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Brazil investigates drug's possible link with birth defects


 In Brazil, many women are using the synthetic prostaglandin misoprostol to induce abortion. Since abortion is illegal in Brazil, they take misoprostol without any medical supervision. It was introduced in Brazil in 1986 as a treatment for gastric ulcers. Its brand name is Cytotec. The prescription drug is widely available on the black market, where the price for 4 200-mg tablets begins at US$100. Use of the drug with failure to abort may be linked to birth defects. A geneticist and a neuropediatrician at the Children's Institute of the Sao Paulo Hospital das Clinicas are studying 9 children with congenital or neurological abnormalities. Physicians in other parts of Brazil are following another 30 children with the same circumstances. A physician in Porto Alegre is following 40 women who took misoprostol but did not abort. As of mid 1994, she had found 3 cases of congenital abnormalities. The Brazilian Society for Clinical Genetics is overseeing an epidemiologic study in 10 major maternity hospitals where researchers will examine all neonates and ask all mothers about the possible use of misoprostol. Staff at the genetics outpatient clinics of 6 leading hospitals are about to conduct a related study among mothers. Both of these studies run the risk of low reporting, since mothers may be disinclined to admit to criminal use of misoprostol. Almost 50% of all women who want pregnancy termination in Brazil use misoprostol. The abortion fails in about 33% of these cases. The evidence suggests an 8-10% risk of abnormalities among women who use misoprostol and experience abortion failure. Ministry of Health sources unofficially appreciate that misoprostol use is reducing the number of women hospitalized with infections caused by abortion attempts with sharp instruments, which in turn has reduced maternal mortality.
