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The Relation Between Vaginal Spermicides and Congenital Disorders-Reply

Hershel Jick, MD; Alexander M. Walker, MD, DrPH; Kenneth J. Rothman, DrPH
JAMA. 1987;258(15):2066. doi:10.1001/jama.1987.03400150058026.
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In Reply.—  Currently available data1,2 on spermicides and malformations argue against a causal association between the two. In commenting on our study,3 however, Dr Shapiro has been drawn into areas about which he is not well informed. We chose as our exposure variable the acquisition of a vaginal spermicide, as recorded in an automated pharmacy file, within 600 days of delivery. After some discussion we specifically chose not to abstract spermicide exposure data from clinical records. Medical charts are limited and frequently misleading with regard to important details of nonprescription drug use. (We did of course arrange for expert review of all available clinical and laboratory data to decide on the nature of the congenital anomalies.) As we stated in our letter last year in JAMA,44 and as we suggested in our original publication,3 we consider use of spermicides prior to conception to be a


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