Intrauterine exposure to mild analgesics during pregnancy and the occurrence of cryptorchidism and hypospadia in the offspring: the Generation R Study

• Published in: Human reproduction (Oxford) Vol. 27; no. 4; pp. 1191 - 1201
• Main Authors: Snijder, Claudia A., Kortenkamp, Andreas, Steegers, Eric A.P., Jaddoe, Vincent W.V., Hofman, Albert, Hass, Ulla, Burdorf, Alex
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-04-2012
• Subjects: Analgesics - adverse effects; Biological and medical sciences; Cohort Studies; Cryptorchidism - chemically induced; Cryptorchidism - epidemiology; Female; Fetal Development - drug effects; Gynecology. Andrology. Obstetrics; Humans; Hypospadias - chemically induced; Hypospadias - epidemiology; Infant, Newborn; Logistic Models; Male; Medical sciences; Netherlands; Odds Ratio; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Pregnancy Trimester, Third; Prenatal Exposure Delayed Effects; Prevalence; Netherlands; hypospadia; analgesics; paracetamol; cryptorchidism; pregnancy; Urinary system disease; Urethral disease; Antimigrainous agent; Hypospadias; Cryptorchidism; Exposure; Urinary tract disease; Congenital disease; Pregnancy; Vertebrata; Generation; Paracetamol; Analgesic; Mammalia; Malformation; Antipyretic; Male genital diseases; Testicular diseases
• ISSN: 0268-1161; 1460-2350
• DOI: 10.1093/humrep/der474

Recently, over-the-counter mild analgesic use during pregnancy has been suggested to influence the risk of reproductive disorders in the offspring. We examined the influence of maternal exposure to mild analgesics during pregnancy on the occurrence of cryptorchidism and hypospadia in their offspring.
METHODS
Associations between maternal exposure to mild analgesics during pregnancy and cryptorchidism or hypospadia in the offspring were studied in 3184 women participating in a large population-based prospective birth cohort study from early pregnancy onwards in the Netherlands (2002–2006), the Generation R Study. Cryptorchidism and hypospadia were identified during routine screening assessments performed in child health care centres by trained physicians. The use of mild analgesics was assessed in three prenatal questionnaires in pregnancy, resulting in four periods of use, namely, periconception period, first 14 weeks of gestation, 14–22 weeks of gestation and 20–32 weeks of gestation. Logistic regression analyses were used to study the associations between maternal exposure to mild analgesics and cryptorchidism and hypospadia.
RESULTS
The cumulative prevalence over 30 months of follow up was 2.1% for cryptorchidism and 0.7% for hypospadia. Use of mild analgesics in the second period of pregnancy (14–22 weeks) increased the risk of congenital cryptorchidism [adjusted odds ratio (OR) 2.12; 95% confidence interval (CI) 1.17–3.83], primarily due to the use of acetaminophen (paracetamol) (adjusted OR 1.89; 95% CI 1.01–3.51). Among mothers of cryptorchid sons, 33.8% reported (23 of 68) the use of mild analgesics during pregnancy, compared with 31.8% (7 of 22) of mothers with a boy with hypospadia and 29.9% (926 of 3094) of mothers with healthy boys.
CONCLUSIONS
Our results suggest that intrauterine exposure to mild analgesics, primarily paracetamol, during the period in pregnancy when male sexual differentiation takes place, increases the risk of cryptorchidism.