Epidemiological assessment of misoprostol teratogenicity

Abstract

Objective To verify if any of the 15 congenital defects already reported in association with misoprostol can be Design Methods Comparison of misoprostol exposure for each specific defect, using the exposure for the rest of defects as a reference group.Population Four thousand six hundred seventy-three consecutive newborn infants with malformations of unknown aetiology, in the Latin American Collaborative Study of Congenital Malformation.Results There was no difference in exposure rate between the malformed (34/4673) and nonmalformed (23/4980) newborns. Four of the five more frequently cited defects in the literature were found to be in excess: constriction ring, terminal transverse-limb defects, hydrocephalus, and arthrogryposis. Equinovarus feet had a normal frequency in our study. Thirteen different defects not described in the literature were seen in our misoprostol exposed cases, but only holoprosencephaly and bladder exstrophy significantly exceeded the expected number. ConclusionsThe confirmation from an epidemiological registry of an association for four of the five more commonly observed congenital defects among misoprostol exposed children described in the literature seems indicative of a real teratogenic effect. The defects are of vascular disruption type. However, additional attempts to achieve abortion could not be excluded as a concurrent contribution.found within an epidemiological registry of congenital defects.Case-control study including case-sick and case-health controls.

Comparison of intracervical laminaria plus vaginal misoprostol and vaginal misoprostol only with variable dosages for medical abortion within 12 hours

“…Reports of uterine rupture are rare in fi rst trimester medical abortion, but the risk seems to increase with gestation [20,21]. Exposure to misoprsol in early pregnancy has been associated with multiple congenital defects, therefore, counsel the women on the risk of fetal abnormality if the pregnancy is continued after exposure to misoprostol [20,22]. According to the results of this analysis, the use of laminaria did not have an effect on the spontaneous expulsion of the fetal sac.…”

Exposure to misoprostol and hormones during pregnancy and risk of congenital anomalies

“…After adjusting for confounders, the positive associations shown in the crude analysis remained for misoprostol (OR = 2.64; 95%CI: 1.03-6.75) and sex hormones (OR = 2.24; 95%CI: 1.06-4.74). 28 . However, there was a positive association between misoprostol and vascular disruption defects.…”

Embriopatías Asociadas Al Uso De Misoprostol

“…De acuerdo a una encuesta realizada en 7 hospitales de Río de Janeiro, aproximadamente el 57% de las mujeres que ingresaban por aborto incompleto admitieron haber usado misoprostol como método abortivo (8,9). Pese a ser un fárma-co bastante efectivo en terminar un embarazo, un 10-15% de las pacientes continúan con la gesta- (10,(17)(18)(19)(20)(21)(22)(23)(24). Se ha estudiado el mecanismo por el cual misoprostol pudiese causar el SM.…”

“…En el caso de alteraciones de las extremidades, estas se generarían por este mecanismo mixto. Por tanto, dichas contracciones pueden potencialmente crear un trastorno vascular en la unidad feto-placentaria además de una restricción espacial (21)(22)(23)(24).…”