Vaginal Spermicides and Congenital Disorders-Reply

Hershel Jick, MD; Alexander M. Walker, MD, MPH; Kenneth J. Rothman, DPH; Lewis B. Holmes, MD
JAMA. 1981;246(23):2677-2678. doi:10.1001/jama.1981.03320230011005.
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In Reply.—  In response to Dr Grossman's query, none of the babies with the anomalies associated with spermicide use were born of mothers who had diabetes, hypertension, chronic heart disease, or epilepsy. Less than 3% of the mothers in the entire series were treated for such conditions.What Dr Felarca and associates have described as "flaws" in our study we consider to be limitations that dictate a conservative interpretation of the results. With regard to their major concern, it should be understood, however, that misclassification of exposure, if random, tends to lead to the absence of an association rather than to a positive association.1 Indeed, if the association between spermicides and congenital disorders is real, the estimates of the effect in our data are likely to be too small, since many of the women classified as exposed to spermicides were doubtless not exposed near the time of conception. As


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