title: Indigenous Medicine Use for Sex Selection During Pregnancy and Risk of Congenital Malformations: A Population-Based Case-Control Study in Haryana, India.
abstract: BACKGROUND
  Congenital malformations (CMFs) are a major public health problem in India. Consanguineous marriages, infections during pregnancy, folic acid deficiency during the periconceptional period, exposure to pesticides and a history of intake of drugs during pregnancy have been hypothesized as risk factors. Drugs include oral contraceptive pills, progesterone analogues, medications for ailments and indigenous drugs to bear male offspring. It is important to analyze the risk factors in order to implement preventive measures. The prime objective of this study was to study the risk factors of visible structural CMFs, with a focus on indigenous medicines for sex selection.
  
  
  METHODS
  A population-based, case-control study was undertaken in Haryana state. Cases included children (0-18 months) with any apparent structural deformity as reported by various Government sources. A consecutive birth from the same area as the case was labelled and included as the control. The sample size calculated was 175 in each group. Mothers of every case and control were interviewed at their respective homes using a structured tool. Descriptive analysis, bivariate analysis, followed by logistic regression was conducted to establish the association between risk factors and CMFs.
  
  
  RESULTS
  The sociodemographic profiles of the cases and controls were similar. Among the various risk factors studied, more than two living children (unadjusted odds ratio [OR] 1.6, 95 % CI 1.04-2.4) and intake of sex-selection drugs (unadjusted OR 2.8, 95 % CI 1.6-5.1) were significant risk factors on bivariate and regression analyses. The risk of having a child with CMFs was threefold more among mothers with a history of intake of indigenous medicines for sex selection (adjusted OR 3; 95 % CI 1.7-5.6).
  
  
  CONCLUSIONS
  The intake of indigenous drugs during pregnancy increased the risk of CMFs almost threefold. This has social as well as economic implications, and hence needs further investigation.
authors.affiliation: Indian Institute of Public Health-Delhi (IIPH-D), Public Health Foundation of India (PHFI), Plot number 47, Sector 44, Gurgaon, 122002, Haryana, India, sutapa.bneogi@iiphd.org.
authors.forename: Sutapa Bandyopadhyay
authors.initials: SB
authors.lastname: Neogi
authors.forename: Preeti H
authors.initials: PH
authors.lastname: Negandhi
authors.forename: Navraj
authors.initials: N
authors.lastname: Sandhu
authors.forename: Ravi Kant
authors.initials: RK
authors.lastname: Gupta
authors.forename: Abhijit
authors.initials: A
authors.lastname: Ganguli
authors.forename: Sanjay
authors.initials: S
authors.lastname: Zodpey
authors.forename: Amarjeet
authors.initials: A
authors.lastname: Singh
authors.forename: Arun
authors.initials: A
authors.lastname: Singh
authors.forename: Rakesh
authors.initials: R
authors.lastname: Gupta
mesh_terms: D000014:Abnormalities, Drug-Induced / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D000013:Congenital Abnormalities / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D007194:India / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008519:Medicine, Traditional / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D011247:Pregnancy; D012307:Risk Factors; D012743:Sex Preselection / Q000379:methods*; D055815:Young Adult