TABLE 6.
Epidemiologic studies of genitourinary infections and birth defects (except gastroschisis)
| Author, year | Study design, setting | Exposure | Outcomes | Main findings |
|---|---|---|---|---|
| Carter et al., 2011 | NBDPS; case-control study of births from 1997 to 2004 from 10 states | Self-reported STIs, PED, or group B streptococcus infection in the month before through the third month of pregnancy; 290 case mothers and 139 control mothers were exposed | Individual birth defects and larger birth defect groupings (e.g., NTDs.) | OR (95% CI) for (a) bilateral renal agenesis/ hypoplasia: 2.89 (1.11, 7.50); CL ± CP: 1.46 (1.03, 2.06); transverse limb deficiency: 1.84 (1.04, 3.26) |
| Cleves et al., 2008 | NBDPS; case-control study of births from 1997 to 2003 from 10 states | Self-reported UTI in the first trimester; 247 case mothers and 290 control mothers were exposed | Individual CHDs, larger CHD groupings, and any CHD | OR (95% CI) for (a) LVOTO: 1.41 (1.04, 1.93); (b) HLHS: 1.61 (1.01, 2.59); (c)AVSD: 2.29 (1.11, 4.73) |
| Ailes et al., 2016 | NBDPS; case-control study of births from 1997 to 2016 from 10 states | Self-reported use of nitrofurantoin, trimethoprim-sulfamethoxazole, or cephalosporine to treat fever-free, doctor-diagnosed UTIs in the month before through the third month of pregnancy compared to penicillin; 608 case mothers and 231 control mothers were exposed | Individual birth defects and larger birth defect groupings (e.g., NTDs) | OR (95% CI) for nitrofurantoin and clefts: 1.97 (1.10,3.53. OR (95% CI) for trimethoprim-sulfamethoxazole for esophageal atresia: 5.31 (1.39, 20.24); diaphragmatic hernia: 5.09 (1.20, 21.69) OR (95% CI) for cephalosporine and anorectal atresia/stenosis: 5.01 (1.34, 18.76) |
| Ferencz et al., 1997 | BWIS; case-control study of births from 1981 to 1989 in the Baltimore-Washington area | Self-reported UTIs in the 3 months before through the third month of pregnancy; 38 ASD case mothers and 467 control mothers were exposed | Individual CHDs, larger CHD groupings, and any CHD | OR (95% CI) for ASD: 1.6 (1.1, 2.3). |
| Wilson et al., 1998 | BWIS; case-control study of births from 1981 to 1989 in the Baltimore-Washington area | Self-reported UTIs in the 3 months before through the third month of pregnancy; 38 ASD case mothers and 467 control mothers were exposed | Individual CHDs, larger CHD groupings, and any CHD | Attributable fraction for UTIs and ASD (95% CI): 6.4 (2.2, 10.7). |
| Acs et al., 2008a | HCCSCA; case-control study births from 1980 to 1996 in Hungary | Recurrent genital herpes in the first trimester and any time during pregnancy collected from antenatal care logbook, medical records, and self-report; 160 case mothers and 228 control mothers were exposed | Individual birth defects, larger birth defect groupings, and any birth defect | No significant ORs |
| Acs et al., 2008b | HCCSCA; case-control study births from 1980 to 1996 in Hungary | Acute PED during the second and third month of pregnancy that was prospectively collected and recorded in antenatal care logbook or medical record; 67 case mothers and 128 control mothers were exposed | Individual birth defects, larger birth defect groupings, and any birth defect | OR (95% CI) for any CHD: 2.6 (1.2, 5.4) |
| Acs et al., 2008c | HCCSCA; case-control study births from 1980 to 1996 in Hungary | Vulvovaginitis and bacterial vaginosis during the second and third month of pregnancy that was prospectively collected and recorded in antenatal care logbook or medical record; 1,536 case mothers and 2,698 control mothers were exposed | Individual birth defects, larger birth defect groupings, and any birth defect | No significant elevated ORs Protective ORs (95% CI) for (a) limb deficiencies: 0.6 (0.4, 0.9); (b) musculo-skeletal birth defects: 0.4 (0.2, 0.9) |
| Banhidy et al., 2006 | HCCSCA; case-control study births from 1980 to 1996 in Hungary | UTI during the second and third months of pregnancy was collected from antenatal care logbook, medical records, and self-report; 1,542 case mothers and 2,188 control mothers were exposed | Individual birth defects, larger birth defect groupings, and any birth defect | No significant ORs |
| Banhidy et al., 2010 | HCCSCA; case-control study of birth from 1980 to 1996 Hungary | Genital warts (caused by HPV) during the second and third months of pregnancy was collected from antenatal care logbook, medical records, and self-report; 17 case mothers and 25 control mothers were exposed | 17 case infants: 4 CHDs, 7 NTDs, 2 hypospadias, 2 syndactyly, and 7 with other birth defects | No significant ORs |
| Metneki et al., 2005 | HCCSCA; case-control study births from 1980 to 1996 in Hungary | UTIs and STIs during the second, third, and fourth month of pregnancy was collected from antenatal care logbook, medical records, and self-report; 14 NTD case mothers and 182 non-NTD case mothers (the comparison group) were exposed | Isolated CL ± CP and PCP | OR (95% CI) for UTI and (a) CL ± CP: 1.7 (1.1, 2.5); (b) PCP: 2.1 (1.2, 3.5) No significant ORs for STI and CL ± CP or PCP |
| Norgard et ah, 2006 | HCCSCA; case-control study births from 1980 to 1996 in Hungary | Herpes labialis during the first trimester and any time during pregnancy was collected from antenatal care logbook, medical records, and self-report; 14 NTD case mothers and 182 non-NTD case mothers (the comparison group) were exposed | Isolated NTDs | No significant ORs for NTDs |
| Dong, Binongo, & Kancherla, 2016 | Case-control study of live singleton births in the United States during 2012 | Chlamydia any time during pregnancy as reported on the birth certificate; 43 (1.7%) case mothers and 55,834 (1.7%) control mothers were exposed | Any cyanotic CHD as reported on the birth certificate | OR (95% CI) for cyanotic CHDs: 1.39 (1.02, 1.90) |
Note. NBDPS = National Birth Defects Prevention Study, BWIS = Baltimore-Washington Infant Study, HCCSCA = Hungarian Case-Control Surveillance of Congenital Abnormalities, STI = sexually transmitted infection., PID = pelvic inflammatory disease, UTI = urinary tract infection, HPV = human papillomavirus, NTDs = neural tube defects, CHD = congenital heart defect, ASD = atrial septal defect, CL ± CP = cleft lip with or without cleft palate, PCP = posterior cleft palate, LVOTO = left ventricular outflow tract obstruction defects; HLHS = hypoplastic left heart syndrome; AVSD = atrioventricular septal defect, OR = odds ratio, CI = confidence interval.