Abstract
Congenital heart disease is the most frequent form of congenital anomaly in newborn infants and accounts for more than a quarter of all serious congenital afflictions worldwide. A genetic etiology is identified in <20 % of cases of congenital heart defects, and in most cases the etiology remains a mystery. In the context of the health burden caused by congenital heart disease, the contribution of non-inherited risk factors is important especially if it turns out to be caused by a drug which can be avoided during pregnancy. We sought to determine whether maternal dydrogesterone treatment in early pregnancy is associated with congenital heart disease in the infant. We conducted a retrospective case–control study of birth defects and associated risk factors. Data were obtained and compared between 202 children born with congenital heart disease and a control group consisting of 200 children. All children were born in the period of 2010–2013. Dydrogesterone exposure was defined as any reported use during the first trimester of pregnancy. Exclusion criteria included stillbirths, children with chromosomal abnormalities and infants of mothers with chronic medical illnesses, e.g., diabetes. Binary logistic regression analyses were used to analyze the data and attempt to identify a causal relationship between drug exposure and congenital heart disease. Mothers of children born with congenital heart disease received more dydrogesterone during first trimester of pregnancy than mothers of children in the control group [adjusted odds ratio 2.71; (95 % CI 1.54–4.24); P = 0.001]. We identified a positive association between dydrogesterone usage during early pregnancy and congenital heart disease in the offspring. Nevertheless, further studies are needed to confirm these results.
Similar content being viewed by others
References
Bracken MD, Holford TR, White C et al (1978) Role of oral contraception in congenital malformations of offspring. Int J Epidemiol 7:309
Chard T (1991) Frequency of implantation and early pregnancy loss in natural cycles. Baillieres Clin Obstet Gynaecol 5:179–189
Greenberg G, Inman WHW, Weatherall JAC et al (1977) Maternal drug histories and congenital abnormalities. BMJ 2:853
Harlap S, Prywes R, Davies AM (1975) Birth defects and estrogens and progesterones in pregnancy. Lancet 1:682
Harlap S, Shiono PH, Ramcharan S (1985) Congenital abnormalities in the offspring of women who used oral and other contraceptives around the time of conception. Int J Fertil 30:39
Heinonen OP, Slone D, Monson RR et al (1976) Cardiovascular birth defects in antenatal exposure to female sex hormones. N Engl J Med 296:67
Heinonen OP, Slone D, Shapiro S (1979) Birth defects and drugs in pregnancy. Littleton Teratol 20(3):487–488
Hook EB (1994) Cardiovascular birth defects and prenatal exposure to female sex hormones: a reevaluation of data from a large prospective study. Teratology 49:162
Janerich DT, Dugan JM, Standfast SJ et al (1977) Congenital heart disease and prenatal exposure to exogenous sex hormones. BMJ 1:1058
Jenkins KJ, Correa A, Feinstein JA, Botto L, Britt AE, Daniels SR, Elixson M, Warnes CA, Webb CL (2007) Noninherited risk factors and congenital cardiovascular defects: current knowledge: a scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young: endorsed by the American Academy of Pediatrics. Circulation 115(23):2995–3014
Kline J (1989) Conception to birth—epidemiology of prenatal development. Monographs in epidemiology and biostatistics, vol 14. Oxford University Press, Oxford
Kullander S, Kallen B (1976) A prospective study of drugs and pregnancy. Acta Obstet Gynecol Scand 55:221
Levy EP, Cohen A, Fraser FC (1973) Hormone treatment during pregnancy and congenital heart disease. Lancet 1:611
Lewallen S (1998) Epidemiology in practice: case–control studies. Community Eye Health 11(28):57–58
Michaelis J, Michaelis H, Gluck E et al (1983) Prospective study of suspected associations between certain drugs administered during early pregnancy and congenital malformations. Teratology 27:57
Mitchell SC, Korones SB, Berendes HW (1971) Congenital heart disease in 56,109 births. Incidence and natural history. Circulation 43:323–332
Nora JJ, Nora AH, Blum J et al (1978) Exogenous progestogen and estrogen implicated in birth defects. JAMA 240:837
Richards AA, Santos LJ, Nichols HA, Crider BP, Elder FF, Hauser NS, Zinn AR, Garg V (2008) Cryptic chromosomal abnormalities identified in children with congenital heart disease. Pediatr Res 64(4):358–363
Royal College of General Practitioners (1976) The outcome of pregnancy in former oral contraceptive users. Br J Obstet Gynaecol 83:608
Savolainen E, Saksela E, Saxen L (1981) Teratogenic hazards of oral contraceptives analyzed in a national malformation register. Am J Obstet Gynecol 140:521
Stirrat GM (1990) Recurrent miscarriage. Lancet 336:673–675
Torfs C, Milkovich L, Van Den Berg BJ (1981) The relationship between hormonal pregnancy tests and congenital abnormalities: a prospective study. Am J Epidemiol 113:563
Varma TR, Morsman J (1982) Evaluation of the early use of proluton-depot (hydroxyprogesterone hexanoate) in early pregnancy. Int J Gynaecol Obstet 20:13
Vessey MP (1979) Outcome of pregnancy in women using different methods of contraception. Br J Obstet Gynaecol 86:548
Wilcox AJ, Weinberg CR, O’Connor JF et al (1988) Incidence of early loss of pregnancy. N Engl J Med 319:189–194
Wiseman RA, Dodds-Smith IC (1984) Cardiovascular birth defects and antenatal exposure to female sex hormones: a reevaluation of some base data. Teratology 30:359
Zaqout M, Aslem ES, Oweida FS, De Wolf D (2014) Prevalence of congenital heart disease among Palestinian children born in the Gaza Strip. Cardiol Young 24(5):905–909
Acknowledgments
We thank the medical director of Al Nassr Pediatric Hospital Dr Mostafa Al Kahlout and the pediatricians for their cooperation.
Conflict of interest
The authors declare they have no conflict of interest to disclose.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Zaqout, M., Aslem, E., Abuqamar, M. et al. The Impact of Oral Intake of Dydrogesterone on Fetal Heart Development During Early Pregnancy. Pediatr Cardiol 36, 1483–1488 (2015). https://doi.org/10.1007/s00246-015-1190-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00246-015-1190-9