Research
Obstetrics
Maternal corticosteroid use and orofacial clefts

https://doi.org/10.1016/j.ajog.2007.05.046Get rights and content

Objective

The purpose of this study was to examine whether maternal corticosteroid use during pregnancy is associated with delivering an infant with an orofacial cleft.

Study Design

This study included data on deliveries from the National Birth Defects Prevention Study, which is a population-based case-control study. Exposures were assessed by telephone interviews for mothers of 1141 cases with cleft lip ± cleft palate (CLP), 628 with cleft palate (CP), and 4143 controls.

Results

Mothers of 33 infants with CLP (2.9%), mothers of 6 infants with CP (1.0%), and 72 control subjects (1.7%) reported corticosteroid use from 4 weeks before through 12 weeks after conception. The crude odds ratio for “any” vs “no” use was 1.7 (95% CI, 1.1-2.6) for CLP and 0.5 (0.2-1.3) for CP. When analyzed by route of administration and medication components, odds ratios for CLP tended to be elevated, and odds ratios for CP tended to be close to 1.

Conclusion

Our results suggest a moderately increased risk of CLP among women who use corticosteroids during early pregnancy.

Section snippets

Materials and Methods

This analysis included data on deliveries that occurred during or after October 1997 and that had estimated dates of delivery during or before December 2002 and were part of the National Birth Defects Prevention Study, a multistate case-control study of >30 different birth defects. This study was an approved activity of the institutional review boards of the participating study centers and the Centers for Disease Control and Prevention. Detailed study methods and descriptions of the

Results

We interviewed mothers of 1141 infants with CLP, 628 infants with CP, and 4143 control infants. Most mothers of control infants were non-Hispanic white (60%), attended college (58%), took folic acid-containing supplements (86%), and did not smoke (81%; Table 1). Mothers were relatively evenly distributed across the centers.

In total, mothers of 33 infants with CLP (2.9%), 6 infants with CP (1.0%), and 72 control infants (1.7%) reported any corticosteroid medication use during the 4 weeks before

Comment

In this study, maternal periconceptional corticosteroid use was associated with a moderately increased risk of CLP, but not CP. Most of the comparisons by route of administration and for specific component medications yielded ORs for CLP of ≥1.5; however, these comparisons had less precision than the overall results, because of smaller sample size. Only topical use was not associated with increased risk of CLP. All corticosteroid medications are associated with at least some systemic

Acknowledgment

Coding of drug information in the National Birth Defects Prevention Study used the Slone Epidemiology Center Drug Dictionary, under license from the Slone Epidemiology Center at Boston University.

References (29)

  • A.E. Czeizel et al.

    Population-based case-control study of teratogenic potential of corticosteroids

    Teratology

    (1997)
  • E. Rodriguez-Pinilla et al.

    Corticosteroids during pregnancy and oral clefts: a case-control study

    Teratology

    (1998)
  • S.L. Carmichael et al.

    Maternal corticosteroid use and orofacial clefts

    Am J Med Genet

    (1999)
  • M.J. Edwards et al.

    Case-control study of cleft lip or palate after maternal use of topical corticosteroids during pregnancy

    Am J Med Genet

    (2003)
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    The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

    Supported by a cooperative agreement from the Centers for Disease Control and Prevention, Centers of Excellence Award No.U50/CCU913241.

    Cite this article as: Carmichael SL, Shaw GM, Ma C, et al. Maternal corticosteroid use and orofacial clefts. Am J Obstet Gynecol 2007;197:585.e1-585.e7.

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