Use of antihistamine medications during early pregnancy and isolated major malformations

Gilboa, Suzanne M.; Strickland, Matthew; Olshan, Andrew F.; Werler, Martha M.; Correa, Adolfo

doi:10.1002/bdra.20513

Cited by 76 publications

(64 citation statements)

References 42 publications

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“…Ten studies fulfi lled the inclusion criteria for the meta-analysis, including the current cohort study. Th e other four were excluded because: one of them had no healthy control groups (Wilton et al 1998); one was a case -control study (Gilboa et al 2009); one study focussed only on one type of malformation (Carter et al 1980); and one study was published as an abstract (Einarson et al 1993) and the same data was included in a peer-reviewed publication (Einarson et al 1997) (Figure 1). Of the ten studies included in our meta-analyses, four studies included women on hydroxyzine (Erez et al 1971;Briggs et al 1994;Heinonen et al 1977;Diav-Citrin et al 2003); four studies were on cetirizine (including the current study) (Weber-Schoendorfer and Schaefer 2008;Kallen 2002;Paulus et al 2004) and two studies were on hydroxyzine and cetirizine (Einarson et al 1997;Schatz and Petitti 1997) (Table IV).…”

Section: Meta-analytic Resultsmentioning

confidence: 99%

The fetal safety of cetirizine: An observational cohort study and meta-analysis

Etwel

Djokanovic

Moretti

et al. 2014

Journal of Obstetrics and Gynaecology

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Cetirizine, a second-generation antihistamine, is an active metabolite of hydroxyzine used in the treatment of allergies, but the data on fetal safety are inconclusive. Pregnant women who were counselled by the 'Motherisk Program' regarding cetirizine exposure were enrolled in a cohort study and compared with pregnant women counselled for non-teratogenic exposures. The objective was to measure the rate of adverse pregnancy outcomes. Subsequently, we also conducted a meta-analysis of cohort studies that examined the pregnancy outcomes of women exposed to hydroxyzine or cetirizine during pregnancy. In the cohort study, there were no significant differences in the rates of major malformations between the cetirizine exposed and comparison group. In the meta-analysis, cetirizine was not associated with increased teratogenic risk. In contrast, a meta-analysis of cetirizine and hydroxyzine studies showed a marginal association with major malformations. Cetirizine is not associated with a clinically important increase in risk of adverse fetal outcomes.

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Section: Meta-analytic Resultsmentioning

confidence: 99%

The fetal safety of cetirizine: An observational cohort study and meta-analysis

Etwel

Djokanovic

Moretti

et al. 2014

Journal of Obstetrics and Gynaecology

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“…There is now a greater understanding of the critical time periods when drugs can lead to cardiac and other defects, making it clear that the epidemiological findings must be interpreted against a background that recognizes that women rarely start taking doxylamine before week 6-8 and by this time the risk of cardiac defects has all but been eliminated [115]. This fact makes any increase in risk notable.…”

Section: Discussionmentioning

confidence: 99%

Links between serotonin reuptake inhibition during pregnancy and neurodevelopmental delay/spectrum disorders: A systematic review of epidemiological and physiological evidence

Healy

Noury

Mangin

2016

JRS

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Abstract. OBJECTIVE:To investigate possible linkages between neurodevelopmental delay and neurodevelopmental spectrum disorders and exposure to medication with effects on serotonin reuptake inhibition during pregnancy. METHODS: We systematically reviewed the epidemiological literature for studies bearing on this relationship in children born with neurodevelopmental spectrum disorder and related conditions, as well as animal studies giving serotonin reuptake inhibitors to pregnant animals and in addition reviewed the literature for proposals as to possible mechanisms that might link effects on serotonin reuptake with cognitive changes post-partum.The epidemiological studies were analysed to produce Forest plots to illustrate possible relations. RESULTS: The odds ratio of Autistic Spectrum or related Disorders in children born to women taking serotonin reuptake inhibiting antidepressants during pregnancy in case control studies was 1.95 (95% C.I. 1.63, 2.34) and in prospective cohort studies was 1.96 (95% C.I. 1.33, 2.90).CONCLUSIONS: There appears to be a link between serotonin reuptake inhibition in pregnancy and developmental delay and spectrum disorders in infancy leading to cognitive difficulties in childhood. More work needs to be done to establish more precisely the nature of the difficulties and possible mechanisms through which this link might be mediated.Keywords: Autism spectrum disorder, neurodevelopmental delay, neurodevelopmental spectrum disorders, antidepressants, serotonin reuptake inhibitors, pregnancy BackgroundThe clinical syndrome later called autism was first reported in 1943 [1]. The first studies of the prevalence of autism or autistic disorder (AD) in the 1960s pointed to a rate of 4 per 10,000 [2,3]. Later studies indicated the existence of a spectrum of disorders, and brought the term autistic spectrum disorder (ASD) into being in the mid-1990s 126 D. Healy et al. / Link between SSRIs in pregnancy and autistic spectrum disordersand ASD also now includes other syndromes such as Pervasive Developmental Disorder and Aspergers Disorder so that it is difficult to know how closely current clinical usage of an ASD diagnosis maps onto AD and ASD as first conceived. Current estimates are that ASD in research studies occurs at a rate of more than 1 in 70 children [5,6].Kanner autism was recognized before the emergence of modern psychotropic drugs, and given its submergence in ASD, it may not now be possible to establish whether it is linked to commonly used psychotropic medications. A number of clinical pictures linked to psychotropic drug use, fetal anticonvulsant syndrome (FACS), fetal valproate syndrome (FVS), and fetal alcohol syndrome (FAS) and fetal alcohol spectrum disorder (FASD) have been described since 1970. Aside from the link to treatment, the clinical features of these disorders are consistent with a diagnosis of ASD but not Kanner autism. A growing number of epidemiological studies point to an increase in rates of ASD. This translates popularly into concerns about a change in the p...

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“…In order to alleviate the symptoms, first-generation or second-generation antihistamines such as cetirizine or loratadine (which are classified in category B according to the FDA) should be administered. The only side effect of loratadine may be rarely occurring hypospadias [19][20][21][22][23].…”

Section: Discussionmentioning

confidence: 99%

Pemphigoid gestationis – a rare dermatosis of the prenatal period. Case report

Skutil¹,

Roztoczyński²

2016

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Introduction. Most skin lesions during pregnancy are associated with hormonal changes. Pemphigoid (herpes) gestationis (PG) is a significant dermatosis of the prenatal period reflecting pathology affecting the mother and fetus. Objective. The aim of the study was to present a PG case, a rare pregnancy dermatosis with a severe clinical outcome during the postpartum period. Case report. We present a case of a patient in whom skin lesions with tense blisters occurred at the 40 th week of pregnancy. Herpes gestationis -a rare skin disease -was diagnosed based on the clinical picture. During the first days of puerperium, because of an aggressive disease course, the patient was transferred to a reference centre for skin disease treatment. She was given corticosteroid therapy, which brought the expected results. Conclusions. Pemphigoid gestationis is a rare and serious dermatosis of the prenatal period. Although the treatment of such diseases is the dermatologists' task, obstetricians are responsible for diagnosis and for fetal monitoring considering placental pathology. STRESZCZENIEWprowadzenie. Większość zmian skórnych w okresie ciąży wiąże się ze zmianami gospodarki hormonalnej. Pemfigoid (opryszczka) ciężar-nych jest ważną dermatozą okresu prenatalnego odzwierciedlającą patologię toczącą się w jednostce matczyno-płodowej. Cel pracy. Przedstawienie przypadku pemfigoidu ciężarnych, rzadkiej dermatozy ciążowej, o ciężkim przebiegu klinicznym w okresie połogu. Opis przypadku. Przedstawiamy przypadek pacjentki, u której w 40. tygodniu ciąży zaobserwowano zmiany skórne w postaci napiętych pę-cherzy, co pozwoliło na podstawie obrazu klinicznego rozpoznać rzadką chorobę skóry, jaką jest opryszczka ciężarnych. W pierwszych dniach połogu ze względu na agresywny przebieg choroby pacjentka została przekazana do ośrodka referencyjnego leczenia chorób skóry. Zastosowana tam terapia glikokortykosteroidami przyniosła zamierzony efekt. Wnioski. Pemfigoid ciężarnych jest rzadką dermatozą okresu prenatalnego, której terapię prowadzą dermatolodzy, a zadaniem położników jest rozpoznanie choroby i monitorowanie stanu płodu z uwzględnie-niem faktu patologii łożyska.Pemphigoid gestationis -a rare dermatosis of the prenatal period. Case report Pemfigoid ciężarnych -rzadka dermatoza okresu prenatalnego. Opis przypadku

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Use of antihistamine medications during early pregnancy and isolated major malformations

Cited by 76 publications

References 42 publications

The fetal safety of cetirizine: An observational cohort study and meta-analysis

The fetal safety of cetirizine: An observational cohort study and meta-analysis

Links between serotonin reuptake inhibition during pregnancy and neurodevelopmental delay/spectrum disorders: A systematic review of epidemiological and physiological evidence

Pemphigoid gestationis – a rare dermatosis of the prenatal period. Case report

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