{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T21:42:25Z","timestamp":1769204545019,"version":"3.49.0"},"reference-count":35,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,2,11]],"date-time":"2024-02-11T00:00:00Z","timestamp":1707609600000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["NOFO #DD18\u2010001"],"award-info":[{"award-number":["NOFO #DD18\u2010001"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["FOA #DD13\u2010003"],"award-info":[{"award-number":["FOA #DD13\u2010003"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["FOA #DD09\u2010001"],"award-info":[{"award-number":["FOA #DD09\u2010001"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["PA #02081"],"award-info":[{"award-number":["PA #02081"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["PA #96043"],"award-info":[{"award-number":["PA #96043"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth Defects Research"],"published-print":{"date-parts":[[2024,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Fungal infections are common among pregnant people. Recent studies suggest positive associations between oral antifungals used to treat fungal infections and congenital heart defects (CHDs).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We estimated associations between first trimester antifungal use and 20 major, specific CHDs using data from the National Birth Defects Prevention Study (NBDPS), a multi\u2010site, case\u2013control study that included pregnancies with estimated delivery dates from October 1997 through December 2011. Infants with CHDs (\u201ccases\u201d) were ascertained from 10 birth defect surveillance programs. Live born infants without major birth defects (\u201ccontrols\u201d) were randomly selected from birth records or hospital discharge lists. First trimester antifungal use was self\u2010reported via maternal interview. We estimated adjusted odds ratios (AORs) and 95% confidence intervals (CIs) using logistic regression with Firth's penalized likelihood.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>First trimester antifungal use was reported by 148\/11,653 (1.3%) case and 123\/11,427 (1.1%) control participants. We estimated AORs for 12 CHDs; six had AORs &gt;1.5 (tetralogy of Fallot, double outlet right ventricle with transposition of the great arteries [DORV\u2010TGA], atrioventricular septal defect, hypoplastic left heart syndrome, pulmonary atresia, muscular ventricular septal defect), and one (pulmonary valve stenosis) had an AOR &lt;0.7. All CIs included the null, except for DORV\u2010TGA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>First trimester antifungal use was rare. We observed some positive associations for several specific CHDs in our analysis, although the CIs largely included the null. Results do not support a large increase in risk, but smaller increases in risk for certain CHD cannot be ruled out.<\/jats:p><\/jats:sec>","DOI":"10.1002\/bdr2.2308","type":"journal-article","created":{"date-parts":[[2024,2,12]],"date-time":"2024-02-12T06:23:46Z","timestamp":1707719026000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Antifungal medication use during early pregnancy and the risk of congenital heart defects in the National Birth Defects Prevention Study, 1997\u20132011"],"prefix":"10.1002","volume":"116","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4355-7557","authenticated-orcid":false,"given":"Eleni A.","family":"Papadopoulos","sequence":"first","affiliation":[{"name":"Birth Defects Registry, Bureau of Environmental and Occupational Epidemiology, New York State Department of Health  Albany New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8420-5040","authenticated-orcid":false,"given":"Meredith M.","family":"Howley","sequence":"additional","affiliation":[{"name":"Birth Defects Registry, Bureau of Environmental and Occupational Epidemiology, New York State Department of Health  Albany New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4702-1007","authenticated-orcid":false,"given":"Sarah C.","family":"Fisher","sequence":"additional","affiliation":[{"name":"Birth Defects Registry, Bureau of Environmental and Occupational Epidemiology, New York State Department of Health  Albany New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alissa R.","family":"Van Zutphen","sequence":"additional","affiliation":[{"name":"Birth Defects Registry, Bureau of Environmental and Occupational Epidemiology, New York State Department of Health  Albany New York USA"},{"name":"Department of Epidemiology and Biostatistics, School of Public Health University at Albany  Rensselaer New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martha M.","family":"Werler","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, School of Public Health Boston University  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5393-9984","authenticated-orcid":false,"given":"Paul A.","family":"Romitti","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, College of Public Health University of Iowa  Iowa City Iowa USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1872-2787","authenticated-orcid":false,"given":"Marilyn L.","family":"Browne","sequence":"additional","affiliation":[{"name":"Birth Defects Registry, Bureau of Environmental and Occupational Epidemiology, New York State Department of Health  Albany New York USA"},{"name":"Department of Epidemiology and Biostatistics, School of Public Health University at Albany  Rensselaer New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"for the National Birth Defects Prevention 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