Abstract
BackgroundSurveillance of congenital anomalies is important to identify potential teratogens.MethodsThis study analysed the prevalence of 61 congenital anomaly subgroups (excluding chromosomal) in 25 population-based EUROCAT registries (1980–2012). Live births, fetal deaths and terminations of pregnancy for fetal anomaly were analysed with multilevel random-effects Poisson regression models.ResultsSeventeen anomaly subgroups had statistically significant trends from 2003–2012; 12 increasing and 5 decreasing.ConclusionsThe annual increasing prevalence of severe congenital heart defects, single ventricle, atrioventricular septal defects and tetralogy of Fallot of 1.4% (95% CI: 0.7% to 2.0%), 4.6% (1.0% to 8.2%), 3.4% (1.3% to 5.5%) and 4.1% (2.4% to 5.7%) respectively may reflect increases in maternal obesity and diabetes (known risk factors). The increased prevalence of cystic adenomatous malformation of the lung [6.5% (3.5% to 9.4%)] and decreased prevalence of limb reduction defects [-2.8% (-4.2% to -1.5%)] are unexplained. For renal dysplasia and maternal infections, increasing trends may be explained by increased screening, and deceases in patent ductus arteriosus at term and increases in craniosynostosis, by improved follow up period after birth and improved diagnosis. For oesophageal atresia, duodenal atresia/stenosis and ano-rectal atresia/stenosis recent changes in prevalence appeared incidental when compared with larger long term fluctuations. For microcephaly and congenital hydronephrosis trends could not be interpreted due to discrepancies in diagnostic criteria. The trends for club foot and syndactyly disappeared once registries with disparate results were excluded. No decrease in neural tube defects was detected, despite efforts at prevention through folic acid supplementation.
Highlights
Since thalidomide and rubella (German measles) were discovered as powerful teratogens [1,2], congenital anomaly registries have been set up to facilitate research and surveillance concerning environmental causes of congenital anomalies, and to provide early warning of new teratogenic exposures[3]
For renal dysplasia and maternal infections, increasing trends may be explained by increased screening, and deceases in patent ductus arteriosus at term and increases in craniosynostosis, by improved follow up period after birth and improved diagnosis
Duodenal atresia/stenosis and ano-rectal atresia/stenosis recent changes in prevalence appeared incidental when compared with larger long term fluctuations
Summary
Since thalidomide and rubella (German measles) were discovered as powerful teratogens [1,2], congenital anomaly registries have been set up to facilitate research and surveillance concerning environmental causes of congenital anomalies, and to provide early warning of new teratogenic exposures[3]. A European network of population-based registries for the epidemiologic surveillance of congenital anomalies (EUROCAT, http://www.eurocat-network.eu/) surveys over 1.7 million births (29% of European birth population) per year from 38 high-quality multiple-source registries in 21 countries in Europe that ascertain congenital anomalies in terminations of pregnancy and births [7,8,9]. This paper presents the latest pan-European ten year trends (2003–2012) in 61 congenital anomaly subgroups (chromosomal anomalies are excluded as recent trends in chromosomal anomalies have already been reported) [12]. Anomalies that had significant increasing or decreasing trends are investigated in greater detail, by presenting the European prevalence over the past 32 years, and the prevalence and trends within each registry over the past ten years. Surveillance of congenital anomalies is important to identify potential teratogens
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