Statins and congenital malformations: cohort study

Abstract

Objective: To examine the teratogenic potential of statins.

Design: Cohort study.

Setting: United States.

Participants: A cohort of 886,996 completed pregnancies linked to liveborn infants of women enrolled in Medicaid from 2000 to 2007.

Methods: We examined the risk of major congenital malformations and organ specific malformations in offspring associated with maternal use of a statin in the first trimester. Propensity score based methods were used to control for potential confounders, including maternal demographic characteristics, obstetric and medical conditions, and use of other drugs.

Results: 1152 (0.13%) women used a statin during the first trimester. In unadjusted analyses, the prevalence of malformations in the offspring of these women was 6.34% compared with 3.55% in those of women who did not use a statin in the first trimester (relative risk 1.79, 95% confidence interval 1.43 to 2.23). Controlling for confounders, particularly pre-existing diabetes, accounted for this increase in risk (1.07, 0.85 to 1.37). There were also no statistically significant increases in any of the organ specific malformations assessed after accounting for confounders. Results were similar across a range of sensitivity analyses.

Conclusions: Our analysis did not find a significant teratogenic effect from maternal use of statins in the first trimester. However, these findings need to be replicated in other large studies, and the long term effects of in utero exposure to statins needs to be assessed, before use of statins in pregnancy can be considered safe.

Relative risks (95% confidence intervals) comparing risk for organ specific malformations in infants of women who did or did not use statins during the first trimester. Medicaid Analytic eXtract 2000-07. *Risk estimate for eye, ear, neck, and face malformations not shown as there were no occurrences in infants exposed to statins (see supplementary table S5 for number and risk of each malformation type)