrosatable compounds increases the risk of congenital defects and/or rate of embryo lethality. To test the hypothesis that NNAT induces malformations during embryogenesis, chicken embryos were examined for lethality and developmental abnormalities after treating fertilized eggs with 0.06-3.63 μg NNAT. After 5 d of incubation (Hamburger and Hamilton stage 27), 90% of embryos in NNAT-treated eggs were alive, of which 23% were malformed. Malformations included heart and neural-tube defects, caudal regression, gastroschisis, microphthalmia, anophthalmia, and craniofacial hypoplasia. The findings from this investigation suggest further studies are needed to determine the mechanisms underlying NNAT-induced embryotoxicity.
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Affiliation(s)
- Nikita Joshi
- a Department of Environmental , Agricultural and Occupational Health, College of Public Health, University of Nebraska Medical Center , Omaha , Nebraska , USA
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