Birth Defects Surveillance System Research Articles

Use of Selective Serotonin-Reuptake Inhibitors in Pregnancy and the Risk of Birth Defects

Estimates of the lifetime risk of major depression in women range from 10% to 25%, peaking during the reproductive years. Today, selective serotonin-reuptake inhibitors (SSRIs) are the most commonly used type of antidepressant medication. Recent studies suggest that taking these drugs while pregnant may be associated with birth defects in general and with congenital heart defects in particular. The investigators have analyzed data from 9622 case infants having major birth defects and 4092 control infants who were born in the years 1997 to 2002 and enrolled in the National Birth Defects Prevention Study. Both cases and controls were chosen through birth defects surveillance systems in 8 states. The mothers took part in a standardized phone interview dealing with exposure to potential risk factors, including medications, before and during pregnancy. Exposure was defined as taking any SSRI from 1 month before to 3 months after conception. Combining cases and control subjects, 3% of study participants reported having used a SSRI at some time before or during pregnancy, and 2.3% during the designated 4-month interval. No significant association was found between the maternal use of SSRIs during early pregnancy and congenital heart defects. There were, however, 3 conditions associated with maternal use of SSRIs. They included anencephaly (adjusted odds ratio [OR], 2.4; 95% confidence interval [CI], 1.1–5.1); craniosynostosis (OR, 2.5; 95% CI, 1.5–4.0); and omphalocele (OR, 2.8; 95% CI, 1.3–5.7). None of the mothers of case infants having defects associated with SSRI use were found to have been exposed at the same time to medications known to have teratogenic effects. This study failed to establish any association between the maternal use of SSRIs during early pregnancy and an elevated risk of congenital heart defects—or of several other classes of birth defects. Three associations were observed, but the absolute risks were small in view of the baseline risk of birth defects inherent in all pregnancies. At the same time, maternal stress and depression during pregnancy have been implicated in adverse reproductive outcomes, and discontinuing antidepressant therapy in pregnant women who are seriously depressed may negatively affect both the mother and infant.

The Fetal Alert Network: Surveying congenital anomalies

To the Editor; Meschino (1) has commented on the innovative nature of the Fetal Alert Network (FAN) in Ontario as was reviewed previously (2); however, we would like to point out that there are only two provinces in Canada that have population-based congenital anomaly (birth defect) registries or surveillance systems, namely British Columbia and Alberta. The remaining provinces that Meschino listed, as did Kim et al (3), have very limited systems such as the maternal serum screen programs of Manitoba and Ontario, perinatal databases of Ontario and Nova Scotia (Nova Scotia also has a fetal anomaly registry) and the Newfoundland provincial medical genetics program with a short ascertainment period. The latter depends on referral to their program and is, therefore, not population-based and would not necessarily have any information on stillbirths or terminations of pregnancy. We agree that it is a serious deficiency not to have a good congenital anomaly surveillance system in Ontario, where 40% of Canada’s births take place. The FAN depends on a patient being referred for prenatal diagnosis to one of the five collaborating centres, but they do not state how they will capture cases who are not referred, who are stillborn or who die with a congenital anomaly after the perinatal period. In our opinion, Ontario could use the FAN as an excellent start but they will need to do much more than that if they are to have a comprehensive population-based surveillance system for birth defects. The FAN’s one-year study of 832 cases comprises only 0.63% of Ontario’s annual births (approximately 132,000) (4). Having a central clearinghouse with the FAN as its base, collecting data from many other sources including the Ontario perinatal system and the maternal serum screen system as well as from genetics clinics, would be a good start. Ontario has also had a problem in the past with the denominator because not all births were registered, but we understand Ontario Vital Statistics is rectifying that. Meschino should realize that ‘traditional surveillance systems’ have not stood still but are, in fact, ascertaining prenatally diagnosed cases and terminations of pregnancy and also have plans to use record linkage methods to perinatal programs. Consequently, data on maternal health, weight, exposure to teratogens and other risk factors can be linked to the congenital anomaly in question. Ethnicity is not necessarily easy to obtain because Canada has decided that it is not to be collected. We also agree with Meschino that congenital anomalies surveillance systems are not adequate if they cannot ascertain prenatally diagnosed cases and terminations, as is the case with the Public Health Agency of Canada’s system (Canadian Congenital Anomalies Surveillance System). We submit that the data from the FAN alone will not allow comparisons with other provinces and countries except for a limited number of sentinel anomalies. The longer an ascertainment period exists, the better the data, but a reasonable compromise is a minimum of one year of age.

Nutrient intakes in women and risks of anophthalmia and microphthalmia in their offspring

There is a paucity of information about risk factors for the human eye anomalies anophthalmia and microphthalmia. In this population-based case-control study we investigated whether periconceptional intakes of supplemental folic acid, dietary folate, vitamin A, and several other nutrients were associated with these eye defects. This study included data on deliveries that had estimated due dates from 1997-2002 and were part of the National Birth Defects Prevention Study (the National Birth Defects Prevention Study is a population-based case-control study of a wide spectrum of birth defects, incorporating data from 10 birth defects surveillance systems in the United States [Arkansas, California, Georgia/Centers for Disease Control and Prevention, Iowa, Massachusetts, New Jersey, New York, North Carolina, Texas, and Utah]). Cases were those infants or fetuses born with either anophthalmia or microphthalmia. Liveborn infants without major malformations were eligible as controls. Maternal interviews were conducted, primarily by telephone, in English or Spanish. Participation in the interview was 71% among case mothers and 68% among control mothers. Interviews were completed with 89 case mothers and 4,143 control mothers. A shortened version of the food frequency questionnaire from the Nurse's Health Study was used to assess frequency of intake of 58 food items during the year before pregnancy. Our results did not indicate reduced risks for these eye malformations associated with maternal intake of vitamin supplements containing folic acid. The data did not show an association between malformation risk and higher or lower intakes of vitamin A. We also did not observe strong evidence that an abundance or a lack of dietary intake of any other nutrient was associated with increased risk of the studied eye malformations. Our observations contribute to a limited body of findings on these rare eye defects.

Fetal Death Certificates as a Source of Surveillance Data for Stillbirths with Birth Defects

We assessed fetal death certificates (FDCs) as a source of surveillance for stillbirths with birth defects by linkage with data from the Metropolitan Atlanta Congenital Defects Program (MACDP), a population-based birth defects surveillance system. Stillbirths with defects in MACDP were identified from 1994 through 2002 and linked to FDCs. Sensitivity of FDCs for capturing stillbirths with defects was estimated, and predictors for a case being reported were assessed. Concordance for selected variables from each data source was evaluated. RESILTS: Two hundred twenty-four of 257 stillbirths with birth defects in MACDP were linked to an FDC (linkage rate = 87.2%; 95% confidence interval [CI] 82.4, 91.0). Stillbirths of non-Hispanic black and Hispanic/other mothers were more likely to be issued an FDC (odds ratio [OR] = 5.6 [95% CI 1.9, 17.0] and 14.0 [95% CI 1.7, 114.0], respectively). Cases undergoing autopsy were more likely to be issued an FDC (OR = 3.2; 95% CI 1.1, 8.7). Performance of an amniocentesis was poorly recorded on FDCs. The sensitivity and positive predictive value of FDCs for selected classes of defects ranged from 10% to 70% and 25% to 93%, respectively. Compared to FDCs, MACDP's active case identification improves the ascertainment of stillbirths with birth defects and the quality of certain recorded data.

Stability of prevalence rates of anorectal malformations in the Alberta Congenital Anomalies Surveillance System 1990-2004

Background/Purpose Anorectal malformations appeared to be increasing in the province of Alberta, Canada. To assess whether this was a significant trend, with the possibility of these having a teratogenic origin, we examined the frequency of anorectal malformations over a 15-year period. Methods We examined the records of the Alberta Congenital Anomaly Surveillance System, which is a semiactive surveillance system using the British Paediatric Association and the Royal College of Paediatrics and Child Health expansions of the International Classification of Diseases–Ninth Revision and the International Classification of Diseases–10th Revision. Results The overall rate was 1/2162 (4.63/10,000 total births) with a marked male predominance (1.7:1). Approximately two thirds of the 273 cases had 1 or more malformations. Conclusion Although there was an increasing trend in the rate from 1999 especially for the multiples, this was not significant. In view of the advances in syndrome identification and molecular diagnostics, consideration should be given to a detailed review of the family history and appropriate testing not only for multiple cases but also for isolated ones.

Maternal Thyroid Disease as a Risk Factor for Craniosynostosis

To study the relationship between maternal thyroid disease and craniosynostosis using data from the National Birth Defects Prevention Study, a multisite, case-control study. Case infants (n=431) were identified through population-based birth defects surveillance systems at eight sites and had craniosynostosis verified by radiographic imaging. Control infants (n=4,094) consisted of a random sample of live births with no major birth defects from the same population as the case infants. Information on thyroid disease was based on self-report: mothers who reported either a thyroid disorder or use of a medication to treat a thyroid disorder during pregnancy were considered to have thyroid disease. Using an unconditional logistic regression model, we considered potential confounding factors (maternal age, race or ethnicity, smoking, body mass index, preexisting diabetes, plurality, gravidity, family history, infant sex). Among case mothers, 19 (4.4%) were classified as having thyroid disease, compared with 65 (1.6%) of control mothers. Maternal thyroid disease was associated with craniosynostosis after controlling for maternal age (adjusted odds ratio 2.47, 95% confidence interval 1.46-4.18), the only factor that remained significant in the final model. These data provide additional evidence that maternal thyroid disease (most likely Graves' disease) or its treatment is associated with craniosynostosis. Given the frequency of maternal thyroid disease, this association warrants further investigation. II.

A possible association between maternal glomerulonephritis and congenital intestinal atresia/stenosis—a population-based case–control study

The objective of the study was to estimate association between maternal glomerulonephritis during pregnancy and structural birth defects, i.e. congenital abnormalities. The prevalence of maternal glomerulonephritis during the first trimester of pregnancy in cases with different congenital abnormalities was compared to that of matched controls without congenital abnormalities in the population-based Hungarian Case-Control Surveillance System of Congenital Abnormalities. Of 22,843 cases with congenital abnormalities, 309 (1.35%) had mothers with glomerulonephritis during pregnancy, compared to 479 (1.26%) of 38,151 controls (adjusted POR with 95% CI = 1.0, 0.9-1.2). Specified groups of congenital abnormalities were also assessed versus controls. Cases with isolated intestinal atresia/stenosis (adjusted POR with 95% CI: 6.8, 1.3-37.4) based on five cases were more likely to have mothers with prospectively and medically recorded glomerulonephritis. In conclusion a higher rate of congenital isolated intestinal atresia/stenosis may be associated with the maternal glomerulonephritis. However, this finding is considered only as signal and further studies are needed to confirm or reject this possible association.

Issues in Estimating the Prevalence of Fetal Alcohol Syndrome: Examination of 2 Counties in New York State

Two demographically similar counties included in the New York Fetal Alcohol Syndrome Surveillance Network had very different prevalence rates. This study examined the components of the surveillance in an attempt to discover the reasons for this discrepancy. Erie County and Monroe County were the 2 most populous counties included in the New York Fetal Alcohol Syndrome Surveillance Network. Erie County includes Buffalo, the second largest city in New York State, and Monroe County includes Rochester, the third largest city. Multiple sources of ascertainment included birth defect surveillance systems, genetic clinics, and early intervention programs. The case definition was based on the Institute of Medicine criteria of an abnormality in each of the following 3 areas: facial features, central nervous system, and growth. Children born in Erie County or Monroe County between 1995 and 1999 were included. The fetal alcohol syndrome prevalence rates in these 2 counties were 0.90 cases per 1000 births and 0.21 cases per 1000 births, respectively. The 2 counties were demographically similar and had similar rates of binge drinking among women of childbearing age. There was less participation in the surveillance system by sources in Monroe County. Erie County had a very active clinician with a specialized fetal alcohol syndrome clinic. The participation of clinicians in one county, especially one with expertise in fetal alcohol syndrome, was the most likely explanation for the differences in prevalence rates between the counties.

Pregnancy complications and birth outcomes of pregnant women with urinary tract infections and related drug treatments

Maternal urinary tract infections in pregnancy showed an association with a higher rate of preterm birth in previous studies. The aim of this study was to check this relationship, and in addition to evaluate the efficacy of recent medical treatments. The population-based large control (without any defects) data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities was evaluated. Of 38,151 newborn infants, 2188 (5.7%) had mothers with urinary tract infections during pregnancy, and 90% of these maternal diseases were prospectively and medically recorded. The prevalence of pre-eclampsia and polyhydramnios showed an association with urinary tract infections during pregnancy. Pregnant women with urinary tract infections in pregnancy had a somewhat shorter gestational age (0.1 week) and a higher proportion of preterm births (10.4% vs 9.1%). These differences were correlated with the severity of urinary tract infections. However, the preterm-inducing effect of maternal urinary tract infections is preventable by some antimicrobial drugs such as ampicillin, cefalexin and cotrimoxazole. In conclusion, maternal urinary tract infections during pregnancy increase pre-eclampsia and polyhydramnios, and in addition the rate of preterm birth; however, the latter is preventable by appropriate drug treatments.

Population‐based birth defects surveillance systems in the United States

Population‐based birth defects surveillance systems in the United States

Pregnancy complications and delivery outcomes in pregnant women with severe migraine

Objective The objective was to study the possible association among maternal migraine during pregnancy, pregnancy complications, and the delivery outcomes: sex ratio, gestational age/birth weight and preterm birth/low birth weight. Study design The population-based large data set of newborn infants without any defects of the Hungarian Case–Control Surveillance System of Congenital Abnormalities, 1980–1996 was analyzed. Results Out of 38,151 newborn infants, 713 (1.9%) had mothers who had severe migraine during pregnancy; 68% were medically recorded. Pregnant women with severe migraine had a higher prevalence of preeclampsia and severe nausea/vomiting, but a lower occurrence of threatened abortion and preterm delivery. However, mean gestational age and birth weight, as well as the proportion of low birth weight and preterm births, were similar in newborn infants born to mothers with or without migraine. Conclusion Severe maternal migraine and its related drug treatment may increase the occurrence of preeclampsia and severe nausea/vomiting during pregnancy, but is not associated with unfavorable delivery outcomes.

Evaluation of the Texas Birth Defects Registry: An active surveillance system

Evaluations of surveillance systems are necessary to determine if the goals of the system are being met, how efficiently the surveillance is being implemented, and if resources are being used appropriately. An evaluation of the Texas Birth Defects Registry was conducted to assess the overall quality of data collection and to examine variations across regions of the state. The registry was evaluated by using published guidelines for evaluating public health surveillance systems; the evaluation included staff interviews, process observation, and secondary data analysis. The registry monitors >370,000 births/year through active surveillance, with considerable disparities in workload across regions of the state. Because of the geographic size and substantial population of Texas, data collection is complex. However, the estimated sensitivity of the system appears sufficient, and rates for selected defects are highly comparable with other U.S. active birth-defect surveillance systems. Registry staff continually monitor the quality of data collection and provide additional training. Amid unstable funding, the registry staff have demonstrated optimal foresight and flexibility to adapt and continue quality data collection. Timeliness needs to be improved and more consistent quality assurance is needed across regions of the state. Retaining staff and increasing visibility are essential to providing more stability. Active surveillance for birth defects is labor-intensive but provides invaluable data for its stakeholders. The Texas Birth Defects Registry has proven to be a quality surveillance system and a beneficial resource for Texas.

Hospitalizations of Newborns With Folate-Sensitive Birth Defects Before and After Fortification of Foods With Folic Acid

The prevalence of neural tube defects is reduced in populations of women who receive folic acid supplementation. Since 1998, grain products in the United States have been fortified with folic acid. Fortification may have additional benefits by reducing the national prevalence of newborn hospitalizations for other folate-sensitive birth defects. Our purpose with this work was to compare rates of hospitalizations of newborns with folate-sensitive birth defects before and after implementation of fortification of grains. National hospital discharge data from the Healthcare Cost and Utilization Project were used to compute rates of newborn hospitalizations for selected birth defects per 10,000 live births in the United States. Newborn hospitalization rates involving congenital anomalies recognizable at birth were analyzed for 5 years before fortification of grains and 5 years after fortification. Additional analyses compared changes in newborn hospitalization rates for birth defects by race/ethnicity, income, insurance status, and region of the country. Newborn hospitalization rates for spina bifida decreased 21% from 1993-1997 to 1998-2002. Newborn hospitalization rates also decreased for anencephaly (20%) and limb-reduction defects (4%). Decline in hospitalizations for spina bifida occurred more often among Hispanic newborns (33%) than among white (13%) or black (21%) newborns. Decline in limb-reduction defects was seen primarily among blacks (11%). Findings using hospitalization data were similar to recent reports using birth defect surveillance systems with the exception of findings for orofacial clefts and conotruncal heart defects. No reductions were noted in newborn hospitalizations for these anomalies. Results from this ecological study fail to demonstrate substantial declines in newborn hospitalizations beyond those anticipated from a reduction in neural tube defects. The society-wide impact of the fortification program on birth defects and other health conditions should continue to be monitored.

Are Encephaloceles Neural Tube Defects?

Encephalocele is classified as a neural tube defect, but questions have been raised regarding whether its epidemiological characteristics are similar to those of other neural tube defects. We compared characteristics of temporal trends in, and the impact of folic acid grain fortification on, the prevalence of encephalocele, spina bifida, and anencephaly using data from the Metropolitan Atlanta Congenital Defects Program, a population-based birth defects surveillance system. Prevalences of encephalocele, spina bifida, and anencephaly were compared by maternal age, gender, race, birth weight, ascertainment period (1968-1981, 1982-1993, or 1994-2002), and fortification period (1994-1996 [prefortification] and 1998-2002 [postfortification]) using prevalence ratios with 95% confidence intervals. Temporal trends were assessed using Poisson and negative binomial regression models. Prevalence rates of encephalocele (n = 167), spina bifida (n = 650), and anencephaly (n = 431) were 1.4, 5.5, and 3.7 per 10 000 live births, respectively. Encephalocele was similar to anencephaly in showing an increased prevalence among girls and multiple gestation pregnancies and to spina bifida and anencephaly in an annual prevalence decrease between 1968 and 2002 (-1.2% for encephalocele, -4.2% for spina bifida, and -3.6% for anencephaly). With fortification, prevalence decreased for spina bifida but not significantly for encephalocele or anencephaly. Encephalocele shows more similarities to spina bifida or anencephaly than it shows differences with respect to characteristics, temporal trend, and impact of fortification. Additional studies should be done to explore the etiologic heterogeneity of encephalocele using better markers of folate status and a wider range of risk factors.

Prevalence of Neural Tube Defects, Folate Status, and Folate Fortification of Enriched Cereal-Grain Products in the United States

In their recent report, Williams et al1 examined data from 21 population-based birth defect surveillance systems for trends in prevalence of spina bifida and anencephaly for specific racial/ethnic groups from 1995 to 2002. Data were stratified into pre-, optional, and mandatory fortification intervals, coincident with the authorization of folate fortification of enriched cereal-grain products by the Food and Drug Administration (FDA) in 1996. Williams et al1 found prevalence values per 10000 births for spina bifida for Hispanic, non-Hispanic white, and non-Hispanic black women of 4.18, 3.37, and 2.90, respectively, for the mandatory fortification interval versus corresponding values for the same groups of 6.49, 5.13, and 3.57, respectively, for the prefortification interval. These results suggested that folate fortification was associated with significant decreases in the prevalence of spina bifida among non-Hispanic white and Hispanic births (34% and 36% decreases, respectively). The 19% decline in the prevalence of spina bifida among non-Hispanic black births was borderline statistically significant.1 This failure to find a statistically significant decline among non-Hispanic black births may have been attributable to smaller samples examined (total cases were 515 for non-Hispanic black births, 2672 for non-Hispanic white births, and 1281 for Hispanic births). In their editorial on the article by Williams et al,1 Brent and Oakley2 argued that folic acid fortification levels in the United States are too low. They have inappropriately generalized the data of Williams et al1 into a broad criticism of the current folic acid fortification program and a call for increased fortification. This warrants our response. Consideration of whether increases in fortification are warranted depends a number of complex issues. For example, are the residual neural tube defects (NTDs) in all racial/ethnic groups folate sensitive? If so, then would increasing the levels of folic acid in enriched cereal-grain products … Address correspondence to Jeanne I. Rader, PhD, Division of Research & Applied Technology, Office of Nutritional Products, Labeling and Dietary Supplements, Center for Food Safety and Applied Nutrition, Food and Drug Administration, 5100 Paint Branch Pkwy, College Park, MD 20740. E-mail: Jeanne.Rader{at}cfsan.fda.gov

Maternal panic disorder and congenital abnormalities: A population‐based case‐control study

Maternal panic disorder in pregnancy is the most common manifestation of anxiety disorders in Hungary. The association between panic disorder during pregnancy and structural birth defects, i.e., congenital abnormalities, was studied. The prevalence of maternal panic disorder in cases with different congenital abnormalities was compared to that of matched controls in the population-based Hungarian Case-Control Surveillance System of Congenital Abnormalities. Of 22,843 cases with congenital abnormalities, 210 (0.9%) had mothers with panic disorder during pregnancy compared to 187 (0.5%) of 38,151 controls (adjusted prevalence odds ratio [POR] 1.6; 95% CI, 1.3-2.0). Specific groups of congenital abnormalities were also assessed versus controls. Cases with isolated cleft lip with or without cleft palate (CL/P) (adjusted POR, 3.4; 95% CI, 1.3-9.0) and multiple congenital abnormalities (adjusted POR, 3.0; 95% CI, 1.2-7.2) were more likely to have had mothers with panic disorder during the study pregnancy. Notably, among mothers with panic disorders, the associations were found only in offspring of untreated mothers. A higher rate of isolated CL/P and multiple congenital abnormalities may be caused by the direct biological effect of panic disorder or by the interaction of maternal panic disorder and lifestyle factors. Antipanic drug treatment seems to have a protective effect for isolated CL/P and multiple congenital abnormalities. Birth Defects Research (Part A), 2006.

Extremely high prevalence of neural tube defects in a 4‐county area in Shanxi Province, China

In the past, northern China's Shanxi Province has reported the highest incidence of neural tube defects (NTDs) in the world. However, little is known about the epidemiology of NTDs in this area in recent years. Data were collected from a population-based birth defects surveillance system in 4 counties that captures information on all live births, stillbirths of at least 20 weeks' gestation, and pregnancy terminations at any gestational age resulting from prenatal diagnosis of a birth defect. We also surveyed mothers of NTD case patients to determine their use of folic acid before and during early pregnancy. During 2003, 160 NTD cases were identified among 11,534 births (NTD birth prevalence = 138.7/10,000 births). The rates of anencephaly, spina bifida and encephalocele were 65.9, 58.1, and 14.7 per 10,000, respectively, and a female predominance was observed among anencephaly cases (male-to-female relative risk [RR], 0.49; 95% confidence interval [CI], 0.30-0.79), but not among spina bifida (RR, 0.90; 95% CI, 0.55-1.45) and encephalocele (RR, 1.03; 95% CI, 0.40-2.69) cases. The percentages of pregnancy termination following prenatal diagnosis of anencephaly, spina bifida, and encephalocele were 50%, 41.8%, and 35.3%, respectively. NTD birth prevalence tended to be higher among mothers aged <20 or > or =30 years (P = .06) and was markedly associated with lower levels of maternal education (P < .001). Among 143 NTD mothers, only 6 (4.2%) used folic acid supplements during the periconceptional period. The NTD birth prevalence rate in the study area is among the highest worldwide. Folic acid deficiency may be one important risk factor.

Pregnancy Complications and Delivery Outcomes of Pregnant Women with Common Cold

To study the association between common cold during pregnancy and pregnancy complications and delivery outcomes: gestational age/birth weight, in addition preterm birth and low birthweight. In the population-based large data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities (HCCSCA), 1980-1996, controls without congenital abnormalities were analysed. Of 38,151 newborn infants, 5,475 (14.4%) had mothers with common cold. The prevalence of threatened preterm delivery, placental disorders and severe nausea and vomiting was lower while the occurrence of anemia was higher in pregnant mothers with common cold than in mothers without common cold. Mothers with common cold in pregnancy had 0.1 week shorter gestational age, thus the proportion of preterm births (9.8% vs 9.1%) was somewhat larger. However, mean birth weight was somewhat larger (3,305 vs 3,271 g) and the proportion of low birthweight newborns (4.2% vs 5.9%) was smaller. Common cold during pregnancy does not increase the occurrence of pregnancy complications except anemia, while delivery outcomes showed minor but opposite (higher rate of preterm birth and lower rate of low birthweight) changes.

Inverse association between severe nausea and vomiting in pregnancy and some congenital abnormalities

The objective of the study was to investigate the possible association between nausea and vomiting in early pregnancy and congenital abnormalities. The prevalence of medically-recorded severe nausea and vomiting in early pregnancy in cases with congenital abnormalities and their available matched population controls without any defect was compared in the population-based large data set of the Hungarian Case-Control Surveillance System of congenital abnormalities, 1980-1996. Of 22,843 cases with as 25 different congenital abnormality groups, 1,713 (7.5%) cases had mothers with medically recorded and treated severe nausea and vomiting during pregnancy. Of 38,151 matched population controls, 3,777 (9.9%) had mothers with severe nausea and vomiting (adjusted prevalence odds ratio (POR) with 95% CI: 0.74, 0.68-0.79). Five congenital abnormality groups: cleft lip with or without cleft palate (0.50, 0.37-0.70), posterior cleft palate (0.53, 0.32-0.89), renal a/dysgenesis (0.23, 0.06-0.96), obstructive defects of urinary tract (0.32, 0.18-0.58), and cardiovascular malformations (0.68, 0.57-0.81) had mothers with a lower prevalence of severe nausea and vomiting in pregnancy (adjusted PORs with 95% CI included in parentheses). Of 25 congenital abnormality groups, 22 had POR lower than 1. Thus in this study the mothers of cases with congenital abnormalities were 26% less likely to have had severe nausea and vomiting in early pregnancy than the mothers of population controls without congenital abnormalities.

Possible association between maternal recurrent orofacial herpes in pregnancy and a lower rate of preterm birth

Objective. To study the possible association between orofacial herpes during pregnancy and pregnancy complications including preterm birth and low birth weight, since the results of previous studies are inconsistent.Method. The population-based large data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities was used; pregnancies in mothers with and without recurrent orofacial herpes were compared.Results. Of 38 151 newborn infants, 572 (1.5%) had mothers with recurrent orofacial herpes during pregnancy, while 37 577 had mothers with no orofacial herpes. Pregnant women with recurrent orofacial herpes had a higher prevalence of severe nausea and vomiting, threatened preterm delivery, and placental disorders but a lower prevalence of preeclampsia. Mothers with recurrent orofacial herpes during pregnancy also had a somewhat longer (0.4 weeks) gestation (adjusted t = 2.7; p = 0.006) and an obviously lower proportion of preterm births (3.5% vs. 9.3%; adjusted POR with 95% CI = 0.42, 0.27–0.65). However, there was no significant difference in the mean birth weight and rate of low birth weight infants between the two study groups.Conclusion. Recurrent orofacial herpes during pregnancy is associated with a smaller proportion of preterm births.