Maternal hypertension, antihypertensive medication use, and the risk of severe hypospadias.
BACKGROUND
Hypertensive disorders occur in an estimated 5-10% of pregnancies, but few studies have examined birth defects in relation to high blood pressure and antihypertensive medication use. The objective of this study was to investigate the relationship between high blood pressure, antihypertensive medication use, and severe hypospadias.


METHODS
We used data from the National Birth Defects Prevention Study, a population-based, multicenter, case-control study of birth defects to assess risks for severe hypospadias in relation to self-reported high blood pressure and prenatal exposures to antihypertensive drugs in 758 male infants with severe hypospadias and 2,058 male controls born between 1997 and 2002. Logistic regression analyses estimated ORs and 95% CIs, adjusted for potential confounders.


RESULTS
We observed slight to moderate elevations in the risk of severe hypospadias for maternal untreated hypertension (adjusted OR 2.1; 95% CI: 1.6-2.9) and antihypertensive medication use during 1 month preconception through pregnancy month 4 (adjusted OR 1.4; 95% CI: 0.7-2.9). The association was strongest for subjects initiating medications after the fourth month (adjusted OR 5.0; 95% CI: 1.9-12.9).


CONCLUSIONS
We observed an association between hypertension, antihypertensive medication use, and the risk of severe hypospadias, particularly when medication use began late in pregnancy. Because hypospadias occurs in early pregnancy, the data suggest that hypertension and its morphologic/physiologic precursors play an etiologic role, perhaps via compromised uteroplacental perfusion. Birth Defects Research (Part A) 2008.
Caton
Alissa R
AR
Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York, USA. arc05@health.state.ny.us
Bell
Erin M
EM
Druschel
Charlotte M
CM
Werler
Martha M
MM
Mitchell
Allen A
AA
Browne
Marilyn L
ML
McNutt
Louise-Anne
LA
Romitti
Paul A
PA
Olney
Richard S
RS
Correa
Adolfo
A
D000959:Antihypertensive Agents / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy*; D007021:Hypospadias / Q000209:etiology*; D008297:Male; D011247:Pregnancy; D011249:Pregnancy Complications, Cardiovascular / Q000188:drug therapy*
D000959:Antihypertensive Agents