Study of stillbirth and major congenital anomaly among newborns in the high-level natural radiation areas of Kerala, India

Abstract

Monitoring newborns for adverse outcomes like stillbirth and major congenital anomalies (MCA) is being carried out in government hospitals since 1995 in and around high-level natural radiation areas, a narrow strip of land on the southwest coast of Kerala, India. Natural deposits of monazite sand containing thorium and its daughter products account for elevated levels of natural radiation. Among 141,540 newborns [140,558 deliveries: 139,589 singleton, 957 twins (6.81‰), 11 triplets (0.078‰), and one quadruplet] screened, 615 (4.35‰) were stillbirth and MCA were seen in 1,370 (9.68‰) newborns. Clubfoot (404, 2.85‰) was the most frequent MCA followed by hypospadias (152, 2.10‰ among male newborns), congenital heart disease (168, 1.19‰), cleft lip/palate (149, 1.05‰), Down syndrome (104, 0.73‰), and neural tube defects (72, 0.51‰). Newborns with MCA among stillbirths were about 20-fold higher at 190.24‰ (117/615) compared to 8.89‰ (1,253/140,925) among live births (P < .001). Logistic regression was carried out to compare stillbirth, overall, and specific MCA among newborns from areas with dose levels of ≤1.5, 1.51-3.0, 3.01-6.0 and >6mGy/year after controlling for maternal age at birth, gravida, consanguinity, ethnicity, and gender of the baby. Clubfoot showed higher prevalence of 3.26‰ at dose level of 1.51-3.0mGy/year compared to 2.33‰ at ≤1.5mGy/year (OR = 1.39; 95% CI, 1.12-1.72), without indication of any clear dose-response. Prevalences of stillbirth, overall MCA, and other specific MCA were similar across different dose levels and were relatively lower than that reported elsewhere in India, probably due to better literacy, health awareness, and practices in the study population.