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K K, Bhawani Shankar N, Vasudevan S. Fetal Autopsy: Insights Into the Spectrum of Dysraphisms With Associated Anomalies. Cureus 2024; 16:e68147. [PMID: 39347145 PMCID: PMC11438577 DOI: 10.7759/cureus.68147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Accepted: 08/29/2024] [Indexed: 10/01/2024] Open
Abstract
Introduction and aim Malformations of the central nervous system (CNS) are one of the most devastating, yet most common congenital anomalies. Congenital CNS anomalies are structural or functional abnormalities of the brain and spinal cord that occur during the intrauterine developmental period and have a high intrauterine mortality. This study aimed to determine the frequency and distribution of neural tube defects (NTDs) in a tertiary care center for a period of 4.5 years. The neural tube defect was analyzed along with the other associated anomalies in the fetus. Its association with maternal risk factors was also analyzed. Materials and methods This retrospective study includes a total of 48 cases of neural tube defects, over a period of 4.5 years from January 2019 to June 2023, retrieved from the archives of the Department of Pathology at Saveetha Medical College. The study population included all fetuses diagnosed with NTDs during the fetal autopsies conducted at Saveetha Medical College during the period of study. The variables studied include maternal age, maternal risk factors, sex of the fetus, other associated anomalies in the fetus, and placental anomalies associated with the NTDs. Results A total of 48 cases of NTDs were included in this study. NTDs were more common among the female fetuses when compared with the male fetuses. The most common NTD observed in our study was anencephaly. The associated anomalies seen with NTDs include dysplastic kidney, unilateral renal agenesis, agenesis of urinary bladder, sacral agenesis, diaphragmatic hernia, bilateral talipes equinovarus deformity in both lower limbs. In the present study, among the placental defects seen in fetuses with NTDs, single umbilical artery was seen in four fetuses with NTDs. Twelve out of the 48 females included in the study did not take folic acid supplements during the antenatal period, and two females had a history of neural tube defects in their previous pregnancies. Conclusion This study emphasizes that intensive screening and documentation of coexistent abnormalities of NTDs is needed. Either ultrasonography/MRI or fetal autopsy should be conducted in order to exhibit certain diagnoses and to conduct proper prenatal genetic counseling for parents with fetuses having NTDs or having a history of fetuses with NTDs regarding ongoing and future pregnancies.
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Affiliation(s)
- Kavitha K
- Department of Pathology, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Neelayadakshi Bhawani Shankar
- Department of Pathology, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
| | - Sudha Vasudevan
- Department of Pathology, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, IND
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Głowska-Ciemny J, Szmyt K, Kuszerska A, Rzepka R, von Kaisenberg C, Kocyłowski R. Fetal and Placental Causes of Elevated Serum Alpha-Fetoprotein Levels in Pregnant Women. J Clin Med 2024; 13:466. [PMID: 38256600 PMCID: PMC10816536 DOI: 10.3390/jcm13020466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/05/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
The most common association related to alpha-fetoprotein (AFP) is fetal neural tube defect (NTD), and indeed, this is where the international career of this protein began. In times when ultrasonography was not yet technically advanced, the detection of high levels of AFP in maternal serum (MS-AFP) and amniotic fluid was the basis for suspecting neural tube defects. In cases where there was no confirmation of NTD, other causes were sought. It has been established that high titers of MS-AFP could originate in other defects or diseases, such as (1) increased proteinuria in severe fetal kidney diseases; (2) pathological overproduction in liver diseases; (3) penetration through the membranes of gastrointestinal organs exposed to amniotic fluid; (4) passage through the walls of skin vessels; and as a side effect of (5) hepatic hematopoiesis and increased transfer through the edematous placenta in fetal anemia. This article provides a review of the current literature on congenital defects and genetic diseases in the fetus where an elevated level of MS-AFP may serve as the initial diagnostic clue for their detection.
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Affiliation(s)
- Joanna Głowska-Ciemny
- PreMediCare Prenatal Research Center, 21 Czarna Rola St., 61-625 Poznan, Poland; (K.S.); (A.K.); (R.K.)
- New Med Medical Center, 100 Szamotulska St., 60-566 Poznan, Poland
| | - Konrad Szmyt
- PreMediCare Prenatal Research Center, 21 Czarna Rola St., 61-625 Poznan, Poland; (K.S.); (A.K.); (R.K.)
| | - Agata Kuszerska
- PreMediCare Prenatal Research Center, 21 Czarna Rola St., 61-625 Poznan, Poland; (K.S.); (A.K.); (R.K.)
- Department of Gynecology and Obstetrics, Institute of Medical Sciences, University of Zielona Gora, 28 Zyty St., 65-046 Zielona Gora, Poland;
| | - Rafał Rzepka
- Department of Gynecology and Obstetrics, Institute of Medical Sciences, University of Zielona Gora, 28 Zyty St., 65-046 Zielona Gora, Poland;
| | - Constantin von Kaisenberg
- Department of Obstetrics and Gynecology, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany;
| | - Rafał Kocyłowski
- PreMediCare Prenatal Research Center, 21 Czarna Rola St., 61-625 Poznan, Poland; (K.S.); (A.K.); (R.K.)
- New Med Medical Center, 100 Szamotulska St., 60-566 Poznan, Poland
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Barlow-Mosha L, Serunjogi R, Kalibbala D, Mumpe-Mwanja D, Williamson D, Valencia D, Tinker SC, Matovu JN, Moore CA, Adler MR, Nelson L, Nankunda J, Nabunya E, Birabwa-Male D, Musoke P. Prevalence of neural tube defects, maternal HIV status, and antiretroviral therapy from a hospital-based birth defect surveillance in Kampala, Uganda. Birth Defects Res 2021; 114:95-104. [PMID: 34766465 PMCID: PMC8828660 DOI: 10.1002/bdr2.1964] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/03/2021] [Accepted: 09/09/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND The estimated prevalence of neural tube defects (NTDs) in Africa is 11.7 per 10,000 live births; however, data on the impact of antiretroviral therapy (ART) during pregnancy and the risk for birth defects in Africa are limited. METHODS Data from a hospital-based surveillance program at four hospitals in Kampala, Uganda were used to estimate the baseline prevalence of NTDs and assess potential associations with HIV status and ART use. All live births, stillbirths, and spontaneous abortions delivered at the participating hospitals affected with selected birth defects between August 2015 and December 2018 were included. Trained midwives collected data from hospital records, maternal interviews, photographs, and narrative descriptions of birth defects. We estimated NTD prevalence per 10,000 births (live, stillbirths, spontaneous abortions), prevalence ratios, and 95% confidence intervals (CIs). RESULTS A total of 110,752 births from 107,133 women were included in the analysis; 9,394 (8.8%) women were HIV-infected and among those with HIV infection, 95.6% (n = 8,977) were on ART at delivery. Overall, 109 births were affected with NTDs, giving a prevalence of 9.8 (95% CI [8.2, 11.9]). Spina bifida (n = 63) was the most common type of NTD, with a prevalence of 5.7 (95% CI [4.4, 7.3]), followed by anencephaly (n = 31), with a prevalence of 2.8 (95% CI [2.0, 4.0]). CONCLUSION The prevalence of NTDs among births in Kampala, Uganda is consistent with current estimates for Africa. With the continued introduction of new medications that may be taken during pregnancy, sustainable birth defect surveillance systems and pharmacovigilance are indicated.
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Affiliation(s)
- Linda Barlow-Mosha
- Makerere University-Johns Hopkins University Research Collaboration (MUJHU), Kampala, Uganda
| | - Robert Serunjogi
- Makerere University-Johns Hopkins University Research Collaboration (MUJHU), Kampala, Uganda
| | - Dennis Kalibbala
- Makerere University-Johns Hopkins University Research Collaboration (MUJHU), Kampala, Uganda
| | - Daniel Mumpe-Mwanja
- Makerere University-Johns Hopkins University Research Collaboration (MUJHU), Kampala, Uganda
| | - Dhelia Williamson
- Division of Global HIV and TB, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Diana Valencia
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Sarah C Tinker
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Joyce Namale Matovu
- Makerere University-Johns Hopkins University Research Collaboration (MUJHU), Kampala, Uganda
| | - Cynthia A Moore
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | - Michelle R Adler
- U.S. Centers for Disease Control and Prevention (CDC), Kampala, Uganda
| | - Lisa Nelson
- U.S. Centers for Disease Control and Prevention (CDC), Kampala, Uganda
| | - Jolly Nankunda
- Department of Paediatrics, Makerere University College of Health Sciences, Kampala, Uganda.,Mulago Specialised Women and Neonatal Hospital, Kampala, Uganda
| | - Evelyn Nabunya
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Philippa Musoke
- Makerere University-Johns Hopkins University Research Collaboration (MUJHU), Kampala, Uganda.,Department of Paediatrics, Makerere University College of Health Sciences, Kampala, Uganda
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Holmes LB, Nasri H, Westgate MN, Toufaily MH, Lin AE. The Active Malformations Surveillance Program, Boston in 1972-2012: Methodology and demographic characteristics. Birth Defects Res 2018; 110:148-156. [DOI: 10.1002/bdr2.1156] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 10/03/2017] [Accepted: 10/12/2017] [Indexed: 01/03/2023]
Affiliation(s)
- Lewis B. Holmes
- Active Malformations Surveillance Program, Department of Pediatric Newborn Medicine; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
- Medical Genetics Unit; MassGeneral Hospital for Children, Harvard Medical School; Boston Massachusetts
| | - Hanah Nasri
- Active Malformations Surveillance Program, Department of Pediatric Newborn Medicine; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
- Medical Genetics Unit; MassGeneral Hospital for Children, Harvard Medical School; Boston Massachusetts
| | - Marie-Noel Westgate
- Active Malformations Surveillance Program, Department of Pediatric Newborn Medicine; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
- Medical Genetics Unit; MassGeneral Hospital for Children, Harvard Medical School; Boston Massachusetts
| | - M. Hassan Toufaily
- Active Malformations Surveillance Program, Department of Pediatric Newborn Medicine; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
- Medical Genetics Unit; MassGeneral Hospital for Children, Harvard Medical School; Boston Massachusetts
| | - Angela E. Lin
- Active Malformations Surveillance Program, Department of Pediatric Newborn Medicine; Brigham and Women's Hospital, Harvard Medical School; Boston Massachusetts
- Medical Genetics Unit; MassGeneral Hospital for Children, Harvard Medical School; Boston Massachusetts
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