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Protecting hydroelectric plants from incidents that adversely impact their cyber-physical systems presents unique challenges due to the plants’ widely dispersed geographic locations and varied configurations as well as the relative nascent nature of the cyberattacks targeting these facilities. To help hydroelectric plants better respond to and mitigate cybersecurity incidents, this Department of Energy Water Power Technologies Office Navigator aligns the processes within the National Institute of Standards 800-61r2 Computer Security Incident Handling Guide with the emergency actions within the FEMA 64 Emergency Action Plan Framework. This work is to be used at a hydroelectric plant to quickly understand how the plant responds to a cyber incident in relationship to the actions involved in an emergency action plan involving a hydroelectric plant. In addition to this product, there are three other products meant to be distributed to a hydroelectric plant to assist in their cyber incident response and recovery. The first, a report on the processes of building a R&R flip book based on a large set of existing guidance. The second, a handy flip book meant to be distributed to hydroelectric plants to assist them during a cybersecurity incident occurring on a hydroelectic plant. And the third is a comprehensive set of resources to assist an operator in locating appropriate guidance during the recovery process.

13 HYDRO ENERGY↗

Effects of periodontitis on postoperative pneumonia in patients with lung and esophageal cancer

Abstract Background Few studies have been conducted on the relationship between chronic periodontitis and postoperative pneumonia (POP) in patients with lung and esophageal cancer. Furthermore, it remains controversial as to whether improving the periodontal condition of patients with lung and esophageal cancer before surgery reduces the incidence of POP. This retrospective study was conducted to assess the effects of periodontal therapy in patients with lung and esophageal cancer to prevent POP. Methods A total of 265 patients with lung or esophageal cancer complicated with chronic periodontitis who underwent open thoracotomy between July 2015 and June 2019 were selected and given the choice of being in the experimental or control group. A total of 141 participants in the experimental group received periodontal therapy, and 124 participants in the control group did not receive periodontal therapy. All clinical data of participants in both groups were retrospectively studied to determine the incidence of POP on the 30th day after discharge from hospital. Results Eight patients in the experimental and six in the control group, respectively, were excluded from the study. It was found that four of the 133 patients suffered from POP in the experimental group (incidence: 3.01%). A total of 18 of 118 patients in the control group had a pulmonary infection (incidence: 15.25%). POP incidence in the experimental group was significantly lower than that in the control group, and in the level analysis of different types of periodontitis, surgical methods, and diseases ( p < 0.05). Conclusions Periodontal treatment is associated with a lower incidence of POP following lung and esophageal cancer surgery. Improving the periodontal condition of patients helps prevent POP. The presence of periodontitis is an important predisposing factor for POP in patients after open thoracotomy. Periodontal examination and therapy are recommended before the surgical treatment of lung or esophageal cancer.

Jia, Chunling↗

Meteorological Conditions in Urban Sites in Knoxville, USA. 2023

This 2023 dataset, which contains four csv files, reports hourly air temperature, wind speed, solar radiation, incident short wave, reflected short wave, incident long wave, emitted long wave, net radiation, and photosynthetically active radiation (PAR) data measured in urban parks in Knoxville, Tennessee, USA. The sites include Cumberland Estates Park (CEP), Socially Equal Energy Efficient Development (SEEED), West Hills (WHP), and Victor Ashe Park (VAP). Air temperature, wind speed and direction, and solar radiation data were obtained from a METER ATMOS 41 All-in-One Weather Station (Pullman, Washington, USA). Incident and emitted radiation (shortwave and longwave) measurements were made using an Apogee (Logan, Utah, USA) net radiometer (Model SN-500-SS). The SQ-521 Full-Spectrum Quantum sensor (Apogee Instruments, Inc) recorded the PAR. The measurement data for CEP, SEEED, and VAP started on July 1, 2023, while WHP started on August 26, 2023. All measurement ended on December 31, 2023. This work is a part of a larger study which investigates the impact of soil moisture and plant evapotranspiration on ambient temperature and relative humidity in several city parks in Knoxville, Tennessee.

Salvador, Christian [ORNL] (ORCID:0000000283287777↗

Meteorological Conditions in Urban Sites in Knoxville, USA. 2025

This 2025 dataset, which contains five csv files, reports hourly air temperature, wind speed, solar radiation, incident short wave, reflected short wave, incident long wave, emitted long wave, net radiation, and photosynthetically active radiation (PAR) data measured in urban parks in Knoxville, Tennessee, USA. The sites include Cumberland Estates Park (CEP), Socially Equal Energy Efficient Development (SEEED), West Hills Park (WHP), West View Park (WVP), and Victor Ashe Park (VAP). Air temperature, wind speed, and solar radiation data were obtained from a METER ATMOS 41 All-in-One Weather Station (Pullman, Washington, USA). Incident and emitted radiation (shortwave and longwave) measurements were made using an Apogee (Logan, Utah, USA) net radiometer (Model SN-500-SS). The SQ-521 Full-Spectrum Quantum sensor (Apogee Instruments, Inc) recorded the PAR. The measurement data for all the sites started on January 1, 2025. and all measurement ended on December 31, 2025. This work is a part of a larger study which investigates the impact of soil moisture and plant evapotranspiration on ambient temperature and relative humidity in several city parks in Knoxville, Tennessee.

Salvador, Christian [ORNL] (ORCID:0000000283287777↗

Support for Reactor Operators in Case of Cyber-Security Threats (NEUP Final Report)

Increasing use of digital technology in nuclear power plants (NPPs) poses cyber-security as a crucial threat to public safety and to continuous energy production. Cyber-security risks are comprised of complex known and unknown interactions between various entities, system vulnerabilities, network protocols, human users and malicious attacks. There is little understanding or research geared towards plant operators’ response under cyber-security threats and operational procedures to cope with such threats. This is particularly critical when a cyber-security event masquerades as a safety incident or an evolving accident. Instead of leading operators to the remediation of the accident, the masked cyber event may lead them to circumvent the safety mechanisms of the plant. Given these challenges, the objective of this project is to develop a tool to characterize abnormal NPP events as “cyber” or “safety” incidents, and to further develop this tool as a real-time operator aid to assist in response to the incident. This NEUP Final Report summarizes the research efforts towards the above goals and the results in the following three aspects. First, a methodology for classifying abnormal NPP events as cyber-attacks or safety incidents was developed. This provides the basis for responding to potential cyber-attacks. In this methodology, the causal relationships between various variables (i.e., physical variables, network variables, and control variables) for a nuclear system under consideration are modeled using dynamic Bayesian networks. Based on observations of certain variables (i.e., the evidence), inference is performed to identify the state of hidden variables, which helps indicate the occurrence of cyber-attacks or safety incidents. The proposed methodology was applied to the full scope NPP simulator system at The Ohio State University as a case study. The result shows that the proposed methodology is capable of distinguishing between cyber-attacks and safety incidents. Second, a game-theoretic approach for responding to cyber-attacks on nuclear power plants was developed. This is the second major goal of the project, and the method is used to recommend optimal responses to reactor operators in the case of cyber-attacks. We consider two cases in this research. In the first case, the interaction between the defender (i.e., the reactor operator) and the attacker is modeled as a two-player, nonzero-sum, Markov game with an infinite time horizon. In the second case, we consider a semi-Markov game between the defender and the attacker within a finite time horizon. The model in the second case enables us to consider the time sensitive response of the defender. In each case, the method for deriving the Nash equilibrium is developed. The Nash Equilibrium of the game provides the valid prediction of both players’ actions because no single player can benefit from unilaterally deviating from the equilibrium policy if the other player adheres to his/hers, hence it provides the best response of the defender to cyber-attacks. The proposed method in each case is demonstrated through a simplified benchmark digital feedwater control system. Third, a prototype display is developed to integrate the above information. The prototype display depicts the communication information to the operator and incorporates the cyber-security tool developed by the team into the interface. It consists of the regular display in current control rooms, as well as a panel used to indicate the occurrence of cyber-attacks or safety events and a panel used to guide the operator’s response to detected cyber-attacks.

22 GENERAL STUDIES OF NUCLEAR REACTORS↗

Hydroelectric Cybersecurity Response and Recovery Overview

Protecting hydroelectric plants from incidents that adversely impact their cyber-physical systems presents unique challenges due to the plants’ widely dispersed geographic locations and varied configurations as well as the relative nascent nature of the cyberattacks targeting these facilities. To help hydroelectric plants better respond to and mitigate cybersecurity incidents, this Department of Energy Water Power Technologies Office Cyber Response & Recovery Overview document discusses the process of defining how a hydroelectric plant might respond to and recover from an anomalous event. In addition to this product, there are three other products meant to be distributed to a hydroelectric plant to assist in their cyber incident response and recovery. The first, a handy flip book that guides an operator in the midst of a cyber event through the R&R process of the incident and if the event warrants, through an emergency action plan to recover the plant itself. The second, a handy guide of hydroelectric and cyber guidance in responding to the cyber and physical systems within a hydroelectric plant. And the third is a correlated alignment of the steps an hydroelectric plant operator would take for both a cyber incident as well as an emergency response process if the event rises to a cyber incident affecting the safe and reliable operations of a hydroelectric plant.

13 HYDRO ENERGY↗

NFPA Distributed Energy Resources Safety Training (DERST) For Emergency Responders

The National Fire Protection Association, with support from the Department of Energy, executed a multi-year initiative to develop, enhance, and disseminate Distributed Energy Resources Safety Training (DERST) tools for U.S. emergency responders. As Distributed Energy Resources (DER)—such as solar photovoltaics, battery energy storage systems (ESS), electric vehicles (EVs), and associated infrastructure—become increasingly prevalent, the NFPA identified a critical need for up-to-date standardized, accessible, and effective safety training tailored for the fire service and related public safety professionals. The project delivered a comprehensive suite of educational resources to improve responders’ abilities to safely manage DER-related incidents. This included: • Revised Modular Training Courses: Updated classroom-based DER safety courses, now modular and accessible nationwide through fire academies and the North American Fire Training Directors (NAFTD) network. • Live Burn Testing & Research: A full-scale controlled burn of a DER-equipped residential structure provided real-world data and insights, forming the basis for updated best practices. • A Gamified Simulation Tool – Firefighters Incident Response Simulation Tool (FIRST): A first-of-its-kind, multiplayer, scenario-based simulation using the Unreal Engine 5.0 to train responders in a realistic virtual, multi-DER incident environment. • Field Familiarization Software Tools & Prop Guide: Digital DER field familiarization evolutions software guide and a prop development manual to support field-based DER training exercises, enhancing responders' hands-on familiarity with DER infrastructure and collaboration on virtual incident responses. • National Dissemination Strategy: Strategic partnerships with NAFTD, Vector Solutions, and others enabled wide-scale distribution, with over 5,000 departments accessing resources and 1,100+ departments adopting the simulator in the first seven months. Also provided a web portal for easy access to all training and simulation programs developed under this grant for the U.S. responder community. Key findings from the project—particularly from the burn test—led to paradigm shifts in fire response tactics. For example, traditional approaches to garage fires may be hazardous if DERs are present, due to explosive off gassing and thermal runaway risks. The new training emphasizes scene assessment, stand-off approaches, thermal imaging verification, and careful post-incident cooling of DER components to prevent reignition. This initiative has had a significant national impact, raising awareness, enhancing preparedness, and supporting safer DER incident response practices. Significant engagement from the media, public safety organizations, and PBS coverage has further amplified the reach and adoption of NFPA’s DER safety training, tools, and simulations.

14 SOLAR ENERGY↗

Modeling and simulation of earthquake soil structure interaction excited by inclined seismic waves

Presented is an application of wave potential formulation (WPF) together with domain reduction method (DRM) to modeling earthquake soil structure interaction (ESSI) behavior in horizontally layered ground under inclined incident seismic waves. Wave potential formulation is used to develop a spatially varying, inclined seismic wave field from incident Primary (P) and Secondary (S) waves that propagate through layered ground. Developed seismic wave field is then used to develop effective forces for Domain Reduction Method that are then used for analyzing ESSI response of a soil structure system. Developed methodology, called WPF-DRM, is verified using analytic solution for a free field response of layered ground subjected to inclined incident waves. Developed WPF-DRM methodology is illustrated through analysis of an ESSI response of a deeply embedded structure, a small modular reactor (SMR) subjected to incident S wave polarized in vertical plane (SV) with variation in inclinations and frequencies. Presented example highlights the influences of incident wave inclination and frequency on ESSI response of analyzed SMR.

58 GEOSCIENCES↗

Explorative Visualization for Traffic Safety using Adaptive Study Areas

The pressing need to improve traffic safety has become a societal concern in many cities around the world. Many traffic accidents are not occurring as stand-alone events but as consequences of other road incidents and hazards. To capture the traffic safety indications from a holistic aspect, this paper presents a suite of visualization techniques to explore large traffic safety datasets collected from different sources using adaptive study areas which include the whole region (Hamilton County, Ohio, U.S.) as well as smaller sub-areas. In the present study, these data source include (1) Hamilton County’s 911 emergency response data, which includes traffic incidents as well as other types of incidents throughout the county, and (2) Tennessee crash data, which contains only vehicle crashes with more detail on the circumstances of each crash. We find that both abstract and spatial visualization techniques are used to derive a better understanding of traffic safety patterns for different traffic participants in various urban environments. In addition to the entire region of Hamilton County, safety is examined on the highways, in the downtown area, and in a shopping district east of the city center. It is possible to characterize incidents in the different areas, gain a better understanding of common incident patterns, and identify outliers in the data. Finally, a textured tile calendar is presented to compare spatiotemporal patterns.

99 GENERAL AND MISCELLANEOUS↗

Department of Energy Water Power Technologies Office Cyber Response & Recovery Flipbook [Slides]

Protecting hydroelectric plants from incidents that adversely impact their cyber-physical systems presents unique challenges due to the plants’ widely dispersed geographic locations and varied configurations as well as the relative nascent nature of the cyberattacks targeting these facilities. To help hydroelectric plants better respond to and mitigate cybersecurity incidents, this Department of Energy Water Power Technologies Office Cyber Response & Recovery Flipbook is to be used at a hydroelectric plant to quickly respond to an anomalous event. In addition to this product, there are three other products meant to be distributed to a hydroelectric plant to assist in their cyber incident response and recovery. The first, a report on the processes of building this flip book based on a large set of existing guidance. The second, a handy guide of hydroelectric and cyber guidance in responding to the cyber and physical systems within a hydroelectric plant. And the third is a correlated alignment of the steps an hydroelectric plant operator would take for both a cyber incident as well as an emergency response process if the event rises to a cyber incident affecting the safe and reliable operations of a hydroelectric plant.

13 HYDRO ENERGY↗

Intern Deliverable Poster 2025

An Incident Response Plan (IRP) is a document that is created and maintained by an organization that provides guidance in the event of a cyber incident. The primary objectives of an IRP are to aid in the detection, response, and recovery from incidents, as well as to enhance preparation and preventative measures. An IRP should outline specific procedures at each stage of an incident, with the goal of minimizing asset damage, data leakage, and operational impact. By investing in a well-defined IRP, organizations can better manage and mitigate risks associated with cyber threats, ensuring business continuity and resilience. This poster summarizes incident response guidelines for wind energy, which faces unique cybersecurity and physical challenges.

17 - WIND ENERGY↗

Using bursty announcements for detecting BGP routing anomalies

Despite the robust structure of the Internet, it is still susceptible to disruptive routing updates that prevent network traffic from reaching its destination. Our research shows that BGP announcements that are associated with disruptive updates tend to occur in groups of relatively high frequency, followed by periods of infrequent activity. We hypothesize that we may use these bursty characteristics to detect anomalous routing incidents. In this work, we use manually verified ground truth metadata and volume of announcements as a baseline measure, and propose a burstiness measure that detects prior anomalous incidents with high recall and better precision than the volume baseline. We quantify the burstiness of inter-arrival times around the date and times of four large-scale incidents: the Indosat hijacking event in April 2014, the Telecom Malaysia leak in June 2015, the Bharti Airtel Ltd. hijack in November 2015, and the MainOne leak in November 2018; and three smaller scale incidents that led to traffic interception: the Belarusian traffic direction in February 2013, the Icelandic traffic direction in July 2013, and the Russian telecom that hijacked financial services in April 2017. Our method leverages the burstiness of disruptive update messages to detect these incidents. We describe limitations, open challenges, and how this method can be used for routing anomaly detection.

97 MATHEMATICS AND COMPUTING↗

Hot Electron Driven Photocatalysis on Plasmon-Resonant Grating Nanostructures

Here, we demonstrate the hot electron injection of photoexcited carriers in an Ag-based plasmon resonant grating structure. By varying the incident angle of irradiation, sharp dips are observed in the reflectance with p-polarized light (electric field perpendicular to grating lines) when there is wavevector matching between the incident light and the plasmon resonant modes of the grating and no angle dependence is observed with s-polarized light. This configuration enables us to compare photoelectrochemical current produced by plasmon resonant excitation with that of bulk metal interband absorption simply by rotating the polarization of the incident light while keeping all other parameters of the measurement fixed. With 633 nm light, we observed a 12-fold enhancement in the photocurrent (i.e., reaction rate) between resonant and nonresonant polarizations at incident angles of ±7.6° from normal. At 785 nm irradiation, we observed similar resonant profiles to those obtained with 633 nm wavelength light but with a 44-fold enhancement factor. Using 532 nm light, we observed two resonant peaks (with approximately 10× enhancement) in the photocurrent at 19.4° and 28.0° incident angles, each corresponding to higher order modes in the grating with more nodes per period. The lower enhancement factors observed at shorter wavelengths are attributed to interband transitions, which provide a damping mechanism for the plasmon resonance. Finite difference time domain (FDTD) simulations of these grating structures confirm the resonant profiles observed in the angle-dependent spectra of these gratings and provide a detailed picture of the electric field profiles on and off resonance.

37 INORGANIC, ORGANIC, PHYSICAL, AND ANALYTICAL CH↗

Uncertainty-Aware and Explainable Human Error Detection in the Operation of Nuclear Power Plants

The timely and accurate identification of incidents, such as human factor error, is important to restore nuclear power plants (NPPs) to a stable state. However, the identification of abnormal operating conditions is difficult because of the existence of multiple scenarios. In addition, to implement mitigation actions rapidly after an incident occurs, operators must accurately identify an incident by monitoring the trends of many variables. The mental burden posed by this can increase human error and cause failure in identifying incidents. Failure to identify incidents directly results in erroneous mitigation measures, which are detrimental to NPPs. In this study, we leverage uncertainty-aware models to identify such errors and thereby increase the chances of mitigating them. We use the data collected from a physical test bed. The goal is to identify both certain and accurate models. For this, the two main aspects of focus in this study are explainable artificial intelligence (XAI) and uncertainty quantification (UQ). While XAI elucidates the decision pathway, UQ evaluates decision reliability. Their integration paints a comprehensive picture, signifying that understanding decisions and their confidence should be interlinked. Thus, in this study we leverage UQ measures (e.g. entropy and mutual information) along with Shapley additive explanations to gain insights into the features contributing to both accuracy and uncertainty in error identification. Furthermore, our results show that uncertainty-aware models combined with XAI tools can explain the artificial intelligence–prescribed decisions, with the potential of better explaining errors for the operators.

21 SPECIFIC NUCLEAR REACTORS AND ASSOCIATED PLANTS↗

Cutaneous and local radiation injuries

The threat of a large-scale radiological or nuclear (R/N) incident looms in the present-day climate, as noted most recently in an editorial in Scientific American (March 2021). These large-scale incidents are infrequent but affect large numbers of people. Smaller-scale R/N incidents occur more often, affecting smaller numbers of people. There is more awareness of acute radiation syndrome (ARS) in the medical community; however, ionising radiation-induced injuries to the skin are much less understood. Here, this article will provide an overview of radiation-induced injuries to the skin, deeper tissues, and organs. The history and nomenclature; types and causes of injuries; pathophysiology; evaluation and diagnosis; current medical management; and current research of the evaluation and management are presented. Cutaneous radiation injuries (CRI) or local radiation injuries (LRI) may lead to cutaneous radiation syndrome, a sub-syndrome of ARS. These injuries may occur from exposure to radioactive particles suspended in the environment (air, soil, water) after a nuclear detonation or an improvised nuclear detonation (IND), a nuclear power plant incident, or an encounter with a radioactive dispersal or exposure device. These incidents may also result in a radiation-combined injury; a chemical, thermal, or traumatic injury, with radiation exposure. Skin injuries from medical diagnostic and therapeutic imaging, medical misadministration of nuclear medicine or radiotherapy, occupational exposures (including research) to radioactive sources are more common but are not the focus of this manuscript. Diagnosis and evaluation of injuries are based on the scenario, clinical picture, and dosimetry, and may be assisted through advanced imaging techniques. Research-based multidisciplinary therapies, both in the laboratory and clinical trial environments, hold promise for future medical management. Great progress is being made in recognising the extent of injuries, understanding their pathophysiology, as well as diagnosis and management; however, research gaps still exist.

61 RADIATION PROTECTION AND DOSIMETRY↗

Measurement of the U 235 ( n , f ) prompt fission neutron spectrum from 10 keV to 10 MeV induced by neutrons of energy from 1 MeV to 20 MeV

The characterization of fission-driven nuclear systems primarily relies on calculations of neutron-induced chain reactions, and these calculations require evaluated nuclear data as input. Calculation accuracy heavily depends on input nuclear data evaluation accuracy, and thus high precision on the experimental input to the nuclear data evaluation is essential for fundamental quantities like the energy spectrum of neutrons emitted from neutron-induced fission (i.e., the prompt fission neutron spectrum, PFNS). Despite decades of measurement efforts, prior to the measurements described in this work there were only three literature data sets for the 235 U(n,f) PFNS at incident neutron energies above 1.0 MeV considered reliable for inclusion in nuclear data evaluations and no reliable data sets above 3.0 MeV incident neutron energy. In this work we report on new measurements of the 235 U(n,f) PFNS spanning a grid of 1.0–20.0 MeV in incident neutron energy and 0.01–10.0 MeV in outgoing (PFNS) neutron energy. These measurements were carried out at the Weapons Neutron Research facility at the Los Alamos Neutron Science Center and used a multifoil parallel-plate avalanche counter target with both a Li-glass and a liquid scintillator detector array in separate experiments to span the quoted outgoing neutron energy ranges. The PFNS results are shown in terms of the energy spectra themselves as well as the average PFNS energy $(\langle{E}\rangle)$ and ratios of $\langle{E}\rangle$ at forward and backward angles. Here, the results are compared with literature data and selected nuclear data evaluations. Generally, the data agree with the ENDF/B-VIII.0 evaluation below 5.0-MeV incident neutron energy and more closely with the JEFF-3.3 evaluation above 5.0 MeV, though no evaluations considered for comparison in this work agree with the data across all of the incident and outgoing neutron energies shown, especially in regions where the third-chance fission process becomes available. Additionally, we show a ratio of the present PFNS results for 235 U(n, f) with a recent and highly correlated experiment to measure the 239 Pu(n, f) PFNS at the same experimental facility and with nearly identical equipment and analysis procedures. Many observations reported in this work are the first of their kind and represent significant advancements for knowledge of the 235 U(n, f) PFNS.

73 NUCLEAR PHYSICS AND RADIATION PHYSICS↗

Proton Quenching in Rare-Earth Inorganic Scintillators: GAGG:Ce and YSO:Ce

Scintillator detectors are an integral component of radiation detection systems for a variety of applications such as medical imaging, accelerator diagnostics, and space science. Typically, a scintillator detector’s response is characterized using gamma sources to understand the detection response to different types of radiation, including charged particle detection. However, there exists a nonlinearity of the amount of light produced from an incident gamma ray of specific energy and the light produced from an incident charged particle of the same energy. This important effect, known as quenching, must be accounted for to interpret energies from charged particles incident on detectors. In this article, we present results of quenching parameterization for two types of cerium-doped inorganic scintillators, Y2SiO5:Ce (YSO:Ce) and Gd3Al2Ga3O12:Ce (GAGG:Ce). We measured the light output from incident proton energies from 1 to 25 MeV using a 3-MV tandem accelerator and two reactions: Au(p,p)Au and 3He(d,p)⁴He. Using gamma-ray sources to calibrate the detectors, we compared the measured electron-equivalent energy versus the incident energy expected. Using an adaptation of the Birks semi-empirical formula, we extracted the Birks parameter (kB) to understand quenching. For one of the GAGG:Ce samples, the kB parameter of 0.0072 [g cm-2 MeV-1] is comparable to a similar study where the value of kB was 0.0065 [g cm-2 MeV-1]. For YSO:Ce, no other kB values were found in the literature. Three different types of GAGG:Ce were used to collect measurements of kB as a function of dopant concentration.

46 INSTRUMENTATION RELATED TO NUCLEAR SCIENCE AND ↗

Pregnancy outcome after first trimester exposure to domperidone—An observational cohort study

Abstract Aim To assess the teratogenic risk of domperidone by comparing the incidence of major malformation with domperidone to a control. Methods Pregnancy outcome data were obtained for women at two Japanese facilities that provide counseling on drug use during pregnancy between April 1988 and December 2017. The incidence of major malformation was calculated among infants born to women taking domperidone ( n = 519), nonteratogenic drugs (control, n = 1673), or metoclopramide (reference, n = 241) during the first trimester of pregnancy. Using the control group as reference, the crude odds ratio (OR) of the incidence of major malformation in the domperidone and metoclopramide groups was calculated using univariable logistic regression analysis. Adjusted OR was also calculated using multivariable logistic regression analysis adjusted for various other factors. Results The incidence of major malformation was 2.9% (14/485, 95% confidence interval [CI]: 1.6–4.8) in the domperidone group, 1.7% (27/1554, 95%CI: 1.1–2.5) in the control group, and 3.6% (8/224, 95%CI: 1.6–6.9) in the metoclopramide group. The adjusted multivariable logistic regression analysis showed no significant difference in incidence between the control and domperidone groups (adjusted OR: 1.86 [95%CI: 0.73–4.70], p = 0.191) or between the control and metoclopramide groups (adjusted OR: 2.20 [95%CI: 0.69–6.98], p = 0.183). Conclusions This observational cohort study showed that domperidone exposure during the first trimester was not associated with increased risk of major malformation in infants. These results may help alleviate the anxiety of patients who took domperidone during pregnancy.

Hishinuma, Kayoko↗