Sura Alwan

Friday, April 16, 2010, 12:30 pm. Room 337, Michael Smith Labs
“Risk Assessment of Birth Defects in Human Pregnancy”
Sura Alwan PhD programme (pdf)
 
EXAMINING COMMITTEE
Chair:
Supervisory Committee: Dr. Jan M. Friedman, Research Supervisor (Medical Genetics), Dr. Patti Janssen (School of Population and Public Health) & Dr. Kay Teschke (School of Population and Public Health)
University Examiners: Dr. Margot Van Allen (Medical Genetics) & Dr. K.S. Joseph (Obstetrics and Gynaecology)
Eternal Examiner:

SUPERVISORY COMMITTEE
Dr. J.M. Friedman, Research Supervisor (Medical Genetics), Dr. A.D. Sadovnick (Medical Genetics), Dr. K. Teschke (School of Population and Public Health) & Dr. P. Janssen (School of Population and Public Health)

ABSTRACT
Major birth defects occur in 2% to 3% of liveborn infants and are the leading cause of infant mortality. The etiology of most birth defects is unknown. The objective of this thesis is to (1) assess the risk of having a child with a birth defect following maternal use of common antidepressant medications and to (2) evaluate the risk of a birth defect or subsequent adverse outcome in relation to restricted fetal growth early in pregnancy.
I used data from the National Birth Defects Prevention Study, a population-based case-control study of birth defects risk factors in the US to assess the rates and patterns of antidepressant medication use around pregnancy and compare the prevalence of common antidepressant medication use among mothers of infants with various birth defects and mothers of controls. I found that selective serotonin reuptake inhibitors (SSRIs) were the most commonly used antidepressants among pregnant women, followed by bupropion, and that the rate of maternal
antidepressant use significantly increased from 1998 to 2005. I also found that maternal use of SSRIs in early pregnancy was associated with the occurrence of anencephaly, craniosynostosis and omphalocele in the infant, whereas early pregnancy exposure to bupropion was associated with an increased risk for left outflow tract heart defects.  
I conducted a retrospective cohort study using ultrasound data on singleton pregnancies in women with regular menstrual cycles whose embryo had a crown rump length (CRL) measurement obtained in the Ultrasound Unit of British Columbia Women’s Hospital. I found that a first trimester CRL in the 10th centile or less was a strong indicator for a subsequent spontaneous abortion, delivering through a cesarean section and having an infant with a low birth weight or length. 
The results presented in this thesis indicate that maternal use of common antidepressant medications early in pregnancy may slightly increase the risk for certain birth defects in the infant and that certain adverse reproductive outcomes are associated with restricted fetal growth in the early stages of pregnancy.


SELECTED PUBLICATIONS
Alwan S, Reefhuis J, Rasmussen SA, Friedman JM: National Birth Defects Prevention Study (2010): Patterns of Antidepressant Medication Use Among Pregnant Women in a US population. Journal of Clinical Pharmacology (in press).

Alwan S, Reefhuis J, Botto LD, Rasmussen SA, Correa A, Friedman JM: National Birth Defects Prevention Study (2010): Maternal Use of Bupropion and Risk of Congenital Heart Defects. American Journal of Obstetrics and Gynecology. (In press)

Alwan S, Friedman JM (2009). Safety of Selective Serotonin Reuptake Inhibitors in Pregnancy. CNS Drugs 23: 493-509 


SELECTED PLATFORM PRESENTATIONS:
Maternal Use of Bupropion and Risk for Congenital Heart Defects, 49th Annual Meeting of the Teratology Society, June 27- July 1st, 2009, Rio Grande, PR, USA.

Maternal Use of Selective Serotonin Reuptake Inhibitors and Risk for Birth Defects. SER-CSEB Joint Meeting, June 27-30, 2005, Toronto, ONT, Canada. 

Maternal Use of Selective Serotonin Reuptake Inhibitors and Risk for Birth Defects, 45th Annual Meeting of the Teratology Society, June 25-30, 2005, St. Pete Beach, Florida, USA.

Teratogen Update: Potential Risks of Angiotensin II Receptor Antagonists during Pregnancy. Invited talk at the 45th Annual Meeting of the Teratology Society, June 25-30, 2005 St. Pete Beach, Florida, USA.

Associations of osseous dysplasia in Neurofibromatosis 1 (NF1). The BC Neurofibromatosis Foundation Symposium, November 16-17, 2003, Vancouver, B.C., Canada. 


AWARDS
CFRI Trainee Travel Award, July 2009 
Young Investigator Travel Award, Teratology Society, June 2004
CFRI Trainee Research Award, June 2008
CFRI Training Studentship Award, Jul 2007-Jun 2008
CFRI Training Studentship Award, Oct 2006-Jun 2007
Full University Graduate Fellowship Award, UBC, 2006-2007
Partial University Graduate Fellowship Award, UBC, 2005-2006
Full University Graduate Fellowship Award, UBC, 2004-2005
Wilson Presentation Award, Teratology Society, June 2005
Young Investigator Travel Award, Teratology Society, June 2004


GRADUATE STUDIES
Field of Study: Medical Genetics
Courses:
MEDG 520: Advances in Human Molecular, Genetics Dr. C. Brown
MEDG 530: Human Genetics, Dr. J.M. Friedman
MEDG 515: Developmental Genetics, Dr. D. Juriloff
MEDG 535: Genetics and Ethics, Dr. S. Cox
MEDG 545: Current Topics in Medical Genetics Research, Dr. D. Juriloff, Dr. M. Harris
MEDG 548A: Directed Studies, Dr. J.M. Friedman
HCEP 502: Epidemiological Methods I, Dr. P. Janssen
HCEP 580B: Pharmacoepidemiology, Dr. M. Etminan

Sura Alwan PhD programme (pdf)