The prevalence of congenital anomalies in Europe

Mortality in Cleft Lip and Palate Patients: A Systematic Review and Meta-analysis

Background

Cleft lip and/or palate (CLP) represents one of the most common congenital anomalies among live births globally. Morbidity associated with CLP is well documented in the literature and stratified through measures such as disability-adjusted life years. However, a paucity of literature details mortality rates among different subgroups of patients with CLP.

Methods

A meta-analysis was performed using preferred reporting items for systematic reviews and meta-analysis guidelines. Included studies reported on mortality rates of patients with CLP in a liveborn cohort. Studies that reported only intraoperative mortality, included fetal mortality, or included non-CLP conditions in mortality rates were excluded. Meta-analysis was performed through subgroup analysis using random-effects models.

Results

Twenty-one studies were included. Mortality rates ranged from 1.22% to 19.8% between studies. Patients with isolated cleft lip had lower odds of mortality compared with CLP (odds ratio [OR] = 0.28 [0.14, 0.56], P = 0.005) or isolated palate (OR = 0.34 [0.24, 0.48], P = 0.0005). Increased odds of mortality were found in patients with comorbidities (OR = 19.79 [11.37, 34.43], P < 0.0001) compared with otherwise healthy CLP patients. Across age groups, neonates (0-28 d) had the highest mortality rate (0.7%-19.8%) followed by infants (0.2%-6.6%), both with P values less than 0.05.

Conclusions

Mortality rates in patients with CLP are higher for those with an additional comorbidity or younger age (<1 y). Further studies stratifying data by cleft phenotype and age are required to better understand factors that contribute to CLP mortality.

Spectrum of congenital anomalies detected through anatomy ultrasound at a referral hospital in Ghana

BACKGROUND

Africa has a high burden of congenital anomalies due in part to limited preconception care, infections, and environmental exposures. However, the true prevalence of congenital anomalies is unclear because of insufficient access to prenatal diagnostic services. We aimed to determine the rate of congenital anomalies, and characterize the anomalies detected prenatally at a referral hospital in Ghana.

METHODS

We performed a four-year retrospective review of all fetal anomaly ultrasounds performed and congenital anomalies detected from January 1st, 2020, to December 31st, 2023, at Korle Bu Teaching Hospital, Accra, Ghana. Data were extracted from the electronic database on maternal age, gestational age at time of ultrasound, and occupation. Detected congenital anomalies were identified, and each anomaly was categorized by ICD-10 code and EUROCAT classification. Descriptive statistics were performed.

RESULTS

The mean maternal age and median gestational age at the time of ultrasound were 31.1 (SD 6.3) years and 26.9 (IQR 22.5-31.0) weeks, respectively. 3,981 anatomy ultrasounds were performed during the study period, and 7.0% (280/3,981) of fetuses had anomalies. Most (70.7%, 198/280) had anomalies detected in an isolated organ system. Anomalies were most identified in the central nervous system (CNS) (45.0%, 126/280), genitourinary (GU) (28.6%, 80/280), and gastrointestinal (GI) systems (21.8%, 61/280). The most common CNS anomaly identified was ventriculomegaly (70.6%, 89/126), out of which 26.2% (33/126) had severe ventriculomegaly, with an overall detection rate of 0.8% (33/3,981). The most common GU anomalies were congenital hydronephrosis (70.0%, 56/80), and congenital posterior urethral valves (28.8%, 23/80). The most common GI anomalies were exomphalos (49.2%, 30/61), and duodenal atresia (23.0%, 14/61). Unrelated to a specific organ system, 3.2% (9/280) of cases had hydrops and 6.1% (17/280) had an associated soft marker of aneuploidy.

CONCLUSIONS

Our study highlights the substantial burden of congenital anomalies detected through prenatal ultrasound at a tertiary referral center in Ghana, with a notably high detection rate of severe ventriculomegaly. This work underscores the feasibility and importance of performing detailed anatomy ultrasounds in Africa. Beyond the clinical benefit, these data lay the groundwork for studies to identify the underlying causes of high rates of anomalies to inform preventive policy and clinical interventions in low-resource settings.

Critical appraisal on neural tube defects and their complexities

Neural tube defects (NTDs), as a group of diseases, are congenital disabilities due to incomplete closure of the neural tube along its length, which otherwise forms the fully developed brain and spinal cord. An amalgamation of genetic, nutritional, and environmental factors plays a role in causing NTDs. They develop relatively early, within the first month of pregnancy-the time of neurulation, which could indicate that the pathogenesis of these diseases could stem from even pre-pregnancy causes like folic acid deficiency. This article provides an overview of the various etiology of NTDs and how they interact, as well as various preventive and curative measures like folic acid and inositol supplementation, stem cell transplant, and postnatal surgery. Identifying potential risk factors can help clinicians develop better management techniques beyond the limited scope of the presently used prophylactic and treatment methods.

MicroRNA regulation in neural tube defects: Insights into pathogenesis and potential therapeutic targets

Neural tube defects (NTDs) represent a significant burden on global pediatric health, contributing to high rates of infant mortality and morbidity. Despite extensive research into their etiology, NTDs continue to pose challenges in diagnosis and treatment. MicroRNAs (miRNAs) have emerged as promising candidates for understanding the molecular mechanisms underlying NTDs and potentially offering avenues for improved diagnosis and therapeutic intervention. This review explores the multifaceted roles of miRNAs in the context of NTD pathogenesis. Studies have identified specific miRNA profiles associated with NTDs, providing insights into their potential as diagnostic biomarkers. Furthermore, dysregulation of certain miRNAs has been implicated in the pathophysiology of NTDs, highlighting their role as potential therapeutic targets. Additionally, animal models and deep sequencing approaches have expanded our understanding of the diverse miRNA expression patterns associated with NTDs. By unraveling the intricate molecular mechanisms underlying NTD pathogenesis, miRNAs offer promising avenues for early detection and intervention, ultimately improving outcomes for affected individuals.

Epidemiology of congenital anomalies in the Gulf Cooperation Council countries: a scoping review

OBJECTIVES

Congenital anomalies (CAs) are significant contributors to perinatal mortality and morbidity. The epidemiology of CAs in the Gulf Cooperation Council (GCC) countries remains insufficiently explored. This scoping review aims to provide a comprehensive overview of the existing literature on the epidemiology of perinatally diagnosed CAs in the GCC countries.

DESIGN

Scoping review.

DATA SOURCES

We searched MEDLINE, Embase, Scopus and Web of Science for articles published between 1 January 2000 and 1 February 2024.

ELIGIBILITY CRITERIA

This review included (a) original observational studies such as cross-sectional, cohort or nested case-control studies, which were sourced from general populations, hospital records or registries; (b) published in English between 2000 and 2024; (c) conducted in any of the six GCC countries; and (d) reporting the prevalence or incidence of CAs.

DATA EXTRACTION AND SYNTHESIS

Two reviewers independently screened titles, abstracts and full texts for inclusion and extracted data using Covidence software.

RESULTS

In total, 51 studies reporting the epidemiology of CAs in the GCC countries were eligible and thus summarised. Saudi Arabia dominated with nearly two-thirds of the studies, while Bahrain contributed the least. All studies were hospital based and primarily retrospective. The most researched CAs were cleft lip and cleft palate as well as nervous and circulatory system anomalies, whereas the least researched CAs were chromosomal abnormalities, digestive anomalies and urinary system anomalies. The review reported discrepancies in CA rates across the region, ranging from 2.5 to 68.7 per 1000 live births for multiple anomalies. Few studies explored the association between CAs and risk factors; the main factors reported were advanced maternal age, maternal diabetes and consanguinity.

CONCLUSIONS

This review summarises the heightened prevalence of CAs in the GCC countries, discrepancies in estimates and gaps in research on specific anomalies. Future research is warranted to explore the association between CAs and various risk factors, thereby enabling the development of targeted preventive strategies.

Health-related quality of life at 5 years of age for children born very preterm with congenital anomalies: a multi-national cohort study

BACKGROUND

This study aimed to investigate the health-related quality of life (HRQoL) at 5 years of age of European children born very preterm across multi-dimensional outcomes by presence and severity of congenital anomalies.

METHODS

The study used data from a European cohort of children born very preterm (<32 weeks of gestation) and followed up to 5 years of age (N = 3493). Multilevel Ordinary Least Squares (OLS) regression were used to explore the associations between the presence and severity of congenital anomalies.

RESULTS

The mean total PedsQL™ GCS score for children with a mild congenital anomaly was lower than the respective value for children without a congenital anomaly by 3.7 points (p < 0.05), controlling for socioeconomic variables only; this effect was attenuated when accumulatively adjusting for perinatal characteristics (3.3 points (p < 0.05)) and neonatal morbidities (3.1 (p < 0.05)). The mean total PedsQL™ GCS scores for children who had a severe congenital anomaly were lower by 7.1 points (p < 0.001), 6.6 points (p < 0.001) and 6.0 points (p < 0.001) when accumulatively adjusting for socioeconomic, perinatal and neonatal variables, respectively.

CONCLUSION

This study revealed that the presence and severity of congenital anomalies are significant predictors of HRQoL outcomes in children born very preterm.

IMPACT

Children born very preterm with congenital anomalies experience poorer health-related quality of life (HRQoL) than their very preterm counterparts born without congenital anomalies. Increased severity of these anomalies compounds the negative impacts on HRQoL. Our findings can be used by stakeholders for clinical and planning purposes.

Undifferentiated Human Amniotic Fluid Progenitor Cells Promote Bone Regeneration in Vivo

The treatment of large bone defects requires bone tissue substitutes. However, the lack of accessible autologous bone, especially in newborns with spina bifida or cleft palate conditions, severely limits therapeutic options involving bone grafts. Here, an engineering approach to reconstruct bone is presented by combining human amniocentesis-derived amniotic fluid progenitor cells (hAFCs) and a biomimetic, injectable, and fully synthetic poly(ethylene glycol) hydrogel that is crosslinked enzymatically by transglutaminase FXIII (TG-PEG). hAFCs are isolated by their colony-forming capacity, expanded in vitro, and undergo osteogenic, chondrogenic, or adipogenic differentiation under appropriate stimulation. When encapsulated in TG-PEG hydrogels, hAFCs rapidly deposit endogenous extracellular matrix (ECM) in vitro. hAFC-laden TG-PEG hydrogels containing low concentrations of bone morphogenetic protein (BMP-2) promote formation of ectopic bone organoids in vivo in a murine model without requiring prior in vitro differentiation. Strikingly, hAFC-induced constructs form as much bone in this model as adult bone marrow-derived stromal cells (hBMSCs), and significantly more than adipose-derived stromal cells (hASCs).  Utilization of autologous hAFCs embedded in TG-PEG hydrogels presents a promising therapeutic strategy for bone replacement, particularly in fetuses and newborns where limited stem cell availability can be overcome through minimally invasive harvest of amniotic fluid.

Disease Activity and Maternal-fetal Outcomes in Pregnant Women With Prolactinoma: A Systematic Review and Meta-analysis

CONTEXT

Women with prolactinoma are usually infertile but can conceive after surgery or treatment with dopamine agonists.

OBJECTIVE

To evaluate the impact of pregnancy in prolactinoma's natural course and in maternal-fetal outcomes.

DATA SOURCES

MEDLINE, EMBASE, LILACS, and CENTRAL.

STUDY SELECTION

Observational studies that included at least 3 pregnant women with prolactinoma.

DATA EXTRACTION

Two independent reviewers selected studies, assessed the risk of bias, and extracted data from the included studies.

DATA SYNTHESIS

Fifty-two studies were included, involving 2544 pregnancies in 1928 women. Stata Statistical Software 18 was used for proportional meta-analyses. The overall frequency of pregnant women on dopamine agonist treatment at conception was 97% and for either continuing or resuming treatment during pregnancy was 6%. The overall frequency of miscarriage was 10% (95% CI, 8-12), 3% for prematurity (95% CI, 2-5), 4% for symptomatic tumor growth during pregnancy (95% CI, 2-8), 4% for visual impairment (95% CI, 2-7), 6% for headache (95% CI, 4-9), and 4% for development of gestational diabetes (95% CI, 3-7). The overall frequency of congenital malformations was 2% (95% CI, 1-4), 2% for perinatal mortality (95% CI, 1-2), and 6% for low birth weight (95% CI, 3-9). Moreover, prolactinoma's size is a significant modifier for visual impairment.

CONCLUSION

Pregnancy in women with prolactinoma is safe in relation to fetal and maternal outcomes with low frequencies of miscarriage, prematurity, symptomatic growth, visual impairment, headache, congenital malformations, perinatal mortality, and low birth weight.

Advancing fetal diagnosis and prognostication using comprehensive prenatal phenotyping and genetic testing

Prenatal diagnoses of congenital malformations have increased significantly in recent years with use of high-resolution prenatal imaging. Despite more precise radiological diagnoses, discussions with expectant parents remain challenging because congenital malformations are associated with a wide spectrum of outcomes. Comprehensive prenatal genetic testing has become an essential tool that improves the accuracy of prognostication. Testing strategies include chromosomal microarray, exome sequencing, and genome sequencing. The diagnostic yield varies depending on the specific malformations, severity of the abnormalities, and multi-organ involvement. The utility of prenatal genetic diagnosis includes increased diagnostic clarity for clinicians and families, informed pregnancy decision-making, neonatal care planning, and reproductive planning. Turnaround time for results of comprehensive genetic testing remains a barrier, especially for parents that are decision-making, although this has improved over time. Uncertainty inherent to many genetic testing results is a challenge. Appropriate genetic counseling is essential for parents to understand the diagnosis and prognosis and to make informed decisions. Recent research has investigated the yield of exome or genome sequencing in structurally normal fetuses, both with non-invasive screening methods and invasive diagnostic testing; the prenatal diagnostic community must evaluate and analyze the significant ethical considerations associated with this practice prior to generalizing its use. IMPACT: Reviews available genetic testing options during the prenatal period in detail. Discusses the impact of prenatal genetic testing on care using case-based examples. Consolidates the current literature on the yield of genetic testing for prenatal diagnosis of congenital malformations.

Emerging trends and cross-country health inequalities in congenital birth defects: insights from the GBD 2021 study

BACKGROUND

Previous studies predominantly focused on single types of congenital birth defects (CBDs) or specific national prevalence. This study adopts a holistic perspective to assess current trends and health inequalities in birth incidence rate of various types of CBDs, providing novel insights to inform public health policy formulation.

METHODS

Global, socio-demographic index (SDI) regional, and country-specific estimates incidence cases and rate at birth of CBDs from 1990 to 2021 were derived from the Global Burden of Disease (GBD) 2021. Joinpoint analysis and autoregressive integrated moving average predictive models were employed to evaluate temporal trends in the birth incidence rate of CBDs for the period 2022-2031. Additionally, analysis of associations and health inequalities were conducted to examine the relationship between SDI and the birth incidence rate of CBDs across countries.

RESULTS

Globally, the birth incidence rate decreased from 5811.17/100k population in 1990 to 5563.72/100k population in 2021, with low SDI regions recording the lowest rate and cases. Joinpoint analysis revealed a global decrease in the birth incidence rate of CBDs (average annual percentage change, AAPC: -0.14%, 95%CI: -0.15% to -0.12%). The most significant decline was observed in neural tube defects (NTD) (AAPC: -1.35%, 95%CI: -1.42% to -1.28%). However, only birth incidence rate of orofacial clefts (OC) is projected to decrease globally the next decade. Within the five SDI regions, the birth incidence rate of OC is also projected to decrease probably. The analysis revealed negative correlations between congenital heart anomalies (CHA), NTD, and SDI, with NTD showing both absolute and relative health inequalities.

CONCLUSIONS

Despite the general decline in overall birth incidence rate of CBDs, projections suggested a probable increasing trend for all types except OC. This underscores the necessity for enhanced surveillance and intervention measures. Furthermore, the successful prevention policies implemented for NTD could serve as effective models for addressing other types of CBDs, thereby improving the current global situation of CBDs.

Global birth prevalence of major congenital anomalies: a systematic review and meta-analysis

BACKGROUND

There is a lack of systematic review on the global prevalence of major congenital anomalies. We performed a systematic review and meta-analysis of population-based studies on global birth prevalence of eight major congenital anomalies (esophageal atresia, congenital diaphragmatic hernia, duodenal atresia, intestinal atresia, gastroschisis, omphalocele, Hirschsprung's disease and anorectal malformation).

METHODS

Population-based studies reporting the birth prevalence of these anomalies were included from 1969 to 2024. Data from eligible studies were pooled in meta-analysis to get global estimates of birth prevalence and prevalence in subgroups of geographic regions, countries with varying income levels and time periods.

RESULTS

One hundred and twenty-three studies including a total of 256,507 cases of congenital anomalies and 769,455,220 births were included in this study. Overall birth prevalence of theses eight anomalies ranged from 0.86 to 3.11 cases per 10,000 births. Anorectal malformation had the highest birth prevalence among these anomalies with 3.11 cases (95% confidence intervals (CI): 2.77-3.50) per 10,000 births. Birth prevalence of congenital diaphragmatic hernia had a great decrease from 4.19 per 10,000 births in the 1960s to 1.30 per 10,000 births in the 2020s. Omphalocele had high prevalence in Africa and low-income countries.

CONCLUSION

This systematic review summarizes birth prevalence of eight major congenital anomalies. The burdens of these anomalies had variations in the world. Information of this study could help with better understanding of epidemiology and etiology of these anomalies.

Prevalence of Congenital Anomalies Among Pregnant Women at a Tertiary Care Center: A Cross-Sectional study

INTRODUCTION

 Congenital anomalies are a major health problem and are responsible for a significant proportion of morbidity and mortality in newborns. The objective of this study was to find the prevalence and type of congenital anomalies along with the presence of factors responsible for their development among antenatal women and pregnancies delivered at Kathmandu Medical College.

METHODS

This was a cross-sectional study conducted over a period of nine months in the Department of Obstetrics and Gynecology, Kathmandu Medical College. All congenital anomaly cases detected antenatally or at delivery were included in the study. Cases were analyzed to find out the prevalence, types of anomalies, and the risk factors involved.

RESULTS

During the study period, 86 congenital anomalies were seen in 1565 cases of delivery and termination of pregnancy, showing a prevalence of 5.49%. Anomalies of the central nervous system (CNS) were the most common (n=29,33.72%) followed by the circulatory system (n=19, 22.10%). Congenital anomalies were mostly diagnosed by prenatal ultrasonography in 68 cases (79%). Among the cases of congenital anomalies, 56 (65%) had termination of pregnancy, 28 (32.60%) were live birth and two (2.40%) were stillborn. The maternal factor that was studied showed that congenital anomalies are frequently seen in the age group of 26-30 years (n=30,34.88%) and multiparous women (n=52, 60.47%).

CONCLUSIONS

The prevalence of congenital anomalies was high, and CNS anomalies were the most common anomaly observed in this study.

Similar prognosis, different decisions: understanding parents about the possibility of termination of pregnancy due to fetal anomalies

In this study, we investigated the factors that influence families' decision-making processes about whether to carry a pregnancy to term or to terminate it in cases of fetal anomalies. A questionnaire was administered to 25 participants who chose to terminate their pregnancy and 25 participants who chose to carry their pregnancy to term. Among the sociodemographic characteristics investigated, only monthly income significantly differed between the groups (p = .044), being higher in the termination group. The participants in the non-termination group decided to proceed in a shorter time (p = .014). The majority of the participants in this group made this decision for religious reasons (56 percent), while in the other group, the decision was mostly based on baby-centered or parent-centered factors (48 percent and 52 percent, respectively) (p < .001). In the non-termination group, there was a significantly higher number of participants who expressed that their religious beliefs played an influential role in their decision (p = .002). In contrast, in the termination group, higher number of participants indicated that the information provided by their doctor was very effective in shaping their decisions (p < .001). According to the results of our study, social, cultural, and religious reasons seem to be the most important factors affecting participants' decisions related to pregnancy termination.

Final Report of Trends in Pregnancy and Birth Survey after the Great East Japan Earthquake and Fukushima Daiichi Nuclear Power Plant Accident: The Fukushima Health Management Survey

This study aimed to assess long-term changes in pregnancy and birth outcomes after the Great East Japan Earthquake and the accident at the Tokyo Electric Power Company's Fukushima Daiichi Nuclear Power Plant in Fukushima Prefecture.　This is the final report on perinatal outcomes of the Prefectural Health Survey, which ended after a 10-year observation period.　Questionnaires based on a pregnancy and birth survey conducted by the Radiation Medical Science Center for the Fukushima Health Management Survey were sent to women who had received maternal and child health handbooks from municipal officers in Fukushima Prefecture.　Annual data from six geographic areas in Fukushima Prefecture were separately analyzed.　The number of eligible respondents, which was approximately 16,000 in 2011 when the earthquake occurred, declined temporarily the following year, recovered temporarily one year later, and has gradually declined since then.　However, the response rate remained at approximately 50% throughout the decade.　The incidence of preterm deliveries, low-birthweight infants, and congenital anomalies did not vary over the decade and showed a similar trend in national surveys and general reports.　Our analysis shows that the disaster had no significant adverse perinatal outcomes in Fukushima Prefecture and we recommend measures to ensure the safe delivery of babies in the region.

Oxygenation and intestinal perfusion and its association with perturbations of the early life gut microbiota composition of children with congenital heart disease

Background

Early life gut microbiota is known to shape the immune system and has a crucial role in immune homeostasis. Only little is known about composition and dynamics of the intestinal microbiota in infants with congenital heart disease (CHD) and potential influencing factors.

Methods

We evaluated the intestinal microbial composition of neonates with CHD (n = 13) compared to healthy controls (HC, n = 30). Fecal samples were analyzed by shotgun metagenomics. Different approaches of statistical modeling were applied to assess the impact of influencing factors on variation in species composition. Unsupervised hierarchical clustering of the microbial composition of neonates with CHD was used to detect associations of distinct clusters with intestinal tissue oxygenation and perfusion parameters, obtained by the "oxygen to see" (O2C) method.

Results

Overall, neonates with CHD showed an intestinal core microbiota dominated by the genera Enterococcus (27%) and Staphylococcus (20%). Furthermore, a lower abundance of the genera Bacteroides (8% vs. 14%), Parabacteroides (1% vs. 3%), Bifidobacterium (4% vs. 12%), and Escherichia (8% vs. 23%) was observed in CHD compared to HCs. CHD patients that were born by vaginal delivery showed a lower fraction of the genera Bacteroides (15% vs. 21%) and Bifidobacterium (7% vs. 22%) compared to HCs and in those born by cesarean section, these genera were not found at all. In infants with CHD, we found a significant impact of oxygen saturation (SpO2) on relative abundances of the intestinal core microbiota by multivariate analysis of variance (F[8,2] = 24.9, p = 0.04). Statistical modeling suggested a large proportional shift from a microbiota dominated by the genus Streptococcus (50%) in conditions with low SpO2 towards the genus Enterococcus (61%) in conditions with high SpO2. We identified three distinct compositional microbial clusters, corresponding neonates differed significantly in intestinal blood flow and global gut perfusion.

Conclusion

Early life differences in gut microbiota of CHD neonates versus HCs are possibly linked to oxygen levels. Delivery method may affect microbiota stability. However, further studies are needed to assess the effect of potential interventions including probiotics or fecal transplants on early life microbiota perturbations in neonates with CHD.

Togaram1 is expressed in the neural tube and its absence causes neural tube closure defects

Neural tube closure defect pathomechanisms in human embryonic development are poorly understood. Here we identified spina bifida patients expressing novel variants of the TOGARAM gene family. TOGARAM1 has been associated with the ciliopathy Joubert syndrome, but its connection to spina bifida and role in neural development is unknown. We show that Togaram1 is expressed in the neural tube and Togaram1 knockout mice have abnormal cilia, reduced sonic hedgehog (Shh) signaling, abnormal neural tube patterning, and display neural tube closure defects. Neural stem cells from Togaram1 knockout embryos showed reduced cilia and defects in Shh signaling. Overexpression in IMCD3 and HEK293 cells of TOGARAM1 carrying the variant found in the spina bifida patient resulted in cilia defect along with reduced pericentriolar material one (PCM1), a critical constituent of centriolar satellites involved in transporting proteins toward the centrosome and primary cilia. Our results demonstrate the role of TOGARAM1 in regulating Shh signaling during early neural development that is critical for neural tube closure and elucidates potential mechanisms whereby the ciliopathy-associated gene TOGARAM1 gives rise to spina bifida aperta in humans.

Live birth prevalence of major congenital anomalies in the United Arab Emirates

Major congenital anomalies (MCAs) significantly contribute to perinatal mortality and morbidity. Globally, the United Arab Emirates has the sixth-highest prevalence rate of congenital anomalies. The lack of clear baseline prevalence data for MCAs impedes the development of interventions to alleviate this burden. This study aimed to estimate the live birth prevalence of perinatally diagnosed MCAs in a sample of the Emirati population. The analysis was based on a cohort of all singleton live births in the Mutaba'ah study. Minor anomalies were excluded and the live birth prevalence of MCAs was estimated as the number of affected births per 1000 live births. Among 4034 singleton live births, 284 neonates were diagnosed with at least one MCAs, corresponding to a live birth prevalence of 70.4/1000 live births (95% confidence interval: 62.7-78.7). Of the 284 neonates, 86% presented with single-system anomalies, while 14% displayed multi-system involvement. The circulatory system was predominately affected (21.3/1000), followed by the urinary, genital, and musculoskeletal systems. Within the circulatory system, anomalies of cardiac septa (88.6%) and great arteries (70.2%) were the most prevalent. The findings indicate a relatively high live birth prevalence of MCAs. Further studies are needed to identify risk factors and explore screening and prevention strategies.

Experimental study on the preventive effect of Anemarrhena rhizome on pregnancy loss and the incidence rate of cleft palate in A/J mice

Pregnancy loss is a significant concern worldwide, encompassing miscarriage and stillbirth. Miscarriage, defined as the loss of a baby before 28 weeks of gestation, accounts for approximately 15% of pregnancies. Stillbirth, occurring at or after 28 weeks of gestation, affects nearly 2.0 million pregnancies annually, predominantly in low- and middle-income regions. This study aims to investigate the potential of Anemarrhena rhizome (AR) herbal medicine in mitigating pregnancy loss and reducing the incidence of cleft palate in A/J mice models. A total of 390 6-week-old A/J mice were used for the study. Three different dosages of dried AR (6, 12, and 18 g) were boiled to prepare water extracts. The mice were divided into experimental groups receiving these extracts and a control group. Pregnancy outcomes, including fetal mortality rates and incidence of cleft palate, were assessed. The experimental groups receiving AR herbal medicine demonstrated significantly lower fetal mortality rates compared to the control group. Additionally, the incidence of cleft palate was notably reduced in the experimental groups, with the AR 6 g and AR 12 g groups showing significant reductions compared to the control group. AR herbal medicine shows promise in mitigating pregnancy loss and reducing the incidence of cleft palate in A/J mice models. These findings suggest the potential of AR as a therapeutic agent for improving fetal health outcomes. Further research is warranted to elucidate the underlying mechanisms and optimize dosage strategies for maximizing its therapeutic benefits in pregnancy-related complications.

Community Awareness and Perceptions of Genitourinary Malformations: A Cross-Sectional Survey Study

BACKGROUND AND OBJECTIVES

On a local and national scale, genitourinary malformations (GUMs) are the second most encountered congenital anomaly in children. GUMs are linked to several risk factors, including maternal co-morbidities and insufficient folic acid. They may also be related to maternal health and care during pregnancy. Expanding our knowledge about these factors is necessary for the development of preventative measures, which could reduce GUM incidence. This study evaluated the local youth's understanding and perceptions of genitourinary anomalies.

MATERIALS AND METHODS

This cross-sectional, qualitative, anonymous, questionnaire-based study involved members of the local population, aged 18 years or over. Based on a 5% type I error rate (α = 0.05) and an 80% response rate, a sample size of 481 was determined. The questionnaire was completed by 902 people. The data were analyzed using SPSS version 25 (IBM).

RESULTS

Over half (57%) of respondents believed that hormonal therapy during pregnancy could increase GUM risk. Moreover, 46% thought that maternal chronic diseases could be another risk factor, while 43% believed that pregnancy-related conditions, such as pre-eclampsia, increased GUM risk. Women had higher odds of high perception scores than men, according to the univariate and multivariate analyses. Most participants (74%) strongly agreed that proper and ongoing prenatal follow-ups are necessary, 69% agreed that premarital medical check-ups are necessary, and 67% believed that optimal nutrition throughout pregnancy is necessary to reduce GUM risk.

CONCLUSIONS

The results emphasize the necessity of developing healthcare strategies specifically designed to increase knowledge about GUMs and overcome incorrect community perceptions of risk factors that could also help improve attitudes towards prevention and ultimately reduce the incidence of GUMs.

Genetic analysis of preaxial polydactyly: identification of novel variants and the role of ZRS duplications in a Chinese cohort of 102 cases

Preaxial polydactyly (PPD) is a congenital limb malformation, previously reported to be caused primarily by variants in the ZRS and upstream preZRS regions. This study investigated genetic variations associated with PPD, focusing on point variants and copy number variations (CNVs) in the ZRS and preZRS regions. Comprehensive genetic analyses were conducted on 102 patients with PPD, including detailed clinical examinations and Sanger sequencing of the ZRS and preZRS regions. Additionally, real-time quantitative PCR (qPCR) was used to detect CNVs in the ZRS region. The evolutionary conservation and population frequencies of identified variants were also evaluated. Six point variants were identified, among which four are likely pathogenic novel variants: 93G > T (g.156584477G > T), 106G > A (g.156584464G > A), 278G > A (g.156584292G > A), and 409A > C (g.156585378A > C). Additionally, qPCR analysis revealed that 66.67% of patients exhibited ZRS duplications. Notably, these duplications were also present in cases with newly identified potential pathogenic point variants. These findings suggest the possible interaction of point variants in ZRS and preZRS through a common pathogenic mechanism, leading jointly to PPD. The findings expand the variant spectrum associated with non-syndromic polydactyly and highlight that, despite different classifications, anterior polydactyly caused by variants in ZRS and nearby regions may share common pathogenic mechanisms. The incorporation of various variant types in genetic screening can effectively enhance the rate of pathogenic variant detection and contribute to the cost-effectiveness of genetic testing for limb developmental defects, thereby promoting healthy births.

Collagen-based materials in male genitourinary diseases and tissue regeneration

Male genitourinary dysfunction causes serious physical or mental distress, such as infertility and psychological harm, which leads to impaired quality of life. Current conventional treatments involving drug therapy, surgical repair, and tissue grafting have a limited effect on recovering the function and fertility of the genitourinary organs. To address these limitations, various biomaterials have been explored, with collagen-based materials increasingly gaining attention for reconstructing the male genitourinary system due to their superior biocompatibility, biodegradability, low antigenicity, biomimetic 3D matrix characteristics, hemostatic efficacy, and tissue regeneration capabilities. This review covers the recent biomedical applications of collagen-based materials including treatment of erectile dysfunction, premature ejaculation, penile girth enlargement, prostate cancer, Peyronie's disease, chronic kidney disease, etc. Although there are relatively few clinical trials, the promising results of the existing studies on animal models reveal a bright future for collagen-based materials in the treatment of male genitourinary diseases.

Graphic Abstract

3D ultrasound evaluation of fetal ears in prenatal syndrome diagnosis - a comparative study

PURPOSE

The aim of the study was to assess fetal ears on prenatal 3D ultrasound and compare ear surface patterns and measurements between fetuses with syndromes and healthy fetuses.

MATERIALS AND METHODS

Our study is based on 3D ultrasound images of 100 fetuses between the 20th and 37th week of gestation. We compared 50 ears of fetuses with syndromes (syndrome group) to 50 gestational age-matched ears of healthy fetuses (control group). The syndrome group consisted of fetuses with Trisomy 21 (n=13), Trisomy 18 (n=9) and other syndromes (n=28). The evaluation was based on measuring the ear length and width as well as developing categories to describe and compare different ear surface anomalies.

RESULTS

Ears of fetuses with Trisomy 18 were on average 0.423 cm smaller in length (P<0.001) and 0.123 cm smaller in width (P=0.031) and grew on average 0.046 cm less in length per week of gestation (P=0.027) than those of healthy fetuses. Ears of fetuses with Trisomy 21 differed from healthy fetuses regarding the form of the helix (P=0.013) and the ratio of the concha to the auricle (P=0.037). Fetuses with syndromes demonstrated less ear surface details than their controls (syndrome group: P=0.018, P=0.005; other syndromes subgroup: P=0.020). We saw an increased richness of ear surface details at a later gestational age both in the fetuses with syndromes and the healthy fetuses.

CONCLUSION

Ears of fetuses with Trisomy 18 were smaller than their matched controls. Fetuses with syndromes varied in the evaluation of their ear surface from those of healthy fetuses. The ear surface can be analyzed with 3D ultrasound and might be useful as a screening parameter in syndrome diagnosis in the future.

Introducing second-trimester anatomic scanning for improved detection and management of congenital anomalies: Experience from a novice center in East Africa

OBJECTIVES

The aim of the current study was to describe the magnitude and pattern of congenital anomalies on routine second-trimester ultrasound and its practical implication in the management of pregnant women with fetal anomalies at a novice center in East Africa.

METHODS

This cross-sectional study was conducted from September 2021 to May 2022 among women who had second-trimester anatomic scanning. Data were collected using a structured questionnaire and analyzed using SPSS version 23.1. Ethical clearance was obtained from the hospital's institutional review board and informed consent was obtained.

RESULTS

The number of congenital anomalies was 45 of 1764 (2.55%). Most (41%) were in the age group 26-30 years and multigravida (62%). Average gestational age at anatomic scanning was 24 weeks. One or more risk factors for congenital anomalies were reported in 19 (31.0%) of the mothers. Most sonographic fetal abnormalities (51.7%) were reported in the central nervous system, followed by renal (18.0%) and skeletal (11.5%). Among the central nervous system anomalies, severe ventriculomegaly was the most common (38.7%), followed by Arnold-Chiari malformation (19.4%). Thirty-five (2%) of the mothers had a lethal fetal congenital anomaly and their pregnancy was terminated after counseling and informed consent.

CONCLUSIONS

The rate of congenital anomalies in this study is comparable with most international data. The introduction of second-trimester anatomic scanning has led to timely termination of anomalous pregnancies, which contributes to reduction in direct and indirect costs of care and family's psychosocial distress and the stigma associated with the birth of and caring for a child with disability.

Fetal Tele-Echocardiography-An Approach to Improving Diagnosis and Management

Introduction: Antenatal diagnosis of cardiac abnormalities and counselling parents about postnatal care require a multidisciplinary team, which includes a paediatric cardiologist, a neonatologist, and a fetal medicine physician. Some of these kinds of expertise are not available in all centres with fetal medicine expertise. However, with modern technology, this could be provided remotely. Our objective was to assess the feasibility and outcomes of prenatal multidisciplinary tele-echocardiography diagnostic and counselling services. Materials and Methods: Two centres based in separate countries provided a joint diagnostic and counselling service over a period of 14 months. The primary centre performed the fetal echocardiography with a Voluson E10 machine, and images were transmitted live using Zoom OPS system with video-consultation and counselling. The fetal echo was performed using the ISUOG Guidelines check list. Results: There was an initial feasibility period of 2 months during which 10 women whose fetuses had normal hearts were scanned to test the workability of the system. Over a period of 12 months, 513 high-risk fetuses were then scanned, and out of these, 27 had congenital malformations. The most common were hypoplastic left heart syndrome (HHLS) and atrio-ventricular septal defect. Tele-echocardiography and counselling were successful in all the cases. Satisfaction with the service was 3.8/4, with the main limitation being the need for further referral to a tertiary centre for delivery. Conclusions: Tele-echocardiography is reliable, and when combined with live counselling and support from a paediatric cardiologist, it is an option acceptable to patients. The greatest benefit was from being counselled by a team of experts at a single consultation rather than having to travel to another centre for consultation. With rapidly evolving technology, making video transmission easier and less expensive, we feel that consideration should be given not only to the development of tele-echocardiography but also to extending it to other aspects of fetal medicine.

Guideline No. 456: Prenatal Screening for Fetal Chromosomal Anomalies

OBJECTIVE

To review the available prenatal aneuploidy screening options and to provide updated clinical guidelines for reproductive care providers.

TARGET POPULATION

All pregnant persons receiving counselling and providing informed consent for prenatal screening.

BENEFITS, HARMS, AND COSTS

Implementation of the recommendations in this guideline should increase clinician competency to offer counselling for prenatal screening options and provide appropriate interventions. Given the variety of available options for prenatal screening with different performance, cost, and availability across Canada, appropriate counselling is of paramount importance to offer the best individual choice to Canadian pregnant persons. Prenatal screening may cause anxiety, and the decisions about prenatal diagnostic procedures are complex given the potential risk of fetal loss.

EVIDENCE

Published literature was retrieved through searches of Medline, PubMed, and the Cochrane Library in and prior to July 2023, using an appropriate controlled vocabulary (prenatal diagnosis, amniocentesis, chorionic villi sampling, non-invasive prenatal screening) and key words (prenatal screening, prenatal genetic counselling). Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies written in English and published from January 1995 to July 2023.

VALIDATION METHODS

The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See online Appendix A (Tables A1 for definitions and A2 for interpretations).

INTENDED AUDIENCE

Health care providers involved in prenatal screening, including general practitioners, obstetricians, midwives, maternal-fetal medicine specialists, geneticists, and radiologists.

SOCIAL MEDIA ABSTRACT

Non-invasive prenatal screening is the most accurate method for detecting major aneuploidies. It is not universally available in the public health system and has some limitations.

SUMMARY STATEMENTS

RECOMMENDATIONS.

Congenital heart defects in children born after assisted reproductive technology: a CoNARTaS study

BACKGROUND AND AIMS

Children born after assisted reproductive technology (ART) have worse perinatal outcomes compared with spontaneously conceived children. This study investigates whether children conceived after ART have a higher risk of congenital heart defects (CHDs) compared with children born after spontaneous conception (SC).

METHODS

All 7 747 637 liveborn children in Denmark (1994-2014), Finland (1990-2014), Norway (1984-2015), and Sweden (1987-2015), where 171 735 children were conceived after ART, were included. National ART and medical birth registry data were cross-linked with data from other health and population registries. Outcomes were major CHDs, severe CHDs, 6 hierarchical CHD lesion groups, and 10 selected major CHDs, diagnosed prenatally or up to 1 year of age (Denmark, Finland, and Sweden) and prenatally or at birth (Norway). The association between ART and CHDs was assessed with multivariable logistic regression analysis, with adjustment for available confounders.

RESULTS

Major CHDs were detected in 3159 children born after ART (1.84%) and in 86 824 children born after SC [1.15%; adjusted odds ratio (AOR) 1.36; 95% confidence interval (CI) 1.31-1.41]. Risk was highest in multiples, regardless of conception method. Severe CHDs were detected in 594 children born after ART (0.35%) and in 19 375 children born after SC (0.26%; AOR 1.30; 95% CI 1.20-1.42). Risk was similar between ICSI and IVF and between frozen and fresh embryo transfer.

CONCLUSIONS

Assisted reproductive technology-conceived children have a higher prevalence of major CHDs, being rare, but severe conditions. The absolute risks are, however, modest and partly associated with multiple pregnancies, more prevalent in ART.

Prevalence, characteristics and risk factors of birth defects in central China livebirths, 2015-2022

Objective

This study analyzed the prevalence, epidemiological characteristics and risk factors of birth defects among livebirths in central China, aiming to provide evidences for the prevention of birth defects and government Decision-makings.

Methods

Birth data from China's Hubei Province between 2015 and 2022 were collected, including basic information of the livebirths, the mothers and the fathers, as well as information about delivery and each prenatal examination. The livebirths prevalence of birth defects was calculated and the trends were mapped. The basic characteristics of birth defects were evaluated by the difference analysis between case and health groups. Univariate and multivariate Poisson regression was performed to examine the independent risk factors for birth defects.

Results

Among 43,568 livebirths, 166 livebirths were born with birth defects, resulted in a total prevalence rate of 3.81 per 1,000 livebirths, showing a remarkable uptrend from 0.41per 1,000 livebirths in 2015 to 9.23 per 1,000 livebirths in 2022. The peak of the prevalence was in January and February. Congenital malformation of the musculoskeletal system was the main type of birth defect in central China livebirths, followed by cleft lip and cleft palate. Overall, newborns with birth defect had significantly earlier delivery gestational age, poorer health and higher proportion of infants with low birth weight than healthy births. The gender of livebirths, excess weight at delivery (≥80 kg) of mothers, more than 2 times of gravidity or parity of mothers, and advanced paternal age (≥40 years) were independent risk factors for birth defects (or specific birth defects).

Conclusion

The livebirths prevalence of birth defects shows increasing trend in central China, which deserves the attention of the government and would-be parents. Elevated paternal age, excess maternal weight, gravidity and parity should be considered when planning their families.

Comparison of total prevalence, perinatal prevalence, and livebirth prevalence of birth defects in Hunan Province, China, 2016-2020

Objective

Birth defect of any type is undesirable and often pose a negative impact on the health and development of the newborn. Birth defects surveillance with datasets from surveillance health-related programs are useful to predict the pattern of birth defects and take preventive measures. In this study, the total prevalence, perinatal prevalence, and livebirth prevalence of birth defects were compared.

Methods

Data were obtained from the Birth Defects Surveillance System in Hunan Province, China, 2016-2020. The total prevalence is the number of birth defects (including livebirths, stillbirths, and selective terminations of pregnancy) per 1,000 births (including livebirths and stillbirths). The perinatal prevalence is the number of birth defects (between 28 weeks gestation and 7 days postpartum) per 1,000 births. The livebirth prevalence is the number of liveborn birth defects per 1,000 births (unit: ‰). Underestimated proportion (unit: %) is the reduction level of perinatal prevalence or livebirth prevalence compared to the total prevalence. Prevalence with 95% confidence intervals (CI) was calculated using the log-binomial method. Chi-square tests (χ 2) were used to examine if significant differences existed in prevalence or underestimated proportion between different groups.

Results

A total of 847,755 births were included in this study, and 23,420 birth defects were identified, including 14,459 (61.74%) birth defects with gestational age > =28 weeks, and 11,465 (48.95%) birth defects in livebirths. The total prevalence, perinatal prevalence, and livebirth prevalence of birth defects were 27.63‰ (95%CI, 27.27-27.98), 17.06‰ (95%CI, 16.78-17.33), and 13.52‰ (95%CI, 13.28-13.77), respectively, and significant differences existed between them (χ2  = 4798.55, p < 0.01). Compared to the total prevalence, the perinatal prevalence and livebirth prevalence were underestimated by 38.26 and 51.05%, respectively. Significant differences existed between the total prevalence, perinatal prevalence, and livebirth prevalence of birth defects in all subgroups according to year, sex, residence, and maternal age (p < 0.05). Significant differences existed between the total prevalence, perinatal prevalence, and livebirth prevalence for 17 specific defects: congenital heart defect, cleft lip-palate, Down syndrome, talipes equinovarus, hydrocephalus, limb reduction, cleft lip, omphalocele, anal atresia, anencephaly, spina bifida, diaphragmatic hernia, encephalocele, gastroschisis, esophageal atresia, bladder exstrophy, and conjoined twins (p < 0.05). In comparison, no significant difference existed between the total prevalence, perinatal prevalence, and livebirth prevalence for 6 specific defects: polydactyly, other external ear defects, syndactyly, hypospadias, cleft palate, and anotia/microtia (p > 0.05).

Conclusion

The total prevalence and livebirth prevalence of birth defects in Hunan Province, China, was not well studied. A systematic study was conducted to compare the total prevalence, perinatal prevalence, and livebirth prevalence of birth defects. The study reveals that significant differences existed between the total prevalence, perinatal prevalence, and livebirth prevalence of birth defects (including many specific defects), and year, sex, residence, and maternal age had significant impacts on it. The outcomes of the study will help to take preventive measures for birth defects as well as benefit the people involving public health and policymakers to improve the current scenario.

Genetic analysis of pregnancy loss and fetal structural anomalies by whole exome sequencing

BACKGROUND

Whole exome sequencing (WES) has been recommended to investigate the genetic cause of fetal structural anomalies. In this retrospective study, we aimed to evaluate the diagnostic yield of WES in our cohort of families with pregnancy loss or termination of pregnancy due to structural anomalies.

METHODS

As aneuploidy, triploidy and copy number variations (CNVs) could be detected by exome-based CNV analysis, only WES is performed in this study. And the results of 375 cases assessed by WES were analyzed.

RESULTS

The overall detection rate was 32.3% (121/375), including aneuploidy and triploidy (7.5%, 28/375), CNVs (5.1%, 19/375) and single-nucleotide variants (SNVs) /insertions or deletions (Indels) (19.7%, 74/375). Among these, the diagnostic yield for likely pathogenic (LP) or pathogenic (P) CNVs is 4.8% (18/375), and the diagnostic yield for LP or P SNVs/Indels is 15.2% (57/375). And an additional 4.8% (18/375) of cases had CNVs or SNVs/Indels classified as variants of uncertain significance (VUS) with potential clinical significance.

CONCLUSIONS

Our findings expand the known mutation spectrum of genetic variants related to fetal abnormalities, increase our understanding of prenatal phenotypes, and enable more accurate counseling of recurrence risk for future pregnancies.

Season, household registry and isolated birth defects: a population-based case-control study in Danyang, China

BACKGROUND

A birth population-based study was conducted in Danyang, Jiangsu Province, to evaluate major birth defects in emerging regions in China with similar maternal and neonatal care conditions.

METHODS

We conducted a population-based study in a cohort of infants born in Danyang from 2014 to 2021, including 55 709 perinatal infants. Four categories of isolated birth defects were defined as cases: congenital heart defects (CHDs; n=2138), polydactyly (n=145), cleft lip with or without palate (CL/P; n=76) and accessory auricles (n=93). Infants with congenital malformations were identified by the Chinese Birth Defects Monitoring Network.

RESULTS

Compared with autumn, conception in spring (OR=1.31 [1.16-1.48]) and winter (OR=1.39 [1.23-1.58]) was associated with an increased risk of CHD. Increased risk of CHD, CL/P and accessory auricles was significantly associated with non-local registered residence (OR=1.17 [1.07-1.28], OR=2.73 [1.52-4.88] and OR=2.11 [1.20-3.71], respectively). Individuals of Han nationality were less likely to have polydactyly (OR=0.23 [0.05-0.98]).

CONCLUSIONS

The season of pregnancy was significantly associated with CHDs. Offspring of mothers with non-local registered hometown had greater risks of CHDs, CL/P and accessory auricles.

Exploring potential causal links between air pollutants and congenital malformations: A two-sample Mendelian Randomization study

Observational studies have suggested an association between air pollutants and congenital malformations; however, conclusions are inconsistent and the causal associations have not been elucidated. In this study, based on publicly available genetic data, a two-sample Mendelian randomization (MR) was applied to explore the associations between particulate matter 2.5 (PM2.5), NOX, NO2 levels and 11 congenital malformations. Inverse variance weighted (IVW), MR-Egger and weighted median were used as analytical methods, with IVW being the main method. A series of sensitivity analyses were used to verify the robustness of the results. For significant associations, multivariable MR (MVMR) was utilized to explore possible mediating effects. The IVW results showed that PM2.5 was associated with congenital malformations of digestive system (OR = 7.72, 95 %CI = 2.33-25.54, P = 8.11E-4) and multiple systems (OR = 8.63, 95 %CI = 1.02-73.43, P = 0.048) risks; NOX was associated with circulatory system (OR = 4.65, 95 %CI = 1.15-18.86, P = 0.031) and cardiac septal defects (OR = 14.09, 95 %CI = 1.62-122.59, P = 0.017) risks; NO2 was correlated with digestive system (OR = 27.12, 95 %CI = 1.81-407.07, P = 0.017) and cardiac septal defects (OR = 22.57, 95 %CI = 2.50-203.45, P = 0.005) risks. Further MVMR analyses suggest that there may be interactions in the effects of these air pollutants on congenital malformations. In conclusion, this study demonstrated a causal association between air pollution and congenital malformations from a genetic perspective.

A Practical, Systematic Approach to Genetic Diagnosis in a Fetus or Neonate with Congenital Anomalies

Congenital anomalies contribute significantly to perinatal, neonatal, and infant morbidity and mortality. The causes of these anomalies vary, ranging from teratogen exposure to genetic disorders. A high suspicion for a genetic condition is especially important because a genetic diagnosis carries a risk of recurrence in future pregnancies. Various methods are available for genetic testing, and each plays a role in establishing a genetic diagnosis. This review summarizes a practical, systematic approach to a fetus or neonate with congenital anomalies.

NON-pharmacological Approach Less Invasive Surfactant Administration (NONA-LISA) trial: protocol for a randomised controlled trial

INTRODUCTION

Using pre-procedure analgesia with the risk of apnoea may complicate the Less Invasive Surfactant Administration (LISA) procedure or reduce the effect of LISA.

METHODS

The NONA-LISA trial (ClinicalTrials.gov, NCT05609877) is a multicentre, blinded, randomised controlled trial aiming at including 324 infants born before 30 gestational weeks, meeting the criteria for surfactant treatment by LISA. Infants will be randomised to LISA after administration of fentanyl 0.5-1 mcg/kg intravenously (fentanyl group) or isotonic saline solution intravenously (saline group). All infants will receive standardised non-pharmacological comfort care before and during the LISA procedure. Additional analgesics will be provided at the clinician's discretion. The primary outcome is the need for invasive ventilation, meaning mechanical or manual ventilation via an endotracheal tube, for at least 30 min (cumulated) within 24 h of the procedure. Secondary outcomes include the modified COMFORTneo score during the procedure, bronchopulmonary dysplasia at 36 weeks, and mortality at 36 weeks.

DISCUSSION

The NONA-LISA trial has the potential to provide evidence for a standardised approach to relief from discomfort in preterm infants during LISA and to reduce invasive ventilation. The results may affect future clinical practice.

IMPACT

Pre-procedure analgesia is associated with apnoea and may complicate procedures that rely on regular spontaneous breathing, such as Less Invasive Surfactant Administration (LISA). This randomised controlled trial addresses the effect of analgesic premedication in LISA by comparing fentanyl with a placebo (isotonic saline) in infants undergoing the LISA procedure. All infants will receive standardised non-pharmacological comfort. The NONA-LISA trial has the potential to provide evidence for a standardised approach to relief from discomfort or pain in preterm infants during LISA and to reduce invasive ventilation. The results may affect future clinical practice regarding analgesic treatment associated with the LISA procedure.

Molecular autopsy for fetal structural anomaly: diagnostic and clinical utility of multidisciplinary team approach

OBJECTIVE

In the West Midlands regional genetics service, cases of perinatal death with a possible genetic diagnosis are evaluated by the perinatal pathology genetic multidisciplinary team (MDT). The MDT assesses autopsy findings and suggests appropriate genomic assessment. The objective of this retrospective service evaluation was to determine the clinical utility of the MDT in assessing perinatal deaths associated with structural anomaly. This is the first evaluation since the introduction of whole-genome and whole-exome sequencing in routine clinical care.

METHODS

This was a retrospective service evaluation including all cases of perinatal death with an associated structural anomaly and suspected genetic etiology that underwent perinatal MDT assessment between January and December 2021. All cases received a full or partial postmortem examination and at least a chromosomal microarray analysis. Demographic characteristics, phenotype, genotype, MDT recommendations, diagnoses, outcomes and impact of postmortem analysis and genetic testing data were collected from patient case notes.

RESULTS

Overall, 123 cases were discussed at the MDT meetings in 2021. Genetic evaluation was recommended in 84 cases and accepted in 64 cases. A range of genetic tests were requested according to indication and availability. Thirty diagnoses were made in 29 cases from 26 unrelated families. The diagnostic yield was 24% (29/123) in all cases or 45% (29/64) in cases with a suspected genetic diagnosis who underwent genetic testing. Postmortem examination provided clinically actionable phenotypic data in 79% of cases. A genetic diagnosis enabled accurate recurrence risk counseling and provision of appropriate follow-up, including prenatal testing and preimplantation diagnosis for patients with inherited conditions.

CONCLUSIONS

Genomic testing was a clinically useful addition to (but not a substitute for) postmortem examination in cases of perinatal death associated with structural anomaly. The MDT approach helped assess cases and plan appropriate follow-up. Expedited whole-genome sequencing or panel-agnostic analysis were most appropriate for heterogeneous presentations. This broad approach can also expand knowledge of prenatal phenotypes and detect novel disease genes, and should be a priority in future research. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Incidence and Antenatal Detection of Congenital Heart Malformations-Data from a Tertiary Obstetric Romanian Center

OBJECTIVES

Congenital heart defects (CHDs) are among the most frequent congenital defects, and they significantly burden the healthcare system due to their high mortality rate and high cost of care for survivors. We aimed to highlight the incidence of CHDs in a tertiary center in Western Romania.

METHODS

A retrospective study was carried out between 2018 and 2022 at the "Pius Brinzeu" Emergency County Hospital Timisoara. Relevant information about the mothers and the newborns were collected and statistically analyzed.

RESULTS

The incidence of CHDs from 2018 to 2022 in our center was 5.3%. Eleven types of malformations were diagnosed postnatally in 541 newborns, with 28.8% of cases having more than one type of CHD. The antenatal detection rate was 28%, with the highest rates for tetralogy of Fallot, hypoplastic left heart syndrome, or significant ventricular septal defects and the lowest for pulmonary stenosis. The lower antenatal detection rate was influenced mainly by incomplete or absent prenatal care.

CONCLUSIONS

The incidence of CHDs is clearly dependent of a multifactorial approach, and the results highlight this. With an incidence almost 50% lower than reported within the literature and a low rate of prenatal detections, CHDs could be a more of a burden to endure regarding medical treatment. Improvements in patients' education, prenatal care, and screening programs could improve diagnosis, decrease mortality, and optimize postnatal care.

Tracheomalacia and tracheomegaly in infants and children with congenital diaphragmatic hernia managed with and without fetoscopic endoluminal tracheal occlusion (FETO): a multicentre, retrospective cohort study

BACKGROUND

Temporary fetoscopic endoluminal tracheal occlusion (FETO) promotes lung growth and increases survival in selected fetuses with congenital diaphragmatic hernia (CDH). FETO is performed percutaneously by inserting into the trachea a balloon designed for vascular occlusion. However, reports on the potential postnatal side-effects of the balloon are scarce. This study aimed to evaluate the prevalence of tracheomalacia in infants with CDH managed with and without FETO and other consequences related to the use of the balloon.

METHODS

In this multicentre, retrospective cohort study, we included infants who were live born with CDH, either with FETO or without, who were managed postnatally at four centres (UZ Leuven, Leuven, Belgium; Antoine Béclère, Clamart, France; BCNatal, Barcelona, Spain; and HCor-Heart Hospital, São Paulo, Brazil) between April 5, 2002, and June 2, 2021. We primarily assessed the prevalence of all (symptomatic and asymptomatic) tracheomalacia as reported in medical records among infants with and without FETO. Secondarily we assessed the prevalence of symptomatic tracheomalacia and its resolution as reported in medical records, and compared tracheal diameters as measured on postnatal x-rays. Crude and adjusted risk ratios (aRRs) and 95% CIs were calculated via modified Poisson regression models with robust error variances for potential association between FETO and tracheomalacia. Variables included in the adjusted model were the side of the hernia, observed-to-expected lung-to-head ratio, and gestational age at birth. Crude and adjusted mean differences and 95% CIs were calculated via linear regression models to assess the presence and magnitude of association between FETO and tracheal diameters. In infants who had undergone FETO we also assessed the localisation of balloon remnants on x-rays, and the methods used for reversal of occlusion and potential complications associated with balloon remnants as documented in clinical records. Finally we investigated whether the presence of balloon remnants was influenced by the interval between balloon removal and delivery.

FINDINGS

505 neonates were included in the study, of whom 287 had undergone FETO and 218 had not. Tracheomalacia was reported in 18 (6%) infants who had undergone FETO and in three (1%) who had not (aRR 6·17 [95% CI 1·83-20·75]; p=0·0030). Tracheomalacia was first reported in the FETO group at a median of 5·0 months (IQR 0·8-13·0). Symptomatic tracheomalacia was reported in 13 (5%) infants who had undergone FETO, which resolved in ten (77%) children by 55·0 months (IQR 14·0-83·0). On average, infants who had undergone FETO had a 31·3% wider trachea (with FETO tracheal diameter 7·43 mm [SD 1·24], without FETO tracheal diameter 5·10 mm [SD 0·84]; crude mean difference 2·32 [95% CI 2·11-2·54]; p<0·0001; adjusted mean difference 2·62 [95% CI 2·35-2·89]; p<0·0001). At birth, the metallic component was visible within the body in 75 (37%) of 205 infants with available thoraco-abdominal x-rays: it was located in the gastrointestinal tract in 60 (80%) and in the lung in 15 (20%). No side-effects were reported for any of the infants during follow-up. The metallic component was more likely to be in the lung than either outside the body or the gastrointestinal tract when the interval between occlusion reversal and birth was less than 24 h.

INTERPRETATION

Although FETO was associated with an increased tracheal diameter and an increased probability of tracheomalacia, symptomatic tracheomalacia typically resolved over time. There is a higher risk of retention of metallic balloon components if reversal of the occlusion occurs less than 24 h before delivery. Finally, there were no reported side-effects of the metallic component of the balloon persisting in the body during follow-up. Longer-term follow-up is needed to ensure that no tracheal problems arise later in life.

FUNDING

None.

Detection of major congenital malformations depends on length of follow-up in Swedish National Health Register Data: Implications for pharmacoepidemiological research on medication safety in pregnancy

BACKGROUND

In observational medication pregnancy safety studies, children are often followed from birth to 1 year of age. However, some major congenital malformations (MCM) may take longer to diagnose.

OBJECTIVES

We aimed to investigate the proportion of children with detected MCMs at different lengths of follow-up and compare them to the proportion detected at 1 year after birth.

METHODS

This population-based register study included all singleton children liveborn in Sweden from 2006 to 2016. MCM were identified by ICD-10 codes in the Medical Birth Register and National Patient Register, aligned to the EUROCAT classification system. Cumulative proportion of children with detected MCM at birth, 90 days, 1, 2, and 3 years was calculated and compared between children born preterm and at term.

RESULTS

In 1,138,113 liveborn children, the cumulative proportion of children with a detected MCM increased from 1.9% at birth to 3.1%, 3.9%, 4.4% and 4.7% at 90 days, 1, 2, and 3 years after birth, respectively, and varied by MCM subgroup. MCMs of the eye, ear-face-neck, nervous system and genitals were detected with the longest delay, with 31%-59% more detected at 3- versus 1-year follow-up. Compared to children born at term, the proportion of children with any MCM was 2.5 times higher amongst preterm children, with a higher proportion detected over the first 90 days for most MCM subgroups.

CONCLUSIONS

The proportion of children with a detected MCM varied by MCM subgroup and follow-up time. In pharmacoepidemiology studies of medication safety in pregnancy using Swedish national data, the length of child follow-up should be chosen in accordance with the expected age at detection if a specific subgroup of MCM is under investigation, for example, eye and genital MCM require longer follow-up for detection than abdominal wall and digestive system MCM. However, in most circumstances, 1 year of follow-up is sufficient.

Prenatal exposure to air pollutants and the risk of congenital heart disease: a Korean national health insurance database-based study

Air pollution and heavy metal exposure are emerging public health concerns. Prenatal exposure to air pollutants and heavy metals has been implicated in the development of congenital heart disease (CHD). However, the relationship between exposure to airborne heavy metals and CHD has not yet been investigated. Therefore, in this large population-based study, we investigated the association between air pollutants, including airborne heavy metals, and the risk of CHD using national health insurance claims data from South Korea. Data regarding 1,129,442 newborns and their mothers were matched with air pollutant levels during the first 8 weeks of gestation. In the five-air pollutant model, we found significant positive correlations between prenatal exposure to sulfur dioxide (SO2; odds ratio [OR] 6.843, 95% confidence interval [CI] 5.746-8.149) and cadmium (Cd; OR 1.513, 95% CI 1.187-1.930) and the risk of ventricular septal defects in newborns. This study highlights the association between prenatal exposure to air pollutants, including airborne heavy metals, and an elevated CHD risk. Further research is essential to validate and expand these findings, with the ultimate goal of enhancing public health outcomes.

Fetal deaths from birth defects in Hunan Province, China, 2016-2020

To describe the fetal death rate of birth defects (including a broad range of specific defects) and to explore the relationship between fetal deaths from birth defects and a broad range of demographic characteristics. Data was derived from the birth defects surveillance system in Hunan Province, China, 2016-2020. Fetal death refers to the intrauterine death of a fetus at any time during the pregnancy, including medical termination of pregnancy. Fetal death rate is the number of fetal deaths per 100 births (including live births and fetal deaths) in a specified group (unit: %). The fetal death rate of birth defects with 95% confidence intervals (CI) was calculated by the log-binomial method. Crude odds ratios (ORs) were calculated to examine the relationship between each demographic characteristic and fetal deaths from birth defects. This study included 847,755 births, and 23,420 birth defects were identified. A total of 11,955 fetal deaths from birth defects were identified, with a fetal death rate of 51.05% (95% CI 50.13-51.96). 15.78% (1887 cases) of fetal deaths from birth defects were at a gestational age of < 20 weeks, 59.05% (7059 cases) were at a gestational age of 20-27 weeks, and 25.17% (3009 cases) were at a gestational age of ≥ 28 weeks. Fetal death rate of birth defects was higher in females than in males (OR = 1.25, 95% CI 1.18-1.32), in rural than in urban areas (OR = 1.43, 95% CI 1.36-1.50), in maternal age 20-24 years (OR = 1.35, 95% CI 1.25-1.47), and ≥ 35 years (OR = 1.19, 95% CI 1.11-1.29) compared to maternal age of 25-29 years, in diagnosed by chromosomal analysis than ultrasound (OR = 6.24, 95% CI 5.15-7.55), and lower in multiple births than in singletons (OR = 0.41, 95% CI 0.36-0.47). The fetal death rate of birth defects increased with the number of previous pregnancies (χ2trend = 49.28, P < 0.01), and decreased with the number of previous deliveries (χ2trend = 4318.91, P < 0.01). Many fetal deaths were associated with birth defects. We found several demographic characteristics associated with fetal deaths from birth defects, which may be related to the severity of the birth defects, economic and medical conditions, and parental attitudes toward birth defects.

Use of Latent Class Analysis to Predict Intensive Care Unit Admission and Mortality in Children with a Major Congenital Anomaly

OBJECTIVE

To define major congenital anomaly (CA) subgroups and assess outcome variability based on defined subgroups.

STUDY DESIGN

This population-based cohort study used registries in Denmark for children born with a major CA between January 1997 and December 2016, with follow-up until December 2018. We performed a latent class analysis (LCA) using child and family clinical and sociodemographic characteristics present at birth, incorporating additional variables occurring until age of 24 months. Cox proportional hazards regression models estimated hazard ratios (HRs) of pediatric mortality and intensive care unit (ICU) admissions for identified LCA classes.

RESULTS

The study included 27 192 children born with a major CA. Twelve variables led to a 4-class solution (entropy = 0.74): (1) children born with higher income and fewer comorbidities (55.4%), (2) children born to young mothers with lower income (24.8%), (3) children born prematurely (10.0%), and (4) children with multiorgan involvement and developmental disability (9.8%). Compared with those in Class 1, mortality and ICU admissions were highest in Class 4 (HR = 8.9, 95% CI = 6.4-12.6 and HR = 4.1, 95% CI = 3.6-4.7, respectively). More modest increases were observed among the other classes for mortality and ICU admissions (Class 2: HR = 1.7, 95% CI = 1.1-2.5 and HR = 1.3, 95% CI = 1.1-1.4, respectively; Class 3: HR = 2.5, 95% CI = 1.5-4.2 and HR = 1.5, 95% CI = 1.3-1.9, respectively).

CONCLUSIONS

Children with a major CA can be categorized into meaningful subgroups with good discriminative ability. These groupings may be useful for risk-stratification in outcome studies.

Prevalence and death rate of birth defects from population-based surveillance in Hunan Province, China, 2010-2020

To describe the prevalence and death rate of birth defects from population-based surveillance in Hunan Province, China. Data were obtained from the population-based Birth Defects Surveillance System in Hunan Province, China (2010-2020). The surveillance population included all live births, stillbirths, infant deaths, and legal terminations of pregnancy from 28 weeks of gestation to 42 days after birth between 2010 and 2020 when the mother resided in the surveillance area (Liuyang County and Shifeng District, Hunan Province). The prevalence of birth defects is the number of birth defects per 1000 infants (‰). The death rate of birth defects is the number of deaths attributable to birth defects per 100 birth defects (%). The prevalence and death rate with 95% confidence intervals (CI) were calculated by the log-binomial method. Crude odds ratios (ORs) were calculated to examine the association of each demographic characteristic with birth defects. Our study included 228,444 infants, and 4453 birth defects were identified, with a prevalence of 19.49‰ (95%CI 18.92-20.07). Congenital heart defects were the most common specific defects (5.29‰), followed by limb defects (4.01‰). Birth defects were more common in males than females (22.34‰ vs. 16.26‰, OR = 1.38, 95%CI 1.30-1.47), in premature birth than not (91.82‰ vs. 16.14‰, OR = 6.16, 95%CI 5.72-6.65), in birth weight < 2500 g (98.26‰ vs. 16.22‰, OR = 6.61, 95%CI 6.11-7.15) or > 4000 g (19.48‰ vs. 16.22‰, OR = 1.21, 95%CI 1.03-1.42) than birth weight 2500-4000 g, in hospitalized deliveries than other institutions (22.16‰ vs. 11.74‰, OR = 1.91, 95%CI 1.76-2.07), in multiple births than singletons (28.50‰ vs. 19.28‰, OR = 1.49, 95%CI 1.27-1.76), in maternal age < 20 years (26.33‰ vs. 18.69‰, OR = 1.42, 95%CI 1.15-1.76) or >  = 35 years (24.31‰ vs. 18.69‰, OR = 1.31, 95%CI 1.18-1.45) than maternal age 25-29 years, and in number of pregnancies >  = 4 (22.91‰ vs. 18.92‰, OR = 1.22, 95%CI 1.10-1.35) than the first pregnancy. A total of 747 deaths attributable to birth defects were identified, including 603 (80.72%) stillbirths, 75 (10.04%) deaths within 7 days after birth, 46 (6.16%) deaths in 7-27 days after birth, 23 (3.08%) deaths in 28-42 days after birth. The death rate of birth defects was 16.78% (95%CI 15.57-17.98). Deaths attributable to birth defects accounted for 51.09% (747/1462) of all deaths. Central nervous system defects had the highest death rate (90.27%), and neonatal genetic metabolic defects had the lowest death rate (0.39%). In summary, we have described the prevalence and epidemiology of birth defects from population-based surveillance in Hunan Province, China, 2010-2020. There were differences in the prevalence and death rate of birth defects between population-based surveillance and hospital-based surveillance.

Acute symptoms of depression and traumatic stress in men and women who terminate pregnancy after the detection of fetal anomaly: A prospective observational study

OBJECTIVE

To assess acute and long-term stress in men and women after the detection of fetal anomalies leading to pregnancy termination.

DESIGN

Prospective observational study.

SETTING

Tertiary referral centre for fetal medicine.

POPULATION

From the initial sample of 180 pregnant women with a fetal anomaly detected by ultrasound examination, a total of 87 women terminated their pregnancy, with 72 partners included in the sample. At the time of detection, the group of women (n = 93) and their partners (n = 81) who did not terminate the pregnancy following a diagnosis were included as a comparison group.

METHODS

These women and their partners were asked to complete the Edinburgh Postnatal Depression Scale (EPDS) and the Impact of Events Scale (IES) questionnaires, both at the time of initial detection and at 6 weeks after the termination of the pregnancy.

MAIN OUTCOME MEASURES

Responses to the EPDS and the IES at the time of initial detection and at 6 weeks after pregnancy termination.

RESULTS

Women who underwent pregnancy termination reported higher symptom levels of depression, but not traumatic stress, prior to the termination than women who chose not to terminate their pregnancy. Among men, there was a difference across depression and all subscales of traumatic stress (e.g. IES intrusion: mean difference 5.31; 95% CI 2.32-8.31). Women experienced more depressive symptoms over time than men (β = 4.33, P < 0.001) and higher symptom levels on all subscales of traumatic stress (e.g. IES intrusion: β = 5.27; P < 0.001).

CONCLUSIONS

Overall, our study underscores the heightened levels of depression and traumatic stress experienced by prospective parents, particularly prior to the decision to terminate a pregnancy following the detection of a fetal anomaly. Although women generally report more pronounced symptoms, it is noteworthy that men also experience considerable traumatic stress during this challenging time.

Fetoscopic Tracheal Occlusion for Isolated Severe Left Diaphragmatic Hernia: A Systematic Review and Meta-Analysis

Background: We aimed to conduct a systematic review and meta-analysis to evaluate the fetoscopic tracheal occlusion in patients with isolated severe and left-sided diaphragmatic hernia. Methods: Cochrane Library, Embase, and PubMed (Medline) databases were searched from inception to February 2024 with no filters or language restrictions. We included studies evaluating the outcomes of fetoscopic intervention compared to expectant management among patients with severe congenital diaphragmatic hernia exclusively on the left side. A random-effects pairwise meta-analysis was performed using RStudio version 4.3.1. Results: In this study, we included 540 patients from three randomized trials and five cohorts. We found an increased likelihood of neonatal survival associated with fetoscopic tracheal occlusion (Odds Ratio, 5.07; 95% Confidence Intervals, 1.91 to 13.44; p < 0.01) across general and subgroup analyses. Nevertheless, there were higher rates of preterm birth (OR, 5.62; 95% CI, 3.47-9.11; p < 0.01) and preterm premature rupture of membranes (OR, 7.13; 95% CI, 3.76-13.54; p < 0.01) in fetal endoscopic tracheal occlusion group compared to the expectant management. Conclusions: Our systematic review and meta-analysis demonstrated the benefit of fetoscopic tracheal occlusion in improving neonatal and six-month postnatal survival in fetuses with severe left-sided CDH. Further studies are still necessary to evaluate the efficacy of tracheal occlusion for isolated right-sided CDH, as well as the optimal timing to perform the intervention.

Perinatal deaths attributable to congenital heart defects in Hunan Province, China, 2016-2020

OBJECTIVE

To explore the association between demographic characteristics and perinatal deaths attributable to congenital heart defects (CHDs).

METHODS

Data were obtained from the Birth Defects Surveillance System of Hunan Province, China, 2016-2020. The surveillance population included fetuses and infants from 28 weeks of gestation to 7 days after birth whose mothers delivered in the surveillance hospitals. Surveillance data included demographic characteristics such as sex, residence, maternal age, and other key information, and were used to calculate the prevalence of CHDs and perinatal mortality rates (PMR) with 95% confidence intervals (CI). Multivariable logistic regression analysis (method: Forward, Wald, α = 0.05) and adjusted odds ratios (ORs) were used to identify factors associated with perinatal deaths attributable to CHDs.

RESULTS

This study included 847755 fetuses, and 4161 CHDs were identified, with a prevalence of 0.49% (95%CI: 0.48-0.51). A total of 976 perinatal deaths attributable to CHDs were identified, including 16 (1.64%) early neonatal deaths and 960 (98.36%) stillbirths, with a PMR of 23.46% (95%CI: 21.98-24.93). In stepwise logistic regression analysis, perinatal deaths attributable to CHDs were more common in rural areas than urban areas (OR = 2.21, 95%CI: 1.76-2.78), more common in maternal age <20 years (OR = 2.40, 95%CI: 1.05-5.47), 20-24 years (OR = 2.13, 95%CI: 1.46-3.11) than maternal age of 25-29 years, more common in 2 (OR = 1.60, 95%CI: 1.18-2.18) or 3 (OR = 1.43, 95%CI: 1.01-2.02) or 4 (OR = 1.84, 95%CI: 1.21-2.78) or > = 5 (OR = 2.02, 95%CI: 1.28-3.18) previous pregnancies than the first pregnancy, and more common in CHDs diagnosed in > = 37 gestional weeks (OR = 77.37, 95%CI: 41.37-144.67) or 33-36 gestional weeks (OR = 305.63, 95%CI: 172.61-541.15) or < = 32 gestional weeks (OR = 395.69, 95%CI: 233.23-671.33) than diagnosed in postnatal period (within 7 days), and less common in multiple births than singletons (OR = 0.48, 95%CI: 0.28-0.80).

CONCLUSIONS

Perinatal deaths were common in CHDs in Hunan in 2016-2020. Several demographic characteristics were associated with perinatal deaths attributable to CHDs, which may be summarized mainly as economic and medical conditions, severity of CHDs, and parental attitudes toward CHDs.

Population-based surveillance of congenital anomalies over 40 years (1981-2020): Results from the Paris Registry of Congenital Malformations (remaPAR)

INTRODUCTION

Registries of congenital anomalies (CAs) play a key role in the epidemiological surveillance of CAs. The objective was to estimate the prevalence of CAs and proportions of prenatal diagnosis, terminations of pregnancy for fetal anomaly (TOPFA) and infant mortality in the Paris Registry of Congenital Malformations (remaPAR) over 40 years, from 1981 to 2020.

MATERIAL AND METHODS

remaPAR records all births (live births, stillbirths ≥22 weeks of gestation and TOPFA at any gestational age) with CAs detected prenatally until the early neonatal period. We estimated the prevalence of CAs and proportions of prenatal diagnosis, TOPFA and infant mortality, overall and for a selected group of CAs in 3-year intervals.

RESULTS

The prevalence of CAs remained stable during the study period: 2.9 % of total births and 2.1 % of live births. Genetic anomalies were the most frequent subgroup (about 23 %), followed by congenital heart defects (about 22 %) and limb defects (about 20 %). Among non-genetic anomalies, the prevalence per 10,000 births was the highest for hypospadias (about 18 %) and the lowest for bilateral renal agenesis (about 1 %). Prenatal diagnoses increased from about 17 % in the 1980s to approximately 70 % in the most recent period (2018-2020), whereas the proportion of early TOPFA <16 weeks of gestation increased from 0.4 % to 14 %. Infant mortality ranged from 0 % for transverse limb reduction defects to 86 % for hypoplastic left heart syndrome.

CONCLUSION

The overall prevalence of CAs was fairly stable in Paris from 1981 to 2020. Prenatal diagnoses substantially increased, accompanied by much smaller increases in TOPFA.

The Impact of the Use of e-Partogram on Maternal and Perinatal Outcomes: A Scoping Review

To overcome shortcomings of the paper partograph, enhance care during labor and delivery, improve record keeping, and help decision-making, several countries have focused on adopting low-cost digital applications. This scoping review highlights the usability and current status of the digital partogram in obstetric care. We conducted a thorough search involving the databases ScienceDirect, PubMed, and Google Scholar for relevant studies from inception till September 2023 by using the keywords "partograph", "electronic", and "obstetric" as well as the Boolean operators "AND" and "OR". Based on the selection criteria, 25 studies exploring the application of electronic partographs (e-partographs) in obstetric care were included in the review. The majority of the studies examined the efficiency and reported the effectiveness of e-partographs in comparison to paper partographs. The e-partograph has also demonstrated a clear benefit in that the healthcare providers filled out the data, and a reminder mechanism was placed, which might help determine whether the labor process was normal or needed more care. Moreover, an e-partograph was simple to adopt and use for obstetric caregivers and had the potential to save time. To sum up, digital partograph produces superior results to paper partograph. The use of an e-partograph can keep deliveries on track while lowering the need for cesarean sections and prolonged labor. The e-partograph provides essential benefits to its users and also provides a warning system with audible and visual cues that might be utilized to detect difficulties during delivery.

Genetic etiology and pregnancy outcomes of fetuses with central nervous system anomalies

PURPOSE

To investigate genetic etiology and pregnancy outcomes of fetal central nervous system (CNS) anomalies.

METHODS

217 fetuses with CNS anomalies were included in our cohort from January 2016 to December 2022. 124 cases received karyotyping and 73 cases simultaneously underwent copy number variant sequencing (CNV-seq). Dynamic ultrasound screening and pregnancy outcomes were followed up, including neonates' neurodevelopmental outcomes.

RESULTS

(1) 20 types of CNS anomalies were revealed by ultrasound and the most common was ventriculomegaly. (2) 14 (11.3%) of 124 cases were found chromosomal abnormalities by karyotyping, and copy number variations (CNVs) were revealed in 13 (17.8%) of 73 cases by CNV-seq. Fetuses with non-isolated CNS anomalies had a higher detection rate (DR) of abnormal karyotypes and CNVs than those with isolated CNS anomalies (25.0% vs. 4.8%; 35.0% vs. 11.3%) (P < 0.05). And the DR of abnormal karyotypes was significantly higher in multiple CNS anomalies than in single CNS anomaly (16.7% vs. 2.8%, P < 0.05), while there were no significant differences in the DR of CNVs. (3) Through dynamic ultrasound, 12 cases were further found progression or additional malformations. (4) Pregnancy outcomes of 209 cases were obtained, including 136 (65.1%) live births, 3 (1.4%) intrauterine fetal deaths, and 70 (33.5%) terminated. Two neonatal deaths at 6 months and one infant with motor and intellectual disabilities were finally found after long-term follow-up.

CONCLUSION

Genetic analysis combined with dynamic ultrasound screening and multidisciplinary consultation plays an important role in evaluating the prognosis of fetal CNS anomalies, especially for those with multiple CNS or extracranial abnormalities.

Anatomic parameters of omphaloceles and their association with anatomic, genetic, or syndromic malformations: a retrospective study

PURPOSE

This retrospective study aims to describe anatomical parameters of omphaloceles and to analyze their association with anatomical, genetic, or syndromic malformations.

METHODS

Cases were selected from digital records of two university centers, a certified regional registry and personal records. Patients from 1998 to 2018 with omphalocele and live birth (LB), termination of pregnancy due to fetal anomaly (TOPFA) and fetal death (FD) were included. Cases born outside Western Switzerland and/or with upper or lower coelosomy were excluded.

RESULTS

We analyzed 162 cases with the following distribution: 57 (35%) LB, 91 (56%) TOPFA and 14 (9%) FD. TOPFA was significantly more frequently performed in cases with non-isolated omphalocele, i.e., omphaloceles with associated major malformations (especially cardiovascular and genitourinary), genetic/chromosomal anomalies, or syndromes. For LB, associated anatomical malformations, genetic or chromosomal anomalies were not significantly associated with the size of the omphalocele or the liver involvement.

CONCLUSIONS

The proportion of cases resulting in TOPFA was higher among fetuses with major malformations, genetic or chromosomal anomalies. Despite the large size of this cohort, and in contrary to previous publications, the size of the omphalocele and/or liver involvement does not allow for conclusions regarding the presence or number of associated malformations, genetic or chromosomal anomalies.