Prenatal exposure to nitrosatable drugs, vitamin C, and risk of selected birth defects. Academic Article uri icon


  • UNLABELLED: Nitrosatable drugs, such as secondary or tertiary amines and amides react with nitrite in an acidic environment to form N-nitroso compounds, teratogens in animal models. Vitamin C is a known nitrosation inhibitor. METHODS: Using data from the National Birth Defects Prevention Study, we assessed nitrosatable drug exposure and vitamin C intake during the first trimester among 11,606 case-mothers of infants with oral clefts, limb deficiencies (LDs), or congenital heart defects and 6807 control-mothers of infants without major birth defects during 1997-2005. Daily intake of vitamin C was estimated from maternal interviews that elicited information about supplement use and dietary intake. RESULTS: With no reported use of nitrosatable drugs as the referent group, a lower odds ratio (OR) was observed for transverse LDs among births to mothers exposed to secondary amine drugs and daily vitamin C supplementation (adjusted odds ratio [aOR] 1.2, 95% confidence interval [CI] 0.83-1.8) compared with women taking these drugs and no supplementation (aOR 2.7, 95% CI 1.5-4.6). The OR for longitudinal LDs associated with secondary amine exposure was lower with daily dietary vitamin C intake 85 mg (aOR 1.2, 95% CI 0.68-2.0) compared with <85 mg (aOR 1.9, 95% CI 1.2-3.1). Daily vitamin C supplementation in combination with higher dietary vitamin C intake reduced associations between nitrosatable drug exposures and limb deficiencies and atrial septal defects not otherwise specified. CONCLUSION: Prenatal dietary and vitamin C supplement intake may diminish the association between nitrosatable drug exposure during pregnancy and selected birth defects.

published proceedings

  • Birth Defects Res A Clin Mol Teratol

author list (cited authors)

  • Shinde, M. U., Vuong, A. M., Brender, J. D., Werler, M. M., Kelley, K. E., Huber, J. C., ... National Birth Defects Prevention Study.

citation count

  • 7

complete list of authors

  • Shinde, Mayura U||Vuong, Ann M||Brender, Jean D||Werler, Martha M||Kelley, Katherine E||Huber, John C||Sharkey, Joseph R||Zheng, Qi||Suarez, Lucina||Langlois, Peter H||Canfield, Mark A||Romitti, Paul A||Malik, Sadia

publication date

  • August 2013