Antifungal medication use during early pregnancy and the risk of congenital heart defects in the National Birth Defects Prevention Study, 1997-2011

Eleni A Papadopoulos; Meredith M Howley; Sarah C Fisher; Alissa R Van Zutphen; Martha M Werler; Paul A Romitti; Marilyn L Browne; National Birth Defects Prevention Study

doi:10.1002/bdr2.2308

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Antifungal medication use during early pregnancy and the risk of congenital heart defects in the National Birth Defects Prevention Study, 1997-2011

Journal article

Peer reviewed

Antifungal medication use during early pregnancy and the risk of congenital heart defects in the National Birth Defects Prevention Study, 1997-2011

Eleni A Papadopoulos, Meredith M Howley, Sarah C Fisher, Alissa R Van Zutphen, Martha M Werler, Paul A Romitti, Marilyn L Browne and National Birth Defects Prevention Study

Birth defects research, Vol.116(2), e2308

02/2024

DOI: 10.1002/bdr2.2308

PMID: 38343154

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Abstract

Fungal infections are common among pregnant people. Recent studies suggest positive associations between oral antifungals used to treat fungal infections and congenital heart defects (CHDs). We estimated associations between first trimester antifungal use and 20 major, specific CHDs using data from the National Birth Defects Prevention Study (NBDPS), a multi-site, case-control study that included pregnancies with estimated delivery dates from October 1997 through December 2011. Infants with CHDs ("cases") were ascertained from 10 birth defect surveillance programs. Live born infants without major birth defects ("controls") were randomly selected from birth records or hospital discharge lists. First trimester antifungal use was self-reported via maternal interview. We estimated adjusted odds ratios (AORs) and 95% confidence intervals (CIs) using logistic regression with Firth's penalized likelihood. First trimester antifungal use was reported by 148/11,653 (1.3%) case and 123/11,427 (1.1%) control participants. We estimated AORs for 12 CHDs; six had AORs >1.5 (tetralogy of Fallot, double outlet right ventricle with transposition of the great arteries [DORV-TGA], atrioventricular septal defect, hypoplastic left heart syndrome, pulmonary atresia, muscular ventricular septal defect), and one (pulmonary valve stenosis) had an AOR <0.7. All CIs included the null, except for DORV-TGA. First trimester antifungal use was rare. We observed some positive associations for several specific CHDs in our analysis, although the CIs largely included the null. Results do not support a large increase in risk, but smaller increases in risk for certain CHD cannot be ruled out.

Pregnancy

Antifungal Agents - adverse effects

Case-Control Studies

Female

Heart Defects, Congenital - epidemiology

Humans

Infant

Mycoses

Transposition of Great Vessels

Details

Title: Subtitle: Antifungal medication use during early pregnancy and the risk of congenital heart defects in the National Birth Defects Prevention Study, 1997-2011
Creators: Eleni A Papadopoulos - New York State Department of Health
Meredith M Howley - New York State Department of Health
Sarah C Fisher - New York State Department of Health
Alissa R Van Zutphen - University at Albany, State University of New York
Martha M Werler - Boston University
Paul A Romitti - University of Iowa
Marilyn L Browne - University at Albany, State University of New York
National Birth Defects Prevention Study
Resource Type: Journal article
Publication Details: Birth defects research, Vol.116(2), e2308
DOI: 10.1002/bdr2.2308
PMID: 38343154
NLM abbreviation: Birth Defects Res
ISSN: 2472-1727
eISSN: 2472-1727
Publisher: Wiley
Grant note: FOA #DD09-001 / CDC HHS PA #02081 / CDC HHS PA #96043 / CDC HHS FOA #DD13-003 / CDC HHS NOFO #DD18-001 / CDC HHS U01 DD001227 / NCBDD CDC HHS
Language: English
Date published: 02/2024
Academic Unit: Epidemiology; Biostatistics
Record Identifier: 9984559877202771

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