Gastroschisis and small
intestinal atresia (SIA) are
birth defects that are thought to arise from vascular disruption of fetal mesenteric vessels. Previous studies of
gastroschisis have suggested that risk is increased for maternal use of vasoactive over-the-counter medications, including specific
analgesics and
decongestants. This retrospective study evaluated the relation between maternal use of
cough/cold/
analgesic medications and risks of
gastroschisis and SIA. From 1995 to 1999, the mothers of 206
gastroschisis cases, 126 SIA cases, and 798 controls in the United States and Canada were interviewed about medication use and illnesses. Risks of
gastroschisis were elevated for use of
aspirin (odds ratio = 2.7, 95% confidence interval: 1.2, 5.9),
pseudoephedrine (odds ratio = 1.8, 95% confidence interval: 1.0, 3.2),
acetaminophen (odds ratio = 1.5, 95% confidence interval: 1.1, 2.2), and
pseudoephedrine combined with
acetaminophen (odds ratio = 4.2, 95% confidence interval: 1.9, 9.2). Risks of SIA were increased for any use of
pseudoephedrine (odds ratio = 2.0, 95% confidence interval: 1.0, 4.0) and for use of
pseudoephedrine in combination with
acetaminophen (odds ratio = 3.0, 95% confidence interval: 1.1, 8.0). Reported
fever, upper respiratory
infection, and
allergy were not associated with risks of either defect. These findings add more evidence that
aspirin use in early pregnancy increases risk of
gastroschisis. Although
pseudoephedrine has previously been shown to increase
gastroschisis risk, findings of this study raise questions about interactions between medications and possible confounding by underlying illness.