{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T12:11:03Z","timestamp":1785499863131,"version":"3.56.0"},"reference-count":23,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2013,9,3]],"date-time":"2013-09-03T00:00:00Z","timestamp":1378166400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Headache"],"published-print":{"date-parts":[[2014,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      Butalbital is a barbiturate contained in combination products with caffeine and an analgesic prescribed for the treatment of migraine and tension\u2010type headaches. Controversy exists as to whether butalbital should continue to be prescribed in the\n                      <jats:styled-content style=\"fixed-case\">U<\/jats:styled-content>\n                      nited\n                      <jats:styled-content style=\"fixed-case\">S<\/jats:styled-content>\n                      tates because of the potential for abuse, overuse headache, and withdrawal syndromes. Butalbital crosses the placenta but there is limited information about potential teratogenicity.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate associations between butalbital and a wide range of specific birth defects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The National Birth Defects Prevention Study is an ongoing, case\u2013control study of nonsyndromic, major birth defects conducted in 10 states. The detailed case classification and large number of cases in the National Birth Defects Prevention Study allowed us to examine the association between maternal self\u2010reported butalbital use and specific birth defects. We conducted an analysis of 8373 unaffected controls and 21,090 case infants with estimated dates of delivery between 1997 and 2007; included were birth defects with 250 or more cases. An exploratory analysis examined groups with 100 to 249 cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seventy\u2010three case mothers and 15 control mothers reported periconceptional butalbital use. Of 30 specific defect groups evaluated, adjusted odds ratios for maternal periconceptional butalbital use were statistically significant for 3 congenital heart defects: tetralogy of Fallot (adjusted odds ratio\u2009=\u20093.04; 95% confidence interval\u2009=\u20091.07\u22128.62), pulmonary valve stenosis (adjusted odds ratio\u2009=\u20095.73; 95% confidence interval\u2009=\u20092.25\u221214.62), and secundum\u2010type atrial septal defect (adjusted odds ratio\u2009=\u20093.06; 95% confidence interval\u2009=\u20091.07\u22128.79). In the exploratory analysis, an elevated odds ratio was detected for 1 congenital heart defect, single ventricle.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We observed relationships between maternal periconceptional butalbital use and certain congenital heart defects. These associations have not been reported before, and some may be spurious. Butalbital use was rare and despite the large size of the National Birth Defects Prevention Study, the number of exposed case and control infants was small. However, if confirmed in additional studies, our findings will be useful in weighing the risks and benefits of butalbital for the treatment of migraine and tension\u2010type headaches.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/head.12203","type":"journal-article","created":{"date-parts":[[2013,9,3]],"date-time":"2013-09-03T16:54:45Z","timestamp":1378227285000},"page":"54-66","source":"Crossref","is-referenced-by-count":24,"title":["Maternal Butalbital Use and Selected Defects in the National Birth Defects Prevention Study"],"prefix":"10.1111","volume":"54","author":[{"given":"Marilyn L.","family":"Browne","sequence":"first","affiliation":[{"name":"Congenital Malformations Registry New York State Department of Health  Albany NY USA"},{"name":"School of Public Health University at Albany  Rensselaer NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alissa R.","family":"Van Zutphen","sequence":"additional","affiliation":[{"name":"Congenital Malformations Registry New York State Department of Health  Albany NY USA"},{"name":"School of Public Health University at Albany  Rensselaer NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo D.","family":"Botto","sequence":"additional","affiliation":[{"name":"Division of Medical Genetics, Dept. of Pediatrics University of Utah  Salt Lake City UT USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol","family":"Louik","sequence":"additional","affiliation":[{"name":"Slone Epidemiology Center Boston University  Boston MA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Richardson","sequence":"additional","affiliation":[{"name":"Congenital Malformations Registry New York State Department of Health  Albany NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte M.","family":"Druschel","sequence":"additional","affiliation":[{"name":"Congenital Malformations Registry New York State Department of Health  Albany NY USA"},{"name":"School of Public Health University at Albany  Rensselaer NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,9,3]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1526-4610.2001.01189.x"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4610.2005.00240.x"},{"key":"e_1_2_7_4_1","first-page":"271","article-title":"Treatment of acute migraine headache","volume":"83","author":"Gilmore B","year":"2011","journal-title":"Am Fam Physician"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1096-9926(199803)57:3<117::AID-TERA1>3.0.CO;2-Y"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(11)70107-7"},{"key":"e_1_2_7_7_1","volume-title":"Birth Defects and Drugs in Pregnancy","author":"Heinonen OP","year":"1977"},{"key":"e_1_2_7_8_1","volume-title":"Drugs in Pregnancy 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