No increased risk of infant hypospadias after maternal use of loratadine in early pregnancy

The original report published in 2001 on a possible association between maternal use of loratadine and an increased risk of infant hypospadias, based on data in the Swedish Medical Birth Register 1995-2001, has been followed up by continued surveillance in the same register. The original “signal” was based on 15 infants with hypospadias among 2780 loratadine-exposed infants born, representing an adjusted odd ratio of about 2.3, statistically significant. Since then another 10 cases have been identified, and 12.5 expected. For the period 2001-2004, another 1911 loratadine-exposed infants have been identified and only two had hypospadias (4 expected). Our present position is that the primary finding was a “signal” which had occurred by chance and the follow-up agrees with independent studies which indicate an absence of an association. This illustrates the care with which apparent statistically significant increases have to be handled when no prior hypothesis exists

Teenage childbearing : pregnancy outcomes and long-term consequences for the mothers

The purposes of the thesis were to study effects of low maternal age on adverse pregnancy outcomes, predictors of teenage childbearing, and long-term effects of teenage motherhood on the women's social situation later in life and risk of premature death. The effects of low maternal age at first birth on risks of adverse pregnancy outcomes, primarily preterm birth and infant mortality, were studied in three population-based cohort studies. We used the Swedish Medical Birth Register, the 1990 Population Census, and the population-based Education Register. The poorer pregnancy outcomes among teenagers aged 18-19 years are mainly an effect of a less favourable socio-economic situation. Infants of younger teenage mothers face an overall increased risk of preterm birth, neonatal and postneonatal mortality that is independent of socio-economic situation. The increased risk of neonatal mortality is entirely an effect of the increased risk of preterm birth. To study whether the increase in risk of poor pregnancy outcomes is due to low age per se, we also studied pregnancy outcomes at second birth in relation to age at first birth. When teenage childbearers had their second birth in adulthood, the risk of preterm birth has declined more than the corresponding risk decline among mother who also had their first birth in adulthood. Our results support the hypothesis that young age is a risk factor for poor pregnancy outcomes, independent of socio-economic conditions. To study familial and environmental effect as predictors of teenage childbearing, we linked the Swedish Twin Register to the Medical Birth Register. We used quantitative genetic analyses to evaluate the impact of genetic and environmental factors on the risk of teenage childbearing. We estimated the effect of life style factors, socio-economic situation, and personality traits on the likelihood of teenage childbearing, and if these factors could explain possible familial effects. Both familial and other environmental factors are important as predictors of teenage childbearing. We found significant effects of smoking habits, housing conditions, and educational level on the risk of teenage childbearing. However, the familial effect on teenage childbearing was not mediated by these factors. In two studies we analysed long-term socio-economic conditions and premature mortality of teenage mothers. We linked the following population-based registers: the Population Register, several Censuses, the Education Register, the Cause of Death Register, and a register of dependence on social welfare and disability pensions. Teenage childbearers face a considerably increased risk of a less favourable situation later in life. They are more likely to be not gainfully employed, to have an unskilled occupation, to be single mothers, to have four or five infants, to be dependent on social welfare and receive disability pensions. Teenage mothers also face an increase in risk of premature death due to in particular cervical cancer, ischaemic heart disease, suicide and inflicted violence. The increased risk of as well a less favourable social situation as premature mortality was independent of background socioeconomic status

Mortality among the elderly in Sweden by social class

Total mortality has been analysed for elderly Swedish men and women by social class. Information on social and demographic factors was obtained from the 1960 Population Census. The mortality was followed up from 1961 to 1979. The study indicates that there are evident social class differences in mortality among people aged 65-83 years. We found increasing class differences with increased age among women, but decreasing class differences with increased age among men. Also, the class gradients before retirement age were steeper than after that age. The opposite was true for women, where the class gradient was more evident among older women than among younger ones. The class gradients were less marked for married than for other marital status groups and the class gradients were steepest in areas with a high degree of urbanization.social class mortality elderly

Maternal use of selective serotonin re-uptake inhibitors in early pregnancy and infant congenital malformations.

BACKGROUND: Maternal use of selective serotonin re-uptake inhibitors (SSRIs) has recently been associated with an increased risk for certain malformations. METHODS: Using the Swedish Medical Birth Register, we identified women who had reported the use of SSRIs in early pregnancy and studied their infants, born between July 1, 1995 and the end of 2004. Congenital malformations were identified from that register, from the Register of Congenital Malformations, and from the Hospital Discharge Register. The effect of drug exposure was studied after adjustment for a number of identified maternal characteristics that could act as confounders. RESULTS: We identified 6,481 women who reported the use of SSRIs in early pregnancy and their 6,555 infants. There was no general increase in malformation risk. An increased risk for cystic kidneys was seen, but this was based on only nine malformed infants, and the pathology varied between these cases. An in-depth study of cardiovascular defects identified an association between such defects and notably ventricular and atrial septum defects and maternal use of paroxetine but not other SSRls. No support for a postulated association between SSRI use and infant craniostenosis or omphalocele was found. CONCLUSIONS: Use of SSRIs in early pregnancy does not seem to be a major risk factor for infant malformations. The association between paroxetine use and infant cardiovascular defects may be a result of multiple testing, but is supported by other studies