1ST TRIMESTER MATERNAL MEDICATION USE IN RELATION TO GASTROSCHISIS

In a case-control surveillance program, first trimester medication use was studied in relation to gastroschisis. There were 76 cases of gast roschisis which were compared with 2,142 controls with other major mal formations. For pseudoephedrine use, we found a significantly elevated relative risk of 3.2 (95% confidence interval, 1.3-7.7), with adjustm ent for confounding. Multivariate relative risks for analgesic/antipyr etics and another decongestant were as follows: salicylates, 1.6 (0.9- 2.7); acetaminophen, 1.7 (1.0-2.9); ibuprofen, 1.3 (0.4-3.7); and phen ylpropanolamine, 1.5 (0.4-5.4). No increases in risk were identified f or use of antihistamines, antibiotics, oral contraceptives, or spermic ides. Because salicylates, pseudoephedrine, and phenylpropanolamine ar e vasoactive, the elevated risks for these drugs support the hypothesi s of vascular disruption in the etiology of gastroschisis. We therefor e examined maternal use of vasoactive medications in relation to a sec ond case group of 416 infants with heterogeneous defects suspected to have a vascular etiology. Relative risks for salicylates, ibuprofen, p seudoephedrine, phenylpropanolamine, and other decongestants approxima ted unity. These positive associations must be considered tentative. T hey have not been reported previously and should be confirmed independ ently. Also, acetaminophen, which may be taken for the same indication s as salicylates and decongestants, but is not thought to be vasoactiv e, was associated with gastroschisis, suggesting that identified assoc iations may be due to an underlying maternal illness.