{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T03:59:31Z","timestamp":1783483171004,"version":"3.55.0"},"reference-count":70,"publisher":"Oxford University Press (OUP)","issue":"4","content-domain":{"domain":["eje.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2017,10]]},"abstract":"<jats:sec>\n<jats:title>Objective<\/jats:title>\n<jats:p>Antithyroid drugs (ATDs) may have teratogenic effects, but more evidence is needed on the risk and types of birth defects after the use of methimazole (MMI) and propylthiouracil (PTU). This study aimed to evaluate the association between the use of ATDs in early pregnancy and birth defects.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Design<\/jats:title>\n<jats:p>Swedish nationwide register-based cohort study.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>The study included 684 340 children live-born in Sweden from 2006 to 2012. Exposure groups defined by maternal ATD use in early pregnancy were MMI (<jats:italic>n<\/jats:italic>\u2009=\u2009162); PTU (<jats:italic>n<\/jats:italic>\u2009=\u2009218); MMI and PTU (<jats:italic>n<\/jats:italic>\u2009=\u200966); ATD before or after, but not in pregnancy (<jats:italic>n<\/jats:italic>\u2009=\u20091551) and non-exposed (never ATD (<jats:italic>n<\/jats:italic>\u2009=\u2009682 343)). Outcome was cumulative incidence of birth defects diagnosed before two years of age.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>The cumulative incidence of birth defects was not significantly different in children exposed to MMI (6.8%, <jats:italic>P<\/jats:italic>\u2009=\u20090.6) or PTU (6.4%, <jats:italic>P<\/jats:italic>\u2009=\u20090.4) vs non-exposed (8.0%). For subtypes of birth defects, MMI was associated with an increased incidence of septal heart defects (<jats:italic>P<\/jats:italic>\u2009=\u20090.02). PTU was associated with ear (<jats:italic>P<\/jats:italic>\u2009=\u20090.005) and obstructive urinary system malformations (<jats:italic>P<\/jats:italic>\u2009=\u20090.006). A case of choanal atresia was observed after exposure to both MMI and PTU. The incidence of birth defects in children born to mothers who received ATD before or after, but not in pregnancy, was 8.8% and not significantly different from non-exposed (<jats:italic>P<\/jats:italic>\u2009=\u20090.3), MMI exposed (<jats:italic>P<\/jats:italic>\u2009=\u20090.4) or PTU exposed (<jats:italic>P<\/jats:italic>\u2009=\u20090.2).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>MMI and PTU were associated with subtypes of birth defects previously reported, but the frequency of ATD exposure in early pregnancy was low and severe malformations described in the MMI embryopathy were rarely observed.<\/jats:p>\n<\/jats:sec>","DOI":"10.1530\/eje-17-0314","type":"journal-article","created":{"date-parts":[[2017,8,6]],"date-time":"2017-08-06T00:10:18Z","timestamp":1501978218000},"page":"369-378","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-1","source":"Crossref","is-referenced-by-count":43,"title":["Birth defects after use of antithyroid drugs in early pregnancy: a Swedish nationwide study"],"prefix":"10.1093","volume":"177","author":[{"given":"Stine Linding","family":"Andersen","sequence":"first","affiliation":[{"name":"1Departments of Endocrinology"},{"name":"2Clinical Biochemistry, Aalborg University Hospital, Aalborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"L\u00f6nn","sequence":"additional","affiliation":[{"name":"3Department of Research and Development, Region Halland, Halmstad, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Vestergaard","sequence":"additional","affiliation":[{"name":"1Departments of Endocrinology"},{"name":"4Department of Clinical Medicine, Aalborg University, Aalborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ove","family":"T\u00f6rring","sequence":"additional","affiliation":[{"name":"5Department of Clinical Research and Education, S\u00f6dersjukhuset, Karolinska Institutet, Stockholm, Sweden"},{"name":"6Division of Endocrinology, Department of Internal Medicine, S\u00f6dersjukhuset, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","reference":[{"key":"ref411","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1089\/thy.2016.0457","article-title":"2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum","volume":"27","year":"2017","journal-title":"Thyroid"},{"key":"ref551","doi-asserted-by":"crossref","first-page":"947","DOI":"10.1210\/jcem.87.2.8126","article-title":"Severe embryopathy and exposure to methimazole in early pregnancy","volume":"87","year":"2002","journal-title":"Journal of Clinical Endocrinology and Metabolism"},{"key":"ref621","first-page":"780394","article-title":"One-stop outpatient management of accessory auricle in children with titanium 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of","volume":"13","journal-title":"European Journal Endocrinology"},{"key":"ref241","doi-asserted-by":"crossref","first-page":"1469","DOI":"10.1016\/j.ijporl.2005.07.008","article-title":"The preauricular sinus: a review of its aetiology, clinical presentation and management","volume":"69","year":"2005","journal-title":"International Journal of Pediatric Otorhinolaryngology"},{"key":"ref21","doi-asserted-by":"crossref","first-page":"751","DOI":"10.1111\/cen.12744","article-title":"Foetal programming by maternal thyroid disease","volume":"83","year":"2015","journal-title":"Clinical Endocrinology"},{"key":"ref501","first-page":"1533","article-title":"Severity of birth defects after propylthiouracil exposure in early pregnancy","volume":"10","year":"2014","journal-title":"Thyroid"},{"key":"ref461","doi-asserted-by":"crossref","first-page":"758","DOI":"10.1089\/thy.2012.0488","article-title":"Prevalence of thyrotoxicosis, antithyroid medication use, and complications among pregnant women 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bias","volume":"23","year":"2013","journal-title":"Thyroid"},{"key":"ref521","doi-asserted-by":"crossref","first-page":"726","DOI":"10.1002\/pds.1294","article-title":"The new Swedish Prescribed drug register \u2013 opportunities for pharmacoepidemiological research and experience from the first six months","volume":"16","year":"2007","journal-title":"Pharmacoepidemiology and Drug Safety"},{"key":"ref381","doi-asserted-by":"crossref","first-page":"164","DOI":"10.1159\/000365101","article-title":"Spontaneous abortion, stillbirth and hyperthyroidism: a Danish population-based study","volume":"3","year":"2014","journal-title":"European Thyroid Journal"},{"key":"ref111","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1089\/thy.2014.0434","article-title":"Gestational thyrotoxicosis, antithyroid drug use and neonatal outcomes within an integrated healthcare delivery 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