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A correction has been published: N Engl J Med 1998;339(21):1553.
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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 Möbius' 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 Möbius' 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 Möbius' syndrome and matched them with 96 infants with neural-tube defects. The mean age at the time of the diagnosis of Möbius' 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 Möbius' 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 Möbius' 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 Möbius' syndrome in infants.
Source Information
From the Motherisk Program, Hospital for Sick Children, and the Fetal Diagnosis and Treatment Centre, University of Toronto, Toronto (A.L.P., G.K.); Departmento de Genetica, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (L.S.); Unidade de Genetica, Hospital de Clinicas de Porto Alegre, Brazil (L.S., I.V.D.S., M.L.); Setor de Genetica, Rede de Hospitais Sarah, Brasilia, Brazil (C.E.S.-M., H.S.); Setor de Genetica, Rede de Hospitais Sarah, Salvador, Brazil (K.-E.F.A.C., S.M.C.); Setor de Genetica, Hospital Universitario Gaffre-Guinle, Rio de Janeiro, Brazil (F.V.); and Disciplina de Genetica, Escola Paulista de Medicina, Universidade Federal de São Paulo, and Unidade de Citogenetica, Hospital dos Servidores Publicos do Estado de São Paulo, São Paulo, Brazil (D.B., V.F.A.M.). Jordão C. Neto, M.D. (Disciplina de Genetica, Escola Paulista de Medicina, Universidade Federal de São Paulo, and Unidade de Citogenetica, Hospital dos Servidores Publicos do Estado de São Paulo, São Paulo, Brazil) was also an author.
Address reprint requests to Dr. Pastuszak at the Fetal Diagnosis and Treatment Centre, University of Toronto, Hospital for Sick Children, 555 University Ave., Toronto, ON M5G 1X8, Canada.
Related Letters:
Use of Misoprostol during Pregnancy and Möbius' Syndrome in Infants
Blanchard K., Winikoff B., Ellertson C., Pastuszak A. L., Schüler L.
Extract |
Full Text
N Engl J Med 1998;
339:1553-1554, Nov 19, 1998.
Correspondence
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