Congenital Anomalies In Relation Research Articles

Educational achievement of children with selected major congenital anomalies and associated factors: a Finnish registry-based study.

Children with major congenital anomalies may be at risk of poor educational outcomes. We aimed to evaluate the educational achievement of children born with major congenital anomalies compared with children without major congenital anomalies in relation to sociodemographic factors. We performed a registry-based study including 401544 children in Finland, graduates of the compulsory school who applied to secondary education. We used health data from the Finnish Register of Congenital Malformations for children born from 1995 to 2002 linked with education data from the Finnish Ministry of Education and Culture. We used generalized linear regression to compare the mean grade differences of children with specific major congenital anomalies and 'All anomalies' subgroup (major congenital anomalies, chromosomal syndromes, and multiple anomalies) with reference children. Children with major congenital anomalies were less likely to apply for further education than reference children (88.0% vs. 96.8%; odds ratio = 4.13; 95% confidence interval, 3.92-4.36). For most non-chromosomal congenital anomalies, children born with congenital anomalies had similar educational achievement to the reference children. For the 'All anomalies' subgroup, children with congenital anomalies had lower educational achievement than reference children. Among children with congenital anomalies, male sex, lower maternal educational levels and younger maternal age were associated with lower educational achievement. For children applying to further education, most non-chromosomal congenital anomalies were not associated with lower educational achievement. Nevertheless, efforts are needed to improve educational achievement in children with major congenital anomalies associated with maternal sociodemographic background.

Occupational and environmental noise exposure during pregnancy and rare health outcomes of offspring: a scoping review focusing on congenital anomalies and perinatal mortality.

As environmental and occupational noise can be health hazards, recent studies have investigated the effects of noise exposure during pregnancy. Despite biological plausibility and animal studies supporting an association, studies focusing on congenital anomalies and perinatal mortality as outcomes of noise exposure are still scarce. We performed a scoping review to collect, summarise, and discuss the existing scientific research about the relationships between noise exposure during pregnancy and congenital anomalies and/or perinatal mortality. We searched electronic databases for papers published between 1970 and March 2021. We included 16 studies (seven on congenital anomalies, three on perinatal mortality, and two on both congenital anomalies and perinatal mortality). We assessed four studies on congenital hearing dysfunction as the definition of congenital anomalies includes functional anomalies. We found few studies on this topic and no studies on the combined effects of occupational and environmental noise exposures. Evidence suggests a small increase in the risk of congenital anomalies in relation to occupational and to a lesser extent environmental noise exposure. In addition, few studies investigated perinatal mortality and the ones that did, used different outcome definitions, so no conclusions could bemade. However, a recent big cross-sectional study demonstrated an association between road traffic noise and stillbirth. A few studies suggest a possible association between congenital hearing dysfunction and occupational noise exposure during pregnancy. Future studies with larger samples, better exposure assessments, and better statistical modelling strategies are needed to investigate these relationships further.

COVID‐19 in pregnancy—what study designs can we use to assess the risk of congenital anomalies in relation to COVID‐19 disease, treatment and vaccination?

BackgroundThe COVID‐19 pandemic has accelerated pregnancy outcome research, but little attention has been given specifically to the risk of congenital anomalies (CA) and first trimester exposures.ObjectivesWe reviewed the main data sources and study designs used internationally, particularly in Europe, for CA research, and their strengths and limitations for investigating COVID‐19 disease, medications and vaccines.PopulationWe classify research designs based on four data sources: a) spontaneous adverse event reporting, where study subjects are positive for both exposure and outcome, b) pregnancy exposure registries, where study subjects are positive for exposure, c) congenital anomaly registries, where study subjects are positive for outcome and d) population healthcare data where the entire population of births is included, irrespective of exposure and outcome.Study DesignEach data source allows different study designs, including case series, exposed pregnancy cohorts (with external comparator), ecological studies, case‐control studies and population cohort studies (with internal comparator).MethodsThe quality of data sources for CA studies is reviewed in relation to criteria including diagnostic accuracy of CA data, size of study population, inclusion of terminations of pregnancy for foetal anomaly, inclusion of first trimester COVID‐19‐related exposures and use of an internal comparator group. Multinational collaboration models are reviewed.ResultsPregnancy exposure registries have been the main design for COVID‐19 pregnancy studies, but lack detail regarding first trimester exposures relevant to CA, or a suitable comparator group. CA registries present opportunities for improving diagnostic accuracy in COVID‐19 research, especially when linked to other data sources. Availability of inpatient hospital medication use in population healthcare data is limited. More use of ongoing mother‐baby linkage systems would improve research efficiency. Multinational collaboration delivers statistical power.ConclusionsChallenges and opportunities exist to improve research on CA in relation to the COVID‐19 pandemic and future pandemics.

Airway Management for Patients with Cervical Spine Lesions

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Energy giants face 35% output cut to hit Paris climate goals

Few studies have investigated congenital anomalies in relation to municipal waste incinerators (MWIs) and results are inconclusive.To conduct a national investigation into the risk of congenital anomalies in babies born to mothers living within 10 km of an MWI associated with: i) modelled concentrations of PM10 as a proxy for MWI emissions more generally and; ii) proximity of residential postcode to nearest MWI, in areas in England and Scotland that are covered by a congenital anomaly register.Retrospective population-based cohort study within 10 km of 10 MWIs in England and Scotland operating between 2003 and 2010. Exposure was proximity to MWI and log of daily mean modelled ground-level particulate matter ≤10 μm diameter (PM10) concentrations.Analysis included 219,486 births, stillbirths and terminations of pregnancy for fetal anomaly of which 5154 were cases of congenital anomalies. Fully adjusted odds ratio (OR) per doubling in PM10 was: 1·00 (95% CI 0·98–1·02) for all congenital anomalies; 0·99 (0·97–1·01) for all congenital anomalies excluding chromosomal anomalies. For every 1 km closer to an MWI adjusted OR was: 1·02 (1·00–1·04) for all congenital anomalies combined; 1·02 (1·00–1·04) for all congenital anomalies excluding chromosomal anomalies; and, for specific anomaly groups, 1·04 (1·01–1·08) for congenital heart defect sand 1·07 (1·02–1·12) for genital anomalies.We found no increased risk of congenital anomalies in relation to modelled PM10 emissions, but there were small excess risks associated with congenital heart defects and genital anomalies in proximity to MWIs. These latter findings may well reflect incomplete control for confounding, but a possible causal effect cannot be excluded.

Risk of congenital anomalies near municipal waste incinerators in England and Scotland: Retrospective population-based cohort study

BackgroundFew studies have investigated congenital anomalies in relation to municipal waste incinerators (MWIs) and results are inconclusive. ObjectivesTo conduct a national investigation into the risk of congenital anomalies in babies born to mothers living within 10 km of an MWI associated with: i) modelled concentrations of PM10 as a proxy for MWI emissions more generally and; ii) proximity of residential postcode to nearest MWI, in areas in England and Scotland that are covered by a congenital anomaly register. MethodsRetrospective population-based cohort study within 10 km of 10 MWIs in England and Scotland operating between 2003 and 2010. Exposure was proximity to MWI and log of daily mean modelled ground-level particulate matter ≤10 μm diameter (PM10) concentrations. ResultsAnalysis included 219,486 births, stillbirths and terminations of pregnancy for fetal anomaly of which 5154 were cases of congenital anomalies. Fully adjusted odds ratio (OR) per doubling in PM10 was: 1·00 (95% CI 0·98–1·02) for all congenital anomalies; 0·99 (0·97–1·01) for all congenital anomalies excluding chromosomal anomalies. For every 1 km closer to an MWI adjusted OR was: 1·02 (1·00–1·04) for all congenital anomalies combined; 1·02 (1·00–1·04) for all congenital anomalies excluding chromosomal anomalies; and, for specific anomaly groups, 1·04 (1·01–1·08) for congenital heart defect sand 1·07 (1·02–1·12) for genital anomalies. DiscussionWe found no increased risk of congenital anomalies in relation to modelled PM10 emissions, but there were small excess risks associated with congenital heart defects and genital anomalies in proximity to MWIs. These latter findings may well reflect incomplete control for confounding, but a possible causal effect cannot be excluded.

Polyhydramnios - frequency of congenital anomalies in relation to the value of the amniotic fluid index.

The aims of our study were to assess the correlation between the amniotic fluid index (AFI) value and the frequency and type of fetal anomalies. The material included 94 patients at the third trimester of pregnancy, 60 with mild polyhydramnios, 19 with moderate one, and 15 with severe one. Polyhydramnios was diagnosed if AFI was > 24 cm. All patients were divided into three groups based on the value of AFI: 1) mild polyhydramnios with AFI between 24.1 and 29.9 cm, 2) moderate polyhydramnios with AFI between 30-34.9 cm, and 3) severe polyhydramnios with AFI ≥ 35 cm. The incidence of fetal malformations correlated significantly with the degree of polyhydramnios and was the highest in patients with severe polyhydramnios (53.3%, p = 0.002). Congenital malformations of the gastrointestinal tract were the most frequent fetal anomalies in the whole group of patients (5.3%). Trisomy 18 was the most frequent aneuploidy found in women with polyhydramnios (2.1%). The incidence of fetal congenital anomalies significantly increases with the degree of polyhydramnios, being most frequent in severe one and rather rare in a mild one. Congenital malformations of the gastrointestinal tract were the most frequent anomalies in patients with polyhy-dramnios, especially in women with severe polyhydramnios.

Risk of congenital anomalies in relation to the uptake of trihalomethane from drinking water during pregnancy

ObjectivesCongenital anomalies have been inconsistently associated with maternal crude estimated exposure to drinking water trihalomethane (THM). We investigated the relationship between individual THM uptake during the first trimester of pregnancy...

Mortality of Children Under Five and Prevalence of Newborn Congenital Anomalies in Relation to Macroeconomic and Socioeconomic Factors in Latvia

Mortality of infants and children younger than 5 years is a globally recognized and broad national welfare indicator. Scientific literature has data on the correlation of mortality indicators with macroeconomic indicators. It is important to study the associations between prevalence and mortality indicators and socioeconomic factors, since deaths from congenital anomalies account for approximately 25%-30% of all deaths in infancy. The aim of the study was to analyze the overall trend in mortality of infants and young children aged 0 to 4 years in relation to macroeconomic factors in Latvia and prevalence of congenital anomalies in newborns in relation to socioeconomic factors. The Newborns' Register and Causes of Death Register were used as data sources; data on specific socioeconomic factors were retrieved from the Central Statistics Office. The results of the study show a strong correlation between mortality in children younger than 5 years and gross domestic product, as well as health budget in LVL per capita and the national unemployment level. The average decrease in infant mortality from congenital anomalies in Latvia was found to be 6.8 cases per 100,000 live births. There is a strong correlation between child mortality and socioeconomic situation in the country. There is a need to analyze the data on child mortality in a transnational context on a regular basis and studying the correlations between child mortality indicators and socioeconomic indicators and health care management parameters.

Landfill sites and congenital anomalies – have we moved forward?

Elliott et al (see page 81) report the findings of a spatial analysis examining the risk of congenital anomalies in relation to the density of landfill sites within 2 km...

Geographic density of landfill sites and risk of congenital anomalies in England

Objective: To investigate the risk of congenital anomalies in relation to an index of geographic density of landfill sites across 5×5 km grid squares in England. Methods: 2 km zones...

Downʼs Syndrome in Births Near Landfill Sites

P-286 Introduction: Excess risk of non-chromosomal congenital anomalies near landfill sites in Great Britain has previously been reported. Some studies on chromosomal congenital anomalies in relation to waste handling processes have indicated small excess risks of Down's syndrome. The aim of the present study was to investigate the risk of giving birth to a baby with Down's syndrome in populations living near landfill sites. Methods: We used the National Down Syndrome Cytogenetic Register (NDSCR) which includes data on Down's syndrome cases in England and Wales. We used national postcoded birth data and NDSCR registrations for the years 1989–1998 complemented by Terminations data (1992–1998) due to Grounds E (risk of foetal handicap). We used distance from postcode of residence to landfill sites to assess potential exposure. Data provided by the national regulatory agencies were merged in a geographical information system to give a database containing 17 752 sites. We constructed a 2 km zone around each site, giving a resolution similar to or higher than that of previous studies, and at the likely limit of dispersion for landfill emissions. People living more than two km from all known landfill sites during the study period comprised the reference population. A ‘near vs. reference’ analysis was implemented within a Bayesian model, calculating expected numbers in the near area based on covariate-adjusted rates estimated from the reference data using a generalised linear model. Results: We found no excess risks of Down's syndrome related to landfill sites (RR= 1.009 (95% confidence interval 0.903–1.116). There were no differences in risk between sites licensed to carry special (= hazardous) waste and other sites. Discussion and Conclusions: Chromosomal congenital anomalies may result from long-term exposure to potential hazards in contrast to non-chromosomal anomalies, which would only be affected by exposures during pregnancy. Assuming a long latency and migration over a long period of time, this would most likely result in substantial exposure misclassification; hence results in our study (and others) may be biased towards the null. Some reports have indicated that low socio-economic status increases the risk of giving birth to a baby with Down syndrome. However, the small changes in risk after adjustment for deprivation in our study supports the concept that factors associated with deprivation, such as smoking, do not strongly influence risk of Down's syndrome. In conclusion, we found no evidence that living near a landfill increases the risk of having a baby with Down syndrome.

Risk of Congenital Anomalies in Relation to Geographic Density of Landfill Sites in England

Risk of Congenital Anomalies in Relation to Geographic Density of Landfill Sites in England

Stillbirth and neonatal mortality due to congenital anomalies: temporal trends and variation by small area deprivation scores in England and Wales, 1986–96

SummaryWe investigated the variation of stillbirth and neonatal mortality due to congenital anomalies in relation to small‐area measures of deprivation in a population‐based study in England and Wales, 1986–96. We found 10 954 stillbirths and neonatal deaths from all non‐chromosomal and chromosomal anomalies during the study period out of a total of 7 487 007 live and stillbirths. The extended perinatal mortality rate (EPM rate) (defined as babies who were stillborn or died within 28 completed days after birth per 10 000 total live and stillbirths) for all chromosomal and all non‐chromosomal anomalies was 1.5/10 000 and 13.2/10 000, respectively, over the whole period. The rate for non‐chromosomal anomalies halved over the decade while the rate for chromosomal anomalies remained unchanged. The relative risks of EPM for chromosomal and non‐chromosomal anomalies were 0.71 [0.80, 0.95] and 1.17 [95%CI 1.06, 1.30], respectively, in the group of wards with highest deprivation compared with the least deprived group. Increasing gradients of EPM with increasing deprivation were observed for (1) grouped non‐chromosomal anomalies including neural tube defects, all renal and urinary anomalies, all musculoskeletal anomalies, and multiple anomalies, and (2) several specific non‐chromosomal anomalies including anencephaly, limb reduction defects, diaphragm and abdominal wall defects. This study provides strong evidence that increased deprivation is associated with increased EPM due to most non‐chromosomal anomalies; the finding of decreased relative risk for chromosomal anomalies is probably related to differences in maternal age distribution between deprivation groups.

Stillbirth and neonatal mortality due to congenital anomalies: temporal trends and variation by small area deprivation scores in England and Wales, 1986-96.

We investigated the variation of stillbirth and neonatal mortality due to congenital anomalies in relation to small-area measures of deprivation in a population-based study in England and Wales, 1986-96. We found 10 954 stillbirths and neonatal deaths from all non-chromosomal and chromosomal anomalies during the study period out of a total of 7 487 007 live and stillbirths. The extended perinatal mortality rate (EPM rate) (defined as babies who were stillborn or died within 28 completed days after birth per 10 000 total live and stillbirths) for all chromosomal and all non-chromosomal anomalies was 1.5/10 000 and 13.2/10 000, respectively, over the whole period. The rate for non-chromosomal anomalies halved over the decade while the rate for chromosomal anomalies remained unchanged. The relative risks of EPM for chromosomal and non-chromosomal anomalies were 0.71 [0.80, 0.95] and 1.17 [95%CI 1.06, 1.30], respectively, in the group of wards with highest deprivation compared with the least deprived group. Increasing gradients of EPM with increasing deprivation were observed for (1) grouped non-chromosomal anomalies including neural tube defects, all renal and urinary anomalies, all musculoskeletal anomalies, and multiple anomalies, and (2) several specific non-chromosomal anomalies including anencephaly, limb reduction defects, diaphragm and abdominal wall defects. This study provides strong evidence that increased deprivation is associated with increased EPM due to most non-chromosomal anomalies; the finding of decreased relative risk for chromosomal anomalies is probably related to differences in maternal age distribution between deprivation groups.

Registration of Congenital Anomalies in the Dutch National Perinatal Registrations 518

Introduction: Concern about possible changes in the birth prevalence of certain congenital anomalies in relation to new reproductive techniques, or use of certain medication during pregnancy highlight the need for good quality national data on congenital anomalies. Up to now there are two regional EUROCAT-registries in the Netherlands, that provide good quality regional data. Because of the known regional differences in Europe, it is however, not possible to extrapolate these regional EUROCAT-data to national data. In the Netherlands there exist also two perinatal registration systems that register congenital anomalies. In the national birth registration (NBR) data are registered by the midwife or obstetrician immediately after birth. In the national neonatology registration (LNR) all children admitted to a pediatric ward in the first month of life are registered. The LNR therefore also contains data on congenital anomalies which are not detectable at birth but become manifest within the first month of life.

An Ecologic Analysis of Congenital Anomalies and Agricultural Chemicals in Colorado, 1989-1991

Objectives — The purpose of this article is to describe the distribution of congenital anomalies in relation to pesticide application, crop type, and farming methods in Colorado. Methods — Birth defects data, assigned to the county of residence of the mother, were obtained from Colorado’s Registry for Children with Special Needs for the years 1989–1991. Counties were grouped by crop reporting districts; these crop reporting districts were classified as high, medium or low based on total acres of each agricultural activity as a ratio of the total acres in the district. Rates were calculated for high, medium, and low districts for 10 different farming practices. Results — Rate ratios for Down syndrome and other chromosomal anomalies were elevated in areas high in herbicide application (3.02, 2.04), irrigated pastureland (2.83, 2.59), and fungicide application (2.39, 2.02). Rate ratios for patent ductus arteriosus were elevated in areas with irrigated pastureland (1.26) and irrigated cropland (1.22). Conclusions — Districts in Colorado high in application of herbicides and fungicides, and areas using irrigation methods have elevated rates of certain birth defects, including chromosomal defects and heart anomalies. A more detailed evaluation of these relationships are needed.