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Feldkamp ML, Canfield MA, Krikov S, Prieto-Merino D, Šípek A, LeLong N, Amar E, Rissmann A, Csaky-Szunyogh M, Tagliabue G, Pierini A, Gatt M, Bergman JEH, Szabova E, Bermejo-Sánchez E, Tucker D, Dastgiri S, Bidondo MP, Canessa A, Zarante I, Hurtado-Villa P, Martinez L, Mutchinick OM, Camelo JL, Benavides-Lara A, Thomas MA, Liu S, Nembhard WN, Gray EB, Nance AE, Mastroiacovo P, Botto LD. Gastroschisis prevalence patterns in 27 surveillance programs from 24 countries, International Clearinghouse for Birth Defects Surveillance and Research, 1980-2017. Birth Defects Res 2024; 116:e2306. [PMID: 38411327 DOI: 10.1002/bdr2.2306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 01/04/2024] [Accepted: 01/05/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND Gastroschisis is a serious birth defect with midgut prolapse into the amniotic cavity. The objectives of this study were to evaluate the prevalence and time trends of gastroschisis among programs in the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR), focusing on regional variations and maternal age changes in the population. METHODS We analyzed data on births from 1980 to 2017 from 27 ICBDSR member programs, representing 24 countries and three regions (Europe+ (includes Iran) , Latin America, North America). Cases were identified using diagnostic codes (i.e., 756.7, 756.71, or Q79.3). We excluded cases of amniotic band syndrome, limb-body wall defect, and ruptured omphalocele. Programs provided annual counts for gastroschisis cases (live births, stillbirths, and legally permitted pregnancy terminations for fetal anomalies) and source population (live births, stillbirths), by maternal age. RESULTS Overall, gastroschisis occurred in 1 of every 3268 births (3.06 per 10,000 births; 95% confidence intervals [CI]: 3.01, 3.11), with marked regional variation. European+ prevalence was 1.49 (95%CI: 1.44, 1.55), Latin American 3.80 (95%CI: 3.69, 3.92) and North American 4.32 (95%CI: 4.22, 4.42). A statistically significant increasing time trend was observed among six European+ , four Latin American, and four North American programs. Women <20 years of age had the highest prevalence in all programs except the Slovak Republic. CONCLUSIONS Gastroschisis prevalence increased over time in 61% of participating programs, and the highest increase in prevalence was observed among the youngest women. Additional inquiry will help to assess the impact of the changing maternal age proportions in the birth population on gastroschisis prevalence.
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Affiliation(s)
- Marcia L Feldkamp
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Mark A Canfield
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas, USA
| | - Sergey Krikov
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | | | - Antonin Šípek
- Czech Republic Department of Medical Genetics, Thomayer Hospital, Prague, Czech Republic
| | - Nathalie LeLong
- Université Paris Cité, Centre of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRA, Paris, France
| | - Emmanuelle Amar
- France REMERA, Registre des malformations en Rhône Alpes, Hospices Civils de Lyon, Lyon, France
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Melinda Csaky-Szunyogh
- Hungarian Congenital Anomalies Registry and Rare Diseases Centre, National Center for Public Health and Pharmacy, Budapest, Hungary
| | - Giovanna Tagliabue
- Lombardy Congenital Anomalies Registry, Cancer Registry Unit, Fondazione IRCCS, Istituto Nazionale dei tumori, Milan, Italy
| | - Anna Pierini
- Unit of Epidemiology of Rare Diseases and Congenital Anomalies, Institute of Clinical Physiology, National Research Council and Fondazione Toscana Gabriele Monasterio, Tuscany Registry of Congenital Defects, Pisa, Italy
| | - Miriam Gatt
- Malta Congenital Anomalies Registry, Directorate for Health Information and Research, Pieta, Malta
| | - Jorieke E H Bergman
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Elena Szabova
- Faculty of Public Health, Slovak Medical University in Bratislava, Bratislava, Slovak Republic
| | - Eva Bermejo-Sánchez
- ECEMC (Spanish Collaborative Study of Congenital Malformations), CIAC (Research Center on Congenital Anomalies), Institute of Rare Diseases Research (IIER), Instituto de Salud Carlos III, Madrid, Spain
| | - David Tucker
- Congenital Anomaly Register & Information Service for Wales, Public Health Wales, Knowledge Directorate, Singleton Hospital, Sketty Lane, Swansea, UK
| | - Saeed Dastgiri
- Health Services Management Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - María Paz Bidondo
- National Network of Congenital Anomalies of Argentina (RENAC), National Institute of Epidemiology (INE), National Administration of Laboratories and Health Institutes, National Ministry of Health Institutes, Buenos Aires, Argentina
| | - Aurora Canessa
- Regional Register Congenital Malformation Maule Health Service (RRMC-SSM), Maule, Chile
| | - Ignacio Zarante
- Instituto de Genética Humana, Pontificia Universidad Javeriana Bogotá, Bogotá, Colombia
| | - Paula Hurtado-Villa
- Facultad de Ciencias de la Salud, Pontificia Universidad Javeriana Cali, Cali, Colombia
| | | | - Osvaldo M Mutchinick
- Department of Genetics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, RYVEMCE, Registry and Epidemiological Surveillance of Congenital Malformations, Mexico City, Mexico
| | - Jorge Lopez Camelo
- ECLAMC, Center for Medical Education and Clinical Research (CEMIC-CONICET), Buenos Aires, Argentina
| | - Adriana Benavides-Lara
- Costa Rican Birth Defects Register Center (CREC), Costa Rican Institute for Research and Teaching in Nutrition and Health (INCIENSA), Cartago, Costa Rica
| | - Mary Ann Thomas
- Department of Medical Genetics and Pediatrics, Alberta Congenital Anomalies Surveillance System, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Shiliang Liu
- Canadian Congenital Anomalies Surveillance System (CCASS), Centre for Surveillance and Applied Research, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Wendy N Nembhard
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences and Arkansas Reproductive Health Monitoring System, Arkansas Children's Research Institute, Little Rock, Arkansas, USA
| | - Elizabeth B Gray
- Metropolitan Atlanta Congenital Defects Program, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Amy E Nance
- Utah Birth Defect Network, Office of Children with Special Care Needs, Division of Family Health, Utah Department of Health and Human Services, Salt Lake City, Utah, USA
| | - Pierpaolo Mastroiacovo
- International Center on Birth Defects, International Clearinghouse for Birth Defects Surveillance and Research, Rome, Italy
| | - Lorenzo D Botto
- Department of Pediatrics, The University of Utah, Salt Lake City, Utah, USA
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2
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Kleven DL, Mai CT, Bermejo-Sánchez E, Groisman B, Walani S, Peck J, Cosentino V, Botto LD, Zezza S, Romitti PA, Mastroiacovo P. Using a health observance event to raise awareness: An assessment of World Birth Defects Day. Birth Defects Res 2023; 115:1140-1150. [PMID: 37306055 PMCID: PMC10947432 DOI: 10.1002/bdr2.2210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/31/2023] [Accepted: 05/31/2023] [Indexed: 06/13/2023]
Abstract
World Birth Defects Day (WorldBDDay), observed annually on March 3, was launched in 2015 to advocate for public health surveillance, research, and prevention of birth defects, along with improved care and treatment for affected individuals. Following its fifth observance in 2019, we assessed WorldBDDay by analyzing: (a) engagement and content of over 2000 WorldBDDay posts on Facebook, Twitter, and Instagram; (b) interview responses from 9 WorldBDDay charter (founding) organizations on their perceptions of strengths and areas for improvement for WorldBDDay; (c) survey responses from 61 WorldBDDay 2019 partner (participating) organizations on their WorldBDDay 2019 activities; and (d) post-2019 social media engagement. Most social media posts (60%) occurred from organizations using Twitter (80% vs. 14% for Instagram and 6% for Facebook), although posts from individuals had higher levels of engagement (e.g., likes and comments). The highest engagement occurred for posts focused on general awareness, prevention, or events. Charter organizations reported the need for existing and new partner engagement, including a designated WorldBDDay contact for regular communication and coordination of activities and prepared prevention-focused messaging. Partner organizations reported using the WorldBDDay toolkit, especially key messages and social media tips, and suggested expanding the toolkit with relevant resources. Post-2019 Twitter engagement was lower than 2019 WorldBDDay (peak event) but showed similar reach to WorldBDDay events prior to 2019. Our assessment identified WorldBDDay health observance events as an important tool to support knowledge dissemination and global community engagement around birth defects. Moving forward, engagement with more individuals and organizations may improve the reach of WorldBDDay.
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Affiliation(s)
- Danielle L. Kleven
- International Centre on Birth Defects (ICBD), International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR), Rome, Italy
| | - Cara T. Mai
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Eva Bermejo-Sánchez
- Spanish Collaborative Study of Congenital Malformations (ECEMC), Unidad de Investigación sobre Anomalías Congénitas (UIAC), Institute of Rare Diseases Research (IIER), Instituto de Salud Carlos III, Madrid, Spain
| | - 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
| | | | - Jessica Peck
- Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee, USA
| | - Viviana Cosentino
- Latin American Collaborative Study of Congenital Malformations (ECLAMC) at Center for Medical Education and Clinical Research (CEMIC-CONICET), Buenos Aires, Argentina
| | - Lorenzo D. Botto
- International Centre on Birth Defects (ICBD), International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR), Rome, Italy
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Simonetta Zezza
- International Centre on Birth Defects (ICBD), International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR), Rome, Italy
| | - Paul A. Romitti
- Department of Epidemiology, University of Iowa, Iowa City, Iowa, USA
| | - Pierpaolo Mastroiacovo
- International Centre on Birth Defects (ICBD), International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR), Rome, Italy
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3
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Kancherla V, Sundar M, Lucita T, Lux A, Bakker MK, Bergman JEH, Bermejo-Sánchez E, Canfield MA, Dastgiri S, Feldkamp ML, Gatt M, Groisman B, Hurtado-Villa P, Kallen K, Landau D, Lelong N, Lopez-Camelo J, Martinez LE, Mastroiacovo P, Morgan M, Mutchinick OM, Nance AE, Nembhard WN, Pierini A, Sipek A, Stallings EB, Szabova E, Tagliabue G, Wertelecki W, Zarante I, Rissmann A. Prevalence and mortality among children with anorectal malformation: A multi-country analysis. Birth Defects Res 2023; 115:390-404. [PMID: 36401554 PMCID: PMC9898144 DOI: 10.1002/bdr2.2129] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/04/2022] [Accepted: 11/02/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE We examined the total prevalence, trends in prevalence, and age-specific mortality among individuals with anorectal malformation (ARM) METHODS: We conducted a retrospective cohort study using data from 24 population- and hospital-based birth defects surveillance programs affiliated with the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR) from 18 countries and for births from 1974 to 2014. We estimated pooled and program-specific total prevalence per 10,000 total births. Poisson regression was used to assess time trends in prevalence from 2001 to 2012 when most programs contributed data. We calculated selected age-specific proportions of deaths, stratified by case status RESULTS: The pooled total prevalence of ARM was 3.26 per 10,000 total births (95% Confidence Interval = 3.19, 3.32) for birth years 1974-2014. About 60% of cases were multiple or syndromic. Prevalence of multiple, syndromic, and stillborn cases decreased from 2001 to 2012. The first week mortality proportion was 12.5%, 3.2%, 28.3%, and 18.2% among all, isolated, multiple, and syndromic cases, respectively CONCLUSIONS: ARM is relatively rare, with multiple and syndromic cases showing decreasing prevalence during the study period. Mortality is a concern during the first week of life, and especially among multiple and syndromic cases. Our descriptive epidemiological findings increase our understanding of geographic variation in the prevalence of ARM and can be used to plan needed clinical services. Exploring factors influencing prevalence and mortality among individuals with ARM could inform future studies.
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Affiliation(s)
- Vijaya Kancherla
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Manasvi Sundar
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Tandaki Lucita
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty, Otto-von-Guericke-University, Magdeburg, Germany
| | - Anke Lux
- Institute for Biometrics and Medical Informatics, Medical Faculty, Otto-von-Guericke-University, Magdeburg, Germany
| | - Marian K Bakker
- Department of Genetics, University of Groningen, University Medical Center Groningen, Eurocat Northern Netherlands, Groningen, The Netherlands
| | - Jorieke EH Bergman
- Department of Genetics, University of Groningen, University Medical Center Groningen, Eurocat Northern Netherlands, Groningen, The Netherlands
| | - Eva Bermejo-Sánchez
- ECEMC (Spanish Collaborative Study of Congenital Malformations), UIAC (Unidad de Investigación sobre Anomalías Congénitas), Instituto de Investigación de Enfermedades Raras (IIER), Instituto de Salud Carlos III, Madrid, Spain
| | - Mark A. Canfield
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas, USA
| | - Saeed Dastgiri
- Tabriz Health Services Management Research Center, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Marcia L. Feldkamp
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Miriam Gatt
- Malta Congenital Anomalies Registry, Directorate for Health Information and Research, Guardamangia, Malta
| | - Boris Groisman
- National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Administration of Laboratories and Health Institutes (ANLIS), National Ministry of Health, Buenos Aires, Argentina
| | - Paula Hurtado-Villa
- Department of Basic Sciences of Health, School of Health, Pontificia Universidad Javeriana Cali, Cali, Colombia
| | - Kärin Kallen
- National Board of Health and Welfare, Stockholm, Sweden
| | - Danielle Landau
- Department of Neonatology, Soroka Medical Center, Beer-Sheva, Israel
| | - Nathalie Lelong
- Université de Paris, Inserm U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France
| | - Jorge Lopez-Camelo
- ECLAMC, Center for Medical Education and Clinical Research (CEMIC-CONICET), Buenos Aires, Argentina
| | - Laura Elia Martinez
- Registro DAN (Registro de Defectos al Nacimiento), Departamento de Genética, Hospital Universitario Dr. José E. González, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Pierpaolo Mastroiacovo
- International Center on Birth Defects, International Clearinghouse for Birth Defects Surveillance and Research, Rome, Italy
| | - Margery Morgan
- CARIS, the Congenital Anomaly Register for Wales, Public Health Wales, Singleton Hospital, Swansea, UK
| | - Osvaldo M. Mutchinick
- RYVEMCE, Department of Genetics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Amy E. Nance
- Utah Department of Health, Bureau of Children with Special Health Care Needs, Utah Birth Defects Network, Salt Lake City, Utah, USA
| | - Wendy N. Nembhard
- Arkansas Center for Birth Defects Research and Prevention and Arkansas Reproductive Health Monitoring System, Fay Boozman College of Public Health, Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Anna Pierini
- Institute of Clinical Physiology, National Research Council and Fondazione Toscana Gabriele Monasterio, Tuscany Registry of Congenital Defects, Pisa, Italy
| | - Antonin Sipek
- Department of Medical Genetics, Thomayer Hospital, Prague, Czech Republic
| | - Erin B. Stallings
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Development Disabilities, US Centers for Disease Control, Atlanta, Georgia, USA
| | - Elena Szabova
- Slovak Teratologic Information Centre (FPH), Slovak Medical University, Bratislava, Slovak Republic
| | - Giovanna Tagliabue
- Cancer Registry Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Lombardy, Italy
| | | | - Ignacio Zarante
- Human Genetics Institute, Pontificia Universidad Javeriana, Bogota, Colombia and Hospital Universitario San Ignacio, Bogota, Colombia
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty, Otto-von-Guericke-University, Magdeburg, Germany
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4
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Kancherla V, Tandaki L, Sundar M, Lux A, Bakker MK, Bergman JEH, Bermejo-Sánchez E, Canfield MA, Feldkamp ML, Groisman B, Hurtado-Villa P, Källén K, Landau D, Lelong N, Lopez-Camelo J, Mastroiacovo P, Morgan M, Mutchinick OM, Nance AE, Nembhard WN, Pierini A, Šípek A, Stallings EB, Szabova E, Wertelecki W, Zarante I, Rissmann A. A Multicountry Analysis of Prevalence and Mortality among Neonates and Children with Bladder Exstrophy. Am J Perinatol 2022:10.1055/s-0042-1748318. [PMID: 35644130 PMCID: PMC9827371 DOI: 10.1055/s-0042-1748318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Bladder exstrophy (BE) is a rare but severe birth defect affecting the lower abdominal wall and genitourinary system. The objective of the study is to examine the total prevalence, trends in prevalence, and age-specific mortality among individuals with BE. STUDY DESIGN We conducted a retrospective cohort study. Data were analyzed from 20 birth defects surveillance programs, members of the International Clearinghouse for Birth Defects Surveillance and Research in 16 countries. Live births, stillbirths, and elective terminations of pregnancy for fetal anomaly (ETOPFA) diagnosed with BE from 1974 to 2014. Pooled and program-specific prevalence of BE per 100,000 total births was calculated. The 95% confidence intervals (CI) for prevalence were estimated using Poisson approximation of binomial distribution. Time trends in prevalence of BE from 2000 to 2014 were examined using Poisson regression. Proportion of deaths among BE cases was calculated on the day of birth, day 2 to 6, day 7 to 27, day 28 to 364, 1 to 4 years, and ≥5 years. Mortality analysis was stratified by isolated, multiple, and syndromic case status. RESULTS The pooled total prevalence of BE was 2.58 per 100,000 total births (95% CI = 2.40, 2.78) for study years 1974 to 2014. Prevalence varied over time with a decreasing trend from 2000 to 2014. The first-week mortality proportion was 3.5, 17.3, and 14.6% among isolated, multiple, and syndromic BE cases, respectively. The majority of first-week mortality occurred on the first day of life among isolated, multiple, and syndromic BE cases. The proportion of first-week deaths was higher among cases reported from programs in Latin America where ETOPFA services were not available. CONCLUSIONS Prevalence of BE varied by program and showed a decreasing trend from 2000 to -2014. Mortality is a concern among multiple and syndromic cases, and a high proportion of deaths among cases occurred during the first week of life. KEY POINTS · Total prevalence of BE was 2.58 per 100,000 births.. · Prevalence decreased from 2000 to 2014.. · The first-week mortality was 9.3%..
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Affiliation(s)
- Vijaya Kancherla
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Lucita Tandaki
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty, Otto-von-Guericke-University, Magdeburg, Germany
| | - Manasvi Sundar
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Anke Lux
- Institute for Biometrics and Medical Informatics, Medical Faculty, Otto-von-Guericke-University, Magdeburg, Germany
| | - Marian K Bakker
- Department of Genetics, University of Groningen, University Medical Center Groningen, Eurocat Northern The Netherlands, Groningen, The Netherlands
| | - Jorieke EH Bergman
- Department of Genetics, University of Groningen, University Medical Center Groningen, Eurocat Northern The Netherlands, Groningen, The Netherlands
| | - Eva Bermejo-Sánchez
- ECEMC (Spanish Collaborative Study of Congenital Malformations), UIAC (Unidad de Investigación sobre Anomalías Congénitas), Instituto de Investigación de Enfermedades Raras (IIER). Instituto de Salud Carlos III. Madrid, Spain
| | - Mark A Canfield
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas
| | - Marcia L Feldkamp
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Boris Groisman
- National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Administration of Laboratories and Health Institutes (ANLIS), National Ministry of Health, Buenos Aires, Argentina
| | - Paula Hurtado-Villa
- Department of Basic Sciences of Health, School of Health, Pontificia Universidad Javeriana Cali, Colombia and Clfnica Imbanaco, Cali, Colombia
| | - Karin Källén
- National Board of Health and Welfare, Stockholm, Sweden
| | - Danielle Landau
- Department of Neonatology, Soroka Medical Center, Beer-Sheva, Israel
| | - Nathalie Lelong
- Université de Paris, Inserm U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS) Paris, France
| | - Jorge Lopez-Camelo
- ECLAMC, Center for Medical Education and Clinical Research (CEMIC-CONICET), Buenos Aires, Argentina
| | - Pierpaolo Mastroiacovo
- International Center on Birth Defects, International Clearinghouse for Birth Defects Surveillance and Research, Rome, Italy
| | - Margery Morgan
- CARIS, the Congenital Anomaly Register for Wales, Singleton Hospital, Swansea, Wales, United Kingdom
| | - Osvaldo M Mutchinick
- RYVEMCE (Registry and Epidemiologie Surveillance of Congenital Malformations), Department of Cenetics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Amy E Nance
- Utah Department of Health, Bureau of Children with Special Health Care Needs, Utah Birth Defects Network, Salt Lake City, Utah
| | - Wendy N Nembhard
- Arkansas Center for Birth Defects Research and Prevention and Arkansas Reproductive Health Monitoring System, University of Arkansas for Medical Sciences, Fay Boozman College of Public Health, Department of Epidemiology, Little Rock, Arkansas
| | - Anna Pierini
- Institute of Clinical Physiology, National Research Council and Fondazione Toscana Gabriele Monasterio, Tuscany Registry of Congenital Defects, Pisa, Italy
| | - Antonin Šípek
- Department of Medical Genetics, Thomayer Hospital, Prague, Czech Republic
| | - Erin B Stallings
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elena Szabova
- Slovak Teratologie Information Centre (FPH), Slovak Medical University, Bratislava, Slovak Republic
| | | | - Ignacio Zarante
- Human Genetics Institute, Pontificia Universidad Javeriana, Bogotá, Colombia and Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty, Otto-von-Guericke-University, Magdeburg, Germany
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5
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Gili JA, López-Camelo JS, Nembhard WN, Bakker M, de Walle HEK, Stallings EB, Kancherla V, Contiero P, Dastgiri S, Feldkamp ML, Nance A, Gatt M, Martínez L, Canessa MA, Groisman B, Hurtado-Villa P, Källén K, Landau D, Lelong N, Morgan M, Arteaga-Vázquez J, Pierini A, Rissmann A, Sipek A, Szabova E, Wertelecki W, Zarante I, Canfield MA, Mastroiacovo P. Analysis of early neonatal case fatality rate among newborns with congenital hydrocephalus, a 2000-2014 multi-country registry-based study. Birth Defects Res 2022; 114:631-644. [PMID: 35633200 DOI: 10.1002/bdr2.2045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/05/2022] [Accepted: 04/29/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Congenital hydrocephalus (CH) comprises a heterogeneous group of birth anomalies with a wide-ranging prevalence across geographic regions and registry type. The aim of the present study was to analyze the early neonatal case fatality rate (CFR) and total birth prevalence of newborns diagnosed with CH. METHODS Data were provided by 25 registries from four continents participating in the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR) on births ascertained between 2000 and 2014. Two CH rates were calculated using a Poisson distribution: early neonatal CFR (death within 7 days) per 100 liveborn CH cases (CFR) and total birth prevalence rate (BPR) per 10,000 births (including live births and stillbirths) (BPR). Heterogeneity between registries was calculated using a meta-analysis approach with random effects. Temporal trends in CFR and BPR within registries were evaluated through Poisson regression modeling. RESULTS A total of 13,112 CH cases among 19,293,280 total births were analyzed. The early neonatal CFR was 5.9 per 100 liveborn cases, 95% confidence interval (CI): 5.4-6.8. The CFR among syndromic cases was 2.7 times (95% CI: 2.2-3.3) higher than among non-syndromic cases (10.4% [95% CI: 9.3-11.7] and 4.4% [95% CI: 3.7-5.2], respectively). The total BPR was 6.8 per 10,000 births (95% CI: 6.7-6.9). Stratified by elective termination of pregnancy for fetal anomalies (ETOPFA), region and system, higher CFR were observed alongside higher BPR rates. The early neonatal CFR and total BPR did not show temporal variation, with the exception of a CFR decrease in one registry. CONCLUSIONS Findings of early neonatal CFR and total BPR were highly heterogeneous among registries participating in ICBDSR. Most registries with higher CFR also had higher BPR. Differences were attributable to type of registry (hospital-based vs. population-based), ETOPFA (allowed yes or no) and geographical regions. These findings contribute to the understanding of regional differences of CH occurrence and early neonatal deaths.
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Affiliation(s)
- Juan Antonio Gili
- ECLAMC, Centro de Educación Médica e Investigaciones Clínicas (CEMIC-CONICET), Buenos Aires, Argentina.,Instituto Académico Pedagógico de Ciencias Humanas, Universidad Nacional de Villa María, Córdoba, Argentina
| | | | - Wendy N Nembhard
- Department of Epidemiology, Arkansas Center for Birth Defects Research and Prevention and Arkansas Reproductive Health Monitoring System, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Marian Bakker
- Department of Genetics, University of Groningen, University Medical Center Groningen, EUROCAT Northern Netherlands, Groningen, The Netherlands
| | - Hermien E K de Walle
- Department of Genetics, University of Groningen, University Medical Center Groningen, EUROCAT Northern Netherlands, Groningen, The Netherlands
| | - Erin B Stallings
- Metro Atlanta Congenital Defects Program (MACDP), Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia, USA
| | - Vijaya Kancherla
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
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- As listed in http://www.fundacion1000.es/Estructura-del-ECEMC for year 2021, Spain
| | - Paolo Contiero
- Lombardy Congenital Anomalies Registry, Cancer Registry Unit, Fondazione IRCCS, Istituto Nazionale Tumori, Milan, Italy
| | - Saeed Dastgiri
- Health Services Management Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Marcia L Feldkamp
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Amy Nance
- Utah Birth Defect Network, Bureau of Children with Special Health Care Needs, Division of Family Health and Preparedness, Utah Department of Health, Salt Lake City, Utah, USA
| | - Miriam Gatt
- Malta Congenital Anomalies Registry, Directorate for Health Information and Research, Tal-Pietà, Malta
| | - Laura Martínez
- Genetics Department, Hospital Universitario Dr. José E. González, Universidad Autonóma de Nuevo León, San Nicolás de los Garza, Mexico
| | - María Aurora Canessa
- Regional Register Congenital Malformation Maule Health Service (RRMC-SSM), Maule, Chile
| | - Boris Groisman
- National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Administration of Laboratories and Health Institutes (ANLIS), National Ministry of Health and Social Development, Buenos Aires, Argentina
| | - Paula Hurtado-Villa
- Department of Basic Sciences of Health, School of Health, Pontificia Universidad Javeriana, Cali, Colombia
| | - Karin Källén
- National Board of Health and Welfare, Stockholm, Sweden
| | - Danielle Landau
- Department of Neonatology, Soroka Medical Center, Beer-Sheva, Israel
| | - Nathalie Lelong
- Université de Paris, CRESS Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRA, Paris, France
| | - Margery Morgan
- CARIS, The Congenital Anomaly Register for Wales, Singleton Hospital, Swansea, Wales, UK
| | - Jazmín Arteaga-Vázquez
- Department of Genetics, RYVEMCE, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico
| | - Anna Pierini
- Institute of Clinical Physiology, National Research Council and Fondazione Toscana Gabriele Monasterio, Tuscany Registry of Congenital Defects, Pisa, Italy
| | - Anke Rissmann
- Medical Faculty, Malformation Monitoring Centre Saxony-Anhalt, Otto-von-Guericke University, Magdeburg, Germany
| | - Antonin Sipek
- Department of Medical Genetics, Thomayer University Hospital, Prague, Czech Republic
| | - Elena Szabova
- Slovak Teratologic Information Centre (FPH), Slovak Medical University, Bratislava, Slovak Republic
| | | | - Ignacio Zarante
- Human Genetics Institute, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Mark A Canfield
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas, USA
| | - Pierpaolo Mastroiacovo
- International Center on Birth Defects, International Clearinghouse for Birth Defects Surveillance and Research, Rome, Italy
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Bortolus R, Filippini F, Cipriani S, Trevisanuto D, Cavallin F, Zanconato G, Somigliana E, Cesari E, Mastroiacovo P, Parazzini F. Efficacy of 4.0 mg versus 0.4 mg Folic Acid Supplementation on the Reproductive Outcomes: A Randomized Controlled Trial. Nutrients 2021; 13:nu13124422. [PMID: 34959975 PMCID: PMC8704306 DOI: 10.3390/nu13124422] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/04/2021] [Accepted: 12/08/2021] [Indexed: 01/13/2023] Open
Abstract
Folic acid (FA) supplementation prevents neural tube defects (NTDs), but the effects on other reproductive outcomes are unclear. While common recommendation is 0.4 mg/day in addition to regular nutrition, the most appropriate dose of FA is still under debate. We investigated the effects of a higher dose of periconception FA on reducing adverse reproductive outcomes. In this multicenter double-blind randomized controlled trial (RCT), 1060 women (aged 18-44 years and planning a pregnancy) were randomly assigned to receive 4.0 mg or 0.4 mg of FA daily. The primary outcome was the occurrence of congenital malformations (CMs). A composite outcome including one or more adverse pregnancy outcomes was also evaluated. A total of 431 women had a natural conception within 1 year. The primary outcome occurred in 8/227 (3.5%) women receiving 4.0 mg FA and 9/204 (4.4%) women receiving 0.4 mg FA (RR 0.80; 95%CI 0.31 to 2.03). The composite outcome occurred in 43/227 (18.9%) women receiving 4.0 mg FA and 75/204 (36.8%) women receiving 0.4 mg FA (RR 0.51; 95%CI 0.40 to 0.68). FA 4.0 mg supplementation was not associated with different occurrence of CMs, compared to FA 0.4 mg supplementation. However, FA 4.0 mg supplementation was associated with lower occurrence of other adverse pregnancy outcomes.
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Affiliation(s)
- Renata Bortolus
- Office for Research Promotion, Verona University Hospital, 37134 Verona, Italy; (R.B.); (F.F.)
| | - Francesca Filippini
- Office for Research Promotion, Verona University Hospital, 37134 Verona, Italy; (R.B.); (F.F.)
| | - Sonia Cipriani
- Department of Woman, Newborn and Child, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.C.); (E.S.)
| | - Daniele Trevisanuto
- Department of Woman’s and Child’s Health, University of Padua, 35128 Padova, Italy;
| | | | - Giovanni Zanconato
- Department of Surgery, Odontostomatology and Maternal and Child Health, University of Verona, 37134 Verona, Italy;
| | - Edgardo Somigliana
- Department of Woman, Newborn and Child, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.C.); (E.S.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Elena Cesari
- Department of Obstetrics and Gynaecology, Sant’Antonio Abate Hospital, 21013 Gallarate, Italy;
| | | | - Fabio Parazzini
- Department of Woman, Newborn and Child, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (S.C.); (E.S.)
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- Correspondence:
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7
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Politis MD, Bermejo-Sánchez E, Canfield MA, Contiero P, Cragan JD, Dastgiri S, de Walle HEK, Feldkamp ML, Nance A, Groisman B, Gatt M, Benavides-Lara A, Hurtado-Villa P, Kallén K, Landau D, Lelong N, Lopez-Camelo J, Martinez L, Morgan M, Mutchinick OM, Pierini A, Rissmann A, Šípek A, Szabova E, Wertelecki W, Zarante I, Bakker MK, Kancherla V, Mastroiacovo P, Nembhard WN. Prevalence and mortality in children with congenital diaphragmatic hernia: a multicountry study. Ann Epidemiol 2020; 56:61-69.e3. [PMID: 33253899 DOI: 10.1016/j.annepidem.2020.11.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE This study determined the prevalence, mortality, and time trends of children with congenital diaphragmatic hernia (CDH). METHODS Twenty-five hospital- and population-based surveillance programs in 19 International Clearinghouse for Birth Defects Surveillance and Research member countries provided birth defects mortality data between 1974 and 2015. CDH cases included live births, stillbirths, or elective termination of pregnancy for fetal anomalies. Prevalence, cumulative mortality rates, and 95% confidence intervals (CIs) were calculated using Poisson regression and a Kaplan-Meier product-limit method. Joinpoint regression analyses were conducted to assess time trends. RESULTS The prevalence of CDH was 2.6 per 10,000 total births (95% CI: 2.5-2.7), slightly increasing between 2001 and 2012 (average annual percent change = 0.5%; 95% CI:-0.6 to 1.6). The total percent mortality of CDH was 37.7%, with hospital-based registries having more deaths among live births than population-based registries (45.1% vs. 33.8%). Mortality rates decreased over time (average annual percent change = -2.4%; 95% CI: -3.8 to 1.1). Most deaths due to CDH occurred among 2- to 6-day-old infants for both registry types (36.3%, hospital-based; 12.1%, population-based). CONCLUSIONS The mortality of CDH has decreased over time. Mortality remains high during the first week and varied by registry type.
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Affiliation(s)
- Maria D Politis
- Arkansas Center for Birth Defects Research and Prevention, and Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Eva Bermejo-Sánchez
- ECEMC (Spanish Collaborative Study of Congenital Malformations), CIAC (Research Center on Congenital Anomalies), Institute of Rare Diseases Research (IIER), Instituto de Salud Carlos III, Madrid, Spain
| | - Mark A Canfield
- Texas Department of State Health Services, Birth Defects Epidemiology and Surveillance Branch, Austin, TX
| | - Paolo Contiero
- Lombardy Congenital Anomalies Registry, Cancer Registry Unit, Fondazione IRCCS, Istituto Nazionale Tumori, Italy
| | - Janet D Cragan
- Metropolitan Atlanta Congenital Defects Program, National Center on Birth Defects and Development Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Saeed Dastgiri
- Health Services Management Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hermien E K de Walle
- Department of Genetics, University of Groningen, University Medical Center Groningen, Eurocat Northern Netherlands, Groningen, the Netherlands
| | - Marcia L Feldkamp
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Amy Nance
- Division of Family Health and Preparedness, Utah Department of Health, Utah Birth Defect Network, Bureau of Children with Special Health Care Needs, Salt Lake City, UT
| | - Boris Groisman
- National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Ministry of Health, Buenos Aires, Argentina
| | - Miriam Gatt
- Malta Congenital Anomalies Registry, Directorate for Health Information and Research, Malta
| | - Adriana Benavides-Lara
- Costa Rican Birth Defects Registry (CREC), Costa Rican Institute of Research and Education in Nutrition and Health (INCIENSA), Cartago, Costa Rica
| | - Paula Hurtado-Villa
- Department of Basic Sciences of Health, School of Health, Pontificia Universidad Javeriana Cali, Colombia
| | - Kärin Kallén
- National Board of Health and Welfare, Stockholm, Sweden
| | - Danielle Landau
- Department of Neonatology, Soroka Medical Center, Beer-Sheva, Israel
| | - Nathalie Lelong
- REMAPAR, Paris Registry of Congenital Malformations, Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, France
| | - Jorge Lopez-Camelo
- ECLAMC, Center for Medical Education and Clinical Research (CEMIC-CONICET), Buenos Aires, Argentina
| | - Laura Martinez
- Genetics Department, Hospital Universitario Dr Jose E. Gonzalez, Universidad Autonóma de Nuevo León, Mexico
| | - Margery Morgan
- CARIS, the Congenital Anomaly Register for Wales, Singleton Hospital, Swansea, Wales, UK
| | - Osvaldo M Mutchinick
- Department of Genetics, RYVEMCE, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico
| | - Anna Pierini
- Institute of Clinical Physiology, National Research Council and Fondazione Toscana Gabriele Monasterio, Tuscany Registry of Congenital Defects, Pisa, Italy
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
| | - Antonin Šípek
- Department of Medical Genetics, Thomayer Hospital, Prague, Czech Republic
| | - Elena Szabova
- Slovak Teratologic Information Centre (FPH), Slovak Medical University, Bratislava, Slovak Republic
| | | | | | - Marian K Bakker
- Department of Genetics, University of Groningen, University Medical Center Groningen, Eurocat Northern Netherlands, Groningen, the Netherlands
| | - Vijaya Kancherla
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
| | - Pierpaolo Mastroiacovo
- International Center on Birth Defects, International Clearinghouse for Birth Defects Surveillance and Research, Rome, Italy
| | - Wendy N Nembhard
- Arkansas Center for Birth Defects Research and Prevention and Arkansas Reproductive Health Monitoring System and Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR.
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8
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Nembhard WN, Bergman JEH, Politis MD, Arteaga-Vázquez J, Bermejo-Sánchez E, Canfield MA, Cragan JD, Dastgiri S, de Walle HEK, Feldkamp ML, Nance A, Gatt M, Groisman B, Hurtado-Villa P, Kallén K, Landau D, Lelong N, Lopez-Camelo J, Martinez L, Morgan M, Pierini A, Rissmann A, Šípek A, Szabova E, Tagliabue G, Wertelecki W, Zarante I, Bakker MK, Kancherla V, Mastroiacovo P. A multi-country study of prevalence and early childhood mortality among children with omphalocele. Birth Defects Res 2020; 112:1787-1801. [PMID: 33067932 DOI: 10.1002/bdr2.1822] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/30/2020] [Accepted: 10/05/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Omphalocele is the second most common abdominal birth defect and often occurs with other structural and genetic defects. The objective of this study was to determine omphalocele prevalence, time trends, and mortality during early childhood, by geographical region, and the presence of associated anomalies. METHODS We conducted a retrospective study with 23 birth defect surveillance systems in 18 countries who are members of the International Clearinghouse for Birth Defects Surveillance and Research that submitted data on cases ascertained from 2000 through 2012, approximately 16 million pregnancies were surveyed that resulted in live births, stillbirths, or elective terminations of pregnancy for fetal anomalies (ETOPFA) and cases with omphalocele were included. Overall prevalence and mortality rates for specific ages were calculated (day of birth, neonatal, infant, and early childhood). We used Kaplan-Meier estimates with 95% confidence intervals (CI) to calculate cumulative mortality and joinpoint regression for time trend analyses. RESULTS The prevalence of omphalocele was 2.6 per 10,000 births (95% CI: 2.5, 2.7) and showed no temporal change from 2000-2012 (average annual percent change = -0.19%, p = .52). The overall mortality rate was 32.1% (95% CI: 30.2, 34.0). Most deaths occurred during the neonatal period and among children with multiple anomalies or syndromic omphalocele. Prevalence and mortality varied by registry type (e.g., hospital- vs. population-based) and inclusion or exclusion of ETOPFA. CONCLUSIONS The prevalence of omphalocele showed no temporal change from 2000-2012. Approximately one-third of children with omphalocele did not survive early childhood with most deaths occurring in the neonatal period.
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Affiliation(s)
- Wendy N Nembhard
- Arkansas Center for Birth Defects Research and Prevention, Fay W. Boozman College of Public Health, Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Little Rock, Arkansas, USA.,Arkansas Reproductive Health Monitoring System, Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Jorieke E H Bergman
- Department of Genetics, EUROCAT Northern Netherlands, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maria D Politis
- Arkansas Center for Birth Defects Research and Prevention, Fay W. Boozman College of Public Health, Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jazmín Arteaga-Vázquez
- RYVEMCE (Mexican Registry and Epidemiological Surveillance of Congenital Malformations), Department of Genetics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Eva Bermejo-Sánchez
- ECEMC (Spanish Collaborative Study of Congenital Malformations) and ECEMC's Clinical Network, Research Unit on Congenital Anomalies, Institute of Rare Diseases Research (IIER), Instituto de Salud Carlos III, Madrid, Spain
| | - Mark A Canfield
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas, USA
| | - Janet D Cragan
- Metropolitan Atlanta Congenital Defects Program, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Saeed Dastgiri
- Health Services Management Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hermien E K de Walle
- Department of Genetics, EUROCAT Northern Netherlands, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marcia L Feldkamp
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Amy Nance
- Utah Birth Defect Network, Bureau of Children with Special Health Care Needs, Division of Family Health and Preparedness, Utah Department of Health, Salt Lake City, Utah, USA
| | - Miriam Gatt
- Malta Congenital Anomalies Registry, Directorate for Health Information and Research, Valletta, Malta
| | - 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 and Social Development, Buenos Aires, Argentina
| | - Paula Hurtado-Villa
- Department of Basic Sciences of Health, School of Health, Pontificia Universidad Javeriana Cali, Cali, Colombia
| | - Kärin Kallén
- National Board of Health and Welfare, Stockholm, Sweden
| | - Danielle Landau
- Department of Neonatology, Soroka Medical Center, Beer-Sheva, Israel
| | - Nathalie Lelong
- REMAPAR, Paris Registry of Congenital Malformations, Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Jorge Lopez-Camelo
- ECLAMC, Center for Medical Education and Clinical Research (CEMIC-CONICET), Buenos Aires, Argentina
| | - Laura Martinez
- Genetics Department, Hospital Universitario Dr Jose E. Gonzalez, Universidad Autonóma de Nuevo León, Nuevo León, Mexico
| | - Margery Morgan
- The Congenital Anomaly Register and Information Service for Wales, Singleton Hospital, Swansea, Wales, UK
| | - Anna Pierini
- Institute of Clinical Physiology, National Research Council/Fondazione Toscana Gabriele Monasterio, Tuscany Registry of Congenital Defects, Pisa, Italy
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
| | - Antonin Šípek
- Department of Medical Genetics, Thomayer Hospital, Prague, Czech Republic
| | - Elena Szabova
- Slovak Teratologic Information Centre (FPH), Slovak Medical University, Bratislava, Slovakia
| | - Giovanna Tagliabue
- Lombardy Congenital Anomalies Registry, Cancer Registry Unit, Fondazione IRCCS, Istituto Nazionale dei tumori, Milan, Italy
| | | | - Ignacio Zarante
- Human Genetics Institute, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Marian K Bakker
- Department of Genetics, EUROCAT Northern Netherlands, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Vijaya Kancherla
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Pierpaolo Mastroiacovo
- International Center on Birth Defects, International Clearinghouse for Birth Defects Surveillance and Research, Rome, Italy
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9
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Bakker MK, Kancherla V, Canfield MA, Bermejo‐Sanchez E, Cragan JD, Dastgiri S, De Walle HEK, Feldkamp ML, Groisman B, Gatt M, Hurtado‐Villa P, Kallen K, Landau D, Lelong N, Lopez Camelo JS, Martínez L, Morgan M, Mutchinick OM, Nembhard WN, Pierini A, Rissmann A, Sipek A, Szabova E, Tagliabue G, Wertelecki W, Zarante I, Mastroiacovo P. Analysis of Mortality among Neonates and Children with Spina Bifida: An International Registry-Based Study, 2001-2012. Paediatr Perinat Epidemiol 2019; 33:436-448. [PMID: 31637749 PMCID: PMC6899817 DOI: 10.1111/ppe.12589] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/26/2019] [Accepted: 08/24/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Medical advancements have resulted in better survival and life expectancy among those with spina bifida, but a significantly increased risk of perinatal and postnatal mortality for individuals with spina bifida remains. OBJECTIVES To examine stillbirth and infant and child mortality among those affected by spina bifida using data from multiple countries. METHODS We conducted an observational study, using data from 24 population- and hospital-based surveillance registries in 18 countries contributing as members of the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR). Cases of spina bifida that resulted in livebirths or stillbirths from 20 weeks' gestation or elective termination of pregnancy for fetal anomaly (ETOPFA) were included. Among liveborn spina bifida cases, we calculated mortality at different ages as number of deaths among liveborn cases divided by total number of liveborn cases with spina bifida. As a secondary outcome measure, we estimated the prevalence of spina bifida per 10 000 total births. The 95% confidence interval for the prevalence estimate was estimated using the Poisson approximation of binomial distribution. RESULTS Between years 2001 and 2012, the overall first-week mortality proportion was 6.9% (95% CI 6.3, 7.7) and was lower in programmes operating in countries with policies that allowed ETOPFA compared with their counterparts (5.9% vs. 8.4%). The majority of first-week mortality occurred on the first day of life. In programmes where information on long-term mortality was available through linkage to administrative databases, survival at 5 years of age was 90%-96% in Europe, and 86%-96% in North America. CONCLUSIONS Our multi-country study showed a high proportion of stillbirth and infant and child deaths among those with spina bifida. Effective folic acid interventions could prevent many cases of spina bifida, thereby preventing associated childhood morbidity and mortality.
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Affiliation(s)
- Marian K. Bakker
- University of GroningenUniversity Medical Center GroningenDepartment of GeneticsEurocat Northern NetherlandsGroningenThe Netherlands
| | - Vijaya Kancherla
- Department of EpidemiologyEmory University Rollins School of Public HealthAtlantaGAUSA
| | - Mark A. Canfield
- Birth Defects Epidemiology and Surveillance BranchTexas Department of State Health ServicesAustinTXUS
| | - Eva Bermejo‐Sanchez
- ECEMC (Spanish Collaborative Study of Congenital Malformations)CIACInstituto de Investigación de Enfermedades Raras (IIER)Instituto de Salud Carlos IIIMadridSpain
| | - Janet D. Cragan
- Division of Congenital and Developmental DisordersNational Center on Birth Defects and Development DisabilitiesCenters for Disease ControlAtlantaGAUSA
| | - Saeed Dastgiri
- Health Services Management Research CentreTabriz University of Medical SciencesTabrizIran
| | - Hermien E. K. De Walle
- University of GroningenUniversity Medical Center GroningenDepartment of GeneticsEurocat Northern NetherlandsGroningenThe Netherlands
| | - Marcia L. Feldkamp
- Department of PediatricsUniversity of Utah School of Medicine and the Utah Birth Defect NetworkSalt Lake CityUTUSA
| | - Boris Groisman
- National Network of Congenital Anomalies of Argentina (RENAC)National Center of Medical GeneticsNational Administration of Laboratories and Health Institutes (ANLIS)National Ministry of HealthBuenos AiresArgentina
| | - Miriam Gatt
- Malta Congenital Anomalies RegistryDirectorate for Health Information and ResearchValettaMalta
| | - Paula Hurtado‐Villa
- Department of Basic Sciences of HealthSchool of HealthPontificia Universidad Javeriana CaliCaliColombia
| | - Karin Kallen
- National Board of Health and Welfare and University of LundStockholmSweden
| | - Daniella Landau
- Department of NeonatologySoroka Medical CenterBeer‐ShevaIsrael
| | - Nathalie Lelong
- Inserm UMR 1153ObstetricalPerinatal and Pediatric Epidemiology Research Team (Epopé)Center for Epidemiology and Statistics Sorbonne Paris CitéDHU Risks in PregnancyParis Descartes UniversityParisFrance
| | - Jorge S. Lopez Camelo
- ECLAMCCenter for Medical Education and Clinical Research (CEMIC‐CONICET)Buenos AiresArgentina
| | - Laura Martínez
- Genetics DepartmentHospital Universitario Dr Jose E. GonzalezUniversidad Autonóma de Nuevo LeónSan Nicolás de los GarzaMexico
| | - Margery Morgan
- CARIS, The Congenital Anomaly Register for WalesSingleton HospitalSwanseaUK
| | - Osvaldo M. Mutchinick
- RYVEMCEDepartment of GeneticsInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico CityMexico
| | - Wendy N. Nembhard
- Department of Epidemiology, Arkansas Center for Birth Defects Research and Prevention and Arkansas Reproductive Health Monitoring SystemFay Boozman College of Public HealthUniversity of Arkansas for Medical SciencesLittle RockARUSA
| | - Anna Pierini
- Institute of Clinical PhysiologyNational Research Council and Fondazione Toscana Gabriele MonasterioTuscany Registry of Congenital DefectsPisaItaly
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony‐AnhaltMedical FacultyOtto‐von‐Guericke UniversityMagdeburgGermany
| | - Antonin Sipek
- Department of Medical GeneticsThomayer HospitalPragueCzech Republic
| | - Elena Szabova
- Slovak Teratologic Information Centre (FPH)Slovak Medical UniversityBratislavaSlovak Republic
| | - Giovanna Tagliabue
- Lombardy Congenital Anomalies RegistryCancer Registry UnitFondazione IRCCSIstituto Nazionale tumoriMilanItaly
| | | | - Ignacio Zarante
- Human Genetics InstitutePontificia Universidad JaverianaBogotáColombia
| | - Pierpaolo Mastroiacovo
- International Center on Birth DefectsInternational Clearinghouse for Birth Defects Surveillance and ResearchRomeItaly
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10
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Abstract
Preventing neural tube defects (NTDs) easily qualifies as a high-value opportunity to improve childhood survival and health: the unmet need is significant (major preventable burden), the intervention is transformative (providing sufficient folic acid), and delivery strategies (e.g., fortification) are effective in low-resource countries. Yet, NTD prevention is lagging. Can public health surveillance help fix this problem? Critics contend that surveillance is largely unnecessary, that limited resources are best spent on interventions, and that surveillance is unrealistic in developing countries. The counterargument is twofold: (1) in the absence of surveillance, interventions will provide fewer benefits and cost more and (2) effective surveillance is likely possible nearly everywhere, with appropriate strategies. As a base strategy, we propose "triple surveillance:" integrating surveillance of cause (folate insufficiency), of disease occurrence (NTD prevalence), and of health outcomes (morbidity, mortality, and disability). For better sustainability and usefulness, it is crucial to refocus and streamline surveillance activities (no recreational data collection), weave surveillance into clinical care (integrate in clinical workflow), and, later, work on including additional risk factors and pediatric outcomes (increase benefits at low marginal cost). By doing so, surveillance becomes not a roadblock but a preferential path to prevention and better care.
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Affiliation(s)
- Lorenzo D Botto
- Division of Medical Genetics, Department of Pediatrics, University of Utah, Salt Lake City, Utah.,International Center on Birth Defects, International Clearinghouse for Birth Defects Surveillance and Research, Rome, Italy
| | - Pierpaolo Mastroiacovo
- International Center on Birth Defects, International Clearinghouse for Birth Defects Surveillance and Research, Rome, Italy
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11
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Bakker MK, Bergman JEH, Krikov S, Amar E, Cocchi G, Cragan J, de Walle HEK, Gatt M, Groisman B, Liu S, Nembhard WN, Pierini A, Rissmann A, Chidambarathanu S, Sipek A, Szabova E, Tagliabue G, Tucker D, Mastroiacovo P, Botto LD. Prenatal diagnosis and prevalence of critical congenital heart defects: an international retrospective cohort study. BMJ Open 2019; 9:e028139. [PMID: 31270117 PMCID: PMC6609145 DOI: 10.1136/bmjopen-2018-028139] [Citation(s) in RCA: 102] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To assess international trends and patterns of prenatal diagnosis of critical congenital heart defects (CCHDs) and their relation to total and live birth CCHD prevalence and mortality. SETTING Fifteen birth defect surveillance programmes that participate in the International Clearinghouse for Birth Defects Surveillance and Research from 12 countries in Europe, North and South America and Asia. PARTICIPANTS Live births, stillbirths and elective terminations of pregnancy for fetal anomaly diagnosed with 1 of 12 selected CCHD, ascertained by the 15 programmes for delivery years 2000 to 2014. RESULTS 18 243 CCHD cases were reported among 8 847 081 births. The median total prevalence was 19.1 per 10 000 births but varied threefold between programmes from 10.1 to 31.0 per 10 000. CCHD were prenatally detected for at least 50% of the cases in one-third of the programmes. However, prenatal detection varied from 13% in Slovak Republic to 87% in some areas in France. Prenatal detection was consistently high for hypoplastic left heart syndrome (64% overall) and was lowest for total anomalous pulmonary venous return (28% overall). Surveillance programmes in countries that do not legally permit terminations of pregnancy tended to have higher live birth prevalence of CCHD. Most programmes showed an increasing trend in prenatally diagnosed CCHD cases. DISCUSSION AND CONCLUSIONS Prenatal detection already accounts for 50% or more of CCHD detected in many programmes and is increasing. Local policies and access likely account for the wide variability of reported occurrence and prenatal diagnosis. Detection rates are high especially for CCHD that are more easily diagnosed on a standard obstetric four-chamber ultrasound or for fetuses that have extracardiac anomalies. These ongoing trends in prenatal diagnosis, potentially in combination with newborn pulse oximetry, are likely to modify the epidemiology and clinical outcomes of CCHD in the near future.
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Affiliation(s)
- Marian K Bakker
- Department of Genetics, Eurocat registration Northern Netherlands, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jorieke E H Bergman
- Department of Genetics, Eurocat registration Northern Netherlands, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sergey Krikov
- Division of Medical Genetics, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Emmanuelle Amar
- Registre Des Malformations en Rhone Alpes, REMERA, Lyon, France
| | - Guido Cocchi
- Neonatology Unit, S.Orsola-Malpighi Hospital, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Janet Cragan
- Metropolitan Atlanta Congenital Defects Program, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Hermien E K de Walle
- Department of Genetics, Eurocat registration Northern Netherlands, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Miriam Gatt
- Malta Congenital Anomalies Registry, Directorate for Health Information and Research, Malta, Malta
| | - Boris Groisman
- National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Ministry of Health, Buenos Aires, Argentina
| | - Shiliang Liu
- Maternal, Child and Youth Health Division, Public Health Agency of Canada, Ottawa, Canada
| | - Wendy N Nembhard
- Arkansas Reproductive Health Monitoring System, University of Arkansas for Medical Sciences, Fay W Boozman College of Public Health and the Arkansas Children's Research Institute, Little Rock, Arkansas, USA
| | - Anna Pierini
- Institute of Clinical Physiology, National Research Council and Fondazione Toscana Gabriele Monasterio, Tuscany Registry of Congenital Defects, Pisa, Italy
| | - Anke Rissmann
- Malformation Monitoring Centre, Medical Faculty, Otto von Guericke University, Magdeburg, Germany
| | | | - Antonin Sipek
- Institute of Medical Biology and Genetics First Faculty of Medicine Charles University and General University Hospital, Prague, Czech Republic
| | - Elena Szabova
- Slovak Teratologic Information Centre (FPH), Slovak Medical University, Bratislava, Slovakia
| | - Giovanna Tagliabue
- Lombardy Birth Defects Registry, Fondazione IRCCS Instituto Nazionale Tumori, Milan, Italy
| | - David Tucker
- Congenital Anomaly Register and Information Service for Wales, Public Health Wales, Swansea, Wales, UK
| | | | - Lorenzo D Botto
- Division of Medical Genetics, Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
- International Center on Birth Defects, University of Utah, Salt Lake City, Utah, USA
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12
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Groisman B, Bermejo-Sánchez E, Romitti PA, Botto LD, Feldkamp ML, Walani SR, Mastroiacovo P. Join World Birth Defects Day. Pediatr Res 2019; 86:3-4. [PMID: 30965352 DOI: 10.1038/s41390-019-0392-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 03/17/2019] [Indexed: 11/09/2022]
Affiliation(s)
- Boris Groisman
- National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Administration of Health Laboratories and Institutes, National Ministry of Health, Buenos Aires, Argentina.
| | - Eva Bermejo-Sánchez
- ECEMC (Spanish Collaborative Study of Congenital Malformations), Centro de Investigación sobre Anomalías Congénitas (CIAC), Institute of Rare Diseases Research (IIER), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Paul A Romitti
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Lorenzo D Botto
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Marcia L Feldkamp
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Salimah R Walani
- Global Health Programs, March of Dimes, Arlington, Virginia, USA
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13
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Groisman B, Barbero P, Mastroiacovo P, Botto LD, Bidondo MP, Liascovich R. Application of quality indicators to data from the National Network of Congenital Anomalies of Argentina. Birth Defects Res 2019; 111:333-340. [PMID: 30756506 DOI: 10.1002/bdr2.1472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/19/2018] [Accepted: 01/16/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND In Argentina, birth defects are a leading cause of infant deaths. In 2009, the National Network for Congenital Anomalies of Argentina (RENAC) was established as a hospital-based surveillance system of major structural birth defects. To assess and enhance the system's data quality, we previously developed data quality indicators (DQI). Our aim was to evaluate quality indicators in RENAC. METHODS We applied the DQI presented in a related publication to the 2016 RENAC data. RESULTS Among the DQI of description, spina bifida coverage and talipes had the lowest results. Regarding prevalence of hypospadias, it was lower than the defined threshold. RENAC did not achieve the ascertainment threshold of a prevalence of 21.5 per 10,000 for critical congenital heart defects. There was a high ratio of spina bifida to anencephaly. CONCLUSIONS DQI provide a focus for improving quality, making decisions, and advocating for interventions. Examples include advocating for newborn screening of critical congenital heart defects with pulse oximetry; developing training programs for clinicians to improve the detection of isolated hypospadias; and developing visual tools and checklists to improve the completeness and accuracy of case description for spina bifida, talipes, and other major malformations. After the interventions, it is important to track the impact by measuring again the DQI.
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Affiliation(s)
- Boris Groisman
- National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Administration of Health Laboratories and Institutes, National Ministry of Health, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Argentina
| | - Pablo Barbero
- National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Administration of Health Laboratories and Institutes, National Ministry of Health, Buenos Aires, Argentina
| | | | - Lorenzo D Botto
- International Centre on Birth Defects (ICBD), Rome, Italy.,Division of Medical Genetics, University of Utah, Salt Lake City, Utah
| | - María Paz Bidondo
- National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Administration of Health Laboratories and Institutes, National Ministry of Health, Buenos Aires, Argentina
| | - Rosa Liascovich
- National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Administration of Health Laboratories and Institutes, National Ministry of Health, Buenos Aires, Argentina.,National Scientific and Technical Research Council (CONICET), Argentina
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14
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Groisman B, Mastroiacovo P, Barbero P, Bidondo MP, Liascovich R, Botto LD. A proposal for the systematic assessment of data quality indicators in birth defects surveillance. Birth Defects Res 2019; 111:324-332. [PMID: 30746866 DOI: 10.1002/bdr2.1474] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/28/2018] [Accepted: 01/18/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND Quality control and improvement are a key part of the implementation of an effective surveillance program. Data quality indicators (DQI) are key tools but have not been widely used, especially in a low-resource setting. METHODS We developed a list of data quality indicators of birth defects surveillance. These DQI address ascertainment, description, coding, and classification. RESULTS We developed 40 DQI that can be used widely to assess the quality of data relative to birth defects of major clinical and public health impact. CONCLUSIONS DQI have to be both comprehensive (e.g., assess all main surveillance processes) and practical (not require sophisticated or costly data elements), so that they can be used effectively in many different settings. We propose this list of DQI for use in surveillance program as a way to document the quality of the program; detect variations within and between programs, and support quality improvements.
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Affiliation(s)
- Boris Groisman
- National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Administration of Health Laboratories and Institutes, National Ministry of Health, Buenos Aires, Argentina.,National Scientific and Technical Reasearch Council- (CONICET), Buenos Aires, Argentina
| | | | - Pablo Barbero
- National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Administration of Health Laboratories and Institutes, National Ministry of Health, Buenos Aires, Argentina
| | - María Paz Bidondo
- National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Administration of Health Laboratories and Institutes, National Ministry of Health, Buenos Aires, Argentina
| | - Rosa Liascovich
- National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Administration of Health Laboratories and Institutes, National Ministry of Health, Buenos Aires, Argentina.,National Scientific and Technical Reasearch Council- (CONICET), Buenos Aires, Argentina
| | - Lorenzo D Botto
- International Centre on Birth Defects (ICBD), Rome, Italy.,Division of Medical Genetics, University of Utah, Salt Lake City, Utah
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15
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Moorthie S, Blencowe H, Darlison MW, Gibbons S, Lawn JE, Mastroiacovo P, Morris JK, Modell B. Chromosomal disorders: estimating baseline birth prevalence and pregnancy outcomes worldwide. J Community Genet 2018; 9:377-386. [PMID: 28948513 PMCID: PMC6167258 DOI: 10.1007/s12687-017-0336-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 09/18/2017] [Indexed: 01/28/2023] Open
Abstract
Chromosomal disorders, of which Down syndrome is the most common, can cause multi-domain disability. In addition, compared to the general population, there is a higher frequency of death before the age of five. In many settings, large gaps in data availability have hampered policy-making, programme priorities and resource allocation for these important conditions. We have developed methods, which overcome this lack of data and allow estimation of the burden of affected pregnancies and their outcomes in different settings worldwide. For example, the methods include a simple equation relating the percentage of mothers 35 and over to Down syndrome birth prevalence. The results obtained provide a starting point for consideration of services that can be implemented for the care and prevention of these disorders.
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Affiliation(s)
| | - Hannah Blencowe
- Centre for Maternal, Adolescent, Reproductive, and Child Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthew W Darlison
- WHO Collaborating Centre for Community Genetics, Centre for Health Informatics and Multiprofessional Education (CHIME), University College London, London, UK.
| | - Stephen Gibbons
- Department of Geography and Environment, London School of Economics, London, UK
| | - Joy E Lawn
- Centre for Maternal, Adolescent, Reproductive, and Child Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Pierpaolo Mastroiacovo
- Coordinating Centre of the International Clearinghouse for Birth Defects Surveillance and Research, Rome, Italy
| | - Joan K Morris
- Centre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Bernadette Modell
- WHO Collaborating Centre for Community Genetics, Centre for Health Informatics and Multiprofessional Education (CHIME), University College London, London, UK
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16
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Bermejo-Sánchez E, Botto LD, Feldkamp ML, Groisman B, Mastroiacovo P. Value of sharing and networking among birth defects surveillance programs: an ICBDSR perspective. J Community Genet 2018; 9:411-415. [PMID: 30229536 DOI: 10.1007/s12687-018-0387-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 09/06/2018] [Indexed: 11/28/2022] Open
Abstract
Birth defects (BD), also known as congenital anomalies, are structural or functional abnormalities present at birth as a result of abnormal prenatal development. Their cause can be broadly categorized as genetic, environmental, or a combination of both. It is estimated that approximately 3-6% of newborn infants worldwide are affected by BD, many of which are associated with serious morbidity, mortality, and lifelong disabilities. The International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR), founded in 1974, promotes worldwide birth defect surveillance, research, and prevention through the ongoing sharing of data, expertise, and training. In this review, we show value and contribution of BD surveillance systems in pursuing these aims. In the time of personalized medicine for many rare and common diseases, there are still massive gaps in our understanding of the causes and mechanisms of many birth defects, especially structural congenital anomalies. The main aim of the Sustainable Development Goals (SDGs), adopted by the United Nations in 2015, is to ensure healthy lives and promote well-being for all children. One specific goal is to end preventable deaths of newborns and children less than 5 years of age by 2030. The SDGs also underscore the need to consider BD as a priority in the global child health agenda. It can be said that counting BD helps BD to count. By sharing data and expertise and joining in surveillance and research, BD surveillance programs can play a major role in increasing our understanding of the causes of BD, and promoting prevention.
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Affiliation(s)
- Eva Bermejo-Sánchez
- Instituto de Investigación de Enfermedades Raras (IIER), Instituto de Salud Carlos III (ISCIII), Avda. Monforte de Lemos, 5. Pabellón 3. 1ª planta, 28029, Madrid, Spain. .,ECEMC (Spanish Collaborative Study of Congenital Malformations), Centro de Investigación sobre Anomalías Congénitas (CIAC), ISCIII, Madrid, Spain. .,CIBER de Enfermedades Raras (CIBERER) (Centre for Biomedical Research on Rare Diseases), U724, Madrid, Spain.
| | - Lorenzo D Botto
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Marcia L Feldkamp
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Boris Groisman
- National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Ministry of Health, Buenos Aires, Argentina
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17
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Moorthie S, Blencowe H, Darlison MW, Lawn J, Morris JK, Modell B, Bittles AH, Blencowe H, Christianson A, Cousens S, Darlison MW, Gibbons S, Hamamy H, Khoshnood B, Howson CP, Lawn J, Mastroiacovo P, Modell B, Moorthie S, Morris JK, Mossey PA, Neville AJ, Petrou M, Povey S, Rankin J, Schuler-Faccini L, Wren C, Yunnis KA. Estimating the birth prevalence and pregnancy outcomes of congenital malformations worldwide. J Community Genet 2018; 9:387-396. [PMID: 30218347 PMCID: PMC6167261 DOI: 10.1007/s12687-018-0384-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 08/29/2018] [Indexed: 12/22/2022] Open
Abstract
Congenital anomaly registries have two main surveillance aims: firstly to define baseline epidemiology of important congenital anomalies to facilitate programme, policy and resource planning, and secondly to identify clusters of cases and any other epidemiological changes that could give early warning of environmental or infectious hazards. However, setting up a sustainable registry and surveillance system is resource-intensive requiring national infrastructure for recording all cases and diagnostic facilities to identify those malformations that that are not externally visible. Consequently, not all countries have yet established robust surveillance systems. For these countries, methods are needed to generate estimates of prevalence of these disorders which can act as a starting point for assessing disease burden and service implications. Here, we describe how registry data from high-income settings can be used for generating reference rates that can be used as provisional estimates for countries with little or no observational data on non-syndromic congenital malformations.
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Affiliation(s)
| | - Hannah Blencowe
- Centre for Maternal, Adolescent, Reproductive, and Child Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthew W Darlison
- Centre for Health Informatics and Multiprofessional Education (CHIME), University College London, London, UK.
| | - Joy Lawn
- Centre for Maternal, Adolescent, Reproductive, and Child Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Joan K Morris
- Centre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Bernadette Modell
- Centre for Health Informatics and Multiprofessional Education (CHIME), University College London, London, UK
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18
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Botto LD, Mastroiacovo P. From cause to care: Triple surveillance for better outcomes in birth defects and rare diseases. Eur J Med Genet 2018; 61:551-555. [PMID: 29902591 DOI: 10.1016/j.ejmg.2018.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/22/2018] [Accepted: 06/10/2018] [Indexed: 11/25/2022]
Abstract
Better outcomes are a priority for all those who care about birth defects and rare diseases. Public health surveillance and epidemiologic data tracking historically have provided good data on disease occurrence but at most uncertain value in promoting better outcomes, be these in terms of supporting primary prevention or better care. We propose three enhancements to improve the value of surveillance. First, merge: eliminate the largely artificial separation between birth defects and rare diseases in surveillance. Second, expand the scope of surveillance to 'triple surveillance': include in surveillance the three components of the causal chain from primary cause (e.g., folic acid insufficiency) to disease occurrence (e.g., spina bifida prevalence) and further to health outcomes (e.g., mortality, morbidity). Third, integrate public health with clinical surveillance: streamline data collection (avoid 'recreational data collection') and use the data rapidly not only for epidemiologic assessment but also for evaluation and improvement of clinical care. Many countries have one or more of the elements of this framework already in place. Typically, however, they are not integrated, and work and data get wasted. Fundamentally, these enhancements require rethinking priorities, partnerships and data sharing policies. By reducing waste (e.g., activities leading to data being collected but not used) they will add value and probably decrease costs. Importantly, such systems can help make visible the health issues of a population and the benefits (or lack thereof) of interventions, and support quality improvement in prevention and delivery of care.
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Affiliation(s)
- Lorenzo D Botto
- Department of Pediatrics, University of Utah, Utah, United States; International Center on Birth Defects, International Clearinghouse for Birth Defects Surveillance and Research, Rome, Italy.
| | - Pierpaolo Mastroiacovo
- International Center on Birth Defects, International Clearinghouse for Birth Defects Surveillance and Research, Rome, Italy
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19
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Flores AL, Turay K, Valencia D, Hillard CL, Sekkarie A, Zaganjor I, Williams J, Qi YP, Cordero AM, Mulinare J, Botto LD, Peña-Rosas JP, Groisman B, Mastroiacovo P. Development and Utility of a Birth Defects Surveillance Toolkit. J Glob Health Perspect 2018; 0:0. [PMID: 32337095 PMCID: PMC7183735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
According to the World Health Organization (WHO), an estimated 303,000 neonates die within their first month of age every year globally as a result of a birth defect. Neural tube defects, serious birth defects of the brain and spine, are among the most common and severe of these birth defects. Since some low- and middle-income countries lack comprehensive, accurate data documenting the burden of these defects, providing technical assistance to help build birth defects surveillance programs can accelerate the collection of data needed to demonstrate this burden and advance prevention initiatives. We developed a birth defects surveillance toolkit, a technical assistance tool for country staff to help them implement birth defects surveillance. An evaluation of the toolkit with partners in Africa was conducted to assess perceptions of the usefulness, effectiveness, and policy impact of the surveillance toolkit and surveillance-related technical assistance provided to countries thus far. Overall, respondents provided very positive feedback about the toolkit components. Recommendations for improvement included customization to country contexts, such as photos reflective of African babies; surveillance examples from other countries; and consistent use of terms.
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Affiliation(s)
- Alina L. Flores
- National Center on Birth Defects and Developmental Disabilities, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Khadija Turay
- Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, USA
| | - Diana Valencia
- National Center on Birth Defects and Developmental Disabilities, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Ahlia Sekkarie
- Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, USA
| | - Ibrahim Zaganjor
- Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, USA
| | - Jennifer Williams
- National Center on Birth Defects and Developmental Disabilities, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yan Ping Qi
- National Center on Birth Defects and Developmental Disabilities, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Amy M Cordero
- National Center on Birth Defects and Developmental Disabilities, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joseph Mulinare
- National Center on Birth Defects and Developmental Disabilities, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Lorenzo D. Botto
- Division of Medical Genetics, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Juan Pablo Peña-Rosas
- Evidence and Programme Guidance, Nutrition for Health and Development, World Health Organization, Geneva, Switzerland
| | - Boris Groisman
- National Network of Congenital Anomalies of Argentina (RENAC), National Ministry of Health
| | - Pierpaolo Mastroiacovo
- Coordinating Centre of the International Clearinghouse for Birth Defects Surveillance and Research, Rome, Italy
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Abstract
A case of local recurrence of melanotic neuroectodermal tumor of infancy (HINT), arising from the anterior fontanel in a 6-month-old female, is presented. The follow-up of 48 months after surgery confirms the benign nature of this tumor despite its local recurrence. Clinical and histopathologic characteristics of this rare tumor are discussed. A review of 12 cases of MNT involving the skull is given. It is emphasized that this entity should be kept in mind in the differential diagnosis of a mass in the craniofacial structures in infancy.
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21
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Pandolfi E, Gesualdo F, Rizzo C, Bella A, Agricola E, Mastroiacovo P, Tozzi AE. Global seroprevalence of rubella among pregnant and childbearing age women: a meta-analysis. Eur J Public Health 2018; 27:530-537. [PMID: 28204465 DOI: 10.1093/eurpub/ckw259] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background We conducted a meta-analysis of articles published between January 2000 and July 2016 with the aim of defining the proportion of rubella seronegative women of childbearing age (WCBA), providing the best information available on the seroprevalence of rubella in this population. We selected articles published in the time period between 2000 and 2016. The pooled prevalence of rubella seronegative women was calculated by a fixed effect model and a random effect model, according to the heterogeneity among studies. Studies were sub-grouped by population type (pregnant women and WCBA with no mention of ongoing pregnancy) and by geographic area [World Health Organization (WHO) region]. Sensitivity analysis was performed to assess the stability of results. We found important differences in rubella seronegativity prevalence estimates by WHO Region. About 88% of the studies conducted on pregnant women reported a seronegativity rate >5%. The pooled rubella seronegativity prevalence was 9.3%. When considering population groups, we obtained a seronegativity pooled estimate of 9.4% for pregnant women and of 9.5% for WCBA with no mention of ongoing pregnancy. This meta-analysis shows that the proportion of WCBA who are susceptible to rubella is still high. The figures are worrisome, taking into account that the WHO set at 5% the rubella susceptibility threshold for WCBA.
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Affiliation(s)
- E Pandolfi
- Bambino Gesù Children's Hospital IRCCS, Multifactorial and Complex Diseases Research Area, Piazza S. Onofrio 4, Rome 00165, Italy
| | - F Gesualdo
- Bambino Gesù Children's Hospital IRCCS, Multifactorial and Complex Diseases Research Area, Piazza S. Onofrio 4, Rome 00165, Italy
| | - C Rizzo
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
| | - A Bella
- National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
| | - E Agricola
- Bambino Gesù Children's Hospital IRCCS, Multifactorial and Complex Diseases Research Area, Piazza S. Onofrio 4, Rome 00165, Italy
| | - P Mastroiacovo
- Alessandra Lisi International Centre on Birth Defects and Prematurity, Via Carlo Mirabello 14, Rome 00192, Italy
| | - A E Tozzi
- Bambino Gesù Children's Hospital IRCCS, Multifactorial and Complex Diseases Research Area, Piazza S. Onofrio 4, Rome 00165, Italy
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Moorthie S, Blencowe H, W Darlison M, Lawn JE, Mastroiacovo P, Morris JK, Modell B. An overview of concepts and approaches used in estimating the burden of congenital disorders globally. J Community Genet 2017; 9:347-362. [PMID: 29022220 PMCID: PMC6167265 DOI: 10.1007/s12687-017-0335-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/30/2017] [Indexed: 01/15/2023] Open
Abstract
Congenital disorders are an important cause of pregnancy loss, premature death and life-long disability. A range of interventions can greatly reduce their burden, but the absence of local epidemiological data on their prevalence and the impact of interventions impede policy and service development in many countries. In an attempt to overcome these deficiencies, we have developed a tool—The Modell Global Database of Congenital Disorders (MGDb) that combines general biological principles and available observational data with demographic data, to generate estimates of the birth prevalence and effects of interventions on mortality and disability due to congenital disorders. MGDb aims to support policy development by generating country, regional and global epidemiological estimates. Here we provide an overview of the concepts and methodological approach used to develop MGDb.
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Affiliation(s)
| | - Hannah Blencowe
- Centre for Maternal, Adolescent, Reproductive, and Child Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Matthew W Darlison
- WHO Collaborating Centre for Community Genetics, Centre for Health Informatics and Multiprofessional Education (CHIME), University College London, London, UK.
| | - Joy E Lawn
- Centre for Maternal, Adolescent, Reproductive, and Child Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Pierpaolo Mastroiacovo
- Coordinating Centre of the International Clearinghouse for Birth Defects Surveillance and Research, Rome, Italy
| | - Joan K Morris
- Centre for Environmental and Preventive Medicine, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Bernadette Modell
- WHO Collaborating Centre for Community Genetics, Centre for Health Informatics and Multiprofessional Education (CHIME), University College London, London, UK
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Bortolus R, Oprandi NC, Rech Morassutti F, Marchetto L, Filippini F, Agricola E, Tozzi AE, Castellani C, Lalatta F, Rusticali B, Mastroiacovo P. Why women do not ask for information on preconception health? A qualitative study. BMC Pregnancy Childbirth 2017; 17:5. [PMID: 28056865 PMCID: PMC5217233 DOI: 10.1186/s12884-016-1198-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Accepted: 12/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Preconception care involves health promotion to reduce risk factors that might affect women and couples of childbearing age. The risk factors of adverse reproductive outcomes include recognized genetic diseases in the family or the individual, previous congenital diseases, miscarriage, prematurity, fetal growth restriction, infertility, chronic maternal diseases, lifestyle, and occupational or environmental factors. Effective preconception care involves a range of preventive, therapeutic and behavioural interventions. Although in Italy there are national preconception care recommendations concerning the general population, they are usually encouraged informally and only for single risk factors. At present there is increasing interest in offering a global intervention in this field. The aim of this study was to investigate attitudes and behaviours of Italian women of childbearing age and healthcare professionals regarding preconception health. METHODS We conducted a qualitative study among women of childbearing age and healthcare professionals between February 2014 and February 2015. Five focus groups were held: 2 with non-pregnant women aged 22 to 44 years and 3 with healthcare professionals. Discussion topics included women's questions about preconception health, worries and barriers regarding preconception care interventions, attitudes and behaviours of women and healthcare professionals towards preconception health, women's information sources. In the analysis of the focus groups priority was given to what was said by the women, supplemented by information from the healthcare professionals' focus groups. RESULTS Fourteen women of childbearing age (8 nulliparae and 6 multiparae) and 12 healthcare professionals (3 nurses, 4 midwives, 5 doctors) participated in the focus groups. The results indicate the presence of many barriers and a lack of awareness of preconception health relating to women, healthcare professionals and policies. Women's knowledge and attitudes towards primary preconception care information are described. The main reference source of information in this field for Italian women seems to be their obstetric-gynaecologist. CONCLUSIONS The study indicates that several barriers influence preconception care in Italy. Moreover, a lack of awareness of preconception health and care among Italian women of childbearing age and healthcare professionals emerges. The findings might contribute to strategies for the implementation of preconception care guidelines.
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Affiliation(s)
- Renata Bortolus
- Office for Research Promotion, Department of the Hospital Management, Verona University Hospital, Verona, Italy.
| | - Nadia C Oprandi
- Office for Research Promotion, Department of the Hospital Management, Verona University Hospital, Verona, Italy
| | - Francesca Rech Morassutti
- Office for Research Promotion, Department of the Hospital Management, Verona University Hospital, Verona, Italy
| | - Luca Marchetto
- Office for Research Promotion, Department of the Hospital Management, Verona University Hospital, Verona, Italy
| | - Francesca Filippini
- Office for Research Promotion, Department of the Hospital Management, Verona University Hospital, Verona, Italy
| | - Eleonora Agricola
- Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Alberto E Tozzi
- Multifactorial Disease and Complex Phenotype Research Area, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Carlo Castellani
- Cystic Fibrosis Centre, Verona University Hospital, Verona, Italy
| | - Faustina Lalatta
- Clinical Genetics Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Pierpaolo Mastroiacovo
- Alessandra Lisi International Centre on Birth Defects and Prematurity - ICBD, Rome, Italy
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Kadir A, Mossey PA, Blencowe H, Moorthie S, Lawn JE, Mastroiacovo P, Modell B. Systematic Review and Meta-Analysis of the Birth Prevalence of Orofacial Clefts in Low- and Middle-Income Countries. Cleft Palate Craniofac J 2016; 54:571-581. [PMID: 27440051 DOI: 10.1597/15-221] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND In the last comprehensive review of the literature published in 2002, little information on the prevalence of orofacial clefts was available from low- and middle-income countries (LMICs). OBJECTIVE To analyze published data on the birth prevalence of cleft lip and/or palate (CL/P) from LMIC. DESIGN Systematic review of the literature and meta-analysis of data from original papers on the birth prevalence of cleft lip and/or cleft palate (CL/P) in LMICs between 1990 and 2014. Secondary inclusion criteria were developed to analyze lower-quality studies from countries with scarce data. MAIN OUTCOME MEASURE Birth prevalence of undifferentiated CL/P (with or without associated syndrome or other anomaly). RESULTS Twenty-eight studies met strict inclusion criteria. Among 31,475,278 total births, the pooled birth prevalence of undifferentiated CL/P was 1.38 per 1000 births (95% confidence interval [CI]: 1.20 to 1.56). Four studies met criteria for secondary analysis, providing data on 75,627 births, with a pooled prevalence of 0.75 CL/P cases per 1000 births (95% CI: 0.56 to 0.95). Comparison of studies was limited by variable definitions of cases and of the reference population and by inconsistent reporting of outcomes. There is significant heterogeneity in the findings. CONCLUSIONS In LMICs, approximately 1 in every 730 children is born with CL/P. To optimize comparability across settings, future research should use a standard classification system and standard criteria for data collection and presentation. As clefting is associated with deprivation, understanding the true scale, risks, and preventive measures for orofacial clefts in LMIC is a matter of both scientific and humanitarian importance.
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Nilsen RM, Leoncini E, Gastaldi P, Allegri V, Agostino R, Faravelli F, Ferrazzoli F, Finale E, Ghirri P, Scarano G, Mastroiacovo P. Prevalence and determinants of preconception folic acid use: an Italian multicenter survey. Ital J Pediatr 2016; 42:65. [PMID: 27411491 PMCID: PMC4944255 DOI: 10.1186/s13052-016-0278-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 07/05/2016] [Indexed: 01/17/2023] Open
Abstract
Background Women in many countries are advised to use folic acid supplements before and early during pregnancy to reduce the risk of neural tube defects in their infants. This study aimed to update the prevalence and to identify possible determinants of preconception folic acid supplement use in Italian women. Methods The study was based on cross-sectional data from seven maternity clinics located in six Italian regions from January to June, 2012. Data on maternal characteristics and supplement use were collected for 2,189 women using a self-administered questionnaire. Results Preconception folic acid use was reported by 23.5 % (n = 515) of the participants. Of these, 479 (93 %) women had taken folic acid supplements on a daily basis as recommended by the health authorities. Women who both had intended their pregnancy and had requested a preconception health visit to a doctor/gynecologist were substantially more likely than the reference group to initiate folic acid supplementation before their pregnancy (48.6 versus 4.8 %). Preconception folic acid use was also associated with higher maternal age, higher education, marriage/cohabitation, lower parity, infertility treatments, and chronic disease. Conclusions Data from seven maternity clinics located in six Italian regions indicate that preconception folic acid supplement use in many Italian women is low. Women who do not plan their pregnancy or do not request a preconception health visit to their doctor have among the lowest prevalence of preconception folic acid use. Improving folate status in these and other supplemental non-users may have important disease preventive effects.
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Affiliation(s)
- Roy M Nilsen
- Department of Global Public Health and Primary Care, University of Bergen, Kalfarveien 31, 5018, Bergen, Norway. .,Alessandra Lisi International Centre on Birth Defects and Prematurity, Rome, Italy.
| | - Emanuele Leoncini
- Alessandra Lisi International Centre on Birth Defects and Prematurity, Rome, Italy
| | - Paolo Gastaldi
- Unit (UOC) Obstetrics and Gynecology, Santo Spirito in Saxia Hospital, Roma, Italy
| | | | - Rocco Agostino
- Department of Mother and Child Health, S. Giovanni Calibita-Fatebenefratelli Hospital, Rome, Italy
| | | | | | - Enrico Finale
- Unit of Obstetrics and Gynecology, Castelli Hospital, Verbania, Italy
| | - Paolo Ghirri
- Unit of Neonatology and Neonatal Intensive Care, Azienda Ospedaliero-Univesitaria Pisana, Pisa, Italy
| | - Gioacchino Scarano
- Department of Medical Genetics, Gaetano Rummo Hospital, Benevento, Italy
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Flores A, Valencia D, Sekkarie A, Hillard CL, Williams J, Groisman B, Botto LD, Peña-Rosas JP, Bauwens L, Mastroiacovo P. Building capacity for birth defects surveillance in Africa: Implementation of an intermediate birth defects surveillance workshop. J Glob Health Perspect 2015; 2015:1. [PMID: 26753106 PMCID: PMC4706176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Each year around the world, it is estimated that 300,000 neonates are born with a neural tube defect. Many countries, however, are still lacking comprehensive birth defects surveillance registries. Comprehensive birth defects surveillance systems can help countries understand the magnitude and distribution of the problem. These systems can also provide information about biological, contextual, social and environmental determinants of birth defects. This information in turn can be used to identify effective and implementable solutions, and to evaluate prevention and management strategies to improve quality performance. This paper summarizes the development and implementation of an online pre-course training and in-person surveillance workshop conducted between 2014 December and 2015 March for representatives from six African countries. Feedback given by participants provided valuable lessons learned that can be applied to subsequent trainings and workshops.
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Affiliation(s)
- Alina Flores
- National Center on Birth Defects and Developmental Disabilities, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Diana Valencia
- National Center on Birth Defects and Developmental Disabilities, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ahlia Sekkarie
- Oak Ridge Institute for Science and Education (ORISE), Oak Ridge, TN, USA
| | | | - Jennifer Williams
- National Center on Birth Defects and Developmental Disabilities, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Boris Groisman
- National Registry of Congenital Anomalies of Argentina (RENAC), National Ministry of Health
| | - Lorenzo D. Botto
- Division of Medical Genetics, Department of Pediatrics, University of Utah, Salt Lake City, UT, USA
| | - Juan Pablo Peña-Rosas
- Evidence and Programme Guidance, Nutrition for Health and Development, World Health Organization, Geneva, Switzerland
| | - Lieven Bauwens
- International Federation for Spina Bifida and Hydrocephalus, Brussels, Belgium
| | - Pierpaolo Mastroiacovo
- Coordinating Centre of the International Clearinghouse for Birth Defects Surveillance and Research, Rome, Italy
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Floridia M, Mastroiacovo P, Ravizza M, Todros T, Chiadò Fiorio Tin M, Marconi AM, Cetin I, Maruotti GM, Liuzzi G, Pinnetti C, Degli Antoni A, Spinillo A, Guerra B, Tamburrini E. Good prenatal detection rate of major birth defects in HIV-infected pregnant women in Italy. Prenat Diagn 2015; 35:1374-8. [DOI: 10.1002/pd.4696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 09/09/2015] [Accepted: 09/20/2015] [Indexed: 11/12/2022]
Affiliation(s)
- M. Floridia
- Department of Therapeutic Research and Medicines Evaluation; Istituto Superiore di Sanità; Rome Italy
| | - P. Mastroiacovo
- ICBD, Alessandra Lisi International Centre on Birth Defects and Prematurity; Rome Italy
| | - M. Ravizza
- Department of Obstetrics and Gynaecology, DMSD San Paolo Hospital Medical School; University of Milan; Milan Italy
| | - T. Todros
- Department of Obstetrics and Neonatology; Città della Salute e della Scienza Hospital and University of Turin; Italy
| | - M. Chiadò Fiorio Tin
- Department of Obstetrics and Neonatology; Città della Salute e della Scienza Hospital and University of Turin; Italy
| | - A. M. Marconi
- Department of Obstetrics and Gynaecology, DMSD San Paolo Hospital Medical School; University of Milan; Milan Italy
| | - I. Cetin
- Department of Obstetrics and Gynaecology; Luigi Sacco Hospital and University of Milan; Italy
| | - G. M. Maruotti
- Department of Neurosciences, Reproductive and Dentistry Science; University Federico II; Naples Italy
| | - G. Liuzzi
- I.N.M.I. Lazzaro Spallanzani; Rome Italy
| | | | - A. Degli Antoni
- Department of Infectious Diseases and Hepatology; Azienda Ospedaliera di Parma; Italy
| | - A. Spinillo
- University of Pavia, Department of Obstetrics and Gynaecology; IRCCS Policlinico San Matteo; Pavia Italy
| | - B. Guerra
- St. Orsola-Malpighi General Hospital; University of Bologna; Bologna Italy
| | - E. Tamburrini
- Department of Infectious Diseases; Catholic University; Rome Italy
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Shawe J, Delbaere I, Ekstrand M, Hegaard HK, Larsson M, Mastroiacovo P, Stern J, Steegers E, Stephenson J, Tydén T. Preconception care policy, guidelines, recommendations and services across six European countries: Belgium (Flanders), Denmark, Italy, the Netherlands, Sweden and the United Kingdom. EUR J CONTRACEP REPR 2014; 20:77-87. [PMID: 25548961 DOI: 10.3109/13625187.2014.990088] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Preconception care is important for the screening, prevention and management of risk factors that affect pregnancy outcomes. We aimed to investigate pre-pregnancy care policies, guidelines, recommendations and services in six European countries. METHODS In 2013, an electronic search and investigation was undertaken of preconception policy, guidelines, recommendations and services available to healthcare professionals and the general public in six European countries: Belgium (Flanders), Denmark, Italy, the Netherlands, Sweden and the United Kingdom. Findings were compared within five categories: Governmental policy and legislation; Professional bodies and organisations; Healthcare providers; Charitable organisations; Web-based public information and internet sites. RESULTS All countries had preconception recommendations for women with chronic diseases, such as diabetes and epilepsy. Recommendations for healthy women and men were fragmented and inconsistent. Preconception guidance was often included in antenatal and pregnancy guidelines. Differences between countries were seen with regard to nutritional and lifestyle advice particularly in relation to fish, caffeine and alcohol consumption, and vitamin supplementation. CONCLUSIONS Current guidelines are heterogeneous. Collaborative research across Europe is required in order to develop evidence-based guidelines for preconception health and care. There is a need to establish a clear strategy for promoting advice and guidance within the European childbearing population.
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Affiliation(s)
- Jill Shawe
- * Faculty of Health & Medical Sciences, University of Surrey , Guildford , UK
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29
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Mastroiacovo P, Nilsen RM, Leoncini E, Gastaldi P, Allegri V, Boiani A, Faravelli F, Ferrazzoli F, Guala A, Madrigali V, Scarano G. Prevalence of maternal preconception risk factors: an Italian multicenter survey. Ital J Pediatr 2014; 40:91. [PMID: 25416843 PMCID: PMC4264313 DOI: 10.1186/s13052-014-0091-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 11/07/2014] [Indexed: 11/24/2022] Open
Abstract
Objectives Adequate preconception maternal health care is essential to reduce the risk of unwanted pregnancy outcomes and complications. Still, many women are exposed to a number of unhealthy risk factors both before and early in pregnancy. This study aimed to estimate the prevalence of a number of important preconception risk factors using data from a recent multicenter study in Italy. Methods The study was based on cross-sectional data from seven maternity clinics located in six different regions in Italy during the period January – June, 2012. Data on maternal preconception risk factors and characteristics were collected from 1,892 women who delivered healthy children and 320 women who were pregnant in the first trimester. Results About 97% of the women (n = 2,212) were exposed to one or more preconception risk factors. The overall prevalence of the most essential maternal risk factors was as follows: 41% had a age ≥35 years, 36% mistimed or did not intend their pregnancy, 58% did not request a preconception health visit to their doctor, 76% did not use folic acid supplements before pregnancy, 26% smoked at the last menstrual period, 19% had a body mass index ≥25 kg/m2 before pregnancy, and 10% suffered from pregestational chronic diseases. The prevalence of certain variables varied between the maternity clinics. Conclusions Many Italian women are exposed to a number of preconception risk factors that have been associated with adverse pregnancy complications and outcomes. More effective intervention programs to improve preconception health in Italian women are strongly needed.
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Pandolfi E, Agricola E, Gonfiantini MV, Gesualdo F, Romano M, Carloni E, Mastroiacovo P, Tozzi AE. Women participating in a web-based preconception study have a high prevalence of risk factors for adverse pregnancy outcomes. BMC Pregnancy Childbirth 2014; 14:169. [PMID: 24885235 PMCID: PMC4038071 DOI: 10.1186/1471-2393-14-169] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 04/28/2014] [Indexed: 12/16/2022] Open
Abstract
Background Adverse pregnancy outcomes (APOs) can be increased by preconception risk factors and lifestyles. We measured the prevalence of preconception risk factors for APOs in a population of Italian women of childbearing age enrolled in a web-based study. Methods Participants were enrolled through a web platform (http://www.mammainforma.it). After enrollment, participants filled in a questionnaire regarding socio-demographic characteristics, clinical data and preconception risk factors for adverse pregnancy outcomes. Through logistic regression, we explored how the prevalence of risk factors was affected by age, education level, employment, parity, physician’s recommendation and knowledge of the specific risk factor. Results We enrolled a total of 728 women. Sixty-two percent had a University degree, 84% were employed and 77% were planning their first pregnancy. Nearly 70% drank alcohol in any quantity; 16% were smokers; 6% was underweight; 21.4% was overweight; 51.6% did not assume folic acid; 22% was susceptible to rubella, 44.5% to hepatitis b and 13.2% to varicella. According to the multivariate analysis, compared to women who already had at least one pregnancy, nulliparous women had a higher BMI [OR 1.60 (CI 1.02;2.48)] and were less likely to be susceptible to rubella [OR 0.33 (CI 0.20;0.58)] and to be consuming alcohol [OR 0.47 (CI 0.31;0.70)] or cigarettes [OR 0.48 (CI 0.26;0.90)]. Appropriate knowledge was associated with a correct behavior regarding smoking, drinking alcohol and folic acid supplementation. Conclusions This study shows that the prevalence of risk factors for APOs in our population is high. Interventions aimed at reducing risk factors for APOs are needed and, to this purpose, a web intervention may represent a feasible tool to integrate tailored information and to inform preconception counseling targeting a specific group of women planning a pregnancy who are engaged on the web.
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Affiliation(s)
- Elisabetta Pandolfi
- Bambino Gesù Children's Hospital IRCCS, Epidemiology Unit, Piazza S, Onofrio 4, 00165 Rome, Italy.
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Bortolus R, Blom F, Filippini F, van Poppel MNM, Leoncini E, de Smit DJ, Benetollo PP, Cornel MC, de Walle HEK, Mastroiacovo P. Prevention of congenital malformations and other adverse pregnancy outcomes with 4.0 mg of folic acid: community-based randomized clinical trial in Italy and the Netherlands. BMC Pregnancy Childbirth 2014; 14:166. [PMID: 24884885 PMCID: PMC4045958 DOI: 10.1186/1471-2393-14-166] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 04/25/2014] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND In 2010 a Cochrane review confirmed that folic acid (FA) supplementation prevents the first- and second-time occurrence of neural tube defects (NTDs). At present some evidence from observational studies supports the hypothesis that FA supplementation can reduce the risk of all congenital malformations (CMs) or the risk of a specific and selected group of them, namely cardiac defects and oral clefts. Furthermore, the effects on the prevention of prematurity, foetal growth retardation and pre-eclampsia are unclear.Although the most common recommendation is to take 0.4 mg/day, the problem of the most appropriate dose of FA is still open.The aim of this project is to assess the effect a higher dose of peri-conceptional FA supplementation on reducing the occurrence of all CMs. Other aims include the promotion of pre-conceptional counselling, comparing rates of selected CMs, miscarriage, pre-eclampsia, preterm birth, small for gestational age, abruptio placentae. METHODS/DESIGN This project is a joint effort by research groups in Italy and the Netherlands. Women of childbearing age, who intend to become pregnant within 12 months are eligible for the studies. Women are randomly assigned to receive 4 mg of FA (treatment in study) or 0.4 mg of FA (referent treatment) daily. Information on pregnancy outcomes are derived from women-and-physician information.We foresee to analyze the data considering all the adverse outcomes of pregnancy taken together in a global end point (e.g.: CMs, miscarriage, pre-eclampsia, preterm birth, small for gestational age). A total of about 1,000 pregnancies need to be evaluated to detect an absolute reduction of the frequency of 8%. Since the sample size needed for studying outcomes separately is large, this project also promotes an international prospective meta-analysis. DISCUSSION The rationale of these randomized clinical trials (RCTs) is the hypothesis that a higher intake of FA is related to a higher risk reduction of NTDs, other CMs and other adverse pregnancy outcomes. Our hope is that these trials will act as catalysers, and lead to other large RCTs studying the effects of this supplementation on CMs and other infant and maternal outcomes. TRIAL REGISTRATION Italian trial: ClinicalTrials.gov Identifier: NCT01244347.Dutch trial: Dutch Trial Register ID: NTR3161.
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Affiliation(s)
- Renata Bortolus
- Office for Research Promotion, Department of the Hospital Management and Pharmacy, Verona University Hospital, P.le A. Stefani, 1-37126 Verona, Italy
| | - Fenneke Blom
- Community Genetics, Department of Clinical Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Francesca Filippini
- Office for Research Promotion, Department of the Hospital Management and Pharmacy, Verona University Hospital, P.le A. Stefani, 1-37126 Verona, Italy
| | - Mireille NM van Poppel
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Emanuele Leoncini
- Alessandra Lisi International Centre on Birth Defects and Prematurity-ICBD, WHO Collaborating Centre, Rome, Italy
| | | | | | - Martina C Cornel
- Community Genetics, Department of Clinical Genetics, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands
| | - Hermien EK de Walle
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Pierpaolo Mastroiacovo
- Alessandra Lisi International Centre on Birth Defects and Prematurity-ICBD, WHO Collaborating Centre, Rome, Italy
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Nilsen RM, Mastroiacovo P, Gunnes N, Alsaker ER, Bjørke-Monsen AL, Eussen SJPM, Haugen M, Johannessen A, Meltzer HM, Stoltenberg C, Ueland PM, Vollset SE. Folic acid supplementation and interpregnancy interval. Paediatr Perinat Epidemiol 2014; 28:270-4. [PMID: 24506308 DOI: 10.1111/ppe.12111] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Maternal folic acid supplementation between subsequent pregnancies may be important to reduce the risk of low folate status associated with short interpregnancy intervals. We examined how the prevalence of preconception folic acid use for a given pregnancy in Norwegian women varied according to the time interval from the previous pregnancy. METHODS Analysis was based on 48 855 pairs of pregnancies with the second pregnancy included in the Norwegian Mother and Child Cohort Study (birth years 1999-2009). Interpregnancy interval was defined as the time from birth of a child to the conception of the subsequent sibling. Preconception folic acid use was defined as any use of folic acid-containing supplements within the last 4 weeks before the second pregnancy. RESULTS The prevalence of preconception folic acid use was 31%. Among women with a term birth (≥37 weeks) in the previous pregnancy (92%), those with interpregnancy intervals ≤12 and ≥49 months were associated with up to 35% lower prevalence of preconception folic acid use for the second pregnancy, relative to the reference group (13-24 months). The low use in short intervals was mainly attributable to lower proportion of planned pregnancies and fewer women with higher education. Among women with a preterm birth (<37 weeks) in the previous pregnancy (8%), preconception folic acid use significantly decreased with increasing pregnancy spacing. CONCLUSIONS Our finding of a lower preconception folic acid use in women with both short and long interpregnancy intervals might help identifying those with higher risk of folate deficiency and preventing unwanted pregnancy outcomes.
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Affiliation(s)
- Roy Miodini Nilsen
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Alessandra Lisi International Centre on Birth Defects and Prematurity, Rome, Italy
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Agricola E, Pandolfi E, Gonfiantini MV, Gesualdo F, Romano M, Carloni E, Mastroiacovo P, Tozzi AE. A cohort study of a tailored web intervention for preconception care. BMC Med Inform Decis Mak 2014; 14:33. [PMID: 24731520 PMCID: PMC4021543 DOI: 10.1186/1472-6947-14-33] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Accepted: 04/07/2014] [Indexed: 11/24/2022] Open
Abstract
Background Preconception care may be an efficacious tool to reduce risk factors for adverse pregnancy outcomes that are associated with lifestyles and health status before pregnancy. We conducted a web-based cohort study in Italian women planning a pregnancy to assess whether a tailored web intervention may change knowledge and behaviours associated with risks for adverse pregnancy outcomes. Methods The study was entirely conducted on the web on a cohort of Italian women of childbearing age. Data collected at baseline on health status, lifestyles and knowledge of risk factors for adverse pregnancy outcomes were used for generating a tailored document including recommendations for folic acid supplementation, obesity and underweight, smoking, alcohol consumption, vaccinations, chronic and genetic diseases, exposure to medications. Prevalence of risk factors and knowledge was assessed 6 months after the intervention. Logistic regression models were used to explore the factors associated with risk factors after the intervention. Results Of the 508 enrolled women, 282 (55.5%) completed the study after 6 months since the delivery of tailored recommendations. At baseline, 48% of the participants took folic acid supplementation (95% CI 43.2; 51.9) and 69% consumed alcohol (95% CI 64.7; 72.9). At the follow up 71% of the participants had a preconception visit with a physician. Moreover we observed a decrease of alcohol consumption (−46.5% 95% CI −53.28; −38.75) and of the proportion of women not taking folic acid supplementation (−23.4% 95% CI −31.0; 15.36). We observed an improvement in knowledge of the information about the preconception behaviours to prevent adverse pregnancy outcomes (20.9% 95% CI 14.6%; 27.1%). Having a preconception visit during follow up was significally associated to an increase in folic acid supplementation (OR 2.53 95% CI 1.40; 4.60). Conclusions Our results suggest that a tailored web intervention may improve general preconception health in women planning a pregnancy. A web preconception intervention may be integrated with classic preconception care by health professionals. Clinical trials should be conducted to confirm these findings.
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Affiliation(s)
- Eleonora Agricola
- Bambino Gesù Children's Hospital IRCCS, Epidemiology Unit, Piazza S, Onofrio 4, Rome 00165, Italy.
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Zappacosta B, Graziano M, Persichilli S, Di Castelnuovo A, Mastroiacovo P, Iacoviello L. 5,10-Methylenetetrahydrofolate reductase (MTHFR) C677T and A1298C polymorphisms: genotype frequency and association with homocysteine and folate levels in middle-southern Italian adults. Cell Biochem Funct 2013; 32:1-4. [PMID: 24277487 DOI: 10.1002/cbf.3019] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 10/31/2013] [Accepted: 10/31/2013] [Indexed: 11/08/2022]
Abstract
Two genetic polymorphisms of methylenetetrahydrofolate reductase (MTHFR) gene (C677T and A1298C) can influence the plasma homocysteine (Hcy) levels, especially in the presence of an inadequate folate status. The aim of this study was to evaluate the frequencies of C677T and of A1298C MTHFR polymorphisms and their correlation with Hcy and serum folate concentrations in a population of blood donors living in a region of middle-southern Italy (the Molise Region). One hundred ninety seven blood donors were studied for total plasma Hcy, serum folate and C677T and A1298C MTHFR genotypes. The frequency of C677T genotypes was 20.8% (CC), 49.8% (CT) and 29.4% (TT); for the A1298C genotypes: 48.7% (AA), 43.7% (AC) and 7.6% (CC). Hcy and serum folate concentrations were significantly different among genotypes of the C677T polymorphism (CC versus CT versus TT: <0.0001 both for Hcy and folate), with Hcy values increasing, and serum folate decreasing, from CC to TT subjects. Regarding to A1298C polymorphism, the difference among genotypes (AA versus AC versus CC; p: 0.026 for Hcy and 0.014 for serum folate), showed an opposite trend for both parameters, with Hcy higher in the wild-type and lower in the homozygotes and serum folate higher in CC than in AA subjects. In conclusion, we found a high frequency of MTHFR allele associated with high level of Hcy and low levels of folate in an Italian southern population.
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Affiliation(s)
- Bruno Zappacosta
- Department of Laboratory Medicine, Fondazione di Ricerca e Cura 'Giovanni Paolo II'. Università Cattolica del S. Cuore, Campobasso, Italy
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Corchia C, Mastroiacovo P. Health promotion for children, mothers and families: here's why we should "think about it before conception". Ital J Pediatr 2013; 39:68. [PMID: 24160999 PMCID: PMC4231334 DOI: 10.1186/1824-7288-39-68] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 10/21/2013] [Indexed: 11/18/2022] Open
Abstract
About 90,000 preterm infants or babies with birth defects are born in Italy every year, nearly 250 per day. These congenital conditions and their outcomes represent the most important burden of disease affecting the health status and the quality of life during infancy, childhood and beyond. In many cases they are fostered by the presence of maternal and/or paternal preconception risk factors whose effects can be modified by primary prevention. In the contemporary vision of maternal and child health, the traditional gap between preconception period and pregnancy is overcome through promotion of reproductive health and wellness in women, men and couples, regardless of their reproductive plans and possible future pregnancies. This paradigm should become the basic foundation to improve and protect infants’, children’s and adolescents’ health. Useful interventions belong to four broad areas: a) promotion of women’s and couples’ health in general, and protection from risk of adverse events in future pregnancies (if any); b) identification and treatment of conditions that increase the risk of adverse reproductive outcomes; c) help for women (couples) planning for pregnancy; d) identification of genetic risks, and help for independent and responsible decision making. Pediatricians and neonatologists can effectively promote primary prevention in the interconception period, when parents seek consultation for their previous child, in adolescent medicine, in family health education, in socio-sanitary network, and in advocacy activities in favor of infants and children. These actions should be part of an operational framework including perinatal outreach programs, information campaigns, and focus on problems of high-risk women, children and families.
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Affiliation(s)
- Carlo Corchia
- ICBD, Alessandra Lisi International Centre on Birth Defects and Prematurity, Rome, Italy.
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Floridia M, Mastroiacovo P, Tamburrini E, Tibaldi C, Todros T, Crepaldi A, Sansone M, Fiscon M, Liuzzi G, Guerra B, Vimercati A, Vichi F, Vicini I, Pinnetti C, Marconi AM, Ravizza M. Birth defects in a national cohort of pregnant women with HIV infection in Italy, 2001-2011. BJOG 2013; 120:1466-75. [PMID: 23721372 DOI: 10.1111/1471-0528.12285] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We used data from a national study of pregnant women with HIV to evaluate the prevalence of congenital abnormalities in newborns from women with HIV infection. DESIGN Observational study. SETTING University and hospital clinics. POPULATION Pregnant women with HIV exposed to antiretroviral treatment at any time during pregnancy. METHODS The total prevalence of birth defects was assessed on live births, stillbirths, and elective terminations for fetal anomaly. The associations between potentially predictive variables and the occurrence of birth defects were expressed as odds ratios (ORs) with 95% confidence intervals (95% CIs) for exposed versus unexposed cases, calculated in univariate and multivariate logistic regression analyses. MAIN OUTCOME MEASURES Birth defects, defined according to the Antiretroviral Pregnancy Registry criteria. RESULTS A total of 1257 pregnancies with exposure at any time to antiretroviral therapy were evaluated. Forty-two cases with major defects were observed. The total prevalence was 3.2% (95% CI 1.9-4.5) for exposure to any antiretroviral drug during the first trimester (23 cases with defects) and 3.4% (95% CI 1.9-4.9) for no antiretroviral exposure during the first trimester (19 cases). No associations were found between major birth defects and first-trimester exposure to any antiretroviral treatment (OR 0.94, 95% CI 0.51-1.75), main drug classes (nucleoside reverse transcriptase inhibitors, OR 0.95, 95% CI 0.51-1.76; non-nucleoside reverse transcriptase inhibitors, OR 1.20, 95% CI 0.56-2.55; protease inhibitors, OR 0.92, 95% CI 0.43-1.95), and individual drugs, including efavirenz (prevalence for efavirenz, 2.5%). CONCLUSIONS This study adds further support to the assumption that first-trimester exposure to antiretroviral treatment does not increase the risk of congenital abnormalities.
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Affiliation(s)
- M Floridia
- Department of Therapeutic Research and Medicines Evaluation, Istituto Superiore di Sanità, Rome, Italy
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Torgerson PR, Mastroiacovo P. The global burden of congenital toxoplasmosis: a systematic review. Bull World Health Organ 2013; 91:501-8. [PMID: 23825877 DOI: 10.2471/blt.12.111732] [Citation(s) in RCA: 387] [Impact Index Per Article: 35.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 03/25/2013] [Accepted: 03/26/2013] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To estimate the global burden of congenital toxoplasmosis (CT), which results from infection of pregnant women with Toxoplasma gondii. METHODS The authors systematically searched 9 major databases for published and unpublished sources and established direct contact with the authors of source materials. Searches were country-specific. To be included, studies had to report on the incidence of CT, on positivity to Toxoplasma-specific IgM in infants and pregnant women (including seroconversion results) or on positivity to Toxoplasma-specific IgG in the general population. Various modelling techniques were used, depending on the country-specific data available, to estimate the CT incidence and burden in each country. These data were then synthesized into an estimate of the global incidence of CT and of the global burden of CT in disability-adjusted life years (DALYs). FINDINGS The global annual incidence of congenital toxoplasmosis was estimated to be 190,100 cases (95% credible interval, CI: 179,300-206,300). This was equivalent to a burden of 1.20 million DALYs (95% CI: 0.76-1.90). High burdens were seen in South America and in some Middle Eastern and low-income countries. CONCLUSION Congenital toxoplasmosis poses a substantial burden of poor health globally. Toxoplasmosis should be included in future updates of the global burden of disease and the corresponding data should be used to support public health interventions to reduce disease burden.
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Affiliation(s)
- Paul R Torgerson
- Section of Epidemiology, Vetsuisse Faculty, University of Zurich, Winterthurestrasse 270, 8057 Zürich, Switzerland.
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Zappacosta B, Persichilli S, Iacoviello L, Di Castelnuovo A, Graziano M, Gervasoni J, Leoncini E, Cimino G, Mastroiacovo P. Folate, vitamin B12 and homocysteine status in an Italian blood donor population. Nutr Metab Cardiovasc Dis 2013; 23:473-480. [PMID: 22209740 DOI: 10.1016/j.numecd.2011.10.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2011] [Revised: 09/27/2011] [Accepted: 10/05/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS The relevance of folate, other B-vitamins and homocysteine (Hcy) for the occurrence or prevention of several diseases has induced growing interest. Unfortunately, little evidence is available regarding B-vitamin concentrations in Italy. This study evaluated in a region of middle-southern Italy, folate, vitamin B12 and Hcy concentrations and the prevalence of their ideal blood levels. The main determinants of B-vitamins and Hcy were also considered. METHODS AND RESULTS Male and female blood donors (n=240), aged 18-66 years and living in Molise region (Italy), were enrolled in the study. They completed a brief questionnaire concerning fruit and vegetables intake, physical activity and smoking; serum and red blood cell (RBC) folate and serum vitamin B12 were measured by an immunoassay on an automated analyzer. Total Hcy was measured by high performance liquid chromatography (HPLC). Geometric means of serum folate, RBC folate and serum vitamin B12 were 10.8nmoll(-1), 426.0nmoll(-1) and 245.0pmoll(-1), respectively. Only 22.5%, 24.2% and 16.3% of blood donors showed an adequate level of serum folate, RBC folate or serum vitamin B12 respectively. When a cut-off of RBC folate ≥906nmoll(-1) was used no women of childbearing age had adequate levels. A geometric mean of 14.0μmoll(-1) was found for total Hcy, with an ideal concentration in 12.1% of subjects. Folate concentration was higher in women and non-smokers and in subjects with higher consumption of fruit and vegetable. CONCLUSION This study shows a low-moderate B-vitamins status in middle-southern Italy, associated with an inadequate fruit and vegetable consumption. A public health strategy should be undertaken to encourage a B-vitamin-rich diet with the addition of vitamin supplements or vitamin fortified foods in population subgroups with special needs.
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Affiliation(s)
- B Zappacosta
- U.O.C. Laboratorio Analisi, Fondazione di Ricerca e Cura "Giovanni Paolo II", Università Cattolica del S. Cuore, 86100 Campobasso, Italy.
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Robert E, Vollset SE, Botto L, Lancaster PA, Merlob P, Mastroiacovo P, Cocchi G, Ashizawa M, Sakamoto S, Orioli I. Malformation surveillance and maternal drug exposure: the MADRE project. Int J Risk Saf Med 2013; 6:75-118. [PMID: 23511545 DOI: 10.3233/jrs-1994-6201] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A project implemented within the framework of the International Clearinghouse for Birth Defect Monitoring Systems is named MADRE: MAlformation DRug Exposure surveillance. The idea is to survey the simultaneous occurrence of malformations and first-trimester drug exposures. In a 2-year period 1990-91, this has yielded 1448 infants known to have been exposed to drugs and that are known to have malformations. Cases have been reported by eight programs: Australia, Central-East France, Israel, Italy IPIMC, Italy IMER, Japan Red Cross Hospitals, Japan Maternal Health and Welfare, and South America. By searching this databank for associations between drugs and malformations, specific relationships can be detected.The 9th revision of the WHO International Classification of Diseases, adapted by the British Paediatric Association, known as ICD9/BPA is used for coding malformations. This is a hierarchical system with 5 digits as the maximum level of specification of each malformation.The ATC (Anatomical Therapeutic Chemical) classifications system is used for coding drugs. This is a multiple level, hierarchical classification with up to 7 digits for specifying each drug.Up to five drugs and malformations are coded for each case using ATC and ICD9/BPA classifications, and all observed drug-malformation pairs form the basis for the analysis. For each drug-malformation combination where three or more cases are observed, a set of 2×2 tables is formed and analyzed as in case-control studies. The odds ratio for the pair, stratified for program, gives the relative risk for the malformation in question, comparing use of the specific drug with all other drugs.Well known or controversial associations were tested in the collected material, and at this stage only one new association is suggested, that is between cardiac defects and maternal treatment with thyroid hormones. This finding has to be further explored with new data.
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Affiliation(s)
- E Robert
- Central-East France Registry of congenital malformations, Institut Européen des Génomutations, 86, rue E. Locard, F-69005 Lyon, France
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Källén BA, Martínez-Frías ML, Castilla EE, Robert E, Lancaster PA, Kringelbach M, Mutchinick OM, Mastroiacovo P. Hormone therapy during pregnancy and isolated hypospadias: an international case-control study. Int J Risk Saf Med 2013; 3:183-97. [PMID: 23511000 DOI: 10.3233/jrs-1992-3402] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mothers of boys with hypospadias and control mothers were interviewed in eight malformation monitoring programs around the world. Hormone therapy was used quite frequently in five but rarely in three of the programs. The odds ratio for hypospadias after hormone therapy during pregnancy was 2.8 (95% confidence limits 1.2, 6.9) but there was no correlation between the timing of hormone therapy and the location of the urethral orifice, nor between the severity of the malformation and hormone therapy. Programs with the highest hormone exposure rate showed the lowest odds ratio for pregnancy bleeding, the most common reason for hormone therapy. These latter findings cast doubts on the causal association between hormone therapy and isolated hypospadias. Alternative explanations are recall or interviewer bias or unidentified confounders.
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Affiliation(s)
- B A Källén
- Department of Embryology, University of Lund, Lund, Sweden
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Agricola E, Gesualdo F, Pandolfi E, Gonfiantini MV, Carloni E, Mastroiacovo P, Tozzi AE. Does googling for preconception care result in information consistent with international guidelines: a comparison of information found by Italian women of childbearing age and health professionals. BMC Med Inform Decis Mak 2013; 13:14. [PMID: 23347453 PMCID: PMC3598770 DOI: 10.1186/1472-6947-13-14] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Accepted: 01/21/2013] [Indexed: 01/25/2023] Open
Abstract
Background Preconception counseling is effective in reducing the risk of adverse pregnancy outcomes. The Internet is commonly used by women and health professionals to search for health information. We compared the consistency of preconception information found on the Internet with the recommendations published by American Journal of Obstetrics and Gynecology (AJOG) simulating a web search by women of childbearing age and health professionals. Methods We reviewed websites resulting from a Google search performed using search strings selected by Italian women of childbearing age and health professionals. We investigated if retrieved information was consistent with AJOG recommendations for preconception care. Logistic regression was used to compare presence of consistent recommendations between women and health professionals. Results The highest frequency of correct recommendations was found for folic acid supplementation (39.4% of websites). Consistency of preconception information did not significantly differ between search strategies except for folic acid supplementation. “Communities and blogs” website category provided less frequently correct recommendations compared with “Medical/Public Agency" category (i.e. folic acid supplementation (aOR 0.254; CI 0.098-0.664; p = <0.01). Commercial links, found in 60% of websites, were associated with presence of correct recommendations excepting few items (i.e. physical exercise (aOR 1.127; CI 0.331-3.840; p = 0.848). Conclusions Preconception information found is poor and inaccurate regardless of the search is performed by women or health professionals. It is unlikely that information found on the web have any positive impact among women and health professionals in our setting. Strategies to improve preconception information on the web and education of health professionals for web searching of health information should be considered.
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Affiliation(s)
- Eleonora Agricola
- Bambino Gesù Children's Hospital IRCCS, Epidemiology, Unit Piazza S. Onofrio 4, 00165, Rome, Italy.
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Modell B, Berry RJ, Boyle CA, Christianson A, Darlison M, Dolk H, Howson CP, Mastroiacovo P, Mossey P, Rankin J. Global regional and national causes of child mortality. Lancet 2012; 380:1556; author reply 1556-7. [PMID: 23122246 DOI: 10.1016/s0140-6736(12)61878-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Poletta FA, López Camelo JS, Gili JA, Leoncini E, Castilla EE, Mastroiacovo P. Methodological approaches to evaluate teratogenic risk using birth defect registries: advantages and disadvantages. PLoS One 2012; 7:e46626. [PMID: 23056376 PMCID: PMC3463517 DOI: 10.1371/journal.pone.0046626] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Accepted: 09/07/2012] [Indexed: 11/18/2022] Open
Abstract
Background Different approaches have been used in case-control studies to estimate maternal exposure to medications and the risk of birth defects. However, the performance of these approaches and how they affect the odds ratio (OR) estimates have not been evaluated using birth-defect surveillance programmes. The aim of this study was to evaluate the scope and limitations of three case-control approaches to assess the teratogenic risk of birth defects in mothers exposed to antiepileptic medications, insulin, or acetaminophen. Methodology/Principal Findings We studied 110,814 non-malformed newborns and 58,514 live newborns with birth defects registered by the Latin American Collaborative Study of Congenital Anomalies (ECLAMC) between 1967 and 2008. Four controls were randomly selected for each case in the same hospital and period, and three different control groups were used: non-malformed newborns (HEALTHY), malformed newborns (SICK), and a subgroup of SICK, only-exposed cases (OECA). Associations were evaluated using OR and Pearson's chi-square (P<0.01). There were no concordance correlations between the HEALTHY and OECA designs, and the average OR differences ranged from 3.0 to 11.5 for the three evaluated medicines. The overestimations observed for HEALTHY design were increased as higher OR values were given, with a high and statistically significant correlation between the difference and the mean. On the contrary, the concordance correlations obtained between the SICK and OECA designs were quite good, with no significant differences in the average risks. Conclusions The HEALTHY design estimates the true population OR, but shows a high rate of false-positive results presumably caused by differential misclassification bias. This bias decreases with the increase of the proportion of exposed controls. SICK and OECA odds ratios cannot be considered a direct estimate of the true population OR except under certain conditions. However, the SICK and OECA designs could provide practical information to generate hypotheses about potential teratogens.
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Affiliation(s)
- Fernando A. Poletta
- ECLAMC (Estudio Colaborativo Latinoamericano de Malformaciones Congénitas) at Centro de Educación Médica e Investigaciones Clínicas (CEMIC) (CONICET), Buenos Aires, Argentina
- INAGEMP (Instituto Nacional de Genética Médica Populacional), Rio de Janeiro, Brazil
| | - Jorge S. López Camelo
- ECLAMC (Estudio Colaborativo Latinoamericano de Malformaciones Congénitas) at Centro de Educación Médica e Investigaciones Clínicas (CEMIC) (CONICET), Buenos Aires, Argentina
- ECLAMC at Instituto Multidisciplinario de Biología Celular (IMBICE) (CIC-CONICET), La Plata, Argentina
- INAGEMP (Instituto Nacional de Genética Médica Populacional), Rio de Janeiro, Brazil
- * E-mail:
| | - Juan A. Gili
- ECLAMC (Estudio Colaborativo Latinoamericano de Malformaciones Congénitas) at Centro de Educación Médica e Investigaciones Clínicas (CEMIC) (CONICET), Buenos Aires, Argentina
- INAGEMP (Instituto Nacional de Genética Médica Populacional), Rio de Janeiro, Brazil
| | - Emmanuele Leoncini
- Headquarters of the International Clearinghouse for Birth Defects Surveillance and Research, Rome, Italy
| | - Eduardo E. Castilla
- ECLAMC (Estudio Colaborativo Latinoamericano de Malformaciones Congénitas) at Centro de Educación Médica e Investigaciones Clínicas (CEMIC) (CONICET), Buenos Aires, Argentina
- ECLAMC at Instituto Oswaldo Cruz, Rio de Janeiro, Brazil
- INAGEMP (Instituto Nacional de Genética Médica Populacional), Rio de Janeiro, Brazil
| | - Pierpaolo Mastroiacovo
- Headquarters of the International Clearinghouse for Birth Defects Surveillance and Research, Rome, Italy
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Nassar N, Leoncini E, Amar E, Arteaga-Vázquez J, Bakker MK, Bower C, Canfield MA, Castilla EE, Cocchi G, Correa A, Csáky-Szunyogh M, Feldkamp ML, Khoshnood B, Landau D, Lelong N, López-Camelo JS, Lowry RB, McDonnell R, Merlob P, Métneki J, Morgan M, Mutchinick OM, Palmer MN, Rissmann A, Siffel C, Sìpek A, Szabova E, Tucker D, Mastroiacovo P. Prevalence of esophageal atresia among 18 international birth defects surveillance programs. ACTA ACUST UNITED AC 2012; 94:893-9. [PMID: 22945024 DOI: 10.1002/bdra.23067] [Citation(s) in RCA: 96] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Revised: 07/09/2012] [Accepted: 07/09/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND The prevalence of esophageal atresia (EA) has been shown to vary across different geographical settings. Investigation of geographical differences may provide an insight into the underlying etiology of EA. METHODS The study population comprised infants diagnosed with EA during 1998 to 2007 from 18 of the 46 birth defects surveillance programs, members of the International Clearinghouse for Birth Defects Surveillance and Research. Total prevalence per 10,000 births for EA was defined as the total number of cases in live births, stillbirths, and elective termination of pregnancy for fetal anomaly (ETOPFA) divided by the total number of all births in the population. RESULTS Among the participating programs, a total of 2943 cases of EA were diagnosed with an average prevalence of 2.44 (95% confidence interval [CI], 2.35-2.53) per 10,000 births, ranging between 1.77 and 3.68 per 10,000 births. Of all infants diagnosed with EA, 2761 (93.8%) were live births, 82 (2.8%) stillbirths, 89 (3.0%) ETOPFA, and 11 (0.4%) had unknown outcomes. The majority of cases (2020, 68.6%), had a reported EA with fistula, 749 (25.5%) were without fistula, and 174 (5.9%) were registered with an unspecified code. CONCLUSIONS On average, EA affected 1 in 4099 births (95% CI, 1 in 3954-4251 births) with prevalence varying across different geographical settings, but relatively consistent over time and comparable between surveillance programs. Findings suggest that differences in the prevalence observed among programs are likely to be attributable to variability in population ethnic compositions or issues in reporting or registration procedures of EA, rather than a real risk occurrence difference. Birth Defects Research (Part A), 2012.
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Affiliation(s)
- Natasha Nassar
- Population Perinatal Health Research, Kolling Institute of Medical Research, University of Sydney, Australia
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Bermejo-Sánchez E, Cuevas L, Amar E, Bianca S, Bianchi F, Botto LD, Canfield MA, Castilla EE, Clementi M, Cocchi G, Landau D, Leoncini E, Li Z, Lowry RB, Mastroiacovo P, Mutchinick OM, Rissmann A, Ritvanen A, Scarano G, Siffel C, Szabova E, Martínez-Frías ML. Phocomelia: a worldwide descriptive epidemiologic study in a large series of cases from the International Clearinghouse for Birth Defects Surveillance and Research, and overview of the literature. Am J Med Genet C Semin Med Genet 2011; 157C:305-20. [PMID: 22002800 PMCID: PMC4427055 DOI: 10.1002/ajmg.c.30320] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Epidemiologic data on phocomelia are scarce. This study presents an epidemiologic analysis of the largest series of phocomelia cases known to date. Data were provided by 19 birth defect surveillance programs, all members of the International Clearinghouse for Birth Defects Surveillance and Research. Depending on the program, data corresponded to a period from 1968 through 2006. A total of 22,740,933 live births, stillbirths and, for some programs, elective terminations of pregnancy for fetal anomaly (ETOPFA) were monitored. After a detailed review of clinical data, only true phocomelia cases were included. Descriptive data are presented and additional analyses compared isolated cases with those with multiple congenital anomalies (MCA), excluding syndromes. We also briefly compared congenital anomalies associated with nonsyndromic phocomelia with those presented with amelia, another rare severe congenital limb defect. A total of 141 phocomelia cases registered gave an overall total prevalence of 0.62 per 100,000 births (95% confidence interval: 0.52-0.73). Three programs (Australia Victoria, South America ECLAMC, Italy North East) had significantly different prevalence estimates. Most cases (53.2%) had isolated phocomelia, while 9.9% had syndromes. Most nonsyndromic cases were monomelic (55.9%), with an excess of left (64.9%) and upper limb (64.9%) involvement. Most nonsyndromic cases (66.9%) were live births; most isolated cases (57.9%) weighed more than 2,499 g; most MCA (60.7%) weighed less than 2,500 g, and were more likely stillbirths (30.8%) or ETOPFA (15.4%) than isolated cases. The most common associated defects were musculoskeletal, cardiac, and intestinal. Epidemiological differences between phocomelia and amelia highlighted possible differences in their causes.
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Orioli IM, Amar E, Bakker MK, Bermejo-Sánchez E, Bianchi F, Canfield MA, Clementi M, Correa A, Csáky-Szunyogh M, Feldkamp ML, Landau D, Leoncini E, Li Z, Lowry RB, Mastroiacovo P, Morgan M, Mutchinick OM, Rissmann A, Ritvanen A, Scarano G, Szabova E, Castilla EE. Cyclopia: an epidemiologic study in a large dataset from the International Clearinghouse of Birth Defects Surveillance and Research. Am J Med Genet C Semin Med Genet 2011; 157C:344-57. [PMID: 22006661 DOI: 10.1002/ajmg.c.30323] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cyclopia is characterized by the presence of a single eye, with varying degrees of doubling of the intrinsic ocular structures, located in the middle of the face. It is the severest facial expression of the holoprosencephaly (HPE) spectrum. This study describes the prevalence, associated malformations, and maternal characteristics among cases with cyclopia. Data originated in 20 Clearinghouse (ICBDSR) affiliated birth defect surveillance systems, reported according to a single pre-established protocol. A total of 257 infants with cyclopia were identified. Overall prevalence was 1 in 100,000 births (95%CI: 0.89-1.14), with only one program being out of range. Across sites, there was no correlation between cyclopia prevalence and number of births (r = 0.08; P = 0.75) or proportion of elective termination of pregnancy (r = -0.01; P = 0.97). The higher prevalence of cyclopia among older mothers (older than 34) was not statistically significant. The majority of cases were liveborn (122/200; 61%) and females predominated (male/total: 42%). A substantial proportion of cyclopias (31%) were caused by chromosomal anomalies, mainly trisomy 13. Another 31% of the cases of cyclopias were associated with defects not typically related to HPE, with more hydrocephalus, heterotaxia defects, neural tube defects, and preaxial reduction defects than the chromosomal group, suggesting the presence of ciliopathies or other unrecognized syndromes. Cyclopia is a very rare defect without much variability in prevalence by geographic location. The heterogeneous etiology with a high prevalence of chromosomal abnormalities, and female predominance in HPE, were confirmed, but no effect of increased maternal age or association with twinning was observed.
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Affiliation(s)
- Iêda M Orioli
- Estudo Colaborativo Latino Americano de Malformações Congênitas at Departamento de Genética, Instituto de Biologia, Rio de Janeiro, Brazil.
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Abstract
The International Clearinghouse for Birth Defects Surveillance and Research conducted a study on very rare defects (VRDs) to test methodologies in their population surveillance and to increase the knowledge of their epidemiology. Eight VRDs: acardia (AC), amelia (AM), bladder exstrophy (BE), cloaca exstrophy (CE), conjoined twins (CT), cyclopia (CY), "true" phocomelia (PH), and sirenomelia (SI) were selected, all of whom showed prevalences in the order of 1/100,000 births, except for BE: 1/48,000 births. Materials in this investigation from 25 million pregnancy outcomes, were provided by 22 Clearinghouse-member programs. The study protocol provided a working definition, a summary of the phenotypic characteristic, and a list of ICD-9 and ICD-10 codes for each VRDs. Learned lessons include: (1) The suspected associations of decreasing risk with advancing maternal age in AM and SI, and increasing risk in BE, and increasing frequency of twins in SI, were confirmed. (2) Morphologically similar defects showed dissimilar epidemiological characteristics, namely, AM and PH, and BE and CE. (3) Heterogeneity in total prevalences for most VRDs among different surveillance programs were attributed to operational reasons, except for SI and CT in which Amerindian ethnicity seems to be associated with higher prevalence. (4) Verbatim description is essential and must be stored in electronic files. In addition to codes. (5) Dysmorphologists or clinical geneticists are an essential part of the coordinating team of the surveillance program. (6) ICD coding system is insufficient. (7) Surveillance programs should be a valuable source of information on exposures to risk factors during pregnancy.
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Affiliation(s)
- Eduardo E Castilla
- Estudio Colaborativo Latino Americano de Malformaciones Congénitas - Laboratorio de Epidemiologia de Malformações Congènitas, Instituto Oswaldo Cruz Rio de Janeiro, RJ, Brazil.
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Orioli IM, Amar E, Arteaga-Vazquez J, Bakker MK, Bianca S, Botto LD, Clementi M, Correa A, Csaky-Szunyogh M, Leoncini E, Li Z, López-Camelo JS, Lowry RB, Marengo L, Martínez-Frías ML, Mastroiacovo P, Morgan M, Pierini A, Ritvanen A, Scarano G, Szabova E, Castilla EE. Sirenomelia: an epidemiologic study in a large dataset from the International Clearinghouse of Birth Defects Surveillance and Research, and literature review. Am J Med Genet C Semin Med Genet 2011; 157C:358-73. [PMID: 22002878 DOI: 10.1002/ajmg.c.30324] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Sirenomelia is a very rare limb anomaly in which the normally paired lower limbs are replaced by a single midline limb. This study describes the prevalence, associated malformations, and maternal characteristics among cases with sirenomelia. Data originated from 19 birth defect surveillance system members of the International Clearinghouse for Birth Defects Surveillance and Research, and were reported according to a single pre-established protocol. Cases were clinically evaluated locally and reviewed centrally. A total of 249 cases with sirenomelia were identified among 25,290,172 births, for a prevalence of 0.98 per 100,000, with higher prevalence in the Mexican registry. An increase of sirenomelia prevalence with maternal age less than 20 years was statistically significant. The proportion of twinning was 9%, higher than the 1% expected. Sex was ambiguous in 47% of cases, and no different from expectation in the rest. The proportion of cases born alive, premature, and weighting less than 2,500 g were 47%, 71.2%, and 88.2%, respectively. Half of the cases with sirenomelia also presented with genital, large bowel, and urinary defects. About 10-15% of the cases had lower spinal column defects, single or anomalous umbilical artery, upper limb, cardiac, and central nervous system defects. There was a greater than expected association of sirenomelia with other very rare defects such as bladder exstrophy, cyclopia/holoprosencephaly, and acardia-acephalus. The application of the new biological network analysis approach, including molecular results, to these associated very rare diseases is suggested for future studies.
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Affiliation(s)
- Iêda M Orioli
- Estudo Colaborativo Latino Americano de Malformações Congênitas at Departamento de Genética, Instituto de Biologia, Rio de Janeiro, Brazil.
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Mutchinick OM, Luna-Muñoz L, Amar E, Bakker MK, Clementi M, Cocchi G, da Graça Dutra M, Feldkamp ML, Landau D, Leoncini E, Li Z, Lowry B, Marengo LK, Martínez-Frías ML, Mastroiacovo P, Métneki J, Morgan M, Pierini A, Rissman A, Ritvanen A, Scarano G, Siffel C, Szabova E, Arteaga-Vázquez J. Conjoined twins: a worldwide collaborative epidemiological study of the International Clearinghouse for Birth Defects Surveillance and Research. Am J Med Genet C Semin Med Genet 2011; 157C:274-87. [PMID: 22002822 DOI: 10.1002/ajmg.c.30321] [Citation(s) in RCA: 100] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Conjoined twins (CT) are a very rare developmental accident of uncertain etiology. Prevalence has been previously estimated to be 1 in 50,000 to 1 in 100,000 births. The process by which monozygotic twins do not fully separate but form CT is not well understood. The purpose of the present study was to analyze diverse epidemiological aspects of CT, including the different variables listed in the Introduction Section of this issue of the Journal. The study was made possible using the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR) structure. This multicenter worldwide research includes the largest sample of CT ever studied. A total of 383 carefully reviewed sets of CT obtained from 26,138,837 births reported by 21 Clearinghouse Surveillance Programs (SP) were included in the analysis. Total prevalence was 1.47 per 100,000 births (95% CI: 1.32-1.62). Salient findings including an evident variation in prevalence among SPs: a marked variation in the type of pregnancy outcome, a similarity in the proportion of CT types among programs: a significant female predominance in CT: particularly of the thoracopagus type and a significant male predominance in parapagus and parasitic types: significant differences in prevalence by ethnicity and an apparent increasing prevalence trend in South American countries. No genetic, environmental or demographic significant associated factors were identified. Further work in epidemiology and molecular research is necessary to understand the etiology and pathogenesis involved in the development of this fascinating phenomenon of nature.
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Affiliation(s)
- Osvaldo M Mutchinick
- Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Departamento de Genética, Registro y Vigilancia Epidemiológica de Malformaciones Congénitas, México City, Mexico.
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Botto LD, Feldkamp ML, Amar E, Carey JC, Castilla EE, Clementi M, Cocchi G, de Walle HE, Halliday J, Leoncini E, Li Z, Lowry RB, Marengo LK, Martínez-Frías ML, Merlob P, Morgan M, Muñoz LL, Rissmann A, Ritvanen A, Scarano G, Mastroiacovo P. Acardia: Epidemiologic findings and literature review from the International Clearinghouse for Birth Defects Surveillance and Research. Am J Med Genet 2011; 157C:262-73. [DOI: 10.1002/ajmg.c.30318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2011] [Accepted: 08/28/2011] [Indexed: 11/09/2022]
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