Association between Prenatal Exposure to Antiretroviral Therapy and Birth Defects: An Analysis of the French Perinatal Cohort Study (ANRS CO1/CO11)
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{"title"=>"Association between Prenatal Exposure to Antiretroviral Therapy and Birth Defects: An Analysis of the French Perinatal Cohort Study (ANRS CO1/CO11)", "type"=>"journal", "authors"=>[{"first_name"=>"Jeanne", "last_name"=>"Sibiude", "scopus_author_id"=>"40561810500"}, {"first_name"=>"Laurent", "last_name"=>"Mandelbrot", "scopus_author_id"=>"7005118217"}, {"first_name"=>"Stéphane", "last_name"=>"Blanche", "scopus_author_id"=>"7101814720"}, {"first_name"=>"Jérôme", "last_name"=>"Le Chenadec", "scopus_author_id"=>"6603101573"}, {"first_name"=>"Naima", "last_name"=>"Boullag-Bonnet", "scopus_author_id"=>"56158062200"}, {"first_name"=>"Albert", "last_name"=>"Faye", "scopus_author_id"=>"7004386880"}, {"first_name"=>"Catherine", "last_name"=>"Dollfus", "scopus_author_id"=>"7004650260"}, {"first_name"=>"Roland", "last_name"=>"Tubiana", "scopus_author_id"=>"7006609948"}, {"first_name"=>"Damien", "last_name"=>"Bonnet", "scopus_author_id"=>"55157529200"}, {"first_name"=>"Nathalie", "last_name"=>"Lelong", "scopus_author_id"=>"7003551292"}, {"first_name"=>"Babak", "last_name"=>"Khoshnood", "scopus_author_id"=>"7004620565"}, {"first_name"=>"Josiane", "last_name"=>"Warszawski", "scopus_author_id"=>"55865012200"}], "year"=>2014, "source"=>"PLoS Medicine", "identifiers"=>{"issn"=>"15491676", "isbn"=>"1549-1676", "pui"=>"373076988", "sgr"=>"84900452605", "doi"=>"10.1371/journal.pmed.1001635", "scopus"=>"2-s2.0-84900452605", "pmid"=>"24781315"}, "id"=>"f1c54eab-dc3c-3355-885a-c5967eb5b678", "abstract"=>"BACKGROUND: Antiretroviral therapy (ART) has major benefits during pregnancy, both for maternal health and to prevent mother-to-child transmission of HIV. Safety issues, including teratogenic risk, need to be evaluated. We estimated the prevalence of birth defects in children born to HIV-infected women receiving ART during pregnancy, and assessed the independent association of birth defects with each antiretroviral (ARV) drug used.\\n\\nMETHODS AND FINDINGS: The French Perinatal Cohort prospectively enrolls HIV-infected women delivering in 90 centers throughout France. Children are followed by pediatricians until 2 y of age according to national guidelines. We included 13,124 live births between 1994 and 2010, among which, 42% (n = 5,388) were exposed to ART in the first trimester of pregnancy. Birth defects were studied using both European Surveillance of Congenital Anomalies (EUROCAT) and Metropolitan Atlanta Congenital Defects Program (MACDP) classifications; associations with ART were evaluated using univariate and multivariate logistic regressions. Correction for multiple comparisons was not performed because the analyses were based on hypotheses emanating from previous findings in the literature and the robustness of the findings of the current study. The prevalence of birth defects was 4.4% (95% CI 4.0%-4.7%), according to the EUROCAT classification. In multivariate analysis adjusting for other ARV drugs, maternal age, geographical origin, intravenous drug use, and type of maternity center, a significant association was found between exposure to zidovudine in the first trimester and congenital heart defects: 2.3% (74/3,267), adjusted odds ratio (AOR) = 2.2 (95% CI 1.3-3.7), p = 0.003, absolute risk difference attributed to zidovudine +1.2% (95% CI +0.5; +1.9%). Didanosine and indinavir were associated with head and neck defects, respectively: 0.5%, AOR = 3.4 (95% CI 1.1-10.4), p = 0.04; 0.9%, AOR = 3.8 (95% CI 1.1-13.8), p = 0.04. We found a significant association between efavirenz and neurological defects (n = 4) using the MACDP classification: AOR = 3.0 (95% CI 1.1-8.5), p = 0.04, absolute risk +0.7% (95% CI +0.07%; +1.3%). But the association was not significant using the less inclusive EUROCAT classification: AOR = 2.1 (95% CI 0.7-5.9), p = 0.16. No association was found between birth defects and lopinavir or ritonavir with a power >85% for an odds ratio of 1.5, nor for nevirapine, tenofovir, stavudine, or abacavir with a power >70%. Limitations of the present study were the absence of data on termination of pregnancy, stillbirths, tobacco and alcohol intake, and concomitant medication.\\n\\nCONCLUSIONS: We found a specific association between in utero exposure to zidovudine and heart defects; the mechanisms need to be elucidated. The association between efavirenz and neurological defects must be interpreted with caution. For the other drugs not associated with birth defects, the results were reassuring. Finally, whatever the impact that some ARV drugs may have on birth defects, it is surpassed by the major role of ART in the successful prevention of mother-to-child transmission of HIV. Please see later in the article for the Editors' Summary.", "link"=>"http://www.mendeley.com/research/association-between-prenatal-exposure-antiretroviral-therapy-birth-defects-analysis-french-perinatal", "reader_count"=>76, "reader_count_by_academic_status"=>{"Unspecified"=>3, "Professor > Associate Professor"=>1, "Librarian"=>1, "Student > Doctoral Student"=>4, "Researcher"=>12, "Student > Ph. D. Student"=>10, "Student > Postgraduate"=>7, "Other"=>12, "Student > Master"=>14, "Student > Bachelor"=>9, "Lecturer > Senior Lecturer"=>2, "Professor"=>1}, "reader_count_by_user_role"=>{"Unspecified"=>3, "Professor > Associate Professor"=>1, "Librarian"=>1, "Student > Doctoral Student"=>4, "Researcher"=>12, "Student > Ph. D. Student"=>10, "Student > Postgraduate"=>7, "Other"=>12, "Student > Master"=>14, "Student > Bachelor"=>9, "Lecturer > Senior Lecturer"=>2, "Professor"=>1}, "reader_count_by_subject_area"=>{"Unspecified"=>5, "Agricultural and Biological Sciences"=>5, "Business, Management and Accounting"=>1, "Computer Science"=>1, "Economics, Econometrics and Finance"=>1, "Nursing and Health Professions"=>2, "Biochemistry, Genetics and Molecular Biology"=>2, "Medicine and Dentistry"=>44, "Neuroscience"=>1, "Pharmacology, Toxicology and Pharmaceutical Science"=>2, "Psychology"=>5, "Social Sciences"=>6, "Immunology and Microbiology"=>1}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>44}, "Social Sciences"=>{"Social Sciences"=>6}, "Psychology"=>{"Psychology"=>5}, "Unspecified"=>{"Unspecified"=>5}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>2}, "Neuroscience"=>{"Neuroscience"=>1}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>1}, "Immunology and Microbiology"=>{"Immunology and Microbiology"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>5}, "Computer Science"=>{"Computer Science"=>1}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>1}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>2}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>2}}, "reader_count_by_country"=>{"Japan"=>1, "Spain"=>1}, "group_count"=>7}

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  • {"files"=>["https://ndownloader.figshare.com/files/1476939"], "description"=>"a<p>Total patients in each category.</p>b<p>Number of birth defects among the <i>N</i> patients of the category.</p>c<p>χ<sup>2</sup> test or Fisher's exact test; missing data excluded.</p>d<p>Association with mode of delivery, premature delivery and low birth weight could be a consequence but not a risk factor for birth defects, and thus were not included in the multivariate analysis.</p>", "links"=>[], "tags"=>["Infectious diseases", "women's health", "Obstetrics and gynecology", "neonatal", "associations", "eurocat", "classification", "perinatal", "cohort"], "article_id"=>1009344, "categories"=>["Biological Sciences"], "users"=>["Jeanne Sibiude", "Laurent Mandelbrot", "Stéphane Blanche", "Jérôme Le Chenadec", "Naima Boullag-Bonnet", "Albert Faye", "Catherine Dollfus", "Roland Tubiana", "Damien Bonnet", "Nathalie Lelong", "Babak Khoshnood", "Josiane Warszawski"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001635.t004", "stats"=>{"downloads"=>1, "page_views"=>12, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Maternal_and_neonatal_characteristics_and_associations_with_overall_birth_defects_according_to_the_EUROCAT_classification_French_Perinatal_Cohort_ANRS_CO1_CO11_/1009344", "title"=>"Maternal and neonatal characteristics, and associations with overall birth defects, according to the EUROCAT classification (French Perinatal Cohort [ANRS CO1/CO11]).", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-04-29 02:48:33"}
  • {"files"=>["https://ndownloader.figshare.com/files/1476937"], "description"=>"<p>All organ system defects significantly associated with ART in multivariate main analysis with either EUROCAT or MACDP classification are presented in this table. AORs obtained by multivariate logistic regression adjusted systematically for maternal age, geographical origin, IDU, and type of maternity center (ranged from 1 to 3 according to the presence of a pediatrician on site, a neonatology unit, or a neonatal intensive care unit), and for all other drugs associated in univariate analysis with <i>p<</i>0.10 to the organ system considered in either classification (central nervous system defects adjusted for didanosine; heart defects adjusted for indinavir, emtricitabine, lamivudine, and zalcitabine; head and neck defects adjusted for zidovudine, zalcitabine, lamivudine, emtricitabine and efavirenz). Univariate analysis showing the association between birth defects by organ system and all drugs evaluated is presented in <a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001635#pmed-1001635-t003\" target=\"_blank\">Table 3</a>. <i>p</i>-Values are global <i>p</i>-value for the three categories in each type of exposure.</p>a<p>Number of birth defects/total in exposure category.</p><p>BD, birth defect; DDI, didanosine; EFV, efavirenz; IND, indinavir; LB, live birth; NA, not applicable/no child in this category; SB, stillbirth; T, trimester; ZDV, zidovudine.</p>", "links"=>[], "tags"=>["Infectious diseases", "women's health", "Obstetrics and gynecology", "defects", "arv", "exposures", "perinatal", "cohort"], "article_id"=>1009342, "categories"=>["Biological Sciences"], "users"=>["Jeanne Sibiude", "Laurent Mandelbrot", "Stéphane Blanche", "Jérôme Le Chenadec", "Naima Boullag-Bonnet", "Albert Faye", "Catherine Dollfus", "Roland Tubiana", "Damien Bonnet", "Nathalie Lelong", "Babak Khoshnood", "Josiane Warszawski"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001635.t006", "stats"=>{"downloads"=>0, "page_views"=>8, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Association_between_birth_defects_by_organ_system_and_ARV_drug_exposures_French_Perinatal_Cohort_ANRS_CO1_CO11_/1009342", "title"=>"Association between birth defects by organ system and ARV drug exposures (French Perinatal Cohort [ANRS CO1/CO11]).", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-04-29 02:48:33"}
  • {"files"=>["https://ndownloader.figshare.com/files/1476934"], "description"=>"<p>EFV, efavirenz; T, trimester; ZDV, zidovudine.</p>", "links"=>[], "tags"=>["Infectious diseases", "women's health", "Obstetrics and gynecology", "antiretroviral", "drugs"], "article_id"=>1009339, "categories"=>["Biological Sciences"], "users"=>["Jeanne Sibiude", "Laurent Mandelbrot", "Stéphane Blanche", "Jérôme Le Chenadec", "Naima Boullag-Bonnet", "Albert Faye", "Catherine Dollfus", "Roland Tubiana", "Damien Bonnet", "Nathalie Lelong", "Babak Khoshnood", "Josiane Warszawski"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001635.t003", "stats"=>{"downloads"=>6, "page_views"=>8, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Evolution_of_antiretroviral_drugs_during_the_study_period_/1009339", "title"=>"Evolution of antiretroviral drugs during the study period.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-04-29 02:48:33"}
  • {"files"=>["https://ndownloader.figshare.com/files/1476933"], "description"=>"<p>Missing data were excluded from all statistical tests.</p>a<p>Total number of patients exposed in each category.</p>b<p>Number of birth defects observed among <i>N</i> patients of the category.</p>c<p>ORs obtained by univariate logistic regression.</p>d<p>Global <i>p</i>-value for exposure to each drug, including the three categories (no exposure, exposure in the first trimester, and exposure in the 2nd or 3rd trimester).</p>e<p>AOR obtained by multivariate logistic regression, adjusted systematically for mother's age, geographical origin, IDU, and maternity center.</p>f<p>Power for an OR of 1.5 concerning exposure in the first trimester to each drug as compared to no exposure to this drug.</p><p>BD, birth defect; NA, not applicable/no child in this category; T, trimester.</p>", "links"=>[], "tags"=>["Infectious diseases", "women's health", "Obstetrics and gynecology", "defects", "antiretroviral", "drugs", "perinatal", "cohort"], "article_id"=>1009338, "categories"=>["Biological Sciences"], "users"=>["Jeanne Sibiude", "Laurent Mandelbrot", "Stéphane Blanche", "Jérôme Le Chenadec", "Naima Boullag-Bonnet", "Albert Faye", "Catherine Dollfus", "Roland Tubiana", "Damien Bonnet", "Nathalie Lelong", "Babak Khoshnood", "Josiane Warszawski"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001635.t002", "stats"=>{"downloads"=>1, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Association_between_overall_birth_defects_and_antiretroviral_drugs_French_Perinatal_Cohort_ANRS_CO1_CO11_/1009338", "title"=>"Association between overall birth defects and antiretroviral drugs (French Perinatal Cohort [ANRS CO1/CO11]).", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-04-29 02:48:33"}
  • {"files"=>["https://ndownloader.figshare.com/files/1476942"], "description"=>"<p>Description of birth defects among terminations of pregnancy (French Perinatal Cohort [ANRS CO1/CO11]).</p>", "links"=>[], "tags"=>["Infectious diseases", "women's health", "Obstetrics and gynecology", "defects", "terminations", "perinatal", "cohort"], "article_id"=>1009347, "categories"=>["Biological Sciences"], "users"=>["Jeanne Sibiude", "Laurent Mandelbrot", "Stéphane Blanche", "Jérôme Le Chenadec", "Naima Boullag-Bonnet", "Albert Faye", "Catherine Dollfus", "Roland Tubiana", "Damien Bonnet", "Nathalie Lelong", "Babak Khoshnood", "Josiane Warszawski"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001635.t009", "stats"=>{"downloads"=>0, "page_views"=>13, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Description_of_birth_defects_among_terminations_of_pregnancy_French_Perinatal_Cohort_ANRS_CO1_CO11_/1009347", "title"=>"Description of birth defects among terminations of pregnancy (French Perinatal Cohort [ANRS CO1/CO11]).", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-04-29 02:48:33"}
  • {"files"=>["https://ndownloader.figshare.com/files/1476941"], "description"=>"<p>Total number of defects exceeds 575 because some children were included in several organ systems. Each child was included only once in each organ system.</p>", "links"=>[], "tags"=>["Infectious diseases", "women's health", "Obstetrics and gynecology", "births", "defects", "perinatal", "cohort"], "article_id"=>1009346, "categories"=>["Biological Sciences"], "users"=>["Jeanne Sibiude", "Laurent Mandelbrot", "Stéphane Blanche", "Jérôme Le Chenadec", "Naima Boullag-Bonnet", "Albert Faye", "Catherine Dollfus", "Roland Tubiana", "Damien Bonnet", "Nathalie Lelong", "Babak Khoshnood", "Josiane Warszawski"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001635.t008", "stats"=>{"downloads"=>0, "page_views"=>7, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Description_of_births_defects_among_13_124_live_births_French_Perinatal_Cohort_ANRS_CO1_CO11_/1009346", "title"=>"Description of births defects among 13,124 live births (French Perinatal Cohort [ANRS CO1/CO11]).", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-04-29 02:48:33"}
  • {"files"=>["https://ndownloader.figshare.com/files/1476935"], "description"=>"<p>BD, birth defect; EFV, efavirenz; T, trimester.</p>", "links"=>[], "tags"=>["Infectious diseases", "women's health", "Obstetrics and gynecology", "studies"], "article_id"=>1009341, "categories"=>["Biological Sciences"], "users"=>["Jeanne Sibiude", "Laurent Mandelbrot", "Stéphane Blanche", "Jérôme Le Chenadec", "Naima Boullag-Bonnet", "Albert Faye", "Catherine Dollfus", "Roland Tubiana", "Damien Bonnet", "Nathalie Lelong", "Babak Khoshnood", "Josiane Warszawski"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001635.t001", "stats"=>{"downloads"=>0, "page_views"=>18, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Main_studies_on_ART_exposure_and_birth_defects_/1009341", "title"=>"Main studies on ART exposure and birth defects.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-04-29 02:48:33"}
  • {"files"=>["https://ndownloader.figshare.com/files/1476932"], "description"=>"<p>Squares indicate AORs for exposure in the first trimester versus no exposure to the drug, adjusted on IDU, geographical origin, maternal age, and maternity center. Lines indicate 95% confidence intervals and square areas are proportional to the power for an OR of 1.5. Total number of birth defects = 575/13,124. Numbers for each ARV drug are shown in <a href=\"http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.1001635#pmed-1001635-t003\" target=\"_blank\">Table 3</a>.</p>", "links"=>[], "tags"=>["Infectious diseases", "women's health", "Obstetrics and gynecology", "defects", "trimester", "antiretroviral", "perinatal", "cohort", "multivariate"], "article_id"=>1009337, "categories"=>["Biological Sciences"], "users"=>["Jeanne Sibiude", "Laurent Mandelbrot", "Stéphane Blanche", "Jérôme Le Chenadec", "Naima Boullag-Bonnet", "Albert Faye", "Catherine Dollfus", "Roland Tubiana", "Damien Bonnet", "Nathalie Lelong", "Babak Khoshnood", "Josiane Warszawski"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001635.g002", "stats"=>{"downloads"=>0, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Association_between_overall_birth_defects_and_first_trimester_antiretroviral_drug_exposure_French_Perinatal_Cohort_ANRS_CO1_CO11_multivariate_analysis_/1009337", "title"=>"Association between overall birth defects and first trimester antiretroviral drug exposure (French Perinatal Cohort [ANRS CO1/CO11]): multivariate analysis.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-04-29 02:48:33"}
  • {"files"=>["https://ndownloader.figshare.com/files/1476931"], "description"=>"<p>Study population: French Perinatal Cohort (ANRS CO1/CO11).</p>", "links"=>[], "tags"=>["Infectious diseases", "women's health", "Obstetrics and gynecology", "french", "perinatal", "cohort"], "article_id"=>1009336, "categories"=>["Biological Sciences"], "users"=>["Jeanne Sibiude", "Laurent Mandelbrot", "Stéphane Blanche", "Jérôme Le Chenadec", "Naima Boullag-Bonnet", "Albert Faye", "Catherine Dollfus", "Roland Tubiana", "Damien Bonnet", "Nathalie Lelong", "Babak Khoshnood", "Josiane Warszawski"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001635.g001", "stats"=>{"downloads"=>0, "page_views"=>18, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Study_population_French_Perinatal_Cohort_ANRS_CO1_CO11_/1009336", "title"=>"Study population: French Perinatal Cohort (ANRS CO1/CO11).", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-04-29 02:48:33"}
  • {"files"=>["https://ndownloader.figshare.com/files/1476940"], "description"=>"<p>Missing data were excluded from all statistical tests.</p>a<p>Total of patients exposed in each category.</p>b<p>Number of birth defects observed among N patients of the category.</p>c<p>OR obtained by univariate logistic regression.</p>d<p>For exposure to each drug, including the three categories (no exposure, exposure in the first trimester and in the second or third trimester).</p>e<p>AOR obtained by multivariate logistic regression.</p><p>BD, birth defect; NA, not applicable/no child in this category; T, trimester.</p>", "links"=>[], "tags"=>["Infectious diseases", "women's health", "Obstetrics and gynecology", "defects", "antiretroviral", "drugs", "macdp", "classification", "perinatal", "cohort"], "article_id"=>1009345, "categories"=>["Biological Sciences"], "users"=>["Jeanne Sibiude", "Laurent Mandelbrot", "Stéphane Blanche", "Jérôme Le Chenadec", "Naima Boullag-Bonnet", "Albert Faye", "Catherine Dollfus", "Roland Tubiana", "Damien Bonnet", "Nathalie Lelong", "Babak Khoshnood", "Josiane Warszawski"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001635.t005", "stats"=>{"downloads"=>4, "page_views"=>9, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Association_between_overall_birth_defects_and_antiretroviral_drugs_according_to_MACDP_classification_French_Perinatal_Cohort_ANRS_CO1_CO11_/1009345", "title"=>"Association between overall birth defects and antiretroviral drugs according to MACDP classification (French Perinatal Cohort [ANRS CO1/CO11]).", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-04-29 02:48:33"}
  • {"files"=>["https://ndownloader.figshare.com/files/1476938"], "description"=>"<p>NA, not applicable/no child in this category; T, trimester.</p>", "links"=>[], "tags"=>["Infectious diseases", "women's health", "Obstetrics and gynecology", "defects", "antiretroviral"], "article_id"=>1009343, "categories"=>["Biological Sciences"], "users"=>["Jeanne Sibiude", "Laurent Mandelbrot", "Stéphane Blanche", "Jérôme Le Chenadec", "Naima Boullag-Bonnet", "Albert Faye", "Catherine Dollfus", "Roland Tubiana", "Damien Bonnet", "Nathalie Lelong", "Babak Khoshnood", "Josiane Warszawski"], "doi"=>"https://dx.doi.org/10.1371/journal.pmed.1001635.t007", "stats"=>{"downloads"=>9, "page_views"=>5, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Univariate_analysis_association_between_birth_defects_by_organ_system_and_antiretroviral_drugs_/1009343", "title"=>"Univariate analysis: association between birth defects by organ system and antiretroviral drugs.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-04-29 02:48:33"}

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