Use of misoprostol during pregnancy and Mobius syndrome in infants

Background Patients with upper gastrointestinal ulceration may be treated with misoprostol, but it is not recommended for pregnant women because it may stimulate uterine contractions and cause vaginal bleeding and miscarriage. Recent data from Bra zil, where misoprostol is used orally and vaginally as an abortifacient, have suggested a relation between the use of misoprostol by women in an unsuccessful attempt to terminate pregnancy and Mobius' syndrome (congenital facial paralysis) in their infants. Methods We compared the frequency of misoprostol use during the first trimester by mothers of infants in whom Mobius' syndrome was diagnosed and mothers of infants with neural-tube defects in Brazil. All diagnoses in infants were made between January 16, 1990, and May 31, 1996, by clinical geneticists at seven hospitals who also interviewed the mothers and recorded information about the administration of misoprostol, among other data. Results We identified 96 infants with Mobius' syndrome and matched them with 96 infants with neural-tube defects. The mean age at the time of the diagnosis of Mobius' syndrome was 16 months (range, 0.5 to 78), and the diagnosis of neural-tube defects was made within 1 week of birth in most cases. Among the mothers of the 96 infants with Mobius' syndrome, 47 (49 percent) had used misoprostol in the first trimester of pregnancy, as compared with 3 (3 percent) of the mothers of the 96 infants with neural-tube defects (odds ratio, 29.7; 95 percent confidence interval, 11.6 to 76.0). Twenty of the mothers of the infants with Mobius' syndrome had taken misoprostol only orally (odds ratio, 38.8; 95 percent confidence interval, 9.5 to 159.4), 20 had taken misoprostol both orally and vaginally, 3 had taken the drug vaginally, and 4 did not report how they took the drug. Conclusions Attempted abortion with misoprostol is associated with an increased risk of Mobius' syndrome in infants. (N Engl J Med 1998;338:1881-5.) (C) 1998, Massachusetts Medical Society.