Vasoactive exposures, vascular events, and hemifacial microsomia.
BACKGROUND
Based on experimental evidence and clinical observations, hemifacial microsomia (HFM) is one of several structural anomalies that are postulated to result from vascular disruption. We collected data in a case-control study to identify whether vasoactive exposures or vascular events during early pregnancy affect the risk of HFM.


METHODS
Cases with a diagnosis of HFM were identified at craniofacial centers in 26 cities across the United States and Canada, from 1996 to 2002. Controls were matched to cases by age and pediatrician practice. Mothers of 230 cases and 678 controls were interviewed about pregnancy events and exposures. Case and control mothers were compared for early pregnancy use of vasoactive medications, cigarettes, and alcohol; singleton or multiple gestation; and diabetes, hypertension, or vaginal bleeding in the first half of pregnancy.


RESULTS
Odds ratios (ORs) were significantly increased for vasoactive mediation use (OR, 1.9 overall; OR, 4.2 among smokers), multiple gestations (OR, 10.5), and diabetes (OR, 6.0). Vaginal bleeding in the second trimester and heavy alcohol intake were associated with increased risks, but the estimates were based on small numbers and, therefore, are unstable. No associations were observed for cigarette smoking without vasoactive medication use, hypertension, and vaginal bleeding in the first trimester.


CONCLUSIONS
The increased risks of HFM associated with vasoactive medication use, multiple gestations, diabetes, and second trimester vaginal bleeding appear collectively to support the hypothesis that vascular disruption is one etiology for HFM, because each of these factors is related to effects on blood vessels.
Werler
Martha M
MM
Slone Epidemiology Center, Boston University, Boston, Massachusetts 02215, USA. mwerler@slone.bu.edu
Sheehan
Jane E
JE
Hayes
Catherine
C
Mitchell
Allen A
AA
Mulliken
John B
JB
D000428:Alcohol Drinking / Q000009:adverse effects; D002170:Canada / Q000453:epidemiology; D016022:Case-Control Studies; D002675:Child, Preschool; D016001:Confidence Intervals; D005146:Facial Asymmetry / Q000150:complications / Q000151:congenital* / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007407:Interviews as Topic; D016017:Odds Ratio; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000453:epidemiology; D011256:Pregnancy Outcome; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D011272:Pregnancy, Multiple; D011297:Prenatal Exposure Delayed Effects; D012189:Retrospective Studies; D012306:Risk; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D014481:United States / Q000453:epidemiology; D014652:Vascular Diseases / Q000453:epidemiology / Q000209:etiology*