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Krieck LK, Barbian MH, Schuler-Faccini L, Pinto Moehlecke Iser B. Congenital anomalies in Santa Catarina, Southern Brazil: macroregional and temporal birth prevalence for the period 2011-2020. J Community Genet 2024:10.1007/s12687-024-00716-9. [PMID: 38918275 DOI: 10.1007/s12687-024-00716-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/17/2024] [Indexed: 06/27/2024] Open
Abstract
Congenital anomalies (CAs) are an important cause of infant mortality and efficient surveillance is necessary for their prevention. Therefore, the objective of this study is to establish baselines of prevalence at birth of priority CAs for surveillance in the state of Santa Catarina, using data from the Live Birth Information System considering the period 2011-2019 (baseline) and 2020 (pandemic year). The analyses were carried out based on the mother's residence health macroregion. The CAs were selected following the ICD-10 coding for chapter XVII. Birth prevalence was calculated per 10,000 live births and the confidence interval was established at 95%. 2011-2019 recorded 88.8/10,000 births with CAs (total). For 2011-2019, limb defects (without polydactyly) were the most prevalent (14.1/10,000), followed by congenital heart defects (8.9), oral clefts (8.2), polydactyly (7.9), Down syndrome (5.6), hypospadias (5.4), neural tube defects (4.7), gastroschisis (3.3), undefined sex (1.2), microcephaly (0.8) and omphalocele (0.3). There were no significant differences in temporal and spatial distribution. However, unusual fluctuations were observed in 2020, which may reflect the pandemic in CAs notifications. In the base period, Santa Catarina recorded CAs below the expected level of being identified at birth. With this, we conclude that the training and awareness of teams are essential for the surveillance of CAs in Santa Catarina.
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Affiliation(s)
- Laysa Kariny Krieck
- Graduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Márcia Helena Barbian
- Graduate Program in Statistics, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Lavinia Schuler-Faccini
- Graduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Medical Genetics Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Betine Pinto Moehlecke Iser
- Graduate Program in Health Sciences, Universidade do Sul de Santa Catarina, Tubarão, Santa Catarina, Brazil.
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Zhou X, Xie D, Jiang Y, Fang J. Prevalence and death rate of birth defects from population-based surveillance in Hunan Province, China, 2010-2020. Sci Rep 2024; 14:14609. [PMID: 38918397 PMCID: PMC11199636 DOI: 10.1038/s41598-024-65072-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 06/17/2024] [Indexed: 06/27/2024] Open
Abstract
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.
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Affiliation(s)
- Xu Zhou
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, 410000, Hunan Province, China
| | - Donghua Xie
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, 410000, Hunan Province, China
| | - Yurong Jiang
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, 410000, Hunan Province, China.
| | - Junqun Fang
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, 410000, Hunan Province, China.
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Elias DE, Santos MR, Campaña H, Poletta FA, Heisecke SL, Gili JA, Ratowiecki J, Cosentino V, Uranga R, Saleme C, Rittler M, Krupitzki HB, Lopez Camelo JS, Gimenez LG. Indirect Effects of Neighbourhood Socioeconomic Status on Preterm Birth Risk in an Argentine Population. Matern Child Health J 2024:10.1007/s10995-024-03951-1. [PMID: 38831170 DOI: 10.1007/s10995-024-03951-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND Preterm birth (PTB) is the main condition related to perinatal morbimortality worldwide. The aim of this study was to determine the indirect effects of neighbourhood socioeconomic status (NSES) on the risk of spontaneous PTB. METHODS We carried out a retrospective case-control study including sociodemographic and obstetric data of multigravid women who gave birth at a maternity hospital in Tucumán, Argentina, between 2005 and 2010: 949 women without previous PTB nor pregnancy loss who delivered at term and 552 who had spontaneous PTB. NSES was estimated from the Unsatisfied Basic Needs index of census data. Variables selected through penalised regressions were used to create a data-driven Bayesian network; then, pathways were identified and mediation analyses performed. RESULTS Maternal age less than 20 years mediated part of the protective effect of high NSES on spontaneous PTB [natural indirect effect (NIE) -0.0125, 95% confidence interval (CI) (-0.0208, -0.0041)] and on few prenatal visits (< 5) [NIE - 0.0095, 95% CI (-0.0166, -0.0025)]. These pathways showed greater sensitivity to unobserved confounders that affect the variables mediator-outcome in the same direction, and exposure-mediator in the opposite direction. They did not show sensitivity to observed potential confounders, nor to the parameterization used to define NSES. Meanwhile, urinary tract infections showed a trend in mediating the effect of low NSES on spontaneous PTB [NIE 0.0044, 95% CI (-0.0006, 0.0093), P 0.0834]. CONCLUSIONS High NSES has protective indirect effects on spontaneous PTB risk, mainly associated with a lower frequency of teenage pregnancy.
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Affiliation(s)
- Dario E Elias
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina.
| | - Maria R Santos
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Comisión de Investigaciones Científicas, Buenos Aires, Argentina
- Instituto Multidisciplinario de Biología Celular, Buenos Aires, Argentina
| | - Hebe Campaña
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Comisión de Investigaciones Científicas, Buenos Aires, Argentina
| | - Fernando A Poletta
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Instituto Nacional de Genética Médica Populacional (INAGEMP), CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
| | - Silvina L Heisecke
- Dirección de Investigación, CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
| | - Juan A Gili
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Instituto Académico Pedagógico de Ciencias Humanas, Universidad Nacional de Villa María, Córdoba, Argentina
| | - Julia Ratowiecki
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Viviana Cosentino
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Hospital Interzonal General de Agudos Luisa C. de Gandulfo, Buenos Aires, Argentina
| | - Rocio Uranga
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Hospital San Juan de Dios, Buenos Aires, Argentina
| | - César Saleme
- Instituto de Maternidad y Ginecología Nuestra Señora de las Mercedes, Tucumán, Argentina
| | - Mónica Rittler
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Hospital Materno Infantil Ramón Sardá, Ciudad Autónoma de Buenos Aires, Argentina
| | - Hugo B Krupitzki
- Dirección de Investigación, CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
- Instituto Universitario, Centro de Educación Médica e Investigaciones Clínicas (CEMIC-IUC), Ciudad Autónoma de Buenos Aires, Argentina
| | - Jorge S Lopez Camelo
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Instituto Nacional de Genética Médica Populacional (INAGEMP), CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
| | - Lucas G Gimenez
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Instituto Nacional de Genética Médica Populacional (INAGEMP), CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
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Zhou X, He J, Wang A, Hua X, Li T, Shu C, Fang J. Multivariate logistic regression analysis of risk factors for birth defects: a study from population-based surveillance data. BMC Public Health 2024; 24:1037. [PMID: 38622560 PMCID: PMC11017609 DOI: 10.1186/s12889-024-18420-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 03/22/2024] [Indexed: 04/17/2024] Open
Abstract
OBJECTIVE To explore risk factors for birth defects (including a broad range of specific defects). METHODS Data were derived from the Population-based Birth Defects Surveillance System in Hunan Province, China, 2014-2020. The surveillance population included all live births, stillbirths, infant deaths, and legal termination of pregnancy between 28 weeks gestation and 42 days postpartum. The prevalence of birth defects (number of birth defects per 1000 infants) and its 95% confidence interval (CI) were calculated. Multivariate logistic regression analysis (method: Forward, Wald, α = 0.05) and adjusted odds ratios (ORs) were used to identify risk factors for birth defects. We used the presence or absence of birth defects (or specific defects) as the dependent variable, and eight variables (sex, residence, number of births, paternal age, maternal age, number of pregnancies, parity, and maternal household registration) were entered as independent variables in multivariate logistic regression analysis. RESULTS Our study included 143,118 infants, and 2984 birth defects were identified, with a prevalence of 20.85% (95%CI: 20.10-21.60). Multivariate logistic regression analyses showed that seven variables (except for parity) were associated with birth defects (or specific defects). There were five factors associated with the overall birth defects. The risk factors included males (OR = 1.49, 95%CI: 1.39-1.61), multiple births (OR = 1.44, 95%CI: 1.18-1.76), paternal age < 20 (OR = 2.20, 95%CI: 1.19-4.09) or 20-24 (OR = 1.66, 95%CI: 1.42-1.94), maternal age 30-34 (OR = 1.16, 95%CI: 1.04-1.29) or > = 35 (OR = 1.56, 95%CI: 1.33-1.81), and maternal non-local household registration (OR = 2.96, 95%CI: 2.39-3.67). Some factors were associated with the specific defects. Males were risk factors for congenital metabolic disorders (OR = 3.86, 95%CI: 3.15-4.72), congenital limb defects (OR = 1.34, 95%CI: 1.14-1.58), and congenital kidney and urinary defects (OR = 2.35, 95%CI: 1.65-3.34). Rural areas were risk factors for congenital metabolic disorders (OR = 1.21, 95%CI: 1.01-1.44). Multiple births were risk factors for congenital heart defects (OR = 2.09, 95%CI: 1.55-2.82), congenital kidney and urinary defects (OR = 2.14, 95%CI: 1.05-4.37), and cleft lip and/or palate (OR = 2.85, 95%CI: 1.32-6.15). Paternal age < 20 was the risk factor for congenital limb defects (OR = 3.27, 95%CI: 1.10-9.71), 20-24 was the risk factor for congenital heart defects (OR = 1.64, 95%CI: 1.24-2.17), congenital metabolic disorders (OR = 1.56, 95%CI: 1.11-2.21), congenital limb defects (OR = 1.61, 95%CI: 1.14-2.29), and congenital ear defects (OR = 2.13, 95%CI: 1.17-3.89). Maternal age < 20 was the risk factor for cleft lip and/or palate (OR = 3.14, 95%CI: 1.24-7.95), 30-34 was the risk factor for congenital limb defects (OR = 1.37, 95%CI: 1.09-1.73), >=35 was the risk factor for congenital heart defects (OR = 1.51, 95%CI: 1.14-1.99), congenital limb defects (OR = 1.98, 95%CI: 1.41-2.78), and congenital ear defects (OR = 1.82, 95%CI: 1.06-3.10). Number of pregnancies = 2 was the risk factor for congenital nervous system defects (OR = 2.27, 95%CI: 1.19-4.32), >=4 was the risk factor for chromosomal abnormalities (OR = 2.03, 95%CI: 1.06-3.88) and congenital nervous system defects (OR = 3.03, 95%CI: 1.23-7.47). Maternal non-local household registration was the risk factor for congenital heart defects (OR = 3.57, 95%CI: 2.54-5.03), congenital metabolic disorders (OR = 1.89, 95%CI: 1.06-3.37), congenital limb defects (OR = 2.94, 95%CI: 1.86-4.66), and congenital ear defects (OR = 3.26, 95%CI: 1.60-6.65). CONCLUSION In summary, several risk factors were associated with birth defects (including a broad range of specific defects). One risk factor may be associated with several defects, and one defect may be associated with several risk factors. Future studies should examine the mechanisms. Our findings have significant public health implications as some factors are modifiable or avoidable, such as promoting childbirths at the appropriate age, improving the medical and socio-economic conditions of non-local household registration residents, and devoting more resources to some specific defects in high-risk groups, which may help reducing birth defects in China.
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Affiliation(s)
- Xu Zhou
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, 410000, China
| | - Jian He
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, 410000, China
| | - Aihua Wang
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, 410000, China
| | - Xinjun Hua
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, 410000, China
| | - Ting Li
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, 410000, China
| | - Chuqiang Shu
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, 410000, China.
| | - Junqun Fang
- Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan Province, 410000, China.
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Noroña DM, Chamba WD, Santamaria SR, Sosa MC, Carrera LL, Rodríguez FA, Martinez MA, Izquierdo-Condoy JS. Clinical profiling of pediatric microtia patients: A cross-sectional analysis at a leading pediatric hospital in Ecuador (2015-2022). Birth Defects Res 2024; 116:e2298. [PMID: 38277412 DOI: 10.1002/bdr2.2298] [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: 10/10/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Microtia is a frequent congenital deformity of the pinna, often with hearing loss. This study reviews the clinical profiles of microtia pediatric patients treated at a referral hospital in Quito, Ecuador, from 2015 to 2022. METHODS A cross-sectional descriptive study was carried out based on the analysis of medical records of pediatric patients with microtia treated between January 2015 and December 2022 at the Hospital Pediátrico Baca Ortiz in Quito, Ecuador. Descriptive statistics were used, and the Chi-square test assessed associations between categorical variables. RESULTS Of the 235 patients evaluated, 59.6% were male, 83.4% lived at high altitudes (2500-3500 m), and 19.1% had a family history of microtia. Grade III microtia was diagnosed in 63.8%, predominantly on the right side. Nearly all (99.1%) had hearing loss. Other anatomical alterations were observed in 27.7%, primarily the preauricular appendage. Bone vibrator implantation was a common treatment for 24.3%. Altitude did not show a significant correlation with microtia characteristics. CONCLUSIONS Most patients had grade III microtia with associated hearing loss. Despite the high prevalence at elevated altitudes, no significant altitude-disease correlation was found. The study highlights the need for further research on microtia in regions like Ecuador.
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Gili JA, Rittler M, Heisecke S, Campaña H, Giménez L, Santos MR, Ratowiecki J, Cosentino V, López Camelo J, Poletta FA. Paternal age and risk for selected birth defects in a large South American sample. Birth Defects Res 2023; 115:1866-1875. [PMID: 37728171 DOI: 10.1002/bdr2.2252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/05/2023] [Accepted: 09/06/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND The relationship between maternal age (MA) and birth defects (BD) has been extensively studied while much less research, mostly with discordant results, has focused on the risk of paternal age (PA) for BD. Furthermore, no consensus has been reached on the best way to control the association of PA with MA. OBJECTIVES The aim of the study was to evaluate the risk of PA increase, at 1-year intervals, for selected BD, especially controlling for the confounding effect of MA. METHODS The sample comprised of 27,944 liveborns presenting 1 of 18 selected isolated BD. Conditional logistic regressions were applied to evaluate the risk of advanced PA and its yearly increase, adjusting by MA and other variables. RESULTS Of the 18 analyzed BD, only the risk for preaxial polydactyly (PreP) showed a significant association with increasing PA, while advanced MA was of low risk. For esophageal and anal atresia, associations with both PA and MA increases were observed. CONCLUSIONS Results support the hypothesis of advanced PA as a risk factor for PreP and helps clarify the so far unexplained nonrandom association between this defect and Down syndrome.
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Affiliation(s)
- Juan A Gili
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
- Estudio Colaborativo Latinoamericano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
- Instituto Académico Pedagógico de Ciencias Humanas, Universidad Nacional de Villa María, Córdoba, Argentina
| | - Monica Rittler
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
- Estudio Colaborativo Latinoamericano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
- Hospital Materno Infantil Ramón Sardá, Buenos Aires, Argentina
| | - Silvina Heisecke
- Dirección de Investigación, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC- CONICET), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Hebe Campaña
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
- Estudio Colaborativo Latinoamericano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
- Comisión de Investigaciones Científicas (CICPBA), Buenos Aires, Argentina
| | - Lucas Giménez
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
- Estudio Colaborativo Latinoamericano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
- Instituto Nacional de Genética Médica Populacional (INAGEMP), CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - María Rita Santos
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
- Estudio Colaborativo Latinoamericano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
- Comisión de Investigaciones Científicas (CICPBA), Buenos Aires, Argentina
- Instituto Multidisciplinario de Biología Celular (IMBICE, CONICET-UNLP-CICPBA), Buenos Aires, Argentina
| | - Julia Ratowiecki
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
- Estudio Colaborativo Latinoamericano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Viviana Cosentino
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
- Estudio Colaborativo Latinoamericano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
- Hospital Interzonal General de Agudos Luisa C. de Gandulfo, Buenos Aires, Argentina
| | - Jorge López Camelo
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
- Estudio Colaborativo Latinoamericano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
- Instituto Nacional de Genética Médica Populacional (INAGEMP), CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
| | - Fernando A Poletta
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
- Estudio Colaborativo Latinoamericano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
- Instituto Nacional de Genética Médica Populacional (INAGEMP), CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Buenos Aires, Argentina
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Rittler M, Campaña H, Heisecke S, Ratowiecki J, Elias D, Gimenez L, Poletta FA, Gili J, Pawluk M, Santos MR, Uranga R, Cosentino V, Camelo JL. Lethality of Birth Defects in Live Born Infants Categorized by Gestational Age and Birth Weight. Am J Perinatol 2023; 40:1406-1412. [PMID: 34634830 DOI: 10.1055/s-0041-1735867] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to describe lethality of birth defects (BDs) in newborns categorized by gestational age and birth weight and to identify BDs associated with prematurity. STUDY DESIGN Live born infants (n = 16,452) with isolated BDs classified by severity, and 42,511 healthy controls were assigned to categories: adequate growth, preterm, or small for gestational age (SGA). Proportion of cases and BDs' lethality rates were obtained by category and compared with controls. RESULTS Overall fewer malformed than nonmalformed infants were of adequate growth, while the opposite occurred in the preterm and SGA categories where gastroschisis and esophageal atresia were among the most outstanding defects. For most severe BDs, the early neonatal death rate was higher than control values in all categories; for mild defects, except cleft lip in the preterm category, they did not differ. Diaphragmatic hernia showed the highest lethality values, while those of spina bifida were among the lowest. Talipes, hypospadias, and septal heart defects were mild defects significantly associated with prematurity. CONCLUSION Although reasons, such as induced preterm delivery of fetuses with certain anomalies, could partially account for their high prematurity rates, susceptibility to preterm birth might exist through underlying mechanisms related with the defects. The identification of BDs associated with prematurity should serve to improve measures that prevent preterm birth especially of fetuses at risk. KEY POINTS · Some BDs predispose to prematurity.. · Prematurity is an additional risk factor for mortality in infants with mild defects.. · Lethality values should be adjusted by gestational age and birth weight..
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Affiliation(s)
- Monica Rittler
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Sección Genética Médica, Dpto. Neonatología, Hospital Materno Infantil Ramón Sardá, Buenos Aires, Argentina
| | - Hebe Campaña
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Comisión de Investigaciones Científicas, Buenos Aires, Argentina
| | - Silvina Heisecke
- Dirección de Investigación, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Julia Ratowiecki
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Dario Elias
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Lucas Gimenez
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Instituto Nacional de Genética Médica Populacional (INAGEMP), CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
| | - Fernando A Poletta
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Instituto Nacional de Genética Médica Populacional (INAGEMP), CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
| | - Juan Gili
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Instituto Nacional de Genética Médica Populacional (INAGEMP), CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
- Instituto Académico Pedagógico de Ciencias Humanas, Universidad Nacional de Villa María, Córdoba, Argentina
| | - Mariela Pawluk
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Maria Rita Santos
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Comisión de Investigaciones Científicas, Buenos Aires, Argentina
- Instituto Multidisciplinario de Biología Celular, Buenos Aires, Argentina
| | - Rocio Uranga
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Consultorios externos, Servicio de Cirugía Maxilofacial y Odontología, Hospital San Juan de Dios, Buenos Aires, Argentina
| | - Viviana Cosentino
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Servicio de Pediatría, Hospital Interzonal General de Agudos Luisa C. de Gandulfo, Buenos Aires, Argentina
| | - Jorge Lopez Camelo
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Instituto Nacional de Genética Médica Populacional (INAGEMP), CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
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8
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Floriani MA, Santos AS, Diniz BL, Glaeser AB, Gazzola Zen PR, Machado Rosa RF. 22q11 Copy Number Variations in a Brazilian Cohort of Children with Congenital Heart Disorders. Mol Syndromol 2023; 14:1-10. [PMID: 36777701 PMCID: PMC9911999 DOI: 10.1159/000525247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 05/19/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Congenital heart disease (CHD) is the most common type of congenital defect reported to be one of the leading causes of mortality in the first year of life. Microdeletion and microduplication syndromes (MMS) are associated with cardiac malformations. Understanding which genetic factors are involved in these conditions directly impacts treatment decisions. We aimed to identify the occurrence of genetic alterations and their association with MMS in CHD pediatric patients evaluated in a reference service of Southern Brazil. Methods Participants were recruited during 2010 in the intensive care unit of a pediatric hospital. MMs and regions of chromosome 22 were screened by SALSA MLPA Probemix P245 Microdeletion Syndromes-1A kit for detection of copy number variations (CNVs). Results MMS were detected in 11 from 207 patients (5.3%). Heterozygous deletion in the 22q11.2 chromosome region was the most prevalent CNV (5 from 11 patients). Also, atypical RTDR1 deletion and 22q11.2 duplication were detected. MLPA was able to reveal microdeletions in SNRPN and NF1 genes in patients with a normal karyotype and FISH. Conclusion Our study reports the prevalence and variability of genomic alterations associated with MMS in CHD pediatric patients. The results by MLPA are of great help in planning and specialized care.
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Affiliation(s)
- Maiara A. Floriani
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | | | - Bruna L. Diniz
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Andressa B. Glaeser
- Graduate Program in Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Paulo R. Gazzola Zen
- Department of Internal Medicine, Clinical Genetics, UFCSPA, Porto Alegre, Brazil,Irmandade da Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Porto Alegre, Brazil
| | - Rafael F. Machado Rosa
- Department of Internal Medicine, Clinical Genetics, UFCSPA, Porto Alegre, Brazil,Irmandade da Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Porto Alegre, Brazil,*Rafael Fabiano Machado Rosa,
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9
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do Amaral Lopes SAV, Guimarães ICB, de Oliva Costa SF, Acosta AX, Abe-Sandes K, Mendes CMC. Risk factors for critical and complex congenital heart diseases: Case-control study. PROGRESS IN PEDIATRIC CARDIOLOGY 2023. [DOI: 10.1016/j.ppedcard.2022.101612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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10
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Venancio FA, Quilião ME, de Almeida Moura D, de Azevedo MV, de Almeida Metzker S, Mareto LK, de Medeiros MJ, Santos-Pinto CDB, de Oliveira EF. Congenital anomalies during the 2015–2018 Zika virus epidemic: a population-based cross-sectional study. BMC Public Health 2022; 22:2069. [DOI: 10.1186/s12889-022-14490-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 10/30/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Congenital anomalies are associated with several clinical and epidemiological complications. Following the Zika epidemic onset in Latin America, the incidence of congenital anomalies increased in Brazil. This study aimed to determine the frequency of congenital anomalies in one Brazilian state and assess potential factors associated with them.
Methods
This cross-sectional descriptive study was based on data concerning congenital anomalies recorded in the Brazilian Live-Born Information System during the Zika epidemic in Mato Grosso do Sul state from 2015 to 2018. Congenital anomalies were stratified according to year of birth and classified using ICD-10 categories.
Results
In total, 1,473 (0.85%) anomalies were registered. Within the number of cases recorded, microcephaly showed the greatest frequency and variations, with a 420% increase observed in the number of cases from 2015 to 2016. We identified an increase in the incidence of central nervous system anomalies, with the highest peak observed in 2016 followed by a subsequent decrease. Musculoskeletal, nervous, and cardiovascular system anomalies, and eye, ear, face, and neck anomalies represented 73.9% of all recorded anomalies. There was an increased chance of congenital anomalies in uneducated (odds ratio [OR] 5.56, 95% confidence interval [CI] 2.61–11.84) and Indigenous (OR 1.32, 95% CI 1.03–1.69) women, as well as among premature births (OR 2.74, 95% CI 2.39–3.13).
Conclusions
We estimated the incidence of congenital anomalies during the Zika epidemic. Our findings could help to support future research and intervention strategies in health facilities to better identify and assist children born with congenital anomalies.
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11
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Genes, exposures, and interactions on preterm birth risk: an exploratory study in an Argentine population. J Community Genet 2022; 13:557-565. [PMID: 35976607 DOI: 10.1007/s12687-022-00605-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 08/12/2022] [Indexed: 10/15/2022] Open
Abstract
Preterm birth (PTB) is the main condition related to perinatal morbimortality worldwide. The aim of this study was to identify associations of spontaneous PTB with genetic variants, exposures, and interactions between and within them. We carried out a retrospective case-control study including parental sociodemographic and obstetric data, and fetal genetic variants. We sequenced the coding and flanking regions of five candidate genes from the placental blood cord of 69 preterm newborns and 61 at term newborns. We identify the characteristics with the greatest predictive power of PTB using penalized regressions, in which we include exposures (E), genetic variants (G), and two-way interactions. Few prenatal visits (< 5) was the main predictor of PTB from 26 G, 35 E, 299 G × G, 564 E × E, and 875 G × E evaluated terms. Within the fetal genetic characteristics, we observed associations of rs4845397 (KCNN3, allele T) variant; G × G interaction between rs12621551 (COL4A3, allele T) and rs73993878 (COL4A3, allele A), which showed sensitivity to anemia; and G × G interaction between rs11680670 (COL4A3, allele T) and rs2074351 (PON1, allele A), which showed sensitivity to vaginal discharge. The results of this exploratory study suggest that social disparities and metabolic pathways linked to uterine relaxation, inflammation/infections, and collagen metabolism would be involved in PTB etiology. Future studies with a larger sample size are necessary to confirm these findings and to analyze a greater number of exposures.
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12
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Elias D, Campaña H, Poletta FA, Heisecke SL, Gili JA, Ratowiecki J, Pawluk M, Santos MR, Cosentino V, Uranga R, Saleme C, Rittler M, Krupitzki HB, Lopez Camelo JS, Gimenez LG. Preterm birth etiological pathways: a Bayesian networks and mediation analysis approach. Pediatr Res 2022; 91:1882-1889. [PMID: 34282276 DOI: 10.1038/s41390-021-01659-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/02/2021] [Accepted: 06/30/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The aim of this study was to determine the mediating effect of spontaneous preterm birth (PTB) main predictors that would allow to suggest etiological pathways. METHODS We carried out a case-control study, including sociodemographic characteristics, habits, health care, and obstetric data of multiparous women who gave birth at a maternity hospital from Tucumán, Argentina, between 2005 and 2010: 998 women without previous PTB who delivered at term and 562 who delivered preterm. We selected factors with the greatest predictive power using a penalized logistic regression model. A data-driven Bayesian network including the selected factors was created where we identified pathways and performed mediation analyses. RESULTS We identified three PTB pathways whose natural indirect effect was greater than zero with a 95% confidence interval: maternal age less than 20 years mediated by few prenatal visits, vaginal bleeding in the first trimester mediated by vaginal bleeding in the second trimester, and urinary tract infection mediated by vaginal bleeding in the second trimester. The effect mediated in these pathways showed greater sensitivity to confounders affecting the variables mediator-outcome and exposure-mediator in the same direction. CONCLUSION The identified pathways suggest PTB etiological lines related to social disparities and exposure to genitourinary tract infections. IMPACT Few prenatal visits (<5) and vaginal bleeding are two of the main predictors for spontaneous preterm birth in the studied population. Few prenatal visits mediates part of the risk associated with maternal age less than 20 years and vaginal bleeding in the second trimester mediates part of the risk associated with vaginal bleeding in the first trimester and with urinary tract infection. Social disparities and exposure to genitourinary tract infections would be etiological lines of spontaneous preterm birth.
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Affiliation(s)
- Dario Elias
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina.
| | - Hebe Campaña
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina.,Comisión de Investigaciones Científicas, Buenos Aires, Argentina
| | - Fernando A Poletta
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina.,Instituto Nacional de Genética Médica Populacional (INAGEMP), CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
| | - Silvina L Heisecke
- Dirección de Investigación, CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
| | - Juan A Gili
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina.,Instituto Académico Pedagógico de Ciencias Humanas, Universidad Nacional de Villa María, Córdoba, Argentina
| | - Julia Ratowiecki
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Mariela Pawluk
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Maria R Santos
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina.,Comisión de Investigaciones Científicas, Buenos Aires, Argentina.,Instituto Multidisciplinario de Biología Celular, Buenos Aires, Argentina
| | - Viviana Cosentino
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina.,Hospital Interzonal General de Agudos Luisa C. de Gandulfo, Buenos Aires, Argentina
| | - Rocio Uranga
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina.,Hospital San Juan de Dios, Buenos Aires, Argentina
| | - Cesar Saleme
- Instituto de Maternidad y Ginecología Nuestra Señora de las Mercedes, Tucumán, Argentina
| | - Monica Rittler
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina.,Hospital Materno Infantil Ramón Sardá, Ciudad Autónoma de Buenos Aires, Argentina
| | - Hugo B Krupitzki
- Dirección de Investigación, CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina.,Instituto Universitario, Centro de Educación Médica e Investigaciones Clínicas (CEMIC-IUC), Ciudad Autónoma de Buenos Aires, Argentina
| | - Jorge S Lopez Camelo
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina.,Instituto Nacional de Genética Médica Populacional (INAGEMP), CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
| | - Lucas G Gimenez
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina.,Instituto Nacional de Genética Médica Populacional (INAGEMP), CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
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13
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Heisecke S, Alfaro EL, Martínez J, Figueroa M, Bronberg R, Ratowiecki J, López Camelo JS, Dipierri JE. Neonatal anthropometry of malformed newborns: A large South American population-based study. Paediatr Perinat Epidemiol 2022; 36:211-219. [PMID: 35188679 DOI: 10.1111/ppe.12843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 11/17/2021] [Accepted: 11/21/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Population-based anthropometric evaluation of malformed newborns is scarce. OBJECTIVES To evaluate malformed newborns' foetal growth using the ICD 10 malformations' classification. METHODS A study including 33,769 newborns (14,857 malformed and 18,912 nonmalformed), selected from 678,840 births from nine South American countries, period 2010-2018, was conducted. Prevalence of severe small and small for gestational age was calculated for malformed and nonmalformed newborns classified by preterm birth categories. Prevalence and relative risk (RR) with its 95% confidence interval (CI) were calculated. The associations between anthropometric phenotypes and congenital malformations were evaluated with generalized linear models. RESULTS Prevalence of preterm and term severe small and small for gestational age newborns was higher in malformed than that in nonmalformed neonates. For grouped ICD 10 malformations categories, the RR for severe small for gestational age was 2.88 (95% CI 2.51, 3.30) and 2.10 (95% CI 1.92, 2.30) for small for gestational age. For at-term and preterm malformed newborns, the RR for severe small for gestational age was 2.21 (95% CI 1.87, 2.61) and 3.21 (95% CI 2.52, 4.10), respectively; for small for gestational age, the RR was 2.31 (95% CI 2.11, 2.53) for at-term newborns and 2.58 (95% CI 2.16, 3.08) for preterm ones. CONCLUSIONS Prevalence and relative risk of severe small and small for gestational age vary according to the group of malformations and gestational age; they increase in congenital malformations of the nervous, respiratory and digestive systems, and in chromosomal abnormalities and are lower for malformations of eye, ear, face and neck and cleft lip and palate. Foetal growth considered together with malformed newborns' gestational age would allow for inferring different risks of morbidity and mortality.
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Affiliation(s)
- Silvina Heisecke
- Dirección de Investigación, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Emma L Alfaro
- Instituto de Ecorregiones Andinas (INECOA), Universidad Nacional de Jujuy-Consejo Nacional de Investigaciones Científicas y Técnicas (UNJu-CONICET), San Salvador de Jujuy, Argentina
| | - Jorge Martínez
- Instituto de Ecorregiones Andinas (INECOA), Universidad Nacional de Jujuy-Consejo Nacional de Investigaciones Científicas y Técnicas (UNJu-CONICET), San Salvador de Jujuy, Argentina.,Instituto de Biología de la Altura, Universidad Nacional de Jujuy, San Salvador de Jujuy, Argentina
| | - Marcelo Figueroa
- Instituto de Ecorregiones Andinas (INECOA), Universidad Nacional de Jujuy-Consejo Nacional de Investigaciones Científicas y Técnicas (UNJu-CONICET), San Salvador de Jujuy, Argentina.,Instituto de Estudios Celulares, Genéticos y Moleculares (ICeGeM), Universidad Nacional de Jujuy, San Salvador de Jujuy, Argentina
| | - Rubén Bronberg
- Área de Genética Médica y Poblacional, Hospital Ramos Mejía, Ciudad Autónoma de Buenos Aires, Argentina
| | - Julia Ratowiecki
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina.,Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Jorge S López Camelo
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina.,Estudio Colaborativo Latino Americano de Malformaciones Congénitas (ECLAMC), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina.,Instituto Nacional de Genética Médica Populacional (INAGEMP), Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - José E Dipierri
- Instituto de Biología de la Altura, Universidad Nacional de Jujuy, San Salvador de Jujuy, Argentina
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14
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Tauma-Arrué A, Chávez-Saldivar S, Mego JC, Luis-Ybáñez O, Coronado-Quispe J, Lucena S, Alvarez C, Melgar E, Morales A, Marquez R, Wilhalme H, Bravo-Jaimes K. Trends in outpatient visits and deaths due to congenital heart defects in Peru. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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15
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de Castro VF, Mattos D, de Carvalho FM, Cavalcanti DP, Duenas-Roque MM, Llerena J, Cosentino VR, Honjo RS, Leite JCL, Sanseverino MT, de Souza MPA, Bernardi P, Bolognese AM, Santana da Silva LC, Barbero P, Correia PS, Bueno LSM, Savastano CP, Orioli IM. New SHH and Known SIX3 Variants in a Series of Latin American Patients with Holoprosencephaly. Mol Syndromol 2021; 12:219-233. [PMID: 34421500 DOI: 10.1159/000515044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 02/04/2021] [Indexed: 11/19/2022] Open
Abstract
Holoprosencephaly (HPE) is the failure of the embryonic forebrain to develop into 2 hemispheres promoting midline cerebral and facial defects. The wide phenotypic variability and causal heterogeneity make genetic counseling difficult. Heterozygous variants with incomplete penetrance and variable expressivity in the SHH, SIX3, ZIC2, and TGIF1 genes explain ∼25% of the known causes of nonchromosomal HPE. We studied these 4 genes and clinically described 27 Latin American families presenting with nonchromosomal HPE. Three new SHH variants and a third known SIX3 likely pathogenic variant found by Sanger sequencing explained 15% of our cases. Genotype-phenotype correlation in these 4 families and published families with identical or similar driver gene, mutated domain, conservation of residue in other species, and the type of variant explain the pathogenicity but not the phenotypic variability. Nine patients, including 2 with SHH pathogenic variants, presented benign variants of the SHH, SIX3, ZIC2, and TGIF1 genes with potential alteration of splicing, a causal proposition in need of further studies. Finding more families with the same SIX3 variant may allow further identification of genetic or environmental modifiers explaining its variable phenotypic expression.
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Affiliation(s)
- Viviane Freitas de Castro
- ECLAMC at Departamento de Genética, UFRJ, Rio de Janeiro, Brazil.,Instituto Nacional de Genética Médica Populacional INAGEMP, Porto Alegre, Brazil
| | - Daniel Mattos
- ECLAMC at Departamento de Genética, UFRJ, Rio de Janeiro, Brazil.,Instituto Nacional de Genética Médica Populacional INAGEMP, Porto Alegre, Brazil
| | - Flavia Martinez de Carvalho
- Instituto Nacional de Genética Médica Populacional INAGEMP, Porto Alegre, Brazil.,ECLAMC at Laboratorio Epidemiol. Malformações Congênitas, IOC/FIOCRUZ, Rio de Janeiro, Brazil
| | | | - Milagros M Duenas-Roque
- ECLAMC at Servicio de Genética, Hospital Nacional Edgardo Rebagliati Martins/EsSalud, Lima, Peru
| | - Juan Llerena
- Instituto Nacional de Genética Médica Populacional INAGEMP, Porto Alegre, Brazil.,ECLAMC at Centro de Genética Médica, IFF/FIOCRUZ, Rio de Janeiro, Brazil
| | | | | | | | | | | | - Pricila Bernardi
- Núcleo de Genética Clínica, Departamento de Clínica Médica/UFSC, Florianópolis, Brazil
| | - Ana Maria Bolognese
- Departamento de Ortodontia, Faculdade de Odontologia/UFRJ, Rio de Janeiro, Brazil
| | - Luiz Carlos Santana da Silva
- Instituto Nacional de Genética Médica Populacional INAGEMP, Porto Alegre, Brazil.,Laboratório de Erros Inatos de Metabolismo, Instituto de Ciências Biológicas/UFP, Belém, Brazil
| | - Pablo Barbero
- RENAC, Centro Nacional de Genética Médica Dr. Eduardo E. Castilla/MS, Buenos Aires, Argentina
| | | | | | | | - Iêda Maria Orioli
- ECLAMC at Departamento de Genética, UFRJ, Rio de Janeiro, Brazil.,Instituto Nacional de Genética Médica Populacional INAGEMP, Porto Alegre, Brazil
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The Differences of Population Birth Defects in Epidemiology Analysis between the Rural and Urban Areas of Hunan Province in China, 2014-2018. BIOMED RESEARCH INTERNATIONAL 2021; 2021:2732983. [PMID: 33969116 PMCID: PMC8081611 DOI: 10.1155/2021/2732983] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 02/25/2021] [Accepted: 04/10/2021] [Indexed: 11/17/2022]
Abstract
Objectives To compare the differences of epidemiology analysis in population birth defects (BDs) between the rural and urban areas of Hunan Province in China. Methods The data of population-based BDs in Liuyang county (rural) and Shifeng district (urban) in Hunan Province for 2014-2018 were analyzed. BD prevalence rates, percentage change, and annual percentage change (APC) by sex and age were calculated to evaluate time trends. Risk factors associated with BDs were assessed using simple and multiple logistic regression analyses. Results The BD prevalence rate per 10,000 perinatal infants (PIs) was 220.54 (95% CI: 211.26-230.13) in Liuyang and 181.14 (95% CI: 161.18-202.87) in Shifeng. Significant decreasing trends in BD prevalence rates were noted in the female PIs (APC = -9.31, P = 0.044) and the total BD prevalence rate in Shifeng (APC = -14.14, P = 0.039). Risk factors for BDs were as follows: rural area, male PIs, PIs with gestational age < 37 weeks, PIs with birth weight < 2500 g, and migrant pregnancies. Conclusions We should focus on rural areas, reduce the prevalence of premature and low birth weight infants, and provide maternal healthcare services for migrant pregnancies for BD prevention from the perspective of population-based BD surveillance.
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Orioli IM, Dolk H, Lopez-Camelo J, Groisman B, Benavides-Lara A, Gimenez LG, Correa DM, Ascurra M, de Aquino Bonilha E, Canessa-Tapia MA, de França GVA, Hurtado-Villa P, Ibarra-Ramírez M, Pardo R, Pastora DM, Zarante I, Soares FS, de Carvalho FM, Piola M. The Latin American network for congenital malformation surveillance: ReLAMC. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2020; 184:1078-1091. [PMID: 33319501 DOI: 10.1002/ajmg.c.31872] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/25/2020] [Accepted: 12/02/2020] [Indexed: 12/14/2022]
Abstract
The early detection of congenital anomaly epidemics occurs when comparing current with previous frequencies in the same population. The success of epidemiologic surveillance depends on numerous factors, including the accuracy of the rates available in the base period, wide population coverage, and short periodicity of analysis. This study aims to describe the Latin American network of congenital malformation surveillance: ReLAMC, created to increase epidemiologic surveillance in Latin America. We describe the main steps, tasks, strategies used, and preliminary results. From 2017 to 2019, five national registries (Argentina [RENAC], Brazil [SINASC/SIM-BRS], Chile [RENACH], Costa Rica [CREC], Paraguay [RENADECOPY-PNPDC]), six regional registries (Bogotá [PVSDC-Bogota], Cali [PVSDC-Cali], Maule [RRMC SSM], Nicaragua [SVDC], Nuevo-León [ReDeCon HU], São Paulo [SINASC/SIM-MSP]) and the ECLAMC hospital network sent data to ReLAMC on a total population of 9,152,674 births, with a total of 101,749 malformed newborns (1.1%; 95% CI 1.10-1.12). Of the 9,000,651 births in countries covering both live and stillbirths, 88,881 were stillborn (0.99%; 95% CI 0.98-0.99), and among stillborns, 6,755 were malformed (7.61%; 95% CI 7.44-7.79). The microcephaly rate was 2.45 per 10,000 births (95% CI 2.35-2.55), hydrocephaly 3.03 (2.92-3.14), spina bifida 2.89 (2.78-3.00), congenital heart defects 15.53 (15.27-15.79), cleft lip 2.02 (1.93-2.11), cleft palate and lip 2.77 (2.66-2.88), talipes 2.56 (2.46-2.67), conjoined twins 0.16 (0.14-0.19), and Down syndrome 5.33 (5.18-5.48). Each congenital anomaly showed heterogeneity in prevalence rates among registries. The harmonization of data in relation to operational differences between registries is the next step in developing the common ReLAMC database.
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Affiliation(s)
- Iêda Maria Orioli
- ReLAMC (Latin American Network of Congenital Malformation Surveillance) at Department of Genetics, Institute of Biology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Instituto Nacional de Genética Médica Populacional INAGEMP, Porto Alegre, Brazil
| | - Helen Dolk
- Maternal Fetal and Infant Research Centre, Institute of Nursing and Health Research, Ulster University, Newtownabbey, Northern Ireland, United Kingdom
| | - Jorge Lopez-Camelo
- Latin American Collaborative Study of Congenital Malformations (ECLAMC) at Center for Medical Education and Clinical Research (CEMIC-CONICET), Buenos Aires, Argentina
| | - Boris Groisman
- National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics (CNGM), National Administration of Laboratories and Health Institutes (ANLIS), National Ministry of Health, Buenos Aires, Argentina
| | - Adriana Benavides-Lara
- Centro de Registro de Enfermedades Congénitas (CREC), Unidad de Enfermedades Congénitas, Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud-INCIENSA, Cartago, Costa Rica
| | - Lucas Gabriel Gimenez
- Latin American Collaborative Study of Congenital Malformations (ECLAMC) at Center for Medical Education and Clinical Research (CEMIC-CONICET), Buenos Aires, Argentina
| | - Daniel Mattos Correa
- ReLAMC (Latin American Network of Congenital Malformation Surveillance) at Department of Genetics, Institute of Biology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marta Ascurra
- Registro Nacional de Defectos Congénitos Paraguay, Programa Nacional de Prevención de Defectos Congénitos (RENADECOPY-PNPDC), Ministerio de Salud Pública y Bienestar Social, Assuncion, Paraguay
| | - Eliana de Aquino Bonilha
- Secretaria Municipal da Saúde de São Paulo, Coordenação de Epidemiologia e Informação, Gerência do SINASC, São Paulo, Brazil
| | | | | | - Paula Hurtado-Villa
- Facultad de Ciencias de la Salud, Pontificia Universidad Javeriana Cali, Cali, Colombia
| | - Marisol Ibarra-Ramírez
- Departamento de Genética, Facultad de Medicina y Hospital Universitario José E. González, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Rosa Pardo
- Unidad de Neonatologia, Sección de Genética, Hospital Clínico Universidad de Chile, Unidad de Genética y Enfermedades Metabólicas, Complejo Asistencial Dr. Sótero del Río: Registro Nacional de Anomalías Congénitas de Chile RENACH, Santiago, Chile
| | | | - Ignacio Zarante
- Instituto de Genética Humana, Pontificia Universidad Javeriana Bogotá, Bogotá, Colombia
| | - Flávia Schneider Soares
- ReLAMC (Latin American Network of Congenital Malformation Surveillance) at Department of Genetics, Institute of Biology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Flávia Martinez de Carvalho
- Laboratory of Congenital Malformations Epidemiology (LEMC), Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Mariana Piola
- Latin American Collaborative Study of Congenital Malformations (ECLAMC) at Center for Medical Education and Clinical Research (CEMIC-CONICET), Buenos Aires, Argentina
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Cavalcanti DP, Fano V, Mellado C, Lacarrubba-Flores MDJ, Silveira C, Silveira KC, del Pino M, Moresco A, Caino S, Mejía RR, García CJ, Lay-Son G, Ferreira CR. Skeletal dysplasias in Latin America. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2020; 184:986-995. [PMID: 33219737 PMCID: PMC9827228 DOI: 10.1002/ajmg.c.31861] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/05/2020] [Accepted: 11/10/2020] [Indexed: 01/11/2023]
Abstract
Skeletal dysplasias (SD) are disturbances in growth due to defects intrinsic to the bone and/or cartilage, usually affecting multiple bones and having a progressive character. In this article, we review the state of clinical and research SD resources available in Latin America, including three specific countries (Brazil, Argentina, and Chile), that have established multidisciplinary clinics for the care of these patients. From the epidemiological point of view, the SD prevalence of 3.2 per 10,000 births from nine South American countries included in the ECLAMC network represents the most accurate estimate not just in Latin America, but worldwide. In Brazil, there are currently five groups focused on SD. The data from one of these groups including the website www.ocd.med.br, created to assist in the diagnosis of SD, are highlighted showing that telemedicine for this purpose represents a good strategy for the region. The experience of more than 30 years of the SD multidisciplinary clinic in an Argentinian Hospital is presented, evidencing a solid experience mainly in the follow-up of the most frequent SD, especially those belonging the FGFR3 group and OI. In Chile, a group with 20 years of experience presents its work with geneticists and pediatricians, focusing on diagnostic purposes and clinical management. Altogether, although SD health-care and research activities in Latin America are in their early stages, the experience in these three countries seems promising and stimulating for the region as a whole.
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Affiliation(s)
- Denise P. Cavalcanti
- Skeletal Dysplasia Group, Medical Genetics Department, Medical Sciences Faculty, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Virginia Fano
- Growth and Development Department, Garrahan Hospital, Buenos Aires, Argentina
| | - Cecilia Mellado
- Study Group of Genetic Skeletal Abnormalities, Genetic Unit, Pediatrics Division, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Maria Dora J. Lacarrubba-Flores
- Skeletal Dysplasia Group, Medical Genetics Department, Medical Sciences Faculty, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Cynthia Silveira
- Skeletal Dysplasia Group, Medical Genetics Department, Medical Sciences Faculty, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Karina C. Silveira
- Skeletal Dysplasia Group, Medical Genetics Department, Medical Sciences Faculty, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Mariana del Pino
- Growth and Development Department, Garrahan Hospital, Buenos Aires, Argentina
| | | | - Silvia Caino
- Growth and Development Department, Garrahan Hospital, Buenos Aires, Argentina
| | - Rosario Ramos Mejía
- Growth and Development Department, Garrahan Hospital, Buenos Aires, Argentina
| | - Cristián J. García
- Study Group of Genetic Skeletal Abnormalities, Department of Radiology, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Guillermo Lay-Son
- Study Group of Genetic Skeletal Abnormalities, Genetic Unit, Pediatrics Division, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carlos R. Ferreira
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
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Daich Varela M, Moya R, Schlottmann PG, Hufnagel RB, Arberas C, Fernández FM, Inga ME, Lores J, Pachajoa H, Prada CE, Sallum JMF. Ophthalmic genetics in South America. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2020; 184:753-761. [PMID: 32856789 DOI: 10.1002/ajmg.c.31832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/14/2020] [Accepted: 07/28/2020] [Indexed: 12/13/2022]
Abstract
South America comprises of heterogeneous topographies, populations, and health care systems. Therefore, it is not surprising to see differences among the countries regarding expertise, education, and practices of ophthalmic genetics for patients with rare eye diseases. Nevertheless, common challenges such as limited genetics training in medical schools and among ophthalmologists, scarcity of diagnostic tools for phenotyping, and expensive genetic testing not covered by the public healthcare systems, are seen in all of them. Here, we provide a detailed report of the current status of ophthalmic genetics, described by the personal views of local ophthalmologists from Brazil, Colombia, Argentina, and Chile. By reporting our strengths and weaknesses as a region, we intend to highlight the need for guidelines on how to manage these patients aligned with public health policies. Our region contributes to research worldwide, with thousands of well diagnosed patients from a number of unique and genetically diverse populations. The constant expansion of ophthalmic genetics and molecular diagnostics requires us to join forces to collaborate across South America and with other countries to improve access to next-generation diagnostics and ultimately improve patient care.
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Affiliation(s)
- Malena Daich Varela
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA.,University of Buenos Aires, Buenos Aires, Argentina
| | - Rene Moya
- Departamento de Retina y Departamento de Genética Ocular, Hospital del Salvador, Universidad de Chile, Santiago, Chile
| | | | - Robert B Hufnagel
- Ophthalmic Genetics and Visual Function Branch, National Eye Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Claudia Arberas
- Sección Genética Médica, Hospital de Niños "R. Gutiérrez", Buenos Aires, Argentina
| | | | | | - Juliana Lores
- Centro de Investigaciones en Anomalías Congénitas y Enfermedades Raras Universidad Icesi, Cali, Colombia.,Fundación Valle del Lili, Cali, Colombia
| | - Harry Pachajoa
- Centro de Investigaciones en Anomalías Congénitas y Enfermedades Raras Universidad Icesi, Cali, Colombia.,Fundación Valle del Lili, Cali, Colombia
| | - Carlos E Prada
- Hospital Internacional de Colombia, Bucaramanga, Colombia.,Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Juliana M Ferraz Sallum
- Department of Ophthalmology, Universidade Federal de São Paulo, Sao Paulo, Brazil.,Instituto de Genética Ocular, Sao Paulo, Brazil
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20
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Elias D, Campaña H, Poletta F, Heisecke S, Gili J, Ratowiecki J, Gimenez L, Pawluk M, Santos MR, Cosentino V, Uranga R, Rittler M, Lopez Camelo J. A graph theory approach to analyze birth defect associations. PLoS One 2020; 15:e0233529. [PMID: 32442191 PMCID: PMC7244144 DOI: 10.1371/journal.pone.0233529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Accepted: 05/06/2020] [Indexed: 01/11/2023] Open
Abstract
Birth defects are prenatal morphological or functional anomalies. Associations among them are studied to identify their etiopathogenesis. The graph theory methods allow analyzing relationships among a complete set of anomalies. A graph consists of nodes which represent the entities (birth defects in the present work), and edges that join nodes indicating the relationships among them. The aim of the present study was to validate the graph theory methods to study birth defect associations. All birth defects monitoring records from the Estudio Colaborativo Latino Americano de Malformaciones Congénitas gathered between 1967 and 2017 were used. From around 5 million live and stillborn infants, 170,430 had one or more birth defects. Volume-adjusted Chi-Square was used to determine the association strength between two birth defects and to weight the graph edges. The complete birth defect graph showed a Log-Normal degree distribution and its characteristics differed from random, scale-free and small-world graphs. The graph comprised 118 nodes and 550 edges. Birth defects with the highest centrality values were nonspecific codes such as Other upper limb anomalies. After partition, the graph yielded 12 groups; most of them were recognizable and included conditions such as VATER and OEIS associations, and Patau syndrome. Our findings validate the graph theory methods to study birth defect associations. This method may contribute to identify underlying etiopathogeneses as well as to improve coding systems.
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Affiliation(s)
- Dario Elias
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas, CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
| | - Hebe Campaña
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas, CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
- Comisión de Investigaciones Científicas, Buenos Aires, Argentina
| | - Fernando Poletta
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas, CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
- Instituto Nacional de Genética Médica Populacional, CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
| | - Silvina Heisecke
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
| | - Juan Gili
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas, CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
- Instituto Académico Pedagógico de Ciencias Humanas, Universidad Nacional de Villa María, Córdoba, Argentina
| | - Julia Ratowiecki
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas, CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
| | - Lucas Gimenez
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas, CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
- Instituto Nacional de Genética Médica Populacional, CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
| | - Mariela Pawluk
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas, CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
| | - Maria Rita Santos
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas, CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
- Comisión de Investigaciones Científicas, Buenos Aires, Argentina
- Instituto Multidisciplinario de Biología Celular, Buenos Aires, Argentina
| | - Viviana Cosentino
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas, CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
| | - Rocio Uranga
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas, CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
- Hospital San Juan de Dios, Buenos Aires, Argentina
| | - Monica Rittler
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas, CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
- Hospital Materno Infantil Ramón Sarda, Buenos Aires, Argentina
| | - Jorge Lopez Camelo
- Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas-Consejo Nacional de Investigaciones Científicas y Técnicas (CEMIC-CONICET), Ciudad Autónoma de Buenos Aires, Argentina
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas, CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
- Instituto Nacional de Genética Médica Populacional, CEMIC-CONICET, Ciudad Autónoma de Buenos Aires, Argentina
- * E-mail:
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Lecoquierre F, Brehin A, Coutant S, Coursimault J, Bazin A, Finck W, Benoist G, Begorre M, Beneteau C, Cailliez D, Chenal P, De Jong M, Degré S, Devisme L, Francannet C, Gérard B, Jeanne C, Joubert M, Journel H, Laurichesse Delmas H, Layet V, Liquier A, Mangione R, Patrier S, Pelluard F, Petit F, Tillouche N, Ravenswaaij‐Arts C, Frebourg T, Saugier‐Veber P, Gruchy N, Nicolas G, Gerard M. Exome sequencing identifies the first genetic determinants of sirenomelia in humans. Hum Mutat 2020; 41:926-933. [DOI: 10.1002/humu.23998] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 01/19/2020] [Accepted: 02/09/2020] [Indexed: 12/25/2022]
Affiliation(s)
- François Lecoquierre
- Department of Genetics and Reference Center for Developmental Disorders, Normandy Center for Genomic and Personalized Medicine, Normandie UnivUNIROUENInserm U1245 and Rouen University Hospital Rouen France
| | - Anne‐Claire Brehin
- Department of Genetics and Reference Center for Developmental Disorders, Normandy Center for Genomic and Personalized Medicine, Normandie UnivUNIROUENInserm U1245 and Rouen University Hospital Rouen France
- Department of FoetopathologyCHU Rouen Rouen France
| | - Sophie Coutant
- Department of Genetics and Reference Center for Developmental Disorders, Normandy Center for Genomic and Personalized Medicine, Normandie UnivUNIROUENInserm U1245 and Rouen University Hospital Rouen France
| | - Juliette Coursimault
- Department of Genetics and Reference Center for Developmental Disorders, Normandy Center for Genomic and Personalized Medicine, Normandie UnivUNIROUENInserm U1245 and Rouen University Hospital Rouen France
| | - Anne Bazin
- Département de Génétique et de Biologie SpécialiséeLaboratoire Cerba Saint Ouen l'Aumone France
| | - Wilfrid Finck
- Unité de Foetopathologie, Laboratoire d'anatomie et cytologie pathologiqueCHU Clermont Ferrand Clermont‐Ferrand France
| | - Guillaume Benoist
- Service de gynécologie‐obstétrique et médecine de la reproductionCentre Hospitalier Universitaire de Caen, Universite de Caen Normandie Caen Basse‐Normandie France
| | | | - Claire Beneteau
- Department of Clinical geneticsCHU Hôpital mère et enfant Nantes France
| | | | - Pierre Chenal
- Department of FoetopathologyHopital Monod Le Havre France
| | - Mirjam De Jong
- Department of GeneticsUniversity Medical Centre Groningen, University of Groningen Groningen The Netherlands
| | | | | | - Christine Francannet
- Centre de référence des anomalies malformatives, Service de génétique médicaleCHU Clermont‐Ferrand Clermont‐Ferrand France
- Centre d'Etude des Malformations Congénitales, CEMC‐AuvergneCHU Clermont‐Ferrand Clermont‐Ferrand France
| | - Bénédicte Gérard
- Department of GeneticsCHU de Strasbourg, Hôpital CivilStrasbourg France
| | - Corinne Jeanne
- Department of Foetopathology, Centre François BaclesseCHU Côte de NacreCaen France
| | | | | | - Hélène Laurichesse Delmas
- Centre d'Etude des Malformations Congénitales, CEMC‐AuvergneCHU Clermont‐Ferrand Clermont‐Ferrand France
- Unité de Médecine Fœtale, Service de gynécologie‐obstétriqueCHU Clermont‐FerrandClermont‐Ferrand France
| | - Valérie Layet
- Department of Clinical GeneticsHopital MonodLe Havre France
| | | | - Raphaele Mangione
- Departement of RadiologyPolyclinique Bordeaux Nord‐AquitaineBordeaux France
| | | | - Fanny Pelluard
- Service d'Anatomie‐Cytologie PathologiqueCentre Hospitalier Universitaire de BordeauxBordeaux France
- INSERM UMR1053, Bordeaux Research in Translational Oncology, BaRITOnUniversité de Bordeaux Bordeaux France
| | - Florence Petit
- Clinique de Génétique “Guy Fontaine”—Centre de référence CLAD, Hôpital Jeanne de FlandreCHU LilleLille France
| | - Nadia Tillouche
- Pôle Femme‐Mère‐Nouveau‐néCentre Hospitalier de ValenciennesValenciennes France
| | - Conny Ravenswaaij‐Arts
- Department of GeneticsUniversity Medical Centre Groningen, University of Groningen Groningen The Netherlands
| | - Thierry Frebourg
- Department of Genetics and Reference Center for Developmental Disorders, Normandy Center for Genomic and Personalized Medicine, Normandie UnivUNIROUENInserm U1245 and Rouen University Hospital Rouen France
| | - Pascale Saugier‐Veber
- Department of Genetics and Reference Center for Developmental Disorders, Normandy Center for Genomic and Personalized Medicine, Normandie UnivUNIROUENInserm U1245 and Rouen University Hospital Rouen France
| | - Nicolas Gruchy
- Department of Genetics, Normandy Center for Genomic and Personalized MedicineCaen University HospitalCaen France
| | - Gaël Nicolas
- Department of Genetics and Reference Center for Developmental Disorders, Normandy Center for Genomic and Personalized Medicine, Normandie UnivUNIROUENInserm U1245 and Rouen University Hospital Rouen France
| | - Marion Gerard
- Department of Genetics, Normandy Center for Genomic and Personalized MedicineCaen University HospitalCaen France
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Oliveira-Brancati CIF, Ferrarese VCC, Costa AR, Fett-Conte AC. Birth defects in Brazil: Outcomes of a population-based study. Genet Mol Biol 2020; 43:e20180186. [PMID: 31429860 PMCID: PMC7198030 DOI: 10.1590/1678-4685-gmb-2018-0186] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 02/02/2019] [Indexed: 01/23/2023] Open
Abstract
Birth defects (BDs) are functional and structural alterations in embryonic or fetal development. With an incidence of approximately 3-5%, BDs are a leading cause of infant mortality and lifelong disability. A population-based prospective case-control study was conducted for one year with 5204 infants, between March 1st, 2011 and February 29th, 2012 in the city of São José do Rio Preto, State of São Paulo, Brazil. The incidence of BDs was 3.2% [95% confidence interval (95%CI): 2.8-3.8%]. The most common congenital anomalies were heart diseases in isolation (11.2%; 95%CI: 7.3-16.9%) followed by Down syndrome (9.5%; 95%CI: 5.9-14.8%), neural tube defects (8.9%; 95%CI: 5.4-14.1), urinary tract anomalies (7.7%; 95%CI: 4.4-12.7%), and polydactyly (7.0%; 95%CI: 4.0-12.0%). The majority of mothers with Down syndrome babies had advanced age. Family members with the same BD, maternal alcohol consumption, gestational diabetes, and previous miscarriages were the most frequent risk factors. The results were similar to published data from other countries except for the incidence of Down syndrome, which was twice as high as reported by other authors and is probably due to the high sociocultural level of the region where the current study was performed, leading to pregnancies at older maternal age.
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Affiliation(s)
| | | | - Antonio Richieri Costa
- Universidade de São Paulo (USP), Hospital de Reabilitação de
Anomalias Craniofaciais, Bauru, SP, Brazil
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23
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Groisman B, Liascovich R, Bidondo MP, Barbero P, Duarte S, Tellechea AL, Holguín J, Rodríguez C, Hurtado-Villa P, Caicedo N, Botta G, Zarante I. Birth defects surveillance: experiences in Argentina and Colombia. J Community Genet 2019; 10:385-393. [PMID: 30607893 PMCID: PMC6591326 DOI: 10.1007/s12687-018-00403-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 12/05/2018] [Accepted: 12/12/2018] [Indexed: 12/14/2022] Open
Abstract
Birth defects (BDs) are structural or functional anomalies, sporadic or hereditary, of prenatal origin. Public health surveillance is defined as the ongoing systematic collection, analysis, and interpretation of outcome-specific data for use in the planning, implementation, and evaluation of public health practice. BD surveillance systems may have different characteristics according to design, coverage, type of surveillance, case ascertainment, case definition, BD description, maximum age of diagnosis, pregnancy outcomes, coding systems, and the location of the coding process (central or local). The aim of this article is to describe and compare methodology, applications, and results of birth defect surveillance systems in two South-American countries: Colombia and Argentina. In both countries, the surveillance systems developed activities in relation to the Zika virus emergency. For most BDs, a statistically significant higher prevalence is observed in Argentina-RENAC than in Colombian registries. This may be due to methodological reasons or real differences in prevalence. The strengths, weaknesses, and the future perspectives of the Argentine and Colombian systems are presented. When developing a surveillance system, the objectives, the available resources, and previous experiences in similar contexts must be taken into account. In that sense, the experience of Argentina and Colombia can be useful for others when developing a birth defect surveillance system.
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Affiliation(s)
- Boris Groisman
- National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Administration of Laboratories and Health Institutes, National Ministry of Health, Av. Las Heras 2670, 3rd floor, 1425, City of Buenos Aires, Argentina.
| | - Rosa Liascovich
- National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Administration of Laboratories and Health Institutes, National Ministry of Health, Av. Las Heras 2670, 3rd floor, 1425, City of Buenos Aires, Argentina
| | - María Paz Bidondo
- National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Administration of Laboratories and Health Institutes, National Ministry of Health, Av. Las Heras 2670, 3rd floor, 1425, City of Buenos Aires, Argentina
| | - Pablo Barbero
- National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Administration of Laboratories and Health Institutes, National Ministry of Health, Av. Las Heras 2670, 3rd floor, 1425, City of Buenos Aires, Argentina
| | - Santiago Duarte
- National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Administration of Laboratories and Health Institutes, National Ministry of Health, Av. Las Heras 2670, 3rd floor, 1425, City of Buenos Aires, Argentina
| | - Ana Laura Tellechea
- National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Administration of Laboratories and Health Institutes, National Ministry of Health, Av. Las Heras 2670, 3rd floor, 1425, City of Buenos Aires, Argentina
| | - Jorge Holguín
- Secretaria de Salud Pública Municipal de Cali, Pontificia Universidad Javeriana Cali, Cali, Colombia
| | - Catherine Rodríguez
- Congenital Malformations Surveillance Programme of Bogotá, Secretaria de Salud de Bogotá, Bogotá, Colombia
| | - Paula Hurtado-Villa
- Congenital Birth Defects Surveillance Programme of Cali, Pontificia Universidad Javeriana Cali, Cali, Colombia
| | - Natalia Caicedo
- Congenital Birth Defects Surveillance Programme of Cali, Pontificia Universidad Javeriana Cali, Cali, Colombia
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24
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Durán P, Liascovich R, Barbero P, Bidondo MP, Groisman B, Serruya S, de Francisco LA, Becerra-Posada F, Gordillo-Tobar A. [Systems for surveillance of birth defects in Latin America and the Caribbean: present and futureSistemas de vigilância de anomalias congênitas na América Latina e Caribe: presente e futuro]. Rev Panam Salud Publica 2019; 43:e44. [PMID: 31139210 PMCID: PMC6526783 DOI: 10.26633/rpsp.2019.44] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 03/01/2019] [Indexed: 11/24/2022] Open
Abstract
Objetivos. Conocer la disponibilidad de los sistemas nacionales de vigilancia de anomalías congénitas en América Latina y el Caribe y describir sus características. Métodos. Estudio transversal mediante una encuesta semiestructurada y autoadministrada en línea remitida en el 2017 por las representaciones locales de la Organización Panamericana de la Salud a las autoridades de los ministerios de salud de todos los países de América Latina y el Caribe. La encuesta recabó información sobre la disponibilidad de un sistema nacional de vigilancia de anomalías congénitas en el país y sus características. Resultados. Once países cuentan con sistema nacional de vigilancia de anomalías congénitas: Argentina, Colombia, Costa Rica, Cuba, Guatemala, México, Panamá, Paraguay, República Dominicana, Uruguay y Venezuela. Los sistemas tienen características heterogéneas: 6 son sistemas de base hospitalaria; 10 incluyen en su definición de caso los nacidos vivos y los fetos muertos. En todos los sistemas de vigilancia se incluyen los casos con anomalías mayores y menores, excepto en Argentina, Colombia y Guatemala que solo registran anomalías congénitas mayores. Solo Argentina, Costa Rica y Uruguay elaboran informes periódicos que consolidan y presentan los resultados de la vigilancia; los registros de Argentina y Costa Rica disponen de manuales operativos. Conclusiones. Se comprobó la aún escasa disponibilidad de sistemas nacionales de vigilancia de anomalías congénitas en América Latina y el Caribe y su elevada heterogeneidad. Es prioritario avanzar hacia la expansión y el fortalecimiento de este tipo de vigilancia en nuestros países.
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Affiliation(s)
- Pablo Durán
- Centro Latinoamericano de Perinatología Centro Latinoamericano de Perinatología Salud de la Mujer y Reproductiva, Organización Panamericana de la Salud/Organización Mundial de la Salud Montevideo Uruguay Centro Latinoamericano de Perinatología, Salud de la Mujer y Reproductiva, Organización Panamericana de la Salud/Organización Mundial de la Salud, Montevideo, Uruguay
| | - Rosa Liascovich
- Red Nacional de Anomalías Congénitas de Argentina (RENAC) Red Nacional de Anomalías Congénitas de Argentina (RENAC) Centro Nacional de Genética Médica, ANLIS Carlos Malbrán, Ministerio de Salud y Desarrollo Social Buenos Aires Argentina Red Nacional de Anomalías Congénitas de Argentina (RENAC), Centro Nacional de Genética Médica, ANLIS Carlos Malbrán, Ministerio de Salud y Desarrollo Social, Buenos Aires, Argentina
| | - Pablo Barbero
- Red Nacional de Anomalías Congénitas de Argentina (RENAC) Red Nacional de Anomalías Congénitas de Argentina (RENAC) Centro Nacional de Genética Médica, ANLIS Carlos Malbrán, Ministerio de Salud y Desarrollo Social Buenos Aires Argentina Red Nacional de Anomalías Congénitas de Argentina (RENAC), Centro Nacional de Genética Médica, ANLIS Carlos Malbrán, Ministerio de Salud y Desarrollo Social, Buenos Aires, Argentina
| | - María Paz Bidondo
- Red Nacional de Anomalías Congénitas de Argentina (RENAC) Red Nacional de Anomalías Congénitas de Argentina (RENAC) Centro Nacional de Genética Médica, ANLIS Carlos Malbrán, Ministerio de Salud y Desarrollo Social Buenos Aires Argentina Red Nacional de Anomalías Congénitas de Argentina (RENAC), Centro Nacional de Genética Médica, ANLIS Carlos Malbrán, Ministerio de Salud y Desarrollo Social, Buenos Aires, Argentina
| | - Boris Groisman
- Red Nacional de Anomalías Congénitas de Argentina (RENAC) Red Nacional de Anomalías Congénitas de Argentina (RENAC) Centro Nacional de Genética Médica, ANLIS Carlos Malbrán, Ministerio de Salud y Desarrollo Social Buenos Aires Argentina Red Nacional de Anomalías Congénitas de Argentina (RENAC), Centro Nacional de Genética Médica, ANLIS Carlos Malbrán, Ministerio de Salud y Desarrollo Social, Buenos Aires, Argentina
| | - Suzanne Serruya
- Centro Latinoamericano de Perinatología Centro Latinoamericano de Perinatología Salud de la Mujer y Reproductiva, Organización Panamericana de la Salud/Organización Mundial de la Salud Montevideo Uruguay Centro Latinoamericano de Perinatología, Salud de la Mujer y Reproductiva, Organización Panamericana de la Salud/Organización Mundial de la Salud, Montevideo, Uruguay
| | - Luis Andrés de Francisco
- Organización Panamericana de la Salud/Organización Mundial de la Salud Organización Panamericana de la Salud/Organización Mundial de la Salud WashingtonDC Estados Unidos de América Organización Panamericana de la Salud/Organización Mundial de la Salud, Washington, DC, Estados Unidos de América
| | - Francisco Becerra-Posada
- Organización Panamericana de la Salud/Organización Mundial de la Salud Organización Panamericana de la Salud/Organización Mundial de la Salud WashingtonDC Estados Unidos de América Organización Panamericana de la Salud/Organización Mundial de la Salud, Washington, DC, Estados Unidos de América
| | - Amparo Gordillo-Tobar
- Banco Mundial Banco Mundial WashingtonD.C. Estados Unidos de América Banco Mundial, Washington, DC, Estados Unidos de América
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Torre-Hernandez CADL, Guedez Y, Pineda-Bernal L, Ojeda HA, Guevara-Guerra YA. [Medical genetics services in VenezuelaServiços de genética médica na Venezuela]. Rev Panam Salud Publica 2019; 42:e78. [PMID: 31093106 PMCID: PMC6386045 DOI: 10.26633/rpsp.2018.78] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 03/12/2018] [Indexed: 11/30/2022] Open
Abstract
Objetivo. Caracterizar los servicios de genética médica de Venezuela con el fin de conocer la distribución de sus recursos, servicios, tecnologías y formación profesional. Métodos. Se realizó una investigación descriptiva, de tipo documental, entre febrero y noviembre de 2016 de los servicios de genética, mediante la revisión de fuentes documentales primarias y el uso de una ficha de recolección de datos en las instituciones de investigación para información referente a disponibilidad de recursos humanos, servicios de atención y diagnóstico, así como formación profesional, y la base de datos de la Sociedad Venezolana de Genética Humana, que permitió identificar los recursos humanos en centros de genética. El criterio de inclusión fue instituciones con recursos humanos formados en genética. Resultados. Los criterios fueron cumplidos por cuatro instituciones de investigación, siete universidades y cuatro hospitales, todos del sector público. En estas instituciones trabajan 124 profesionales, 56 son médicos y 68 se desempeñan en el área de laboratorio. Sesenta y dos por ciento de los profesionales pertenecen a las instituciones de investigación; estas cuentan con servicios de atención clínico, diagnóstico molecular, bioquímico y, con menos frecuencia, los análisis citogenéticos, prenatales y forenses. Cinco regiones del país tienen entre dos y cuatro médicos genetistas por millón de habitantes. El 96% de los profesionales de laboratorio se localizan en dos regiones (Capital y Zuliana), cinco regiones carecen de ellos. Las instituciones de investigación han formado en genética el 40% de los recursos humanos actuales del país. Conclusiones. Los servicios de genética presentan gran variabilidad de opciones diagnósticas, un acceso limitado y grandes aportes en formación profesional; se requieren políticas coordinadas que los integre y disminuya las brechas.
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Affiliation(s)
| | - Yvonne Guedez
- Servicio Autónomo Instituto de Altos Estudios "Dr. Arnoldo Gabaldón", Aragua, Venezuela
| | - Lennie Pineda-Bernal
- Instituto de Investigaciones Genéticas "Dr. Heber Villalobos Cabrera", Universidad del Zulia, Maracaibo, Venezuela
| | - Héctor A Ojeda
- Laboratorio de Genética Humana, Instituto Venezolano de Investigaciones Científicas (IVIC), Miranda, Venezuela
| | - Yuliana A Guevara-Guerra
- Unidad de Errores Innatos del Metabolismo, Fundación Instituto de Estudios Avanzados (IDEA), Miranda, Venezuela
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26
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Zarante I, Hurtado-Villa P, Walani SR, Kancherla V, López Camelo J, Giugliani R, Groisman B, Howson CP, Durán P. A consensus statement on birth defects surveillance, prevention, and care in Latin America and the Caribbean. Rev Panam Salud Publica 2019; 43:e2. [PMID: 31093226 PMCID: PMC6419921 DOI: 10.26633/rpsp.2019.2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 10/11/2018] [Indexed: 11/24/2022] Open
Abstract
Birth defects contribute up to 21% of the mortality in those under 5 years of age in Latin America and the Caribbean (LAC), and that burden has been compounded by the Zika virus epidemic. In 2001, the March of Dimes launched a series of biennial assemblies called the International Conference on Birth Defects and Disabilities in the Developing World (ICBD). The latest ICBD, in 2017, convened in Bogotá, Colombia, and was attended by over 300 professionals, policymakers, and donors. The conference attendees, a majority of whom were from LAC, supported a call to action in the form of a consensus statement. The consensus statement lists key actions for maximizing birth defects surveillance, prevention, and care in LAC: 1) improving surveillance; 2) reducing risks for birth defects; 3) fortifying staple foods; 4) preventing and treating infections associated with birth defects; 5) implementing newborn screening; 6) providing care and services for people with birth defects and disabilities; 7) involving governments, civil society, and international agencies; and 8) advancing research for birth defects. Implementation and scale-up of evidence-based interventions using multisectoral and multidisciplinary collaborative approaches were endorsed. LAC countries can leverage technology and social media to advance and advocate for approaches identified in the consensus statement. The consensus statement can be used as a guide by both governments and nongovernmental agencies to take immediate steps for improving the quality of life of those living with birth defects and associated disabilities in the LAC countries.
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Affiliation(s)
- Ignacio Zarante
- Pontificia Universidad Javeriana Pontificia Universidad Javeriana School of Medicine Human Genetics Institute Bogotá Colombia Human Genetics Institute, School of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Paula Hurtado-Villa
- Pontificia Universidad Javeriana Pontificia Universidad Javeriana Faculty of Health Sciences Basic Health Sciences Department Cali Colombia Basic Health Sciences Department, Faculty of Health Sciences, Pontificia Universidad Javeriana, Cali, Colombia
| | - Salimah R Walani
- March of Dimes March of Dimes ArlingtonVirginia United States of America March of Dimes, Arlington, Virginia, United States of America
| | - Vijaya Kancherla
- Emory University Rollins School of Public Health Department of Epidemiology Center for Spina Bifida Prevention AtlantaGeorgia United States of America Center for Spina Bifida Prevention, Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America
| | - Jorge López Camelo
- Center for Medical Education and Clinical Research (CEMIC-CONICET) Center for Medical Education and Clinical Research (CEMIC-CONICET) Latin American Collaborative Study of Congenital Malformations (ECLAMC) Buenos Aires Argentina Latin American Collaborative Study of Congenital Malformations (ECLAMC), Center for Medical Education and Clinical Research (CEMIC-CONICET), Buenos Aires, Argentina
| | - Roberto Giugliani
- Hospital de Clinicas de Porto Alegre Federal University of Rio Grande do Sul Medical Genetics Service Department of Genetics Porto Alegre Brasil Department of Genetics, Federal University of Rio Grande do Sul, Medical Genetics Service, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Boris Groisman
- National Administration of Laboratories and Health Institutes National Administration of Laboratories and Health Institutes National Center of Medical Genetics National Network of Congenital Anomalies of Argentina Buenos Aires Argentina National Network of Congenital Anomalies of Argentina, National Center of Medical Genetics, National Administration of Laboratories and Health Institutes, Buenos Aires, Argentina
| | - Christopher P Howson
- Howson & Partners for Global Health Howson & Partners for Global Health Santa FeNew Mexico United States of America Howson & Partners for Global Health, Santa Fe, New Mexico, United States of America
| | - Pablo Durán
- Pan American Health Organization/World Health Organization Pan American Health Organization/World Health Organization Women's and Reproductive Health Latin American Center for Perinatology Montevideo Uruguay Latin American Center for Perinatology, Women's and Reproductive Health, Pan American Health Organization/World Health Organization, Montevideo, Uruguay
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27
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Bautista LE, Herrera VM. An assessment of public health surveillance of Zika virus infection and potentially associated outcomes in Latin America. BMC Public Health 2018; 18:656. [PMID: 29793453 PMCID: PMC5968501 DOI: 10.1186/s12889-018-5566-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 05/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We evaluated whether outbreaks of Zika virus (ZIKV) infection, newborn microcephaly, and Guillain-Barré syndrome (GBS) in Latin America may be detected through current surveillance systems, and how cases detected through surveillance may increase health care burden. METHODS We estimated the sensitivity and specificity of surveillance case definitions using published data. We assumed a 10% ZIKV infection risk during a non-outbreak period and hypothetical increases in risk during an outbreak period. We used sensitivity and specificity estimates to correct for non-differential misclassification, and calculated a misclassification-corrected relative risk comparing both periods. To identify the smallest hypothetical increase in risk resulting in a detectable outbreak we compared the misclassification-corrected relative risk to the relative risk corresponding to the upper limit of the endemic channel (mean + 2 SD). We also estimated the proportion of false positive cases detected during the outbreak. We followed the same approach for microcephaly and GBS, but assumed the risk of ZIKV infection doubled during the outbreak, and ZIKV infection increased the risk of both diseases. RESULTS ZIKV infection outbreaks were not detectable through non-serological surveillance. Outbreaks were detectable through serologic surveillance if infection risk increased by at least 10%, but more than 50% of all cases were false positive. Outbreaks of severe microcephaly were detected if ZIKV infection increased prevalence of this condition by at least 24.0 times. When ZIKV infection did not increase the prevalence of severe microcephaly, 34.7 to 82.5% of all cases were false positive, depending on diagnostic accuracy. GBS outbreaks were detected if ZIKV infection increased the GBS risk by at least seven times. For optimal GBS diagnosis accuracy, the proportion of false positive cases ranged from 29 to 54% and from 45 to 56% depending on the incidence of GBS mimics. CONCLUSIONS Current surveillance systems have a low probability of detecting outbreaks of ZIKV infection, severe microcephaly, and GBS, and could result in significant increases in health care burden, due to the detection of large numbers of false positive cases. In view of these limitations, Latin American countries should consider alternative options for surveillance.
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Affiliation(s)
- Leonelo E Bautista
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin at Madison, 610 Walnut Street, WARF 703, Madison, WI, 53726-2397, USA.
| | - Víctor M Herrera
- Center for Biomedical Research, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
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28
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Wehby GL, López-Camelo JS. Maternal Education Gradients in Infant Health in Four South American Countries. Matern Child Health J 2018; 21:2122-2131. [PMID: 28699095 DOI: 10.1007/s10995-017-2327-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objective We investigate gradients (i.e. differences) in infant health outcomes by maternal education in Argentina, Brazil, Chile, and Venezuela and explore channels related to father's education, household labor outcomes, and maternal health, fertility, and use of prenatal services and technology. Methods We employ secondary interview and birth record data similarly collected across a network of birth hospitals from the early 1980s through 2011 within the Latin American Collaborative Study of Congenital Anomalies (ECLAMC). Focusing on children without birth defects, we estimate gradients in several infant health outcomes including birth weight, gestational age, and hospital discharge status by maternal education using ordinary least squares regression models adjusting for several demographic factors. To explore channels, we add as covariates father's education, parental occupational activity, maternal health and fertility history, and use of prenatal services and technology and evaluate changes in the coefficient of maternal education. We use the same models for each country sample. Results We find important differences in gradients across countries. We find evidence for educational gradients in preterm birth in three countries but weaker evidence for gradients in fetal growth. The extent to which observed household and maternal factors explain these gradients based on changes in the regression coefficient of maternal education when controlling for these factors as covariates also varies between countries. In contrast, we generally find evidence across all countries that higher maternal education is associated with increased use of prenatal care services and technology. Conclusions Our findings suggest that differences in infant health by maternal education and their underlying mechanisms vary and are not necessarily generalizable across countries. However, the positive association between maternal education and use of prenatal services and technology is more consistent across examined countries.
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Affiliation(s)
- George L Wehby
- Departments of Health Management and Policy, Economics, and Preventive & Community Dentistry, and Public Policy Center, University of Iowa, 145 N. Riverside Dr., 100 College of Public Health Bldg., Room N250, Iowa City, IA, 52242-2007, USA. .,National Bureau of Economic Research, Cambridge, MA, USA.
| | - Jorge S López-Camelo
- Center of Medical Education and Clinical Investigation/Centro de Educación Médica e Investigación Clínica (CEMIC), Buenos Aires, Argentina
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Poletta FA, Rittler M, Saleme C, Campaña H, Gili JA, Pawluk MS, Gimenez LG, Cosentino VR, Castilla EE, López-Camelo JS. Neural tube defects: Sex ratio changes after fortification with folic acid. PLoS One 2018. [PMID: 29538416 PMCID: PMC5851584 DOI: 10.1371/journal.pone.0193127] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background Historically, neural tube defects (NTDs) have predominated in female infants but the reasons remain unclear. In South America, the pre- folic acid fortification (FAF) rates of NTDs were around 18/10,000 births for females and 12/10,000 births for males, with an estimated sex ratio (male/female) of 0.67. During the post- FAF period, unpublished routine reports have indicated changes in the sex ratio for these defects while some descriptive reports are controversial. To date and to our knowledge, however, no studies specifically focusing on these changes to test this hypothesis directly have been undertaken. The aim of this study was to analyze changes in the sex ratio of infants with NTDs after FAF in South American countries. Materials and methods With a descriptive cross-sectional study design, 2,597 infants with isolated NTDs born between 1990 and 2013 in 3 countries participating in the Latin American Collaborative Study of Congenital Malformations (ECLAMC) network were included: (Chile N = 521 and Argentina N = 1,619 [with FAF policies]; Venezuela N = 457 [without FAF policies; used as control]; total births = 2,229,561). The differences-in-differences method and Poisson regressions were used to evaluate the sex ratio shift from female to male before vs. after FAF, and to assess whether these differences were related to the fortification. Results and conclusions In Chile and Argentina the prevalence of NTDs, particularly anencephaly and cervico-thoracic spina bifida, showed a greater reduction rate in females than in males after FAF, resulting in a change of the sex ratio of infants with NTDs. Some mechanisms possibly involved in this differential reduction are proposed which might be useful to identify the pathogenesis of NTDs as a whole and specifically of those susceptible to the protective effect of folic acid.
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Affiliation(s)
- Fernando A. Poletta
- Latin American Collaborative Study of Congenital Malformations (ECLAMC) at Center for Medical Education and Clinical Research (CEMIC-CONICET), Buenos Aires, Argentina
- ECLAMC at INAGEMP (National Institute of Population Medical Genetics), Rio de Janeiro, Brazil
| | - Monica Rittler
- ECLAMC at Hospital Materno Infantil Ramón Sardá, University of Buenos Aires, Buenos Aires, Argentina
| | - Cesar Saleme
- ECLAMC at Maternity Hospital Nuestra Señora de las Mercedes, Tucumán, Argentina
| | - Hebe Campaña
- Latin American Collaborative Study of Congenital Malformations (ECLAMC) at Center for Medical Education and Clinical Research (CEMIC-CONICET), Buenos Aires, Argentina
| | - Juan A. Gili
- Latin American Collaborative Study of Congenital Malformations (ECLAMC) at Center for Medical Education and Clinical Research (CEMIC-CONICET), Buenos Aires, Argentina
| | - Mariela S. Pawluk
- Latin American Collaborative Study of Congenital Malformations (ECLAMC) at Center for Medical Education and Clinical Research (CEMIC-CONICET), Buenos Aires, Argentina
| | - Lucas G. Gimenez
- Latin American Collaborative Study of Congenital Malformations (ECLAMC) at Center for Medical Education and Clinical Research (CEMIC-CONICET), Buenos Aires, Argentina
| | - Viviana R. Cosentino
- Latin American Collaborative Study of Congenital Malformations (ECLAMC) at Center for Medical Education and Clinical Research (CEMIC-CONICET), Buenos Aires, Argentina
| | - Eduardo E. Castilla
- Latin American Collaborative Study of Congenital Malformations (ECLAMC) at Center for Medical Education and Clinical Research (CEMIC-CONICET), Buenos Aires, Argentina
- ECLAMC at INAGEMP (National Institute of Population Medical Genetics), Rio de Janeiro, Brazil
| | - Jorge S. López-Camelo
- Latin American Collaborative Study of Congenital Malformations (ECLAMC) at Center for Medical Education and Clinical Research (CEMIC-CONICET), Buenos Aires, Argentina
- ECLAMC at INAGEMP (National Institute of Population Medical Genetics), Rio de Janeiro, Brazil
- * E-mail:
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do Nascimento RL, Castilla EE, Dutra MDG, Orioli IM. ICD-10 impact on ascertainment and accuracy of oral cleft cases as recorded by the Brazilian national live birth information system. Am J Med Genet A 2018; 176:907-914. [PMID: 29424949 DOI: 10.1002/ajmg.a.38634] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Revised: 01/12/2018] [Accepted: 01/16/2018] [Indexed: 12/12/2022]
Abstract
We compared Brazilian oral cleft (OC) frequencies between the population-based Brazilian System of Live Birth (SINASC) and the hospital-based Latin American Collaborative Study of Congenital Malformations (ECLAMC), trying to understand the paucity of cleft of lip and palate (CLP) in the first system. SINASC uses the International Classification of Disease version 10 (ICD-10) for congenital defects coding, ECLAMC uses ICD-8 with modifications. In SINASC, the CLP frequency was 1.7 per 10,000 (95% confidence limits 1.7-1.8), cleft lip (CL) 1.6 (1.5-1.7), and cleft palate (CP) 2.0 (1.9-2.1). In ECLAMC, the CLP frequency was 10.4 per 10,000 (9.0-12.1), CL 5.5 (4.5-6.7), and CP 4.4. (4.5-6.7). In SINASC, only 33% of the oral clefts were CLP, versus 51% in ECLAMC. Part of this discrepancy may have been due to the relative excess of CP and CL cases. Although congenital defect frequencies are usually lower in population than in hospital-based registries, differences in the proportion of the main OC categories are not expected and are probably due to ICD-10 coding issues, such as lumping of unilateral CL and CL without other specifications. ICD-10 codes, whose deficiency for oral clefts is fully explained in the literature, lack modifiers for severity, or clinical subtypes. This paper shows the practical aspect of the ICD-10 system deficiency in capturing cleft lip and palate (CLP) subtypes, as demonstrated in SINASC covering three million births per year. Such errors are expected to occur in any registry that uses the ICD-10 coding system, and must be adjusted, given its relevance worldwide.
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Affiliation(s)
- Ricardo Lima do Nascimento
- Department of Genetics, Institute of Biology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,INAGEMP (National Institute of Population Medical Genetics), Rio de Janeiro, Brazil
| | - Eduardo E Castilla
- INAGEMP (National Institute of Population Medical Genetics), Rio de Janeiro, Brazil.,LEMC (Laboratory of Congenital Malformations Epidemiology), Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.,CEMIC (Center for Medical Education and Clinical Research), Buenos Aires, Argentina
| | - Maria da Graça Dutra
- INAGEMP (National Institute of Population Medical Genetics), Rio de Janeiro, Brazil.,LEMC (Laboratory of Congenital Malformations Epidemiology), Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Iêda M Orioli
- Department of Genetics, Institute of Biology, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,INAGEMP (National Institute of Population Medical Genetics), Rio de Janeiro, Brazil
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Bautista LE. Maternal Zika virus infection and newborn microcephaly-an analysis of the epidemiological evidence. Ann Epidemiol 2017; 28:111-118. [PMID: 29277550 DOI: 10.1016/j.annepidem.2017.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 10/16/2017] [Accepted: 11/20/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate whether existing data and evidence support a causal link between maternal Zika virus (ZIKV) infection and newborn microcephaly. METHODS I quantified and compared the prevalence of all and severe microcephaly in Brazil, during and before 2015-2016, to assess whether an outbreak has occurred, used time series analysis to evaluate if the presumed outbreak was linked to a previous outbreak of ZIKV infections, and quantitatively synthesized published data from observational studies testing this association. RESULTS The prevalences of microcephaly in 2015-2016 were similar or lower than background levels (prevalence ratio [PR] for all microcephaly: 0.19; 95% confidence intervals [CI]: 0.17, 0.20). Changes in the number of cases of ZIKV infections at times matching 11-18 weeks of pregnancy were not followed by changes in the number of microcephaly cases (PR for infection at 12 weeks: 1.02; 95% CI: 0.99, 1.05). In observational studies, the prevalence of microcephaly was not significantly increased in newborns of Zika-infected mothers (average PR: 1.30; 95% CI: 0.84, 2.02). CONCLUSIONS Existing evidence is insufficient to claim maternal ZIKV infection causes microcephaly. Although a public health response seems sensible, it should be consistent with existing knowledge and consider risks, potential benefits and harm, and competing priorities.
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Affiliation(s)
- Leonelo E Bautista
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin at Madison.
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Orioli IM, Dolk H, Lopez-Camelo JS, Mattos D, Poletta FA, Dutra MG, Carvalho FM, Castilla EE. Prevalence and clinical profile of microcephaly in South America pre-Zika, 2005-14: prevalence and case-control study. BMJ 2017; 359:j5018. [PMID: 29162597 PMCID: PMC5696624 DOI: 10.1136/bmj.j5018] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Objective To describe the prevalence and clinical spectrum of microcephaly in South America for the period 2005-14, before the start of the Zika epidemic in 2015, as a baseline for future surveillance as the Zika epidemic spreads and as other infectious causes may emerge in future.Design Prevalence and case-control study.Data sources ECLAMC (Latin American Collaborative Study of Congenital Malformations) database derived from 107 hospitals in 10 South American countries, 2005 to 2014. Data on microcephaly cases, four non-malformed controls per case, and all hospital births (all births for hospital based prevalence, resident within municipality for population based prevalence). For 2010-14, head circumference data were available and compared with Intergrowth charts.Results 552 microcephaly cases were registered, giving a hospital based prevalence of 4.4 (95% confidence interval 4.1 to 4.9) per 10 000 births and a population based prevalence of 3.0 (2.7 to 3.4) per 10 000. Prevalence varied significantly between countries and between regions and hospitals within countries. Thirty two per cent (n=175) of cases were prenatally diagnosed; 29% (n=159) were perinatal deaths. Twenty three per cent (n=128) were associated with a diagnosed genetic syndrome, 34% (n=189) polymalformed without a syndrome diagnosis, 12% (n=65) with associated neural malformations, and 26% (n=145) microcephaly only. In addition, 3.8% (n=21) had a STORCH (syphilis, toxoplasmosis, other including HIV, rubella, cytomegalovirus, and herpes simplex) infection diagnosis and 2.0% (n=11) had consanguineous parents. Head circumference measurements available for 184/235 cases in 2010-14 showed 45% (n=82) more than 3 SD below the mean, 24% (n=44) between 3 SD and 2 SD below the mean, and 32% (n=58) larger than -2 SD.Conclusion Extrapolated to the nearly 7 million annual births in South America, an estimated 2000-2500 microcephaly cases were diagnosed among births each year before the Zika epidemic began in 2015. Clinicians are using more than simple metrics to make microcephaly diagnoses. Endemic infections are important enduring causes of microcephaly.
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Affiliation(s)
- Iêda M Orioli
- Latin American Collaborative Study of Congenital Malformations (ECLAMC) at Department of Genetics, Institute of Biology, Federal University of Rio de Janeiro, 21944-001, Rio de Janeiro, Brazil
- National Institute of Population Medical Genetics (INAGEMP), Porto Alegre, Brazil
| | - Helen Dolk
- Maternal Fetal and Infant Research Centre, Institute of Nursing and Health Research, Ulster University, Newtownabbey, Northern Ireland, UK
| | - Jorge S Lopez-Camelo
- National Institute of Population Medical Genetics (INAGEMP), Porto Alegre, Brazil
- ECLAMC at Center for Medical Education and Clinical Research (CEMIC-CONICET), Buenos Aires, Argentina
| | - Daniel Mattos
- Latin American Collaborative Study of Congenital Malformations (ECLAMC) at Department of Genetics, Institute of Biology, Federal University of Rio de Janeiro, 21944-001, Rio de Janeiro, Brazil
- National Institute of Population Medical Genetics (INAGEMP), Porto Alegre, Brazil
| | - Fernando A Poletta
- National Institute of Population Medical Genetics (INAGEMP), Porto Alegre, Brazil
- ECLAMC at Center for Medical Education and Clinical Research (CEMIC-CONICET), Buenos Aires, Argentina
| | - Maria G Dutra
- National Institute of Population Medical Genetics (INAGEMP), Porto Alegre, Brazil
- ECLAMC at Laboratory of Congenital Malformations Epidemiology, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Flavia M Carvalho
- National Institute of Population Medical Genetics (INAGEMP), Porto Alegre, Brazil
- ECLAMC at Laboratory of Congenital Malformations Epidemiology, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Rio de Janeiro, Brazil
| | - Eduardo E Castilla
- National Institute of Population Medical Genetics (INAGEMP), Porto Alegre, Brazil
- ECLAMC at Center for Medical Education and Clinical Research (CEMIC-CONICET), Buenos Aires, Argentina
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Pawluk MS, Campaña H, Rittler M, Poletta FA, Cosentino VR, Gili JA, Gimenez LG, López Camelo JS. Individual deprivation, regional deprivation, and risk for oral clefts in Argentina. Rev Panam Salud Publica 2017. [PMID: 29466515 PMCID: PMC6645331 DOI: 10.26633/rpsp.2017.110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective. The aim of this study was to analyze the effects of individual low socioeconomic status (SES) and deprived geographical area (GA) on the occurrence of isolated cleft lip with or without cleft palate (CL±P) in Argentina.
Methods. This case-control study included 577 newborns with isolated CL±P and 13 344 healthy controls, born between 1992 and 2001, from a total population of 546 129 births in 39 hospitals in Argentina. Census data on unsatisfied basic needs were used to establish the degree of geographical area deprivation. An SES index for each individual was established, using maternal age, gravidity, low paternal and maternal education, and low-level paternal occupation. Logistic regression was used to assess the effects of low SES and of deprived GA on CL±P.
Results. A slightly increased risk of CL±P was observed in mothers with a low SES, while a deprived GA showed no effect. Native ancestry, acute maternal illnesses, and poor prenatal care were significant risk factors for CL±P for the mothers with low SES, after using propensity scores to adjust for the demographic characteristics in cases and controls.
Conclusions. Low individual SES slightly increased the risk for CL±P, but a deprived GA did not have that effect. There was no interaction between individual SES and deprived GA. Factors related to low individual SES—including poor prenatal care, low parental education, lack of information, and lifestyle factors—should be primarily targeted as risk factors for CL±P rather than factors related to a deprived place of residence.
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Affiliation(s)
- Mariela Soledad Pawluk
- Estudio Colaborativo Latinoamericano de Malformaciones Congénitas (ECLAMC), Laboratorio de Epidemiología Genética, Centro de Educación Médica e Investigaciones Clínicas (CEMIC-CONICET), Buenos Aires, Argentina
| | | | - Monica Rittler
- Estudio Colaborativo Latinoamericano de Malformaciones Congénitas (ECLAMC), Hospital Materno Infantil Ramón Sarda, Buenos Aires, Argentina
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Fernández N, Pérez J, Monterrey P, Poletta FA, Bägli DJ, Lorenzo AJ, Zarante I. ECLAMC Study: Prevalence patterns of hypospadias in South America: Multi-national analysis over a 24-year period. Int Braz J Urol 2017; 43:325-334. [PMID: 27802003 PMCID: PMC5433373 DOI: 10.1590/s1677-5538.ibju.2016.0002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 04/24/2016] [Accepted: 04/24/2016] [Indexed: 03/27/2024] Open
Abstract
OBJECTIVE To evaluate prevalence trends of hypospadias in South-America it is essential to perform multicenter and multinational studies with the same methodology. Herein we present systematic data as part of an international multicenter initiative evaluating congenital malformations in South America over a 24-year period. MATERIALS AND METHODS A nested case-control study was conducted using the Latin American Collaborative Study of Congenital Malformations (ECLAMC), between January 1989 and December 2012. Cases were stratified as isolated (IH) and non-isolated hypospadias (NIH). Global prevalence was calculated and discriminated by country. Associations between birth weight and gestational age, and NIH distribution by associated abnormality and severity of hypospadias, were analyzed. RESULTS A total of 159 hospitals from six countries participated, reporting surveillance on 4.020.384 newborns. A total of 4.537 hypospadias cases were detected, with a global prevalence of 11.3/10.000 newborns. Trend analyses showed in Chile, Brazil and Uruguay a statistically significant increase in prevalence. Analysis of severity and associated anomalies did not to find an association for distal cases, but did for proximal (RR=1.64 [95% CI=1.33-2.03]). CONCLUSION This is one of only a few Latin American multicenter studies reporting on the epidemiology of hypospadias in South America in the last two decades. Our data adds to evidence suggesting an increase in some countries in the region at different times. There were also variations in prevalence according to severity. This study adds to literature describing associated anomalies at a hospital-based level.
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Affiliation(s)
- Nicolás Fernández
- Departamento de Urología, Pontificia Universidad Javeriana, Departamento de Urología, Hospital Universitario San Ignacio, Bogotá, Colombia
- Instituto de Genética Humana, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Jaime Pérez
- Departamento de Urología, Pontificia Universidad Javeriana, Departamento de Urología, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Pedro Monterrey
- Departamento de Matemáticas, Rosario University, Bogotá, Colombia
| | - Fernando A. Poletta
- ECLAMC (Estudio Colaborativo Latinoamericano de Malformaciones Congénitas) at Centro de Educación Médica e Investigaciones Clínicas (CEMIC-CONICET), Buenos Aires, Argentina and Instituto Nacional de Genética Médica Populacional (INaGeMP), Rio de Janeiro, Brasil
| | - Darius J. Bägli
- Division of Urology, Department of Surgery, Hospital for Sick Children and University of Toronto, Toronto, Ontario
| | - Armando J. Lorenzo
- Division of Urology, Department of Surgery, Hospital for Sick Children and University of Toronto, Toronto, Ontario
| | - Ignacio Zarante
- Instituto de Genética Humana, Pontificia Universidad Javeriana, Bogotá, Colombia
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Differences in early cognitive and receptive-expressive neurodevelopment by ancestry and underlying pathways in Brazil and Argentina. Infant Behav Dev 2017; 46:100-114. [PMID: 28068525 DOI: 10.1016/j.infbeh.2016.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 11/22/2016] [Accepted: 12/03/2016] [Indexed: 12/21/2022]
Abstract
We examine disparities in early child cognitive and receptive-expressive skills by ethnic ancestry among infants aged 3-24 months from Brazil and Argentina. We employ unique data on the neurodevelopment of children who were seeking routine well-child care at a set of pediatric clinics in these countries. The sample included children who had normal birth outcomes and no major health complications, allowing us to focus on variation in neurodevelopment among children without major physical health limitations. The physicians attending the pediatric clinics were trained in administering the Bayley Infant Neurodevelopmental Screener, a standardized instrument used to screen an infant's risk of neurodevelopmental problems on various domains of abilities. We evaluate disparities in overall neurodevelopmental scores and risk for neurodevelopmental problems as well as in cognitive functioning and receptive-expressive neurodevelopment. We also examine the extent to which household demographic and socioeconomic characteristics and geographic location explain these disparities. We find large gaps in both cognitive and receptive-expressive neurodevelopment by ancestry. In Brazil, children of African ancestry have lower scores on both cognitive and receptive-expressive domains and on overall neurodevelopment than children of European ancestry. In Argentina, children of Native ancestry have lower scores on these outcomes than children of European ancestry. These gaps however are largely explained by differences in geographic location and household characteristics, highlighting the importance of policies that reduce socioeconomic and geographic disparities in social capital and economic development for eliminating ethnic disparities in infant neurodevelopment.
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de Araújo JSS, Regis CT, Gomes RGS, Mourato FA, Mattos SDS. Impact of Telemedicine in the Screening for Congenital Heart Disease in a Center from Northeast Brazil. J Trop Pediatr 2016; 62:471-476. [PMID: 27273306 DOI: 10.1093/tropej/fmw033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To describe the incidence of congenital heart disease before and after the establishment of a telemedicine screening program, in a reference center from Northeast Brazil. METHODS This is a descriptive, retrospective and comparative study based on the institutional data from a reference center in perinatology for a period of 16 years. Institutional data were collected from a 16-year period (2001-15). Data were divided into two periods: prior to (2001-11) and after (2012-15) the establishment of a telemedicine screening program. RESULTS After the implementation of the screening process, almost all kinds of heart disease showed a significant increase in their incidence (p < 0.05). With this, the incidence of major heart diseases approached those specified in developed regions. CONCLUSION The implementation of a screening process model for congenital heart diseases can change the context of patients with congenital heart diseases in poor regions.
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Affiliation(s)
| | - Cláudio Teixeira Regis
- Círculo Do Coração De Pernambuco, Recife, Pernambuco, Brazil.,Instituto Cândida Vargas, João Pessoa, Paraíba, Brazil
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Porras-Hurtado GL, León-Castañeda OM, Molano-Hurtado J, Quiceno SL, Pachajoa H, Montoya JJ. [Prevalence of birth defects in Risaralda, 2010-2013]. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2016; 36:556-563. [PMID: 27992982 DOI: 10.7705/biomedica.v36i4.2771] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 03/16/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION The data regarding birth defects at local levels in developing countries like Colombia are scarce. OBJECTIVE To describe the profile of congenital abnormalities in the province of Risaralda, Colombia. MATERIALS AND METHODS We included the information on infants with structural and functional abnormalities at birth between June, 2010, and December, 2013, from records of the Instituto Nacional de Salud, and compared it with those of children born in the same period in a local clinic participating in the Collaborative Study of Congenital Malformations. We analyzed the data using Stata 10®. RESULTS We found a prevalence of nine defects per 1,000 newborns from the total live births in Risaralda. The local clinic registered in the Collaborative Study of Congenital Malformations registered a prevalence of 34 defects per 1,000 births. Most frequent defects were heart defects, followed by cleft lip and palate, abdominal wall defects, skeletal dysplasia, hydrocephalus, polydactyly and Down syndrome. CONCLUSIONS Having a baseline on the prevalence of congenital defects in Risaralda is very useful in the design of prevention policies oriented to decrease congenital defects incidence and severity. Inclusion of maternity hospitals in the Collaborative Study of Congenital Malformations strengthens national recording and reporting of birth defects.
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Affiliation(s)
- Gloria Liliana Porras-Hurtado
- Grupo Salud Comfamiliar, Clínica Comfamiliar, Pereira, Colombia Estudio Colaborativo Latinoamericano de Malformaciones Congénitas, ECLAMC, Bogotá, D.C., Colombia.
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Wehby GL, Pawluk M, Nyarko KA, López-Camelo JS. Explaining ethnic disparities in preterm birth in Argentina and Ecuador. Glob Public Health 2016; 13:1126-1143. [PMID: 27875924 DOI: 10.1080/17441692.2016.1251603] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Little is understood about racial/ethnic disparities in infant health in South America. We quantified the extent to which the disparity in preterm birth (PTB; <37 gestational weeks) rate between infants of Native only ancestry and those of European only ancestry in Argentina and Ecuador are explained by household socio-economic, demographic, healthcare use, and geographic location indicators. The samples included 5199 infants born between 2000 and 2011 from Argentina and 1579 infants born between 2001 and 2011 from Ecuador. An Oaxaca-Blinder type decomposition model adapted to binary outcomes was estimated to explain the disparity in PTB risk across groups of variables and specific variables. Maternal use of prenatal care services significantly explained the PTB disparity, by nearly 57% and 30% in Argentina and Ecuador, respectively. Household socio-economic status explained an additional 26% of the PTB disparity in Argentina. Differences in maternal use of prenatal care may partly explain ethnic disparities in PTB in Argentina and Ecuador. Improving access to prenatal care may reduce ethnic disparities in PTB risk in these countries.
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Affiliation(s)
- George L Wehby
- a Departments of Health Management and Policy, Economics, and Preventive & Community Dentistry, and Public Policy Center , University of Iowa , Iowa City , IA , USA.,b National Bureau of Economic Research , Cambridge , MA , USA
| | - Mariela Pawluk
- c Center of Medical Education and Clinical Investigation/Centro de Educación Médica e Investigación Clínica (CEMIC) , Buenos Aires , Argentina
| | - Kwame A Nyarko
- d Department of Health Management and Policy , University of Iowa , Iowa City , IA, USA
| | - Jorge S López-Camelo
- c Center of Medical Education and Clinical Investigation/Centro de Educación Médica e Investigación Clínica (CEMIC) , Buenos Aires , Argentina.,e Latin American Collaborative Study of Congenital Anomalies/Estudio Colaborativo Latinoamericano de Malformaciones Congénitas (ECLAMC) , Buenos Aires , Argentina
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The impact of unemployment cycles on child and maternal health in Argentina. Int J Public Health 2016; 62:197-207. [PMID: 27572492 DOI: 10.1007/s00038-016-0857-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 06/21/2016] [Accepted: 07/08/2016] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES The purpose of this study is to examine the effects of economic cycles in Argentina on infant and maternal health between 1994 and 2006, a period that spans the major economic crisis in 1999-2002. METHODS We evaluate the effects of province-level unemployment rates on several infant health outcomes, including birth weight, gestational age, fetal growth rate, and hospital discharge status after birth in a sample of 15,000 infants born in 13 provinces. Maternal health and healthcare outcomes include acute and chronic illnesses, infectious diseases, and use of prenatal visits and technology. Regression models control for hospital and year fixed effects and province-specific time trends. RESULTS Unemployment rise reduces fetal growth rate particularly among high educated parents. Also, maternal poverty-related infectious diseases increase, although reporting of acute illnesses declines (an effect more pronounced among low educated parents). There is also some evidence for reduced access to prenatal care and technology among less educated parents with higher unemployment. CONCLUSIONS Unemployment rise in Argentina has adversely affected certain infant and maternal health outcomes, but several measures show no evidence of significant change.
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Geographic clusters of congenital anomalies in Argentina. J Community Genet 2016; 8:1-7. [PMID: 27541682 DOI: 10.1007/s12687-016-0276-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 07/28/2016] [Indexed: 01/04/2023] Open
Abstract
Geographical clusters are defined as the occurrence of an unusual number of cases higher than expected in a given geographical area in a certain period of time. The aim of this study was to identify potential geographical clusters of specific selected congenital anomalies (CA) in Argentina. The cases were ascertained from 703,325 births, examined in 133 maternity hospitals in the 24 provinces of Argentina. We used the spatial scan statistic to determine areas of Argentina which had statistically significant elevations of prevalence. Prenatal diagnosis followed by referral of high-risk pregnancies to high complexity hospitals in a hospital-based surveillance system can create artifactual clusters. We assessed the referral bias by evaluating the prevalence heterogeneity within each cluster. Eight clusters of selected CAs with unusually high birth prevalence were identified: anencephaly, encephalocele, spina bifida, diaphragmatic hernia, talipes equinovarus, omphalocele, Cleft lip with or without cleft palate (CL/P), and Down syndrome. The clusters of Down syndrome and CL/P observed in this study match the previously reported clusters. These findings support local targeted interventions to lower the prevalence of the CAs and/or further research on the cause of each cluster. The clusters of spina bifida, anencephaly, encephalocele, omphalocele, congenital diaphragmatic hernia, and talipes equinovarus may be influenced by prenatal diagnosis and referral to high complexity hospitals.
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Vieira-Machado CD, Tostes M, Alves G, Nazer J, Martinez L, Wettig E, Pizarro Rivadeneira O, Diaz Caamaño M, Larenas Ascui J, Pavez P, Dutra MDG, Castilla EE, Orioli IM. Uniparental ancestry markers in Chilean populations. Genet Mol Biol 2016; 39:573-579. [PMID: 27561109 PMCID: PMC5127147 DOI: 10.1590/1678-4685-gmb-2015-0273] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 02/23/2016] [Indexed: 11/29/2022] Open
Abstract
The presence of Native Americans, Europeans, and Africans has led to the development
of a multi-ethnic, admixed population in Chile. This study aimed to contribute to the
characterization of the uniparental genetic structure of three Chilean regions.
Newborns from seven hospitals in Independencia, Providencia, Santiago, Curicó,
Cauquenes, Valdívia, and Puerto Montt communes, belonging to the Chilean regions of
Santiago, Maule, and Los Lagos, were studied. The presence of Native American
mitochondrial DNA (mtDNA) haplogroups and two markers present in the non-recombinant
region of the Y chromosome, DYS199 and DYS287, indicative of Native American and
African ancestry, respectively, was determined. A high Native American matrilineal
contribution and a low Native American and African patrilineal contributions were
found in all three studied regions. As previously found in Chilean admixed
populations, the Native American matrilineal contribution was lower in Santiago than
in the other studied regions. However, there was an unexpectedly higher contribution
of Native American ancestry in one of the studied communes in Santiago, probably due
to the high rate of immigration from other regions of the country. The population
genetic sub-structure we detected in Santiago using few uniparental markers requires
further confirmation, owing to possible stratification for autosomal and X-chromosome
markers.
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Affiliation(s)
- Camilla Dutra Vieira-Machado
- Latin American Collaborative Study of Congenital Malformations (ECLAMC) and National Institute of Population Medical Genetics (INAGEMP), Departmento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Maluah Tostes
- Latin American Collaborative Study of Congenital Malformations (ECLAMC) and National Institute of Population Medical Genetics (INAGEMP), Departmento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Gabrielle Alves
- Latin American Collaborative Study of Congenital Malformations (ECLAMC) and National Institute of Population Medical Genetics (INAGEMP), Departmento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
| | - Julio Nazer
- Neonatal Service, Department of Obstetrics and Gynecology, Hospital Clínico de La Universidad del Chile, Santiago, Chile
| | | | | | | | | | | | | | - Maria da Graça Dutra
- Latin American Collaborative Study of Congenital Malformations (ECLAMC) and National Institute of Population Medical Genetics (INAGEMP), Laboratory of Congenital Malformations Epidemiology (LEMC), Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil
| | - Eduardo Enrique Castilla
- Latin American Collaborative Study of Congenital Malformations (ECLAMC) and National Institute of Population Medical Genetics (INAGEMP), Laboratory of Congenital Malformations Epidemiology (LEMC), Instituto Oswaldo Cruz (IOC), Fundação Oswaldo Cruz (Fiocruz), Rio de Janeiro, RJ, Brazil.,Latin American Collaborative Study of Congenital Malformations (ECLAMC) Center for Medical Education and Clinical Research (CEMIC) Buenos Aires, Argentina
| | - Ieda Maria Orioli
- Latin American Collaborative Study of Congenital Malformations (ECLAMC) and National Institute of Population Medical Genetics (INAGEMP), Departmento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
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Estrada-Veras JI, Cabrera-Peña GA, Pérez-Estrella de Ferrán C. Medical genetics and genomic medicine in the Dominican Republic: challenges and opportunities. Mol Genet Genomic Med 2016; 4:243-56. [PMID: 27247952 PMCID: PMC4867558 DOI: 10.1002/mgg3.224] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Medical genetics and genomic medicine in the Dominican Republic: challenges and opportunities.
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Affiliation(s)
- Juvianee I Estrada-Veras
- Medical Genetics Branch National Human Genome Research Institute Section of Human Biochemical Genetics National Institutes of Health Bethesda Maryland
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Gili JA, Poletta FA, Giménez LG, Pawluk MS, Campaña H, Castilla EE, López-Camelo JS. Descriptive analysis of high birth prevalence rate geographical clusters of congenital anomalies in South America. ACTA ACUST UNITED AC 2016; 106:257-66. [PMID: 26887535 DOI: 10.1002/bdra.23481] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 12/07/2015] [Indexed: 11/06/2022]
Abstract
BACKGROUND The birth prevalence rate (BPR) of congenital anomalies (CAs) is heterogeneous and exhibits geographical and sociocultural variations throughout the world. In South America (SA), high birth prevalence regions of congenital anomalies have been observed. The aim of this study was to identify, describe, and characterize geographical clusters of congenital anomalies in SA. METHODS This observational descriptive study is based on clinical epidemiological data registered by the Latin-American Collaborative Study of Congenital Malformations network. Between 1995 and 2012, a total of 25,082 malformed newborns were ascertained from 2,557,424 births at 129 hospitals in SA. The spatial scan statistic was used to determine geographical regions with high BPR of CAs. The BPR was obtained with a Poisson regression model. Odds ratios were estimated for several risk factors inside the geographical clusters. RESULTS We confirmed the existence of high BPR regions of CAs in SA. Indicators of low socioeconomic conditions, such as a low maternal education, extreme age childbearing, infectious diseases, and medicine use during pregnancy were detected as risk factors inside these regions. Native and African ancestries with high frequency of consanguineous marriages could explain partially these high BPR clusters. CONCLUSION The recognition of clusters could be a starting point in the identification of susceptibility genes associated with the occurrence of CA in high BPR regions.
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Affiliation(s)
- Juan Antonio Gili
- Estudio Colaborativo Latinoamericano de Malformaciones Congénitas-ECLAMC, Laboratorio de Epidemiologia Genética, Dirección de Investigación, CEMIC-CONICET, Buenos Aires, Argentina
| | - Fernando Adrián Poletta
- Estudio Colaborativo Latinoamericano de Malformaciones Congénitas-ECLAMC, Laboratorio de Epidemiologia Genética, Dirección de Investigación, CEMIC-CONICET, Buenos Aires, Argentina.,Estudio Colaborativo Latinoamericano de Malformaciones Congénitas-ECLAMC, Instituto Nacional de Genética Médica Populacional, Rio de Janeiro, Brazil
| | - Lucas Gabriel Giménez
- Estudio Colaborativo Latinoamericano de Malformaciones Congénitas-ECLAMC, Laboratorio de Epidemiologia Genética, Dirección de Investigación, CEMIC-CONICET, Buenos Aires, Argentina
| | - Mariela Soledad Pawluk
- Estudio Colaborativo Latinoamericano de Malformaciones Congénitas-ECLAMC, Laboratorio de Epidemiologia Genética, Dirección de Investigación, CEMIC-CONICET, Buenos Aires, Argentina
| | - Hebe Campaña
- Estudio Colaborativo Latinoamericano de Malformaciones Congénitas-ECLAMC, Laboratorio de Epidemiologia Genética, Dirección de Investigación, CEMIC-CONICET, Buenos Aires, Argentina
| | - Eduardo Enrique Castilla
- Estudio Colaborativo Latinoamericano de Malformaciones Congénitas-ECLAMC, Laboratorio de Epidemiologia Genética, Dirección de Investigación, CEMIC-CONICET, Buenos Aires, Argentina.,Estudio Colaborativo Latinoamericano de Malformaciones Congénitas-ECLAMC, Instituto Nacional de Genética Médica Populacional, Rio de Janeiro, Brazil
| | - Jorge Santiago López-Camelo
- Estudio Colaborativo Latinoamericano de Malformaciones Congénitas-ECLAMC, Laboratorio de Epidemiologia Genética, Dirección de Investigación, CEMIC-CONICET, Buenos Aires, Argentina.,Estudio Colaborativo Latinoamericano de Malformaciones Congénitas-ECLAMC, Instituto Nacional de Genética Médica Populacional, Rio de Janeiro, Brazil
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Westphal F, Araujo Júnior E, Fustinoni SM, Abrahão AR. Maternal risks and predictor factors for the termination of pregnancy in fetuses with severe congenital anomaly: experience from a single reference center in Brazil. J Matern Fetal Neonatal Med 2016; 29:3762-7. [PMID: 26821254 DOI: 10.3109/14767058.2016.1147557] [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] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To assess the maternal complications in pregnant women with fetuses with several congenital anomaly as well as the predictor variables for the termination of pregnancy. METHODS We performed a retrospective cohort study with 94 medical records of pregnant women with fetal infeasibility confirmed in the postnatal period by clinical, radiological or anatomopathological exams. To compare the categorical variables regarding the termination and nontermination of pregnancy, we used analysis of variance (ANOVA) and the Mann-Whitney U-test. To assess the variables that were more associated with the judicial request for the termination of pregnancy, we used logistic regression. RESULTS The termination of pregnancy was performed in 41 (43.6%) and nontermination of pregnancy in 53 (56.4%) pregnant women. Pregnant women who did not terminate the pregnancy had more complications in the gestational period (p < 0.0001) and in the postpartum period (p = 0.0088). After multiple logistic regressions, the following variables influenced the decision to terminate the pregnancy: type of congenital anomaly (OR: 18.59; 95%CI: 1.96; 175.87) and living children (OR: 0.45; 95%CI: 0.25; 0.80). CONCLUSION Most of the pregnant women with fetal infeasibility opted for nontermination of pregnancy and these patients had more obstetrical complications. The type of congenital anomaly and living children were the factors most associated with the choice for the termination of pregnancy.
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Affiliation(s)
- Flavia Westphal
- a Department of Midwifery , Paulista School of Nurse-Federal University of São Paulo , São Paulo - SP , Brazil and
| | - Edward Araujo Júnior
- b Department of Obstetrics , Paulista School of Nurse-Federal University of São Paulo , São Paulo - SP , Brazil
| | - Suzete Maria Fustinoni
- a Department of Midwifery , Paulista School of Nurse-Federal University of São Paulo , São Paulo - SP , Brazil and
| | - Anelise Riedel Abrahão
- a Department of Midwifery , Paulista School of Nurse-Federal University of São Paulo , São Paulo - SP , Brazil and
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Gimenez LG, Krupitzki HB, Momany AM, Gili JA, Poletta FA, Campaña H, Cosentino VR, Saleme C, Pawluk M, Murray JC, Castilla EE, Gadow EC, Lopez-Camelo JS. Maternal and neonatal epidemiological features in clinical subtypes of preterm birth. J Matern Fetal Neonatal Med 2015; 29:3153-61. [PMID: 26701680 DOI: 10.3109/14767058.2015.1118035] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study was designed to characterize and compare the maternal and newborn epidemiological characteristics through analysis of environmental factors, sociodemographic characteristics and clinical characteristics between the different clinical subtypes of preterm birth (PTB): Idiopathic (PTB-I), premature rupture of the membranes (PTB-PPROM) and medically indicated (PTB-M). The two subtypes PTB-I and PTB-PPROM grouped are called spontaneous preterm births (PTB-S). METHODS A retrospective, observational study was conducted in 1.291 preterm nonmalformed singleton live-born children to nulliparous and multiparous mother's in Tucumán-Argentina between 2005 and 2010. Over 50 maternal variables and 10 newborn variables were compared between the different clinical subtypes. The comparisons were done to identify heterogeneity between subtypes of preterm birth: (PTB-S) versus (PTB-M), and within spontaneous subtype: (PTB-I) versus (PTB-PPROM). In the same way, two conditional logistic multivariate regressions were used to compare the odds ratio (OR) between PTB-S and PTB-M, as well as PTB-I and PTB-PPROM. We matched for maternal age when comparing maternal variables and gestational age when comparing infant variables. RESULTS The PTB-I subtype was characterized by younger mothers of lower socio-economic status, PTB-PPROM was characterized by environmental factors resulting from inflammatory processes, and PTB-M was characterized by increased maternal or fetal risk pregnancies. CONCLUSIONS The main risk factor for PTB-I and PTB-M was having had a prior preterm delivery; however, previous spontaneous abortion was not a risk factor, suggesting a reproductive selection mechanism.
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Affiliation(s)
- Lucas G Gimenez
- a Dirección De Investigación, CEMIC (Centro De Educación Médica E Investigaciones Clínicas) , Galván 4102 , Buenos Aires , Argentina .,b ECLAMC (Estudio Colaborativo Latinoamericano De Malformaciones Congénitas) at CEMIC , Buenos Aires , Argentina
| | - Hugo B Krupitzki
- a Dirección De Investigación, CEMIC (Centro De Educación Médica E Investigaciones Clínicas) , Galván 4102 , Buenos Aires , Argentina
| | | | - Juan A Gili
- a Dirección De Investigación, CEMIC (Centro De Educación Médica E Investigaciones Clínicas) , Galván 4102 , Buenos Aires , Argentina .,b ECLAMC (Estudio Colaborativo Latinoamericano De Malformaciones Congénitas) at CEMIC , Buenos Aires , Argentina
| | - Fernando A Poletta
- a Dirección De Investigación, CEMIC (Centro De Educación Médica E Investigaciones Clínicas) , Galván 4102 , Buenos Aires , Argentina .,b ECLAMC (Estudio Colaborativo Latinoamericano De Malformaciones Congénitas) at CEMIC , Buenos Aires , Argentina .,d Fundação Oswaldo Cruz, INAGEMP (Instituto Nacional De Genética Médica Populacional) at Laboratório De Epidemiologia De Malformações Congênitas, Instituto Oswaldo Cruz , Rio De Janeiro , Brazil
| | - Hebe Campaña
- e CIC (Comisión De Investigaciones Científicas) at La Plata , Buenos Aires , Argentina , and
| | - Viviana R Cosentino
- b ECLAMC (Estudio Colaborativo Latinoamericano De Malformaciones Congénitas) at CEMIC , Buenos Aires , Argentina
| | - César Saleme
- f Maternidad Nuestra Señora De La Merced , Tucumán , Argentina
| | - Mariela Pawluk
- a Dirección De Investigación, CEMIC (Centro De Educación Médica E Investigaciones Clínicas) , Galván 4102 , Buenos Aires , Argentina .,b ECLAMC (Estudio Colaborativo Latinoamericano De Malformaciones Congénitas) at CEMIC , Buenos Aires , Argentina
| | | | - Eduardo E Castilla
- b ECLAMC (Estudio Colaborativo Latinoamericano De Malformaciones Congénitas) at CEMIC , Buenos Aires , Argentina .,d Fundação Oswaldo Cruz, INAGEMP (Instituto Nacional De Genética Médica Populacional) at Laboratório De Epidemiologia De Malformações Congênitas, Instituto Oswaldo Cruz , Rio De Janeiro , Brazil
| | - Enrique C Gadow
- a Dirección De Investigación, CEMIC (Centro De Educación Médica E Investigaciones Clínicas) , Galván 4102 , Buenos Aires , Argentina
| | - Jorge S Lopez-Camelo
- a Dirección De Investigación, CEMIC (Centro De Educación Médica E Investigaciones Clínicas) , Galván 4102 , Buenos Aires , Argentina .,b ECLAMC (Estudio Colaborativo Latinoamericano De Malformaciones Congénitas) at CEMIC , Buenos Aires , Argentina .,d Fundação Oswaldo Cruz, INAGEMP (Instituto Nacional De Genética Médica Populacional) at Laboratório De Epidemiologia De Malformações Congênitas, Instituto Oswaldo Cruz , Rio De Janeiro , Brazil
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Nyarko KA, Lopez-Camelo J, Castilla EE, Wehby GL. Explaining racial disparities in infant health in Brazil. Am J Public Health 2015; 105 Suppl 4:S575-84, S563-74. [PMID: 26313046 DOI: 10.2105/ajph.2012.301021r] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to quantify how socioeconomic, health care, demographic, and geographic effects explain racial disparities in low birth weight (LBW) and preterm birth (PTB) rates in Brazil. METHODS We employed a sample of 8949 infants born between 1995 and 2009 in 15 cities and 7 provinces in Brazil. We focused on disparities in LBW (< 2500 g) and PTB (< 37 gestational weeks) prevalence between infants of African ancestry alone or African mixed with other ancestries, and European ancestry alone. We used a decomposition model to quantify the contributions of conceptually relevant factors to these disparities. RESULTS The model explained 45% to 94% of LBW and 64% to 94% of PTB disparities between the African ancestry groups and European ancestry. Differences in prenatal care use and geographic location were the most important contributors, followed by socioeconomic differences. The model explained the majority of the disparities for mixed African ancestry and part of the disparity for African ancestry alone. CONCLUSIONS Public policies to improve children's health should target prenatal care and geographic location differences to reduce health disparities between infants of African and European ancestries in Brazil.
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Affiliation(s)
- Kwame A Nyarko
- Kwame A. Nyarko and George L. Wehby are with the Department of Health Management and Policy, University of Iowa, Iowa City. Jorge Lopez-Camelo and Eduardo E. Castilla are with Estudio Colaborativo Latino Americano de Malformaciones Congenitas (ECLAMC), Centro de Educación Médica e Investigación Clínica, Buenos Aires, Argentina, and ECLAMC, Laboratório de Epidemiologia de Malformações Congênitas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Jorge Lopez-Camelo
- Kwame A. Nyarko and George L. Wehby are with the Department of Health Management and Policy, University of Iowa, Iowa City. Jorge Lopez-Camelo and Eduardo E. Castilla are with Estudio Colaborativo Latino Americano de Malformaciones Congenitas (ECLAMC), Centro de Educación Médica e Investigación Clínica, Buenos Aires, Argentina, and ECLAMC, Laboratório de Epidemiologia de Malformações Congênitas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Eduardo E Castilla
- Kwame A. Nyarko and George L. Wehby are with the Department of Health Management and Policy, University of Iowa, Iowa City. Jorge Lopez-Camelo and Eduardo E. Castilla are with Estudio Colaborativo Latino Americano de Malformaciones Congenitas (ECLAMC), Centro de Educación Médica e Investigación Clínica, Buenos Aires, Argentina, and ECLAMC, Laboratório de Epidemiologia de Malformações Congênitas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - George L Wehby
- Kwame A. Nyarko and George L. Wehby are with the Department of Health Management and Policy, University of Iowa, Iowa City. Jorge Lopez-Camelo and Eduardo E. Castilla are with Estudio Colaborativo Latino Americano de Malformaciones Congenitas (ECLAMC), Centro de Educación Médica e Investigación Clínica, Buenos Aires, Argentina, and ECLAMC, Laboratório de Epidemiologia de Malformações Congênitas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Nyarko KA, López-Camelo J, Castilla EE, Wehby GL. Explicación de las disparidades raciales en la salud neonatal en Brasil. Am J Public Health 2015. [DOI: 10.2105/ajph.2012.301021s] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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48
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Fonseca RF, de Carvalho FM, Poletta FA, Montaner D, Dopazo J, Mereb JC, Moreira MAM, Seuanez HN, Vieira AR, Castilla EE, Orioli IM. Family-based genome-wide association study in Patagonia confirms the association of theDMDlocus and cleft lip and palate. Eur J Oral Sci 2015; 123:381-384. [DOI: 10.1111/eos.12212] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2015] [Indexed: 02/03/2023]
Affiliation(s)
- Renata F. Fonseca
- Department of Genetics; Institute of Biology, Federal University of Rio de Janeiro; Rio de Janeiro Brazil
- ECLAMC (Latin-American Collaborative Study of Congenital Malformations) at INAGEMP (National Institute of Population Medical Genetics); Rio de Janeiro Brazil
| | - Flávia M. de Carvalho
- Department of Genetics; Institute of Biology, Federal University of Rio de Janeiro; Rio de Janeiro Brazil
- ECLAMC (Latin-American Collaborative Study of Congenital Malformations) at INAGEMP (National Institute of Population Medical Genetics); Rio de Janeiro Brazil
- ECLAMC at LEMC (Laboratory of Congenital Malformation Epidemiology); Oswaldo Cruz Institute; FIOCRUZ; Rio de Janeiro Brazil
| | - Fernando A. Poletta
- ECLAMC (Latin-American Collaborative Study of Congenital Malformations) at INAGEMP (National Institute of Population Medical Genetics); Rio de Janeiro Brazil
- ECLAMC at LEMC (Laboratory of Congenital Malformation Epidemiology); Oswaldo Cruz Institute; FIOCRUZ; Rio de Janeiro Brazil
- ECLAMC at CEMIC (Center for Medical Education and Clinical Research) and CONICET (National Council for Scientific and Technical Investigation); Buenos Aires Argentina
| | - David Montaner
- CIPF (Computational Genomics Department, Centro de Investigación Príncipe Felipe); and CIBERER (Centro de Investigación Biomédica en Red de Enfermedades Raras); Valencia Spain
| | - Joaquin Dopazo
- CIPF (Computational Genomics Department, Centro de Investigación Príncipe Felipe); and CIBERER (Centro de Investigación Biomédica en Red de Enfermedades Raras); Valencia Spain
| | - Juan C. Mereb
- (In memoriam); ECLAMC at Hospital Zonal El Bolsón; El Bolsón Argentina
| | | | - Hector N. Seuanez
- Department of Genetics; Institute of Biology, Federal University of Rio de Janeiro; Rio de Janeiro Brazil
- Genetics Division; National Cancer Institute; Rio de Janeiro Brazil
| | - Alexandre R. Vieira
- Departments of Oral Biology and Pediatric Dentistry and Center for Craniofacial and Dental Genetics; School of Dental Medicine; University of Pittsburgh; Pittsburgh PA USA
| | - Eduardo E. Castilla
- ECLAMC (Latin-American Collaborative Study of Congenital Malformations) at INAGEMP (National Institute of Population Medical Genetics); Rio de Janeiro Brazil
- ECLAMC at LEMC (Laboratory of Congenital Malformation Epidemiology); Oswaldo Cruz Institute; FIOCRUZ; Rio de Janeiro Brazil
- ECLAMC at CEMIC (Center for Medical Education and Clinical Research) and CONICET (National Council for Scientific and Technical Investigation); Buenos Aires Argentina
| | - Iêda M. Orioli
- Department of Genetics; Institute of Biology, Federal University of Rio de Janeiro; Rio de Janeiro Brazil
- ECLAMC (Latin-American Collaborative Study of Congenital Malformations) at INAGEMP (National Institute of Population Medical Genetics); Rio de Janeiro Brazil
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Castillo Taucher S. Medical genetics and genomic medicine in Chile: opportunities for improvement. Mol Genet Genomic Med 2015; 3:243-7. [PMID: 26247042 PMCID: PMC4521961 DOI: 10.1002/mgg3.166] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Silvia Castillo Taucher
- Sección Genética, Departamento de Medicina, Hospital Clínico Universidad de Chile Santiago, Chile ; Sección Citogenética, Laboratorio Clínico, Clínica Alemana de Santiago Santiago, Chile
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Penchaszadeh VB. Ethical issues in genetics and public health in Latin America with a focus on Argentina. J Community Genet 2015; 6:223-30. [PMID: 25666434 PMCID: PMC4524838 DOI: 10.1007/s12687-015-0217-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 01/21/2015] [Indexed: 10/24/2022] Open
Abstract
This paper reviews the health situation and developments in medical genetics and bioethics in Latin America, with a focus on Argentina. The region is the most inequitable in the world, with an average Gini Index of 52.5 and 25 % of the population living in poverty. Health expenditures are low and health systems are fragmented and privatised, with curtailed governmental responsibility and regulation. Health-care decision making is mostly in the hands of private insurance corporations and the medical-industrial complex, so that what is (or is not) covered by health plans is arbitrary and determined by the market and not by population health needs. This inequity and the lack of meaningful governmental intervention in the provision of health care, including genetic services, are at the heart of the bioethical dilemmas in Latin America. It is not surprising, therefore, that bioethics in the region has developed an approach grounded in social justice, equity and human rights as guiding principles, in contrast to the individualism espoused by Anglo-Saxon bioethics. The main ethical issues identified in genetics in Latin America are (1) inequity in access to genetic services, particularly in prenatal diagnosis, (2) genetic discrimination and (3) the lack of adherence to internationally accepted requisites of clinical validity and utility for diagnostic and predictive genetic testing. In this context, there is a risk that the impressive advances in genetics/genomics occurring in developed countries may fail to improve the public's health and deepen inequity, with the implementation of expensive genetic technologies of unproven validity.
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