title: Maternal flu or fever, medication use, and neural tube defects: a population-based case-control study in Northern China.
abstract: BACKGROUND
  Maternal exposure to flu or fever has been associated with increased risk for neural tube defects (NTDs); however, few studies have considered the effects of medications on the effects of flu or fever. We evaluated the effect of maternal flu or fever, medication use (antibiotics, antipyretics), and their joint effect on NTDs.
  
  
  METHODS
  Data came from an ongoing population-based case-control study of infants with external malformations in northern China. The case group included 363 infants with NTDs identified between January 2003 and June 2005. Controls were 523 newborn infants without identified congenital anomalies matched by county, sex, maternal ethnic group, and the closest date of conception for infants with any major external malformation. Data were collected by a trained health worker through face-to-face interviews after delivery.
  
  
  RESULTS
  NTD risks were significantly associated with maternal flu or fever (adjusted odds ratio [AOR] = 3.93, 95% CI: 2.48-6.23) and antipyretic use (AOR = 4.86, 95% CI: 1.33-17.78), but not with antibiotic use (AOR = 1.75, 95% CI: 0.91-3.38) after adjusting for potential confounders. NTD risk associated with maternal antipyretic use was markedly higher for anencephaly (AOR = 7.03, 95% CI: 1.70-29.04) than for spina bifida (AOR = 3.98, 95% CI: 0.95-16.74). Mothers with flu or fever who were also using antipyretics showed a markedly higher AOR for anencephaly (14.75 vs. 4.52), spina bifida (16.30 vs. 3.85), and all NTDs combined (13.91 vs. 4.04) than mothers with flu or fever who were not using antipyretics. Maternal antibiotics did not markedly change the effects of flu or fever on anencephaly (4.17 vs. 4.83), spina bifida (5.08 vs. 4.21), and all NTDs combined (5.05 vs. 4.29).
  
  
  CONCLUSIONS
  Maternal flu or fever and antipyretic use during the periconceptional period increases the risk for NTDs. Maternal exposure to antipyretics together with flu or fever results in a markedly higher risk of NTDs than exposure to flu or fever alone.
authors.affiliation: Institute of Reproductive and Child Health, Peking University Health Science Center, Beijing, People's Republic of China.
authors.forename: Zhiwen
authors.initials: Z
authors.lastname: Li
authors.forename: Aiguo
authors.initials: A
authors.lastname: Ren
authors.forename: Jianmeng
authors.initials: J
authors.lastname: Liu
authors.forename: Lijun
authors.initials: L
authors.lastname: Pei
authors.forename: Le
authors.initials: L
authors.lastname: Zhang
authors.forename: Zhanying
authors.initials: Z
authors.lastname: Guo
authors.forename: Zhu
authors.initials: Z
authors.lastname: Li
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000453:epidemiology*; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000009:adverse effects* / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016022:Case-Control Studies; D002681:China; D005260:Female; D005334:Fever / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D007231:Infant, Newborn; D007251:Influenza, Human / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D009436:Neural Tube Defects / Q000139:chemically induced* / Q000453:epidemiology*; D019338:Polypharmacy; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000188:drug therapy / Q000453:epidemiology*; D011297:Prenatal Exposure Delayed Effects; D012923:Social Class
chemical_list: D018712:Analgesics, Non-Narcotic; D000900:Anti-Bacterial Agents