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Guilbaud L, Maurice P, Lallemant P, De Saint-Denis T, Maisonneuve E, Dhombres F, Friszer S, Di Rocco F, Garel C, Moutard ML, Lachtar MA, Rigouzzo A, Forin V, Zérah M, Jouannic JM. Open fetal surgery for myelomeningocele repair in France. J Gynecol Obstet Hum Reprod 2021; 50:102155. [PMID: 33915336 DOI: 10.1016/j.jogoh.2021.102155] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/22/2021] [Accepted: 04/23/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Open fetal myelomeningocele (MMC) surgery is currently the standard of care option for prenatal MMC repair. We described the population referred to our center and reviewed outcome after open fetal MMC repair. MATERIAL AND METHODS All patients referred to our center for MMC were reviewed from July 2014 to June 2020. For all the patients who underwent fetal MMC repair, surgical details, maternal characteristics and data from the neonatal to the three-years-old evaluations were collected. RESULTS Among the 126 patients referred to our center, 49.2% were eligible and 27.4% (n = 17) of them underwent fetal MMC repair. Average gestational age at fetal surgery was 24+6 weeks. There was no case of fetal complication and the only maternal complication was one case of transfusion. We recorded 70% of premature rupture of membranes and 47% of premature labor. Average gestational age at delivery was 34+2 weeks and no patient delivered before 30 weeks. There was no case of uterine scar dehiscence or maternal complication during cesarean section. After birth, 59% of the children had a hindbrain herniation reversal. At 1-year-old, 42% were assigned a functional level of one or more better than expected according to the prenatal anatomic level and 25% required a ventriculoperitoneal shunt. At 3-year-old, all the children attended school and 75% were able to walk with orthotics or independently. CONCLUSION Open fetal surgery enables anatomical repair of the MMC lesion, a potential benefit on cerebral anomalies and motor function, with a low rate of perinatal and maternal complications.
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Affiliation(s)
- Lucie Guilbaud
- Sorbonne University, AP-HP, Trousseau Hospital, DMU ORIGYNE, Department of Fetal Medicine, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; National Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies (MAVEM Center), AP-HP, Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75012 Paris, France.
| | - Paul Maurice
- Sorbonne University, AP-HP, Trousseau Hospital, DMU ORIGYNE, Department of Fetal Medicine, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; National Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies (MAVEM Center), AP-HP, Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - Pauline Lallemant
- National Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies (MAVEM Center), AP-HP, Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; Sorbonne University, AP-HP, Trousseau Hospital, Department of Physical Medicine and Rehabilitation, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - Timothée De Saint-Denis
- National Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies (MAVEM Center), AP-HP, Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; Paris University, AP-HP, Necker Enfants Malades Hospital, Department of Pediatric Neurosurgery, 149 Rue de Sèvres, 75015 Paris, France
| | - Emeline Maisonneuve
- Sorbonne University, AP-HP, Trousseau Hospital, DMU ORIGYNE, Department of Fetal Medicine, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; National Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies (MAVEM Center), AP-HP, Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - Ferdinand Dhombres
- Sorbonne University, AP-HP, Trousseau Hospital, DMU ORIGYNE, Department of Fetal Medicine, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; National Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies (MAVEM Center), AP-HP, Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - Stéphanie Friszer
- Sorbonne University, AP-HP, Trousseau Hospital, DMU ORIGYNE, Department of Fetal Medicine, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; National Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies (MAVEM Center), AP-HP, Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - Federico Di Rocco
- Lyon Claude Bernard University, hôpital Femme-Mère-Enfant, Department of Pediatric Neurosurgery, 59 Boulevard Pinel, 69500 Bron, France
| | - Catherine Garel
- National Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies (MAVEM Center), AP-HP, Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; Sorbonne University, AP-HP, Trousseau Hospital, Department of Pediatric Radiology, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - Marie-Laure Moutard
- National Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies (MAVEM Center), AP-HP, Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; Sorbonne University, AP-HP, Trousseau Hospital, DMU ORIGYNE, Department of Pediatric Neurology, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - Mohamed-Ali Lachtar
- Sorbonne University, AP-HP, Trousseau Hospital, DMU ORIGYNE, Neonatal Intensive Care Unit, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - Agnès Rigouzzo
- Sorbonne University, AP-HP, Trousseau Hospital, Department of Anesthesiology, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - Véronique Forin
- National Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies (MAVEM Center), AP-HP, Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; Sorbonne University, AP-HP, Trousseau Hospital, Department of Physical Medicine and Rehabilitation, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
| | - Michel Zérah
- National Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies (MAVEM Center), AP-HP, Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; Paris University, AP-HP, Necker Enfants Malades Hospital, Department of Pediatric Neurosurgery, 149 Rue de Sèvres, 75015 Paris, France
| | - Jean-Marie Jouannic
- Sorbonne University, AP-HP, Trousseau Hospital, DMU ORIGYNE, Department of Fetal Medicine, 26 Avenue du Dr Arnold Netter, 75012 Paris, France; National Reference Center for Rare Disease: Vertebral and Spinal Cord Anomalies (MAVEM Center), AP-HP, Trousseau Hospital, 26 Avenue du Dr Arnold Netter, 75012 Paris, France
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Forci K, Bouaiti EA, Alami MH, Mdaghri Alaoui A, Thimou Izgua A. Incidence of neural tube defects and their risk factors within a cohort of Moroccan newborn infants. BMC Pediatr 2021; 21:124. [PMID: 33722213 PMCID: PMC7958414 DOI: 10.1186/s12887-021-02584-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 02/28/2021] [Indexed: 11/24/2022] Open
Abstract
Background Neural tube defects (NTDs) are a group of birth defects that result from a partial or complete failure of the neural tube to close during embryogenesis. Their prevalence varies between 0.5 to 2 per 1000 births in countries without folic acid supplementation. The aim of our study is to assess the NTDs incidence and describe the risk factors within Moroccan newborn infants. Method This is a descriptive study over a period of 5 and a half years including all births at “Les Orangers” Maternity and Reproductive Health Hospital of Rabat with notification of NTD cases, whether isolated or combined with other anomalies. Data were reported on pre-established sheets and on the teratovigilance registry. Statistical analysis was performed with SPSS version 18 statistical software. Results During the study period, 43,923 births were recorded including 44 cases of neural tube defects, an incidence rate of 1 per 1000 births, with a female predominance; sex ratio = 0.8. These defects included anencephaly (50%), spina bifida (38.6%) and encephalocele (11.4%). The risk factors detected during this study include consanguinity (34%), consumption of fenugreek or other plants (36%), diabetes (4.5%) and medication (2.2%). A family history of malformation was reported in 6.8% of cases and among siblings in 4.5% of cases. The average maternal age was 30.38 ± 6.88 and the average gestational age was 36.80 ± 5.11. A quarter of mothers did not benefit from any medical monitoring during pregnancy while 59% did not take folic acid supplementation during the first trimester of pregnancy and none of them took B9 vitamin during the periconceptional period. The antenatal diagnosis was performed in 63% of cases. The mortality rate was 3.8 per 10,000 and 16% of cases evolved positively. Conclusion NTDs require high intensity and multidisciplinary care which stresses the importance, in our context, of strengthening and optimizing acid folic supplementation strategies during the periconceptional period.
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Affiliation(s)
- Khenata Forci
- Congenital Defects Research Team, Faculty of Medicine and Pharmacy, University Mohamed V Rabat, P.B: 174 Downtown Rabat, Rabat, Morocco.
| | - El Arbi Bouaiti
- Laboratory of Biostatistics, Clinical & Epidemiological Research, Faculty of Medicine and Pharmacy of Rabat, University Mohamed V Rabat, Rabat, Morocco
| | - Mohamed Hassan Alami
- Congenital Defects Research Team, Faculty of Medicine and Pharmacy, University Mohamed V Rabat, P.B: 174 Downtown Rabat, Rabat, Morocco.,"Les Orangers" Maternity and Reproductive Health Hospital of Rabat, CHU IBN SINA, Rabat, Morocco
| | - Asmaa Mdaghri Alaoui
- Congenital Defects Research Team, Faculty of Medicine and Pharmacy, University Mohamed V Rabat, P.B: 174 Downtown Rabat, Rabat, Morocco.,Dysmorphology and Congenital Anomalies Unit, Pediatric Department 2, HER, CHU IBN SINA, Rabat, Morocco
| | - Amal Thimou Izgua
- Congenital Defects Research Team, Faculty of Medicine and Pharmacy, University Mohamed V Rabat, P.B: 174 Downtown Rabat, Rabat, Morocco.,Center for consultations and external explorations, HER, CHU IBN SINA, Rabat, Morocco
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Portes M, Mousty E, Grosjean F, Lamouroux A, Faure JM, Fuchs F, Letouzey V. [Training simulation during the announcement of fetal malformation discovered on screening ultrasound: Results of a pilot study]. ACTA ACUST UNITED AC 2020; 49:122-127. [PMID: 32919088 DOI: 10.1016/j.gofs.2020.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Breaking bad news (BBN) to a pregnant woman with fetal abnormalities (FA) on ultrasound (US) examination is a challenge. Announcement technique influences patient reaction. Physicians receive little training in BBN. The simulation and using a BBN protocol as the English SPIKES protocol which guides the announcement consultation according to 6 steps (Setting Up, Perception, Invitation, Knowledge, Emotions and Empathy, Strategy and Summary) can be used for this teaching. The objective was to assess feasibility simulation scenarii of BBN for FA discovered during US and to evaluate the usefulness of SPIKES protocol in this situation. METHODS Two scenarios have been created combining US simulator (US Mentor, Symbionix®) with simulated patient (SP). Scenarii objectives were to diagnose FA and break it to SP. Checklist derived from SPIKES was fulfilled by two investigators thanks to video recording, the SP and every participant (residents, physicians, fetal medicine specialists [FMS]). Participants filled out survey about the usefulness of this exercise too. RESULTS Nine physicians (3 residents, 4 physicians, 2 FMS) produced 18 scenarii. Seventy-eight percent of physicians thought simulation was like real situation of BBN during US examination. Majority of participant (88%) found that this simulation training could help them to increase their ability to BBN and that it can be used to teach residents (89%) or physicians (100%). FMS had better SPIKES checklist than physicians (P<0,05). CONCLUSION Simulation scenario of BBN for FA discovered during US is feasible by combining US simulator and SP. SPIKES protocol can be useful but a validated checklist should be created.
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Affiliation(s)
- M Portes
- Service de gynécologie obstétrique, CHU de Nîmes, 4, rue du Pr-Robert-Debré, 30029 Nîmes, France.
| | - E Mousty
- Service de gynécologie obstétrique, CHU de Nîmes, 4, rue du Pr-Robert-Debré, 30029 Nîmes, France
| | - F Grosjean
- Service de gynécologie obstétrique, CHU de Nîmes, 4, rue du Pr-Robert-Debré, 30029 Nîmes, France
| | - A Lamouroux
- Service de gynécologie obstétrique, CHU de Nîmes, 4, rue du Pr-Robert-Debré, 30029 Nîmes, France
| | - J M Faure
- Service de gynécologie obstétrique, CHU de Montpellier Arnaud-de-Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
| | - F Fuchs
- Service de gynécologie obstétrique, CHU de Montpellier Arnaud-de-Villeneuve, 371, avenue du Doyen-Gaston-Giraud, 34090 Montpellier, France
| | - V Letouzey
- Service de gynécologie obstétrique, CHU de Nîmes, 4, rue du Pr-Robert-Debré, 30029 Nîmes, France
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Pregnancy outcome following in utero exposure to azathioprine: A French comparative observational study. Therapie 2018; 73:199-207. [DOI: 10.1016/j.therap.2017.06.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 05/15/2017] [Accepted: 06/30/2017] [Indexed: 01/05/2023]
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Ferrier C, Dhombres F, Guilbaud L, Durand-Zaleski I, Jouannic JM. [Ultrasound screening for birth defects: A medico-economic review]. ACTA ACUST UNITED AC 2017; 45:408-415. [PMID: 28720225 DOI: 10.1016/j.gofs.2017.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 06/14/2017] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The systematic use of ultrasound during pregnancy aims at birth defect detection. Our objective was to assess the economic efficiency of prenatal ultrasound screening for fetal malformations. METHODS We carried out a literature review on Medline via PubMed between 1985 and 2015, from the economic perspective of the prenatal ultrasound screening for fetal malformations. RESULTS The literature on this subject was sparse and we selected only twelve articles presenting relevant economic data, of which only eight were proper medico-economic studies. We found arguments for the economic effectiveness of ultrasound screening for fetal malformation detection, which is largely linked to the terminations of pregnancies and to the cost of the handicaps "avoided". However, none of the reviewed articles could reach medico-economic conclusions. Additionally, we highlighted various elements making economic analyses more complex in this field: the choice of the method, the uncertainty around two essential parameters (the efficiency of ultrasound and the costs of procedures) and the difficulties to compare or to generalize results. We also noticed important methodological heterogeneity among the studies and the absence of French study. CONCLUSIONS Previously published data are insufficient to assess the economic efficiency of prenatal ultrasound screening for fetal malformations.
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Affiliation(s)
- C Ferrier
- Service de médecine fœtale, pôle de périnatalité, hôpital Armand-Trousseau, AP-HP, UPMC, Paris 6, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France; Unité de recherche clinique en économie de la santé d'Île-de-France, Hôtel-Dieu de Paris, 1, place du parvis de Notre-Dame, 75004 Paris, France
| | - F Dhombres
- Service de médecine fœtale, pôle de périnatalité, hôpital Armand-Trousseau, AP-HP, UPMC, Paris 6, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France.
| | - L Guilbaud
- Service de médecine fœtale, pôle de périnatalité, hôpital Armand-Trousseau, AP-HP, UPMC, Paris 6, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
| | - I Durand-Zaleski
- Unité de recherche clinique en économie de la santé d'Île-de-France, Hôtel-Dieu de Paris, 1, place du parvis de Notre-Dame, 75004 Paris, France
| | - J-M Jouannic
- Service de médecine fœtale, pôle de périnatalité, hôpital Armand-Trousseau, AP-HP, UPMC, Paris 6, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France
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[Preliminary results from the French study on prenatal repair for fetal myelomeningoceles (the PRIUM study)]. ACTA ACUST UNITED AC 2015; 45:738-44. [PMID: 26566108 DOI: 10.1016/j.jgyn.2015.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 09/04/2015] [Accepted: 09/15/2015] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To present the preliminary results of the PRIUM study, a French pilot study of prenatal repair for myelomeningoceles (MMC). MATERIAL AND METHODS The fetal surgery for MMC is offered in cases of patients that did not opt for termination of pregnancy. RESULTS Thirty-six patients were referred in an 18-month period. Eight patients were not eligible for prenatal repair. Another type of dysraphism was made in 6 cases (one spina-lipoma, 5 cases of limited dorsal myeloschisis). Twenty-two patients were eligible to fetal surgery. A prenatal repair was performed in three cases (14%). Four patients opted for a conventional postnatal treatment. Fifteen patients opted for termination of the pregnancy. CONCLUSION The establishment of a prenatal repair of MMC protocol in France was justified. The experience of the first 18months of this study however suggests that only a limited number of couples will choose this procedure after specialized counseling in a reference center.
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Bertagna F, Rakza T, Vaksmann G, Ramdane-Sebbane N, Devisme L, Storme L, Francart C, Vaast P, Houfflin-Debarge V. Transposition of the great arteries: factors influencing prenatal diagnosis. Prenat Diagn 2014; 34:534-7. [PMID: 24532355 DOI: 10.1002/pd.4343] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 02/11/2014] [Accepted: 02/11/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The objective of this study is to highlight the factors that may affect prenatal diagnosis of transposition of the great arteries (TGA) in order to improve it. METHODS This is a retrospective study performed between 2004 and 2009 in the maternity units from North of France. We identified a total of 68 cases of TGA (isolated or associated with only VSD or coarctation of aorta), of which 32 (47.1%) had prenatal diagnosis (PND+) and 36 did not (PND-). Maternal characteristics and ultrasound factors were studied in relation to PND. RESULTS Maternal weight and body mass index were significantly higher in the PND- group (70.4 kg and 26.5 kg/m(2) vs 63.6 kg and 23.6 kg/m(2) , respectively). Maternal obesity (body mass index >30) was significantly more frequent in the PND- group (27.8% vs 12.5%). More than a quarter of TGA (28.1%) were diagnosed during the third trimester. CONCLUSION Obesity is the main cause of missed PND of TGA. Obese patients with suboptimal prenatal scans may benefit from reassessment of fetal cardiac anatomy and/or from referral for fetal echocardiography.
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Affiliation(s)
- F Bertagna
- Department of Obstetrics, Jeanne de Flandre Hospital, CHU Lille, Lille, France
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Garabedian C, Di Rocco F, Fallet-Bianco C, Zerah M, Jouannic JM. [Prenatal repair of myelomeningocele: State of the art]. ACTA ACUST UNITED AC 2013; 42:227-31. [PMID: 23453920 DOI: 10.1016/j.jgyn.2012.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 10/22/2012] [Accepted: 10/25/2012] [Indexed: 12/20/2022]
Abstract
Myelomeningocele is characterized by the extrusion of the spinal cord into a sac filled with cerebrospinal fluid. One part of the postnatal disabilities could be related to the spinal damage and to the cerebral repercussion of the leak of cerebrospinal fluid from the defect. Several experimental studies in animals have demonstrated that a surgical repair of the lesion at middle gestation reduced the postnatal disabilities. These results were confirmed in humans by the Management of Myelomeningocele (MOM) Trial. However, the prenatal surgical repair is associated with maternal and fetal morbidity.
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Affiliation(s)
- C Garabedian
- Pôle de périnatalité, centre pluridisciplinaire de diagnostic prénatal de l'Est parisien, université Paris 6, hôpital Trousseau, AP-HP, 26, avenue Arnold-Netter, 75012 Paris, France
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Lelong N, Thieulin AC, Vodovar V, Goffinet F, Khoshnood B. Surveillance épidémiologique et diagnostic prénatal des malformations congénitales en population parisienne : évolution sur 27 ans, 1981–2007. Arch Pediatr 2012; 19:1030-8. [DOI: 10.1016/j.arcped.2012.06.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 05/23/2012] [Accepted: 06/29/2012] [Indexed: 10/26/2022]
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Congenital heart defects in La Réunion Island: a 6-year survey within a EUROCAT-affiliated congenital anomalies registry. Cardiol Young 2012; 22:547-57. [PMID: 22325463 DOI: 10.1017/s1047951112000054] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES This study compares the prevalence and perinatal mortality of congenital heart defects on La Réunion with European (EUROCAT) standards. METHODS AND RESULTS Data were extracted from a EUROCAT-affiliated congenital malformations registry, covering 88,025 births during the period 2002-2007, on the whole island territory. A total of 512 congenital heart defects were registered, including 424 live births, 18 foetal deaths from 16 weeks of gestation, and 70 terminations of pregnancy. The total prevalence of congenital heart defects was 5.8 per 1000 births and live birth prevalence was 4.8 per 1000. The total prevalence of non-chromosomal congenital heart defects was 5.1 per 1000 births, of which 3% were perinatal deaths, 33.3% prenatally diagnosed, and 11.6% termination of pregnancy. Severe non-chromosomal congenital heart defects - excluding ventricular septal defects, atrial septal defects, and pulmonary valve stenosis - occurred in 2.1 per 1000 births, of which 10.3% were perinatal deaths, 59.1% prenatally diagnosed, and 24.3% termination of pregnancy. Of the severe congenital heart defects, the rates of single ventricle (0.20‰), Ebstein anomaly (0.11‰), common arterial trunk (0.25‰), and atrioventricular septal defect (0.62‰) exceeded averages found in Europe, although coarctation of the aorta was infrequent. Conversely, rates of ventricular septal defects, atrial septal defects, and pulmonary valve stenosis were inferior to European standards. Slightly less than half of the congenital heart defects of chromosomal origin were associated with Down syndrome. CONCLUSION In La Réunion, the total prevalence of congenital heart defects is far inferior to that found in Europe. The difference can be attributable to lower prevalences of mild congenital heart defects.
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Nassar N, Leoncini E, Amar E, Arteaga-Vázquez J, Bakker MK, Bower C, Canfield MA, Castilla EE, Cocchi G, Correa A, Csáky-Szunyogh M, Feldkamp ML, Khoshnood B, Landau D, Lelong N, López-Camelo JS, Lowry RB, McDonnell R, Merlob P, Métneki J, Morgan M, Mutchinick OM, Palmer MN, Rissmann A, Siffel C, Sìpek A, Szabova E, Tucker D, Mastroiacovo P. Prevalence of esophageal atresia among 18 international birth defects surveillance programs. ACTA ACUST UNITED AC 2012; 94:893-9. [PMID: 22945024 DOI: 10.1002/bdra.23067] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 07/09/2012] [Accepted: 07/09/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND The prevalence of esophageal atresia (EA) has been shown to vary across different geographical settings. Investigation of geographical differences may provide an insight into the underlying etiology of EA. METHODS The study population comprised infants diagnosed with EA during 1998 to 2007 from 18 of the 46 birth defects surveillance programs, members of the International Clearinghouse for Birth Defects Surveillance and Research. Total prevalence per 10,000 births for EA was defined as the total number of cases in live births, stillbirths, and elective termination of pregnancy for fetal anomaly (ETOPFA) divided by the total number of all births in the population. RESULTS Among the participating programs, a total of 2943 cases of EA were diagnosed with an average prevalence of 2.44 (95% confidence interval [CI], 2.35-2.53) per 10,000 births, ranging between 1.77 and 3.68 per 10,000 births. Of all infants diagnosed with EA, 2761 (93.8%) were live births, 82 (2.8%) stillbirths, 89 (3.0%) ETOPFA, and 11 (0.4%) had unknown outcomes. The majority of cases (2020, 68.6%), had a reported EA with fistula, 749 (25.5%) were without fistula, and 174 (5.9%) were registered with an unspecified code. CONCLUSIONS On average, EA affected 1 in 4099 births (95% CI, 1 in 3954-4251 births) with prevalence varying across different geographical settings, but relatively consistent over time and comparable between surveillance programs. Findings suggest that differences in the prevalence observed among programs are likely to be attributable to variability in population ethnic compositions or issues in reporting or registration procedures of EA, rather than a real risk occurrence difference. Birth Defects Research (Part A), 2012.
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Affiliation(s)
- Natasha Nassar
- Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney, Australia
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Paternal occupational exposures and the risk of congenital malformations--a case-control study. Int J Occup Med Environ Health 2011; 24:218-27. [PMID: 21590429 DOI: 10.2478/s13382-011-0019-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 03/14/2011] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES This study examined the association between certain paternal occupational exposures during the periconceptional period and the risk of congenital malformations. MATERIALS AND METHODS A case-control study was carried out from December 2009 to April 2010; on 242 congenital malformation cases and 270 controls. Paternal occupational exposure to certain workplace hazards was assessed by a detailed questionnaire to evaluate the occupational exposure for both fathers and mothers including pesticides, solvents, welding fumes, lead, working with video display terminals (VDTs) and computer monitors. In addition, the questionnaire assessed the presence of other risk factors such as consanguinity, smoking and history of any maternal diseases during the pregnancy with the child. RESULTS The results revealed that the odds of having a child with congenital malformation was higher (P < 0.01) if the father was occupationally exposed to pesticides (OR: 3.42, 95% CI: 1.97-5.92), solvents (OR: 5.63, 95% CI: 2.77-11.42), or welding fumes (OR: 2.98, 0.99-8.54) during the periconceptional period. However, consanguinity (OR: 1.91, 95% CI: 1.25-2.92) was a risk factor of developing congenital malformations among offspring. CONCLUSION Control of workplace exposures and adherence to threshold limit values of those hazards should be adopted to minimize the risk of developing congenital malformations among offspring.
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Lacroix I, Berrebi A, Garipuy D, Schmitt L, Hammou Y, Chaumerliac C, Lapeyre-Mestre M, Montastruc JL, Damase-Michel C. Buprenorphine versus methadone in pregnant opioid-dependent women: a prospective multicenter study. Eur J Clin Pharmacol 2011; 67:1053-9. [DOI: 10.1007/s00228-011-1049-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 04/08/2011] [Indexed: 11/29/2022]
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Antenatal imaging: does the postnatal impact justify the effort? Pediatr Radiol 2011; 41:417-31. [PMID: 21229350 DOI: 10.1007/s00247-010-1929-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 11/03/2010] [Accepted: 11/08/2010] [Indexed: 10/18/2022]
Abstract
This review explores what is already understood about antenatal diagnosis of a variety of conditions,including Down syndrome, what progress has been made in this field, the role that imaging plays in the diagnostic pathway and the impact on management of pregnancies and the parental decision process. An overview of future potential developments is also made.
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Levesque BG, Kane SV. IBD: measuring what counts-safety of IBD medications in pregnancy. Nat Rev Gastroenterol Hepatol 2011; 8:126-8. [PMID: 21304477 DOI: 10.1038/nrgastro.2011.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2022]
Abstract
Uncertainty about the risks of medications for IBD during pregnancy is a challenge for clinicians and patients. a recent prospective cohort study suggests that women under medical care for their disease have few adverse events.
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Affiliation(s)
- Barrett G Levesque
- Division of Gastroenterology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Abstract
Background—
This study determines the prevalence of Congenital Heart Defects (CHD), diagnosed prenatally or in infancy, and fetal and perinatal mortality associated with CHD in Europe.
Methods and Results—
Data were extracted from the European Surveillance of Congenital Anomalies central database for 29 population-based congenital anomaly registries in 16 European countries covering 3.3 million births during the period 2000 to 2005. CHD cases (n=26 598) comprised live births, fetal deaths from 20 weeks gestation, and terminations of pregnancy for fetal anomaly (TOPFA). The average total prevalence of CHD was 8.0 per 1000 births, and live birth prevalence was 7.2 per 1000 births, varying between countries. The total prevalence of nonchromosomal CHD was 7.0 per 1000 births, of which 3.6% were perinatal deaths, 20% prenatally diagnosed, and 5.6% TOPFA. Severe nonchromosomal CHD (ie, excluding ventricular septal defects, atrial septal defects, and pulmonary valve stenosis) occurred in 2.0 per 1000 births, of which 8.1% were perinatal deaths, 40% were prenatally diagnosed, and 14% were TOPFA (TOPFA range between countries 0% to 32%). Live-born CHD associated with Down syndrome occurred in 0.5 per 1000 births, with >4-fold variation between countries.
Conclusion—
Annually in the European Union, we estimate 36 000 children are live born with CHD and 3000 who are diagnosed with CHD die as a TOFPA, late fetal death, or early neonatal death. Investing in primary prevention and pathogenetic research is essential to reduce this burden, as well as continuing to improve cardiac services from in utero to adulthood.
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Affiliation(s)
- Helen Dolk
- From the EUROCAT Central Registry, Centre for Maternal, Fetal and Infant Research, Institute of Nursing Research, University of Ulster, UK (H.D., M.L.); and Department of Pediatrics, Hospital Lillebaelt, Kolding, Denmark (E.G.)
| | - Maria Loane
- From the EUROCAT Central Registry, Centre for Maternal, Fetal and Infant Research, Institute of Nursing Research, University of Ulster, UK (H.D., M.L.); and Department of Pediatrics, Hospital Lillebaelt, Kolding, Denmark (E.G.)
| | - Ester Garne
- From the EUROCAT Central Registry, Centre for Maternal, Fetal and Infant Research, Institute of Nursing Research, University of Ulster, UK (H.D., M.L.); and Department of Pediatrics, Hospital Lillebaelt, Kolding, Denmark (E.G.)
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Sibiude J, Gavard L, Floch-Tudal C, Mandelbrot L. Perinatal Care and Outcome of Fetuses with Trisomies 13 and 18 following a Parental Decision Not to Terminate the Pregnancy. Fetal Diagn Ther 2011; 29:233-7. [DOI: 10.1159/000322133] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Accepted: 10/19/2010] [Indexed: 11/19/2022]
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18
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Koenig D, Spreux A, Hiéronimus S, Chichmanian RM, Bastiani F, Fénichel P, Brucker-Davis F. Birth defects observed with maternal carbimazole treatment: Six cases reported to Nice's Pharmacovigilance Center. ANNALES D'ENDOCRINOLOGIE 2010; 71:535-42. [DOI: 10.1016/j.ando.2010.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2010] [Accepted: 07/01/2010] [Indexed: 10/19/2022]
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19
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Leoncini E, Botto LD, Cocchi G, Annerén G, Bower C, Halliday J, Amar E, Bakker MK, Bianca S, Canessa Tapia MA, Castilla EE, Csáky-Szunyogh M, Dastgiri S, Feldkamp ML, Gatt M, Hirahara F, Landau D, Lowry RB, Marengo L, McDonnell R, Mathew TM, Morgan M, Mutchinick OM, Pierini A, Poetzsch S, Ritvanen A, Scarano G, Siffel C, Sípek A, Szabova E, Tagliabue G, Vollset SE, Wertelecki W, Zhuchenko L, Mastroiacovo P. How valid are the rates of Down syndrome internationally? Findings from the International Clearinghouse for Birth Defects Surveillance and Research. Am J Med Genet A 2010; 152A:1670-80. [PMID: 20578135 DOI: 10.1002/ajmg.a.33493] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Rates of Down syndrome (DS) show considerable international variation, but a systematic assessment of this variation is lacking. The goal of this study was to develop and test a method to assess the validity of DS rates in surveillance programs, as an indicator of quality of ascertainment. The proposed method compares the observed number of cases with DS (livebirths plus elective pregnancy terminations, adjusted for spontaneous fetal losses that would have occurred if the pregnancy had been allowed to continue) in each single year of maternal age, with the expected number of cases based on the best-published data on rates by year of maternal age. To test this method we used data from birth years 2000 to 2005 from 32 surveillance programs of the International Clearinghouse for Birth Defects Surveillance and Research. We computed the adjusted observed versus expected ratio (aOE) of DS birth prevalence among women 25-44 years old. The aOE ratio was close to unity in 13 programs (the 95% confidence interval included 1), above 1 in 2 programs and below 1 in 18 programs (P < 0.05). These findings suggest that DS rates internationally can be evaluated simply and systematically, and underscores how adjusting for spontaneous fetal loss is crucial and feasible. The aOE ratio can help better interpret and compare the reported rates, measure the degree of under- or over-registration, and promote quality improvement in surveillance programs that will ultimately provide better data for research, service planning, and public health programs.
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Affiliation(s)
- Emanuele Leoncini
- Centre of the International Clearinghouse for Birth Defects Surveillance and Research, Roma, Italy
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Lisi A, Botto LD, Robert-Gnansia E, Castilla EE, Bakker MK, Bianca S, Cocchi G, de Vigan C, da Graça Dutra M, Horacek J, Merlob P, Pierini A, Scarano G, Sipek A, Yamanaka M, Mastroiacovo P. Surveillance of adverse fetal effects of medications (SAFE-Med): Findings from the International Clearinghouse of Birth Defects Surveillance and Research. Reprod Toxicol 2010; 29:433-42. [DOI: 10.1016/j.reprotox.2010.03.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Revised: 03/03/2010] [Accepted: 03/21/2010] [Indexed: 11/28/2022]
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Cocchi G, Gualdi S, Bower C, Halliday J, Jonsson B, Myrelid Å, Mastroiacovo P, Amar E, Bakker MK, Correa A, Doray B, Melve KK, Koshnood B, Landau D, Mutchinick OM, Pierini A, Ritvanen A, Ruddock V, Scarano G, Sibbald B, Sípek A, Tenconi R, Tucker D, Annerén G. International trends of Down syndrome 1993-2004: Births in relation to maternal age and terminations of pregnancies. ACTA ACUST UNITED AC 2010; 88:474-9. [DOI: 10.1002/bdra.20666] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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22
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Evaluation of Prenatally Diagnosed Structural Congenital Anomalies. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2009; 31:875-881. [DOI: 10.1016/s1701-2163(16)34307-9] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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23
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Gagnon A, Wilson RD, Allen VM, Audibert F, Blight C, Brock JA, Désilets VA, Gagnon A, Johnson JA, Langlois S, Murphy-Kaulbeck L, Wyatt P. Évaluation des anomalies congénitales structurelles diagnostiquées pendant la période prénatale. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2009. [DOI: 10.1016/s1701-2163(16)34308-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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24
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Prescription of drugs during pregnancy: a study using EFEMERIS, the new French database. Eur J Clin Pharmacol 2009; 65:839-46. [DOI: 10.1007/s00228-009-0647-2] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2008] [Accepted: 03/18/2009] [Indexed: 10/20/2022]
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25
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Fernández Ibieta M, Ramos Amador JT, Bellón Cano JM, González-Tomé MI, Guillén Martín S, Navarro Gómez M, de José MI, Beceiro J, Iglesias E, Prieto L, Santos MJ, Martínez Guardia N, Roa MA, Regidor J. [Birth defects in a cohort of uninfected children born to HIV-infected women]. An Pediatr (Barc) 2009; 70:253-64. [PMID: 19246263 DOI: 10.1016/j.anpedi.2008.10.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2008] [Revised: 10/29/2008] [Accepted: 10/30/2008] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Mother-to-Child HIV transmission is now just 1% in western countries, due to prevention measures. Antiretroviral Treatment (ART) drugs do have adverse effects, anaemia and myelosupression caused by cidovudina being the most commonly observed effects. In the present study, we have analysed the proportion and characteristics of congenital malformations (CM) or birth defects (BD) in a cohort of uninfected children born to HIV-infected women. METHODS A total of 623 uninfected children belonging to the FIPSE cohort were followed up according to standardised protocols. This cohort includes 8 public hospitals from Madrid and follows up HIV-infected pregnant women and their children. Children were classified according to prematurity, ethnic origin, birth weight, withdrawal syndrome, in-utero treatment. Birth defects were described and defined according to the EUROCAT, the European registry for BD. Mild errors of morphogenesis were excluded from the analysis. Categorical variables were compared with the X(2) or the Fisher test. RESULTS A total of 78% (486) of the mothers were of Caucasian origin; 18.8% (117) used some illicit drug (heroine, cocaine or methadone) during gestation; 51 mothers (8.1%) received no ART, 10 (1.6%) received monotherapy and 469 (75.3%) received HAART. BD were seen in 52 children, with the most frequent being genitourinary and cardiological. Anaemia in the first trimester was an associated risk for BD (17.9% vs. 8.1%, P = 0,04). Similarly, mothers who used any illicit drug (plus methadone), had a slightly higher risk for BD in their offspring (13.8% vs. 7.6%, P = 0,04) There was no increased risk for BD significantly associated with any of the in-utero used antiretrovirals, although Nevirapine use in-utero showed a protective effect. Children born to mothers who received ART in the first trimester had the same rate of BD (7.4%) as those whose mothers started ART in the second trimester (8.8%), P = 0,67. CONCLUSIONS The proportion of BD that we have observed seems higher than those shown in other European teratogenicity studies and also higher than those shown in cohorts with HIV and antiretroviral exposed infants. This may be due to the fact that our series show the results of an active surveillance system (that includes ultrasound), where BD classically appear in a higher proportion. Immunovirological characteristics of the mother did not influence the proportion of BD, but anaemia in the fist trimester and the use of illicit drugs (or methadone) did. No specific antiretroviral drug was associated with an increase in BD, although Nevirapine showed a possible protective effect in the statistical analysis. Mothers who started antiretrovirals in the first trimester do not have more BD in their offspring than mothers who started on antiretrovirals later on.
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Affiliation(s)
- M Fernández Ibieta
- Servicio de Pediatría, Hospital Universitario de Getafe, Madrid, España.
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Ray CL, Morin L. Routine Versus Indicated Third Trimester Ultrasound: Is a Randomized Trial Feasible? JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2009; 31:113-9. [DOI: 10.1016/s1701-2163(16)34094-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Seror V, Ville Y. Prenatal screening for Down syndrome: women's involvement in decision-making and their attitudes to screening. Prenat Diagn 2009; 29:120-8. [DOI: 10.1002/pd.2183] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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28
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Leoncini E, Baranello G, Orioli IM, Annerén G, Bakker M, Bianchi F, Bower C, Canfield MA, Castilla EE, Cocchi G, Correa A, De Vigan C, Doray B, Feldkamp ML, Gatt M, Irgens LM, Lowry RB, Maraschini A, Mc Donnell R, Morgan M, Mutchinick O, Poetzsch S, Riley M, Ritvanen A, Gnansia ER, Scarano G, Sipek A, Tenconi R, Mastroiacovo P. Frequency of holoprosencephaly in the International Clearinghouse Birth Defects Surveillance Systems: searching for population variations. ACTA ACUST UNITED AC 2008; 82:585-91. [PMID: 18566978 DOI: 10.1002/bdra.20479] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Holoprosencephaly (HPE) is a developmental field defect of the brain that results in incomplete separation of the cerebral hemispheres that includes less severe phenotypes, such as arhinencephaly and single median maxillary central incisor. Information on the epidemiology of HPE is limited, both because few population-based studies have been reported, and because small studies must observe a greater number of years in order to accumulate sufficient numbers of births for a reliable estimate. METHODS We collected data from 2000 through 2004 from 24 of the 46 Birth Defects Registry Members of the International Clearinghouse for Birth Defects Surveillance and Research. This study is based on more than 7 million births in various areas from North and South America, Europe, and Australia. RESULTS A total of 963 HPE cases were registered, yielding an overall prevalence of 1.31 per 10,000 births. Because the estimate was heterogeneous, possible causes of variations among populations were analyzed: random variation, under-reporting and over-reporting bias, variation in proportion of termination of pregnancies among all registered cases and real differences among populations. CONCLUSIONS The data do not suggest large differences in total prevalence of HPE among the studied populations that would be useful to generate etiological hypotheses.
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Affiliation(s)
- Emanuele Leoncini
- Centre of the International Clearinghouse for Birth Defects Surveillance and Research, Roma, Italy
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[Contribution of new techniques of fetal imaging to the prenatal diagnosis of fetal malformations]. Arch Pediatr 2008; 15:715-7. [PMID: 18582725 DOI: 10.1016/s0929-693x(08)71886-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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30
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Seror V. Fitting observed and theoretical choices - women's choices about prenatal diagnosis of Down syndrome. HEALTH ECONOMICS 2008; 17:557-77. [PMID: 17806133 DOI: 10.1002/hec.1276] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
Choices regarding prenatal diagnosis of Down syndrome - the most frequent chromosomal defect - are particularly relevant to decision analysis, since women's decisions are based on the assessment of their risk of carrying a child with Down syndrome, and involve tradeoffs (giving birth to an affected child vs procedure-related miscarriage). The aim of this study, based on face-to-face interviews with 78 women aged 25-35 with prior experience of pregnancy, was to compare the women' expressed choices towards prenatal diagnosis with those derived from theoretical models of choice (expected utility theory, rank-dependent theory, and cumulative prospect theory). The main finding obtained in this study was that the cumulative prospect model fitted the observed choices best: both subjective transformation of probabilities and loss aversion, which are basic features of the cumulative prospect model, have to be taken into account to make the observed choices consistent with the theoretical ones.
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Affiliation(s)
- Valerie Seror
- INSERM, Research Unit 379, Social Sciences Applied to Medical Innovation, Marseille F-13000, France.
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Verret C, Jutand MA, De Vigan C, Bégassat M, Bensefa-Colas L, Brochard P, Salamon R. Reproductive health and pregnancy outcomes among French gulf war veterans. BMC Public Health 2008; 8:141. [PMID: 18442369 PMCID: PMC2387146 DOI: 10.1186/1471-2458-8-141] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2007] [Accepted: 04/28/2008] [Indexed: 11/10/2022] Open
Abstract
Background Since 1993, many studies on the health of Persian Gulf War veterans (PGWVs) have been undertaken. Some authors have concluded that an association exists between Gulf War service and reported infertility or miscarriage, but that effects on PGWV's children were limited. The present study's objective was to describe the reproductive outcome and health of offspring of French Gulf War veterans. Methods The French Study on the Persian Gulf War (PGW) and its Health Consequences is an exhaustive cross-sectional study on all French PGWVs conducted from 2002 to 2004. Data were collected by postal self-administered questionnaire. A case-control study nested in this cohort was conducted to evaluate the link between PGW-related exposures and fathering a child with a birth defect. Results In the present study, 9% of the 5,666 Gulf veterans who participated reported fertility disorders, and 12% of male veterans reported at least one miscarriage among their partners after the PGW. Overall, 4.2% of fathers reported at least one child with a birth defect conceived after the mission. No PGW-related exposure was associated with any birth defect in children fathered after the PGW mission. Concerning the reported health of children born after the PGW, 1.0% of children presented a pre-term delivery and 2.7% a birth defect. The main birth defects reported were musculoskeletal malformations (0.5%) and urinary system malformations (0.3%). Birth defect incidence in PGWV children conceived after the mission was similar to birth defect incidence described by the Paris Registry of Congenital Malformations, except for Down syndrome (PGWV children incidence was lower than Registry incidence). Conclusion This study did not highlight a high frequency of fertility disorders or miscarriage among French PGW veterans. We found no evidence for a link between paternal exposure during the Gulf War and increased risk of birth defects among French PGWV children.
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Affiliation(s)
- Catherine Verret
- Laboratory of Occupational and Environmental Health, Victor Segalen Bordeaux 2 University, Bordeaux, France.
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Ray CL, Lacerte M, Iglesias MH, Audibert F, Morin L. Routine Third Trimester Ultrasound: What Is the Evidence? JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2008; 30:118-122. [DOI: 10.1016/s1701-2163(16)32734-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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de Vigan C, Khoshnood B, Cadio E, Vodovar V, Goffinet F. Diagnostic prénatal et prévalence de la trisomie 21 en population parisienne, 2001–2005. ACTA ACUST UNITED AC 2008; 36:146-150. [DOI: 10.1016/j.gyobfe.2007.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2007] [Accepted: 12/05/2007] [Indexed: 11/15/2022]
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Papiernik E, Zeitlin J, Delmas D, Draper ES, Gadzinowski J, Künzel W, Cuttini M, Di Lallo D, Weber T, Kollée L, Bekaert A, Bréart G. Termination of pregnancy among very preterm births and its impact on very preterm mortality: results from ten European population-based cohorts in the MOSAIC study. BJOG 2008; 115:361-8. [DOI: 10.1111/j.1471-0528.2007.01611.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mallol-Mesnard N, Menegaux F, Lacour B, Hartmann O, Frappaz D, Doz F, Bertozzi AI, Chastagner P, Hémon D, Clavel J. Birth characteristics and childhood malignant central nervous sytem tumors: The ESCALE study (French Society for Childhood Cancer). ACTA ACUST UNITED AC 2008; 32:79-86. [PMID: 18396378 DOI: 10.1016/j.cdp.2008.02.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2008] [Indexed: 02/01/2023]
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Mangione R, Fries N, Godard P, Fontanges M, Haddad G, Mirlesse V. [Outcome of fetuses with malformations discovered before 14 weeks. Where the discovery is revealed by echography during the first trimester, is it responsible for the voluntary termination of the pregnancy? Comparison before and after July 2001]. ACTA ACUST UNITED AC 2007; 37:154-62. [PMID: 18036748 DOI: 10.1016/j.jgyn.2007.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2007] [Revised: 05/30/2007] [Accepted: 08/27/2007] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The aims of this study were to review detection of fetal malformations during the first trimester and to study pregnancy and infant outcomes. We wanted to check if the lengthening of the legal delay for volontary termination of pregnancy changes the outcome of the pregnancy, in cases outside of the legal requirements. MATERIALS AND METHODS This study was overseen by the french college of fetal echography (CFEF). All the cases of abnormality detected before 14 weeks' gestational age, excluding the isolated increased nuchal translucency, were extracted from the total population examined, and details were entered into the database of the French College of Fetal Echography. All case records were then analyzed. We compared two populations: before and after July 2001. RESULTS We observed 336 fetuses with malformation(s), 108 before July 2001 and 208 after that date. One percent (0.5-1.6) of scans performed between 10 and 14 weeks revealed fetal abnormalities apart from isolated increased nuchal translucency. Of the 336 cases retained for investigation, 109 increased nuchal translucency or hygroma associated with other malformation(s), 103 central nervous system anomalies, 85 malformations of the thoracoabdominal wall, 81 limb abnormalities, 41 had renal malformations, 28 spinal abnormalities, 21 had heart malformations, 16 involved biometric abnormalities, 12 involved abnormalities of the appendages, and 11 facial abnormalities. Medical termination of pregnancy was performed in 75% of cases. Death in utero occurred in 9% of cases, 12% of infants were born alive. In 3.9% of cases, an abortion was performed. There were no differences between both populations before and after July 2001. CONCLUSION Excluding isolated increased nuchal translucency or hygroma, malformation before 14 weeks' gestational age was detected in 1% of fetuses. The most common malformations detected in the first trimester were non-isolated increased nuchal translucency and malformations of the thoracoabdominal wall and the brain. The prognosis for fetuses with malformations detected during the first trimester was very poor as only 12% of these infants were born alive, some of them with severe malformations. In our study, and given its limitations, there were no differences between the number of voluntary terminations performed before and after July 2001.
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Affiliation(s)
- R Mangione
- Polyclinique Bordeaux-Nord-Aquitaine, 15, rue Claude-Boucher, 33000 Bordeaux, France.
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