1st Journal Reading

Maternal treatment with opioid analgesics and risk for birth defects

Presenter : dr Fista Divi Amesia Moderator : dr H. Hatta Ansyori SpOG (K)

Introduction Treatment with opioid • Major birth defects affect about 3% of the 4 million US live births each year and are a leading cause of infant mortality • 1 % in US birth Treatment with opioid • Often used in severe pain • Sometimes Combined with NSAID • Some in low doses used as cough suppresant Treatment with opioid • In first trimester the effect to development fetus during pregnancy are not fully understood • Mostly related with CHD .

North Carolina. Texas. Iowa. Study Location Arkansas.MATERIALS AND METHODS an ongoing population-based casecontrol study. New York. and Utah The study was approved by institutional review boards of the Centers for Disease Control and Prevention. New Jersey. through Dec 31. mothers with preexisting diabetes and opioid exposure in the form of illicit drugs are excluded . 2005. 1997. Data from the National Birth Defects Prevention Study(NBDPS) for infants born Oct 1. The subjects  birth defect with unknowns etiologies . Massachusetts. Georgia. California. birth defect with known etiologies is excluded from this study.

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449 case mothers and 2. 95% CI. 1. 95% CI. or gastroschisis (OR.6). 1.1– 6. 1. 95% CI.9) in infants.2–3. hypoplastic left heart syndrome (OR. 95% CI.0% of 6701 control mothers. 2.2).3–3.4–4. spina bifida (OR.0.Results Result • Therapeutic opioid use was reported by 2.8. result • associations between maternal therapeutic use of opioid medications in early pregnancy and several types of CHD . 1. 2.7.1). result • Treatment was statistically significantly associated with conoventricular septal defects (OR.1–2. 2.4.3).6% of 17. 2. 1. 95% CI.0. atrioventricular septal defects (OR. 1.

7 (0.0(1.84–3.3) 1.7) Total no No.8) Anomalous pulmonary venous return Single ventricle/complex 206 201 4 4 0.4) 2.71 (0.Associations between maternal opioid analgesic treatment and specific major birth defects Birth defect Hypothesis-testing analysis Controls Anencephaly/craniorachischis Spina bifida Any of included heart defects 6701 340 718 7724 134 9 26 211 Referent 1.4 (1. exposed aOR (95% CI) Laterality defects with CHD Atrioventricular septal defect 198 175 4 9 1.22–2.1–1.3–3.2) .42–3.1 (0.2 2.2) 1.42–3.2 (0.4 (1.2–4.

Associations between maternal opioid analgesic treatment and specific major birth defects .

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including some types of CHD. although better pathogenetic understanding is needed to explain why opioid analgesic treatment is associated with some defects but not others. .Conclusion Maternal opioid analgesic treatment early in pregnancy was associated with certain types of birth defects in infants.which are important contributors to infant morbidity and mortality. Identification of a biologically plausible mechanism supports this finding.

they all used opioid treatment during early pregnancy Yes. all patients follow up from the same time Was the follow-up of these patients sufficiently long and complete? Was outcome criteria assessed by “blind” ? Yes If there was found subgroup with different prognosis.CRITICAL APPRAISAL PROGNOSTIC Was a defined. all result the same . Was there adjustment for important prognostic factors? No. representative sample of patients assembled at a common (usually early) point in the course of their disease? Yes.

Was this result of this study important? Yes. especially for maternal treatment with opiod to prevent birth defect in the future How likely are the outcomes over time? Yes How accurate prognostic prediction? Were the study patients similar to your patient? 95% CI Yes . many patient in our country used the same medications Yes Will the evidence make a clinically important impact on your conclusions about what to offer or tell your patient? .

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