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misoprostolFrom: Greg and Amy Hinson (hinsons@surfsouth.com)Sat Jun 27 10:17:42 1998
>Below is a New Engl. Jrnl. of Med. abstract of an article about Cytotec >and birth defects. It is about women who used it, presumably before 20 >wks, as an abortifacient. Some used it orally and some vaginally. Any >thoughts about ramifications towards our use at term for inductions? > >Greg Hinson, MD > >The New England Journal of Medicine -- June 25, 1998 -- Volume 338, Number 26 > >Use of Misoprostol during Pregnancy and Mobius' Syndrome in Infants > >Anne L. Pastuszak, Lavinia Schuler, Carlos E. Speck-Martins, Katia-Edni >F.A. Coelho, Synthia M. Cordello, Fernando Vargas, Decio Brunoni, Ida V.D. >Schwarz, Mariela Larrandaburu, Heloisa Safattle, Vera F.A. Meloni, Gideon >Koren, Jordao C. Neto > >Abstract > > Background. Patients with upper gastrointestinal ulceration >may be treated with misoprostol, but it is not recommended for pregnant >women because it may stimulate uterine contractions and cause vaginal >bleeding and miscarriage. Recent data from Brazil, where misoprostol is >used orally and vaginally as an abortifacient, have suggested a relation >between the use of misoprostol by women in an unsuccessful attempt to >terminate pregnancy and Mobius' syndrome (congenital facial paralysis) in >their infants. > > Methods. We compared the frequency of misoprostol use during >the first trimester by mothers of infants in whom Mobius' syndrome was >diagnosed and mothers of infants with neural-tube defects in Brazil. All >diagnoses in infants were made between January 16, 1990, and May 31, 1996, >by clinical geneticists at seven hospitals who also interviewed the >mothers and recorded information about the administration of misoprostol, >among other data. > > Results. We identified 96 infants with Mobius' syndrome and >matched them with 96 infants with neural-tube defects. The mean age at >the time of the diagnosis of Mobius' syndrome was 16 months (range, 0.5 to >78), and the diagnosis of neural-tube defects was made within 1 week of >birth in most cases. Among the mothers of the 96 infants with Mobius' >syndrome, 47 (49 percent) had used misoprostol in the first trimester of >pregnancy, as compared with 3 (3 percent) of the mothers of the 96 infants >with neural-tube defects (odds ratio, 29.7; 95 percent confidence >interval, 11.6 to 76.0). Twenty of the mothers of the infants with Mobius' >syndrome had taken misoprostol only orally (odds ratio, 38.8; 95 percent >confidence interval, 9.5 to 159.4), 20 had taken misoprostol both orally >and vaginally, 3 had taken the drug vaginally, and 4 did not report how >they took the drug. > > Conclusions. Attempted abortion with misoprostol is >associated with an increased risk of Mobius' syndrome in infants. (N Engl >J Med 1998;338:1881-5.) >
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