1
|
Modifiable Risk Factors of Non-Syndromic Orofacial Clefts: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121846. [PMID: 36553290 PMCID: PMC9777067 DOI: 10.3390/children9121846] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 11/29/2022]
Abstract
OFCs (orofacial clefts) are among the most frequent congenital defects, but their etiology has yet to be clarified. OFCs affect different structures and functions with social, psychological and economic implications in children and their families. Identifying modifiable risk factors is mandatory to prevent the occurrence of non-syndromic OFCs (NSOFCs). PubMed, Cochrane Library, Scopus and Web of Science were searched from 1 January 2012 to 25 May 2022 and a total of 7668 publications were identified. Studies focusing on the risk factors of NSOFCs were selected, leading to 62 case-control and randomized clinical trials. Risk factors were categorized into non-modifiable and modifiable. The first group includes genetic polymorphisms, gender of the newborn, ethnicity, and familiarity. Within the second group, risk factors that can only be modified before conception (consanguinity, parental age at conception, socio-economical and educational level, area of residency and climate), and risk factors modifiable before and after conception (weight, nutritional state, acute and chronic diseases, psychophysical stress, licit and illicit drugs, alcohol, smoke, pollutants and contaminants) have been distinguished. This study provides a wide overview of the risk factors of NSOFCs, focusing on modifiable ones, to suggest new perspectives in education, prevention, medical interventions and clinical research.
Collapse
|
2
|
Martinez ME, Pinz I, Preda M, Norton CR, Gridley T, Hernandez A. DIO3 protects against thyrotoxicosis-derived cranio-encephalic and cardiac congenital abnormalities. JCI Insight 2022; 7:e161214. [PMID: 36166296 PMCID: PMC9675556 DOI: 10.1172/jci.insight.161214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 09/21/2022] [Indexed: 12/15/2022] Open
Abstract
Maternal hyperthyroidism is associated with an increased incidence of congenital abnormalities at birth, but it is not clear which of these defects arise from a transient developmental excess of thyroid hormone and which depend on pregnancy stage, antithyroid drug choice, or unwanted subsequent fetal hypothyroidism. To address this issue, we studied a mouse model of comprehensive developmental thyrotoxicosis secondary to a lack of type 3 deiodinase (DIO3). Dio3-/- mice exhibited reduced neonatal viability on most genetic backgrounds and perinatal lethality on a C57BL/6 background. Dio3-/- mice exhibited severe growth retardation during the neonatal period and cartilage loss. Mice surviving after birth manifested brain and cranial dysmorphisms, severe hydrocephalus, choanal atresia, and cleft palate. These abnormalities were noticeable in C57BL/6J Dio3-/- mice at fetal stages, in addition to a thyrotoxic heart with septal defects and thin ventricular walls. Our findings stress the protecting role of DIO3 during development and support the hypothesis that human congenital abnormalities associated with hyperthyroidism during pregnancy are caused by transient thyrotoxicosis before clinical intervention. Our results also suggest thyroid hormone involvement in the etiology of idiopathic pathologies including cleft palate, choanal atresia, Chiari malformations, Kaschin-Beck disease, and Temple and other cranio-encephalic and heart syndromes.
Collapse
Affiliation(s)
- M. Elena Martinez
- Center for Molecular Medicine, MaineHealth Institute for Research, MaineHealth, Scarborough, Maine, USA
| | - Ilka Pinz
- Center for Molecular Medicine, MaineHealth Institute for Research, MaineHealth, Scarborough, Maine, USA
- Graduate School of Biomedical Sciences and Engineering, University of Maine, Orono, Maine, USA
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Marilena Preda
- Center for Molecular Medicine, MaineHealth Institute for Research, MaineHealth, Scarborough, Maine, USA
| | - Christine R. Norton
- Center for Molecular Medicine, MaineHealth Institute for Research, MaineHealth, Scarborough, Maine, USA
| | - Thomas Gridley
- Center for Molecular Medicine, MaineHealth Institute for Research, MaineHealth, Scarborough, Maine, USA
- Graduate School of Biomedical Sciences and Engineering, University of Maine, Orono, Maine, USA
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Arturo Hernandez
- Center for Molecular Medicine, MaineHealth Institute for Research, MaineHealth, Scarborough, Maine, USA
- Graduate School of Biomedical Sciences and Engineering, University of Maine, Orono, Maine, USA
- Department of Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| |
Collapse
|
3
|
Asfour SS, Al-Mouqdad MM. Gastroschisis Due to Maternal Exposure to Carbimazole in A Term Neonate. Cureus 2022; 14:e24808. [PMID: 35686264 PMCID: PMC9170418 DOI: 10.7759/cureus.24808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2022] [Indexed: 12/03/2022] Open
Abstract
Pregnant women with hyperthyroidism need careful management, which is due to the increased risk of maternal and fetal complications. However, safe and effective therapies for hyperthyroidism during pregnancy remain limited. Carbimazole is an anti-thyroid agent and has been used to treat hyperthyroidism. Gastroschisis is a congenital severe abdominal birth defect of the fetus but its etiology remains unclear. Here, we present a case of a female term neonate who developed gastroschisis after being exposed to carbimazole in uteroduring the first and half of the second trimester.
Collapse
|
4
|
Romeo AN, Običan SG. Teratogen update: Antithyroid medications. Birth Defects Res 2020; 112:1150-1170. [PMID: 32738035 DOI: 10.1002/bdr2.1771] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Thyroid disorders including hyperthyroidism are common during pregnancy. Untreated hyperthyroidism can result in adverse outcomes for pregnancy. METHODS Iodine, propylthiouracil (PTU), carbimazole (CMZ), and methimazole (MMI) are common medications for hyperthyroidism treatment. The literature regarding antithyroid medication use in pregnancy and breastfeeding is reviewed. RESULTS Animal studies for PTU have suggested congenital anomalies while animal studies for MMI have only indicated adverse outcomes at higher doses than used in humans. Epidemiological studies have noted an increased risk of congenital anomalies for PTU less often than CMZ or MMI but the epidemiological evidence remains mixed. A pattern of anomalies has been described for CMZ and MMI, from both case and epidemiological studies, including choanal atresia, aplasia cutis congenita, and other facial, heart, gastrointestinal, and skin anomalies. Closer examination of cases indicates that a few cases of the anomalies have occurred without exposure to CMZ or MMI and outside of the proposed critical period. PTU has a small risk of hepatotoxicity which rarely results in liver transplantation and death. Some authors have suggested that PTU be prescribed in early pregnancy and switched to MMI in late pregnancy. Untreated hyperthyroidism, from either a lack of medications or switching medications during the first trimester, may also increase the chance of congenital anomalies. Multiple case studies and larger epidemiological studies have failed to provide clear, consistent outcomes for the use of PTU, CMZ, and MMI in pregnancy. MMI and PTU both enter the breastmilk in small amounts. CONCLUSION Additional research is needed to assist in the medical management and exposure counseling of pregnant and breastfeeding women with hyperthyroidism.
Collapse
Affiliation(s)
- Alfred N Romeo
- MotherToBaby Utah, Utah Department of Health, Salt Lake City, Utah, USA
| | - Sarah G Običan
- Department of Obstetrics and Gynecology, Morsani College of Medicine, University of South Florida, Tampa, Florida, USA
| |
Collapse
|
5
|
Ács L, Bányai D, Nemes B, Nagy K, Ács N, Bánhidy F, Rózsa N. Maternal‐related factors in the origin of isolated cleft palate—A population‐based case‐control study. Orthod Craniofac Res 2020; 23:174-180. [DOI: 10.1111/ocr.12361] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 11/24/2019] [Accepted: 12/11/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Lili Ács
- Department of Paediatric Dentistry and Orthodontics Semmelweis University Faculty of Dentistry Budapest Hungary
| | - Dorottya Bányai
- Department of Paediatric Dentistry and Orthodontics Semmelweis University Faculty of Dentistry Budapest Hungary
| | - Bálint Nemes
- Department of Paediatric Dentistry and Orthodontics Semmelweis University Faculty of Dentistry Budapest Hungary
| | - Krisztián Nagy
- 1st Department of Paediatrics Semmelweis University School of Medicine Budapest Hungary
- OMFS‐IMPATH KU Research Group Leuven Belgium
| | - Nándor Ács
- Department of Obstetrics and Gynaecology Semmelweis University School of Medicine Budapest Hungary
| | - Ferenc Bánhidy
- Department of Obstetrics and Gynaecology Semmelweis University School of Medicine Budapest Hungary
| | - Noémi Rózsa
- Department of Paediatric Dentistry and Orthodontics Semmelweis University Faculty of Dentistry Budapest Hungary
| |
Collapse
|
6
|
El Guendouz F, Hammoune N, Hommadi A, Zerhouni H, Baizri H. Carbimazole embryopathy. ANNALES D'ENDOCRINOLOGIE 2017; 78:478-480. [PMID: 28870708 DOI: 10.1016/j.ando.2016.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 05/22/2015] [Accepted: 01/07/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Fayçal El Guendouz
- Department of Endocrinology, Diabetes and Metabolism, Avicenne Military Hospital, Marrakech, Morocco.
| | - Nabil Hammoune
- Department of Radiology, third Military Hospital, El Aiun, Morocco.
| | | | - Hicham Zerhouni
- Department of Pediatric Surgical Emergencies, Children's Hospital, Rabat, Morocco.
| | - Hicham Baizri
- Department of Endocrinology, Diabetes and Metabolism, Avicenne Military Hospital, Marrakech, Morocco.
| |
Collapse
|
7
|
Sachs C, Tebacher-Alt M, Mark M, Cribier B, Lipsker D. [Aplasia cutis congenita and antithyroid drugs during pregnancy: Case series and literature review]. Ann Dermatol Venereol 2016; 143:423-35. [PMID: 27033749 DOI: 10.1016/j.annder.2016.02.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/24/2015] [Accepted: 02/19/2016] [Indexed: 01/20/2023]
Abstract
BACKGROUND Aplasia cutis congenita (ACC) following in utero exposure to antithyroid drugs such as methimazole/carbimazole (MTZ/CMZ) has been reported since 1972. Though currently included in MTZ/CMZ embryopathy, it remains poorly characterized and is little discussed. Having seen two cases within a short period of time, we carried out a literature review and searched the French pharmacovigilance database for notification of cases. PATIENTS AND METHODS We performed a search of the literature in the Medline database using the following keywords: "aplasia cutis congenita", "birth skin defects", "pregnancy" and "drug". All articles reporting cases of ACC following in utero exposure to antithyroid drugs were included. All cases of ACC under antithyroid drugs reported to French pharmacovigilance centres were analysed. RESULTS Three hundred and sixty-eight articles were retrieved and 31 were analysed, including a further 4, mentioned in selected articles, giving 59 cases of ACC under MTZ/CMZ reported in the literature and having an intrinsic accountability score of plausible or dubious. ACC was typically isolated, single, small in size, and localised on the median scalp area. Exposure occurred in the first weeks of gestation. There were 6 familial cases involving siblings. Ten ACC and MTZ/CMZ cases were reported to pharmacovigilance centres in France. DISCUSSION Practitioners should be aware of ACC following MTZ/CMZ exposure in utero, whether it occurs in isolation or not. It is likely a teratogenic effect of MTZ/CMZ enhanced by a genetic predisposition.
Collapse
Affiliation(s)
- C Sachs
- Clinique dermatologique, université de Strasbourg, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - M Tebacher-Alt
- Service de pharmacovigilance, université de Strasbourg, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - M Mark
- Service de biologie du développement et de la reproduction, université de Strasbourg, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - B Cribier
- Clinique dermatologique, université de Strasbourg, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France
| | - D Lipsker
- Clinique dermatologique, université de Strasbourg, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67091 Strasbourg cedex, France.
| |
Collapse
|
8
|
Li H, Zheng J, Luo J, Zeng R, Feng N, Zhu N, Feng Q. Congenital anomalies in children exposed to antithyroid drugs in-utero: a meta-analysis of cohort studies. PLoS One 2015; 10:e0126610. [PMID: 25974033 PMCID: PMC4431808 DOI: 10.1371/journal.pone.0126610] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 04/06/2015] [Indexed: 12/26/2022] Open
Abstract
Background Hyperthyroidism affects about 0.2%-2.7% of all pregnancies, and is commonly managed with antithyroid drugs (ATDs). However, previous studies about the effects of ATDs on congenital anomalies are controversial. Therefore, the present meta-analysis was performed to explore the risk of congenital anomalies in children exposed to ATDs in-utero. Methods Embase, Pubmed, Web of Knowledge, and BIOSIS Citation Index were searched to find out studies about congenital anomalies in children exposed to ATDs in-utero reported up to May 2014. The references cited by the retrieved articles were also searched. The relative risks (RRs) and confidence intervals (CIs) for the individual studies were pooled by fixed effects models, and heterogeneity was analyzed by chi-square and I2 tests. Results Eight studies met the inclusion criteria. Exposure to propylthiouracil (PTU), methimazole/carbimazole (MMI/CMZ), and PTU & MMI/CMZ was investigated in 7, 7 and 2 studies, respectively. The pooled RR was 1.20 (95%CI: 1.02-1.42), 1.64 (95%CI: 1.39-1.92), and 1.83 (95%CI: 1.30-2.56) for congenital anomalies after exposure to PTU, MMI/CMZ, and PTU & MMI/CMZ, respectively. Conclusions The meta-analysis suggests that exposure to ATDs in-utero increases the risk of congenital anomalies. The use of ATDs in pregnancy should be limited when possible. Further research is needed to delineate the exact teratogenic risk for particular congenital anomaly.
Collapse
Affiliation(s)
- Huixia Li
- Department of Maternal and Children Health, School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Jianfei Zheng
- Department of Emergency and Intensive Care Medicine, The second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | - Jiayou Luo
- Department of Maternal and Children Health, School of Public Health, Central South University, Changsha, Hunan Province, China
- * E-mail:
| | - Rong Zeng
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha Hunan Province, China
| | - Na Feng
- Department of Maternal and Children Health, School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Na Zhu
- Department of Maternal and Children Health, School of Public Health, Central South University, Changsha, Hunan Province, China
| | - Qi Feng
- Department of Maternal and Children Health, School of Public Health, Central South University, Changsha, Hunan Province, China
| |
Collapse
|
9
|
Laurberg P, Andersen SL. Therapy of endocrine disease: antithyroid drug use in early pregnancy and birth defects: time windows of relative safety and high risk? Eur J Endocrinol 2014; 171:R13-20. [PMID: 24662319 DOI: 10.1530/eje-14-0135] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Antithyroid drugs (ATDs) may have teratogenic effects when used in early pregnancy. OBJECTIVE To review the association between the time period of ATD exposure in early pregnancy and the development of birth defects. METHODS We identified publications on birth defects after early pregnancy exposure to the ATDs methimazole (MMI; and its prodrug carbimazole (CMZ)) and propylthiouracil (PTU). Cases of birth defects after ATD treatment had been initiated or terminated within the first 10 weeks of pregnancy were identified and studied in detail. RESULTS A total of 92 publications were read in detail. Two recent large controlled studies showed ATD-associated birth defects in 2-3% of exposed children, and MMI/CMZ-associated defects were often severe. Out of the total number of publications, 17 included cases of birth defects with early pregnancy stop/start of ATD treatment, and these cases suggested that the high risk was confined to gestational weeks 6-10, which is the major period of organogenesis. Thus, the cases reported suggest that the risk of birth defects could be minimized if pregnant women terminate ATD intake before gestational week 6. CONCLUSION Both MMI and PTU use in early pregnancy may lead to birth defects in 2-3% of the exposed children. MMI-associated defects are often severe. Proposals are given on how to minimize the risk of birth defects in fertile women treated for hyperthyroidism with ATDs.
Collapse
Affiliation(s)
- Peter Laurberg
- Department of EndocrinologyAalborg University Hospital, DK-9000 Aalborg, DenmarkDepartment of Clinical MedicineAalborg University, Aalborg, DenmarkDepartment of EndocrinologyAalborg University Hospital, DK-9000 Aalborg, DenmarkDepartment of Clinical MedicineAalborg University, Aalborg, Denmark
| | - Stine Linding Andersen
- Department of EndocrinologyAalborg University Hospital, DK-9000 Aalborg, DenmarkDepartment of Clinical MedicineAalborg University, Aalborg, DenmarkDepartment of EndocrinologyAalborg University Hospital, DK-9000 Aalborg, DenmarkDepartment of Clinical MedicineAalborg University, Aalborg, Denmark
| |
Collapse
|
10
|
Kancherla V, Romitti PA, Sun L, Carey JC, Burns TL, Siega-Riz AM, Druschel CM, Lin AE, Olney RS. Descriptive and risk factor analysis for choanal atresia: The National Birth Defects Prevention Study, 1997-2007. Eur J Med Genet 2014; 57:220-9. [PMID: 24576610 PMCID: PMC4520237 DOI: 10.1016/j.ejmg.2014.02.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 02/09/2014] [Indexed: 12/13/2022]
Abstract
Choanal atresia causes serious posterior nasal obstruction. This defect is the leading cause of nasal surgery in newborns, although its etiology is largely unknown. Data from the National Birth Defects Prevention Study, a population-based case-control study, were used to examine associations between maternal self-reports of exposures and occurrence of choanal atresia in their offspring. Overall, 117 case and 8350 control mothers with deliveries from 1997 through 2007 provided telephone interview reports of pre-pregnancy (one year before conception) and periconceptional (one month before through three months after conception) exposures. The exposures analyzed were pre-pregnancy dietary intake, pre-pregnancy and periconceptional caffeine consumption, and periconceptional cigarette smoking, alcohol drinking, and medication use. Independent associations between each exposure and all choanal atresia cases combined (n = 117) and isolated choanal atresia cases (those without additional unrelated major defects; n = 61) were examined. Odds ratios (ORs), both unadjusted (uORs) and adjusted (aORs) for potential confounders, and 95% confidence intervals (CIs) were estimated using unconditional logistic regression analysis. For all choanal atresia cases combined, positive associations were observed with maternal pre-pregnancy intake in the highest quartile for vitamin B-12 (aOR = 1.9; CI = 1.1,3.1), zinc (aOR = 1.7; CI = 1.0,3.1), and niacin (aOR = 1.8; CI = 1.0,3.1), and intake in the lowest quartile for methionine (aOR = 1.6; CI = 1.0,2.6) and vitamin D (aOR = 1.6; CI = 1.0,2.4) compared to intake in the two intermediate quartiles combined. Further, a positive association was observed with periconceptional use of thyroid medications (uOR = 2.6; CI = 1.0,6.3) compared to no use of such medications. Among isolated choanal atresia cases, negative associations were observed for pantothenic acid (aOR = 0.4; CI = 0.2,0.9) and fat (aOR = 0.5; 95% CI = 0.2,1.0) intake in the lowest quartile compared to that in the intermediate quartiles, and positive associations were observed for periconceptional cigarette smoking (aOR = 2.3; CI = 1.1,4.7) compared to no smoking and pre-pregnancy daily coffee intake of 3 or more cups (aOR = 2.5; CI = 1.1,5.6) compared to intake of less than 1 cup per day. The positive association for periconceptional exposure to thyroid medications also persisted for isolated choanal atresia cases (uOR = 4.0; CI = 1.1,11.2). Because of the large number of associations tested, these findings may be due to chance. Alternatively, they may contribute new hypotheses regarding the etiology of choanal atresia; thus, requiring replication in additional studies.
Collapse
Affiliation(s)
- Vijaya Kancherla
- Department of Epidemiology, The University of Iowa, Iowa City, IA, USA
| | - Paul A Romitti
- Department of Epidemiology, The University of Iowa, Iowa City, IA, USA.
| | - Lixian Sun
- Department of Epidemiology, The University of Iowa, Iowa City, IA, USA
| | - John C Carey
- Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Trudy L Burns
- Department of Epidemiology, The University of Iowa, Iowa City, IA, USA
| | - Anna Maria Siega-Riz
- Department of Epidemiology and Nutrition, University of North Carolina, Chapel Hill, NC, USA
| | | | - Angela E Lin
- Medical Genetics, MassGeneral Hospital for Children, Boston, MA, USA
| | - Richard S Olney
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|
11
|
Goel H, Dudding T. Carbimazole/methimazole embryopathy in siblings: A possible genetic susceptibility. ACTA ACUST UNITED AC 2013; 97:755-8. [DOI: 10.1002/bdra.23200] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 07/12/2013] [Accepted: 09/21/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Himanshu Goel
- Hunter Genetics; Waratah NSW Australia
- University of Newcastle; Callaghan NSW Australia
| | - Tracy Dudding
- Hunter Genetics; Waratah NSW Australia
- University of Newcastle; Callaghan NSW Australia
| |
Collapse
|
12
|
Panait N, Michel F, D'Ercole C, Merrot T. Esophageal atresia, small omphalocele and ileal prolapse through a patent omphalomesenteric duct: a methimazole embryopathy? [Corrected]. J Pediatr Surg 2013; 48:E9-11. [PMID: 23845657 DOI: 10.1016/j.jpedsurg.2013.03.073] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2012] [Revised: 03/26/2013] [Accepted: 03/27/2013] [Indexed: 11/17/2022]
Abstract
Newborns prenatally exposed to methimazole (active metabolite of carbamizole) for maternal hyperthyroidism may present some disorders in common, but the phenotype is not well defined. Choanal atresia is the most frequent, and other anomalies such as esophageal atresia and aplasia cutis were described with this embryopathy. Additionally, patent omphalomesenteric duct or Meckel's diverticulum in similar association was reported in some patients. The predisposed genetic background has to be considered. We report the case of a newborn exposed to carbamizole during the first 4 weeks of pregnancy and define an association related to prenatal methamizole exposure consisting of esophageal atresia, small omphalocele, and ileal prolapse through a patent omphalomesenteric duct.
Collapse
Affiliation(s)
- Nicoleta Panait
- Department of Pediatric Surgery, AP-HM, Hôpital Nord, Marseille, France.
| | | | | | | |
Collapse
|
13
|
Ting YH, Zhou Y, Lao TT. Carbimazole embryopathy in a Chinese population: Case series and literature review. ACTA ACUST UNITED AC 2013; 97:225-9. [DOI: 10.1002/bdra.23117] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 01/22/2013] [Accepted: 01/24/2013] [Indexed: 01/11/2023]
Affiliation(s)
- Yuen Ha Ting
- Fetal Medicine Unit; Department of Obstetrics and Gynecology; Prince of Wales Hospital; the Chinese University of Hong Kong; Hong Kong
| | - Yan Zhou
- Department of Obstetrics and Gynecology; Wuhan Medical Care Center for Women and Children; Wuhan; China
| | - Terence T. Lao
- Fetal Medicine Unit; Department of Obstetrics and Gynecology; Prince of Wales Hospital; the Chinese University of Hong Kong; Hong Kong
| |
Collapse
|
14
|
Taylor PN, Vaidya B. Side effects of anti-thyroid drugs and their impact on the choice of treatment for thyrotoxicosis in pregnancy. Eur Thyroid J 2012; 1:176-85. [PMID: 24783017 PMCID: PMC3821480 DOI: 10.1159/000342920] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 08/23/2012] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Hyperthyroidism in pregnancy is a serious condition and its management is complex. Whilst carbimazole/methimazole (CBZ/MMI) and propylthiouracil (PTU) have similar efficacies in controlling hyperthyroidism, their risk of side effects such as major congenital abnormalities and hepatotoxicity are different. METHODS Various combinations of the terms 'anti-thyroid drugs', 'thionamide', 'carbimazole', 'methimazole', 'propylthiouracil', 'pregnancy', 'side effects', 'agranulocytosis', 'birth defects', 'congenital malformations', 'embryopathy', 'aplasia cutis', 'hepatotoxicity', 'hepatic failure', 'maternal' and 'fetus' were used to search MEDLINE and the Cochrane library. The references of retrieved papers were also reviewed. RESULTS There is increasing evidence for a CBZ/MMI embryopathy, whilst data remain lacking for major congenital abnormalities with PTU. In contrast, PTU is associated with increased risk of severe liver injury. Management strategies to reduce these risks by using PTU in the first trimester and CBZ/MMI in the later trimesters remain untested. CONCLUSION More evidence is still needed in defining the relative risks between CBZ/MMI and PTU of major congenital abnormalities and severe liver injury in pregnancy. Studies are also needed to establish the suitability of recent management suggestions in switching from PTU to CBZ/MMI after the first trimester. Major adverse outcomes secondary to CBZ/MMI and PTU are rare, and inadequately treated hyperthyroidism poses a far greater risk.
Collapse
Affiliation(s)
- Peter N. Taylor
- Thyroid Research Group, Institute of Experimental and Molecular Medicine, School of Medicine, Cardiff University, Cardiff, London
- London School of Hygiene and Tropical Medicine, London
| | - Bijay Vaidya
- Department of Endocrinology, Royal Devon and Exeter Hospital and Peninsula Medical School, Exeter, UK
- *Dr. B. Vaidya, Department of Endocrinology, Royal Devon and Exeter Hospital, Barrack Road, Exeter EX2 5DW (UK), E-Mail
| |
Collapse
|
15
|
Bowman P, Vaidya B. Suspected Spontaneous Reports of Birth Defects in the UK Associated with the Use of Carbimazole and Propylthiouracil in Pregnancy. J Thyroid Res 2011; 2011:235130. [PMID: 21922050 PMCID: PMC3172977 DOI: 10.4061/2011/235130] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 06/19/2011] [Accepted: 06/19/2011] [Indexed: 11/28/2022] Open
Abstract
The concept of a carbimazole embryopathy underlies current Endocrine Society advice to avoid this drug in early pregnancy, favouring propylthiouracil as an alternative for the treatment of maternal hyperthyroidism. We aimed to establish whether suspected spontaneous reporting of adverse drug reactions in the UK via the Yellow Card Scheme supports a carbimazole embryopathy and the lack of association between propylthiouracil and congenital anomalies. All birth defects related to maternal treatment with carbimazole or propylthiouracil reported over a 47-year period via the Yellow Card Scheme were analysed. 57 cases with 97 anomalies were reported following in utero exposure to carbimazole. These anomalies included aplasia cutis, choanal atresia, tracheo-oesophageal fistula, and patent vitellointestinal duct, which have previously been reported in association with carbimazole/methimazole exposure in utero. Only 6 cases with 11 anomalies were reported for propylthiouracil, all within the last 15 years. Therefore, these findings may support a carbimazole embryopathy. There are few birth defects associated with propylthiouracil, but this should be interpreted in the context of higher historical prescription rates for carbimazole.
Collapse
Affiliation(s)
- Pamela Bowman
- Department of Paediatrics, Royal Devon and Exeter Hospital, Exeter, Devon EX25DW, UK
| | | |
Collapse
|