TABLE 3.
Associations between periconceptional anesthesia exposure, by type, and birth defects, National Birth Defects Prevention Study, 1997–2011
| Unexposed n |
General anesthesia |
Local anesthesia |
|||
|---|---|---|---|---|---|
| Defect | n | OR (95% CI)a | n | OR (95% CI)a | |
| Controls, n (%) | 11,343 (98.6) | 73 (0.6) | 89 (0.8) | ||
| Any birth defect, n (%) | 29,741 (98.5) | 226 (0.7) | 230 (0.8) | ||
| Noncardiac defects | 19,269 | 145 | 148 | ||
| Amniotic band syndrome and limb body wall complex (ABS-LBWC) | 324 | 2 | 1 | ||
| ABS-LBWC: Limb anomalies only | 203 | 1 | 0 | ||
| Neural tube defects | 2,073 | 16 | 1.2 (0.6–2.2) | 21 | 1.4 (0.8–2.4) |
| Anencephaly | 633 | 7 | 1.5 (0.6–3.9) | 6 | 1.1 (0.4–3.0) |
| Spina bifida | 1,222 | 7 | 0.9 (0.4–2.1) | 12 | 1.5 (0.8–2.9) |
| Encephalocele | 218 | 2 | 3 | 1.8 (0.4–5.4) | |
| Hydrocephaly | 488 | 5 | 1.6 (0.6–4.4) | 4 | 1.0 (0.3–2.8) |
| Dandy–Walker malformation | 178 | 2 | 1 | ||
| Holoprosencephaly | 164 | 2 | 3 | 2.3 (0.5–7.2) | |
| Cataracts b | 346 | 3 | 1.4 (0.3–4.5) | 2 | |
| Anophthalmia/microphthalmia | 218 | 4 | 2.9 (0.8–7.7) | 4 | 2.3 (0.6–6.3) |
| Glaucoma/anterior chamber defectsb | 179 | 2 | 0 | ||
| Anotia/microtia | 684 | 4 | 0.9 (0.2–2.4) | 2 | |
| Choanal atresia | 158 | 0 | 1 | ||
| Oral cleftsc | 4,610 | 29 | 0.8 (0.5–1.4) | 33 | 1.0 (0.6–1.5) |
| Cleft palate onlyc | 1,574 | 9 | 0.8 (0.3–1.7) | 7 | 0.6 (0.2–1.3) |
| Cleft lip with or without cleft palatec | 3,036 | 20 | 0.9 (0.5–1.5) | 26 | 1.2 (0.8–1.9) |
| Cleft lip with cleft palatec | 1,964 | 13 | 0.8 (0.4–1.6) | 17 | 1.2 (0.7–2.2) |
| Cleft lip onlyc | 1,072 | 7 | 1.0 (0.5–2.3) | 9 | 1.2 (0.6–2.4) |
| Esophageal atresia | 726 | 1 | 9 | 1.3 (0.6–3.0) | |
| Intestinal atresia/stenosis | 467 | 1 | 2 | ||
| Duodenal atresia/stenosis | 230 | 1 | 1 | ||
| Anorectal atresia/stenosis | 868 | 8 | 1.1 (0.5–2.6) | 7 | 1.0 (0.4–2.4) |
| High anorectal atresia/stenosis | 210 | 2 | 1 | ||
| Low anorectal atresia/stenosis | 460 | 4 | 1.4 (0.4–3.6) | 3 | 0.8 (0.2–2.5) |
| Cloacal exstrophy | 95 | 2 | 0 | ||
| Biliary atresia | 196 | 2 | 2 | ||
| Hypospadiasd | 2,489 | 23 | 0.9 (0.5–1.7) | 18 | 0.9 (0.5–1.6) |
| Bilateral renal agenesis/hypoplasia | 175 | 2 | 2 | ||
| Limb deficiency | 1,211 | 10 | 1.2 (0.6–2.5) | 14 | 1.4 (0.8–2.6) |
| Longitudinal or intercalary limb deficiency | 515 | 6 | 1.8 (0.8–4.2) | 8 | 1.9 (0.8–4.2) |
| Longitudinal preaxial limb deficiency | 270 | 2 | 4 | 1.9 (0.5–5.1) | |
| Transverse limb deficiency | 702 | 4 | 0.9 (0.2–2.4) | 6 | 1.0 (0.4–2.6) |
| Craniosynostosis | 1,545 | 15 | 1.5 (0.8–2.7) | 14 | 1.0 (0.5–1.9) |
| Diaphragmatic hernia | 822 | 7 | 1.5 (0.6–3.4) | 4 | 0.6 (0.2–1.7) |
| Omphalocele | 409 | 2 | 3 | 0.9 (0.2–2.8) | |
| Gastroschisis | 1,383 | 11 | 0.9 (0.4–2.1) | 9 | 1.4 (0.7–3.1) |
| Sacral agenesis | 101 | 0 | 1 | ||
| Cardiac defects | 11,416 | 87 | 88 | ||
| Conotruncal defects | |||||
| Truncus arteriosus | 129 | 0 | 1 | ||
| Tetralogy of Fallot | 1,173 | 11 | 1.2 (0.6–2.6) | 8 | 1.0 (0.5–2.2) |
| D-transposition of the great arteries (TGA) | 731 | 7 | 0.9 (0.3–2.5) | 7 | 1.3 (0.6–2.9) |
| Double outlet right ventricle with TGA | 166 | 1 | 0 | ||
| Double outlet right ventricle (non-TGA) | 100 | 0 | 2 | ||
| Conoventricular VSDe | 111 | 1 | 3 | 3.3 (0.6–10.4) | |
| Atrioventricular septal defect | 337 | 4 | 1.8 (0.5–5.0) | 0 | |
| Anomalous pulmonary venous return | 373 | 1 | 2 | ||
| Total anomalous pulmonary venous return | 298 | 1 | 2 | ||
| Left ventricular outflow tract defects | |||||
| Hypoplastic left heart syndrome | 626 | 6 | 1.0 (0.4–2.8) | 10 | 1.6 (0.8–3.5) |
| Coarctation of the aorta | 1,116 | 5 | 0.6 (0.2–1.8) | 6 | 0.7 (0.3–1.6) |
| Aortic stenosis | 475 | 1 | 3 | 0.8 (0.2–2.4) | |
| Right ventricular outflow tract defects | |||||
| Pulmonary atresia | 247 | 4 | 2.5 (0.7–6.8) | 1 | |
| Pulmonary valve stenosisf | 1,503 | 15 | 1.3 (0.6–2.4) | 12 | 1.0 (0.5–1.9) |
| Tricuspid atresia | 167 | 4 | 3.7 (1.0–10.1) | 2 | |
| Ebstein malformation | 169 | 0 | 1 | ||
| Septal defects | |||||
| Perimembranous VSDe | 1,407 | 6 | 0.5 (0.2–1.4) | 6 | 0.6 (0.3–1.5) |
| Muscular VSD g | 187 | 0 | 2 | ||
| ASD secundum or NOS | 2,966 | 28 | 1.3 (0.8–2.1) | 24 | 1.1 (0.7–1.9) |
| Single ventricle | 166 | 1 | 2 | ||
| Heterotaxy with CHD | 338 | 2 | 0 | ||
Abbreviations: ASD, atrial septal defect; CHD, congenital heart defect; NOS, not otherwise specified; VSD, ventricular septal defect.
Groups with 5+ exposed cases are adjusted for maternal age (years, continuous), race/ethnicity (white, other), BMI (kg/m2, continuous), first trimester exposure to radiation-emitting scans (Xray, CAT/CT, radionuclide), and study site.
n = 9,671 unexposed controls, n = 58 general anesthesia exposed controls, n = 74 local anesthesia exposed controls.
n = 11,211 unexposed controls, n = 73 general anesthesia exposed controls, n = 88 local anesthesia exposed controls.
n = 5,756 unexposed controls, n = 40 general anesthesia exposed controls, n = 46 local anesthesia exposed controls.
n = 6,555 unexposed controls, n = 44 general anesthesia exposed controls, n = 54 local anesthesia exposed controls.
n = 10,885 unexposed controls, n = 70 general anesthesia exposed controls, n = 88 local anesthesia exposed controls.
n = 695 unexposed controls, n = 7 general anesthesia exposed controls, n = 6 local anesthesia exposed controls.