对乙酰氨基酚与出生缺陷解读.pptVIP

To investigate whether exposure during the first trimester of pregnancy to single-ingredient acetaminophen increases the risk of major birth defects. The usual recommended dose of acetaminophen is close to its toxic adult dose (the therapeutic index is narrow), raising concern for maternal overdose and fetal toxicity (对乙酰氨基酚90%~95%在肝脏代谢.每天总量不超过2克，是安全的。若每天服用该药的总量超过4克，则可致肝损害；大于10克，患者有可能因肝衰竭而死亡。) A recent study found that 65.5% of women reported its use sometime during pregnancy, and 54.2% used acetaminophen during the first trimester. Fetal growth and adverse birth outcomes in women receiving prescriptions for acetaminophen during pregnancy. Thulstrup AM, S?rensen HTet al. Am J Perinatol 1999;16:321–6. Acetaminophen use during pregnancy:effects on risk for congenital abnormalities. Rebordosa C, Kogevinas M, Am J Obstet Gynecol 2008;198:178.e1–7 Women who delivered between January 1,1997, and December 31, 2004, and participated in the telephone interview were included. Children were included in the case or control groups if they were born after October 1, 1997, and had an estimated date of delivery (EDD) before January 1, 2005 The case group includes live births, stillbirths, and pregnancy terminations with selected birth defects identified through population-based birth-defect registries. Those in the case group with a known cause for the birth defect (eg,chromosomal or genetic disorders) are excluded. Participants for the control group are selected randomly from all live births to represent the case population of each center 1997.10.1--2005.1.1出生的儿童 评估出生缺陷患儿风险变量 1、maternal age (younger than 20 years, 20–24 years,25–29 years, 30 years or older) 2、education (less than 12years, 12 years, more than 12 years), 3、body mass index in kg/m2 (lower than 18.5, 18.5–24.9,25.0–29.9, 30.0 or higher), 4、 gestational diabetes (yes, no), 5、fever (yes, no), 6、smoking in the first trimester (yes, no), 7、folic acid use from 3 months before conception through 8、the f