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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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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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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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Mattila M, Niinistö S, Takkinen HM, Tapanainen H, Reinivuo H, Åkerlund M, Suomi J, Ahonen S, Ilonen J, Toppari J, Knip M, Veijola R, Virtanen SM. Maternal Nitrate and Nitrite Intakes during Pregnancy and Risk of Islet Autoimmunity and Type 1 Diabetes: The DIPP Cohort Study. J Nutr 2020; 150:2969-2976. [PMID: 32856042 DOI: 10.1093/jn/nxaa250] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/26/2020] [Accepted: 07/27/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND High dietary intake of nitrate and nitrite might increase the risk of type 1 diabetes. To our knowledge, no earlier prospective study has explored whether maternal dietary intake of nitrate and nitrite during pregnancy is associated with the risk of type 1 diabetes in the offspring. OBJECTIVE Our aim was to study association between maternal intake of nitrate and nitrite during pregnancy and the risk of islet autoimmunity and type 1 diabetes in the offspring. DESIGN Children born between 1997 and 2004 at Oulu and Tampere University Hospitals in Finland and carrying increased human leukocyte antigen (HLA)-conferred risk for type 1 diabetes were followed in the Type 1 Diabetes Prediction and Prevention (DIPP) study from 3 mo of age. Islet autoantibodies were screened at 3- to 12-mo intervals from serum samples. Of 4879 children, 312 developed islet autoimmunity and 178 developed type 1 diabetes during a 15-y follow-up. Maternal intake of nitrate and nitrite during the eighth month of pregnancy was assessed after birth using a validated self-administered FFQ. Cox proportional hazards regression was used for the statistical analyses. RESULTS Maternal intake of nitrate and nitrite during pregnancy was not associated with the child's risk of islet autoimmunity [nitrate: HR 0.99 (95% CI: 0.88, 1.11); nitrite: HR 1.03 (95% CI: 0.92, 1.15)] or type 1 diabetes [nitrate: HR 1.02 (95% CI: 0.88, 1.17); nitrite: HR 0.97 (95% CI: 0.83, 1.12)] when adjusted for energy (residual method), sex, HLA risk group, and family history of diabetes. Further adjustment for dietary antioxidants (vitamin C, vitamin E, and selenium) did not change the results. CONCLUSION Maternal dietary intake of nitrate or nitrite during pregnancy is not associated with the risk of islet autoimmunity or type 1 diabetes in the offspring genetically at risk for type 1 diabetes.
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Affiliation(s)
- Markus Mattila
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland.,Research, Development and Innovation Centre, Tampere University Hospital, Tampere, Finland.,Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Sari Niinistö
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hanna-Mari Takkinen
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland.,Research, Development and Innovation Centre, Tampere University Hospital, Tampere, Finland.,Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Heli Tapanainen
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Heli Reinivuo
- Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Mari Åkerlund
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland.,Research, Development and Innovation Centre, Tampere University Hospital, Tampere, Finland.,Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Johanna Suomi
- Risk Assessment Unit, Research and Laboratory Department, Finnish Food Authority, Helsinki, Finland
| | - Suvi Ahonen
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland.,Research, Development and Innovation Centre, Tampere University Hospital, Tampere, Finland.,Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jorma Ilonen
- Immunogenetics Laboratory, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Jorma Toppari
- Department of Pediatrics, Turku University Hospital, Turku, Finland.,Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Mikael Knip
- Pediatric Research Center, Children's Hospital, University of Helsinki, Helsinki, Finland.,Helsinki University Hospital, Helsinki, Finland.,The Clinical and Metabolic Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Riitta Veijola
- Department of Pediatrics, PEDEGO Research Unit, Medical Research Center, University of Oulu, Oulu, Finland.,Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Suvi M Virtanen
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Tampere, Finland.,Research, Development and Innovation Centre, Tampere University Hospital, Tampere, Finland.,Department of Public Health Solutions, Finnish Institute for Health and Welfare, Helsinki, Finland
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6
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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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7
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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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