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Boudet-Berquier J, Demattei C, Guldner L, Gallay A, Manouvrier S, Botton J, Philippat C, Delva F, Bloch J, Semaille C, Odent S, Perthus I, Randrianaivo H, Babajko S, Barjat T, Beneteau C, Brennetot N, Garne E, Haddad G, Hocine M, Lacroix I, Leuraud K, Mench M, Morris J, Patrier S, Sartelet A, Verloes A, Bonaldi C, Le Barbier M, Gagnière B, Pépin P, Ollivier R, Bitoun M, King L, Guajardo-Villar A, Gomes E, Desenclos JC, Regnault N, Benachi A. A multidisciplinary and structured investigation of three suspected clusters of transverse upper limb reduction defects in France. Eur J Epidemiol 2024; 39:753-771. [PMID: 38671254 DOI: 10.1007/s10654-024-01125-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 04/01/2024] [Indexed: 04/28/2024]
Abstract
INTRODUCTION Between 2019-2021, facing public concern, a scientific expert committee (SEC) reanalysed suspected clusters of transverse upper limb reduction defects (TULRD) in three administrative areas in France, where initial investigations had not identified any risk exposure. We share here the national approach we developed for managing suspicious clusters of the same group of congenital anomalies occurring in several areas. METHODS The SEC analysed the medical records of TURLD suspected cases and performed spatiotemporal analyses on confirmed cases. If the cluster was statistically significant and included at least three cases, the SEC reviewed exposures obtained from questionnaires, environmental databases, and a survey among farmers living near to cases' homes concerning their plant product use. RESULTS After case re-ascertainment, no statistically significant cluster was observed in the first administrative areas. In the second area, a cluster of four children born in two nearby towns over two years was confirmed, but as with the initial investigations, no exposure to a known risk factor explaining the number of cases in excess was identified. In the third area, a cluster including just two cases born the same year in the same town was confirmed. DISCUSSION Our experience highlights that in the event of suspicious clusters occurring in different areas of a country, a coordinated and standardised approach should be preferred.
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Affiliation(s)
- Julie Boudet-Berquier
- Non-Communicable Diseases and Injuries Department, Santé Publique France, Saint Maurice, France.
| | - Christophe Demattei
- Department of Biostatistics, Clinical Epidemiology, Public Health and Innovation in Methodology (BESPIM), Centre Hospitalier Universitaire de Nîmes, Nîmes, Languedoc-Roussillon, France
| | - Laurence Guldner
- Environment and Work Department, Santé Publique France, Saint Maurice, Health, France
| | - Anne Gallay
- Non-Communicable Diseases and Injuries Department, Santé Publique France, Saint Maurice, France
| | - Sylvie Manouvrier
- Reference Centre of Developmental Anomalies and Defect Syndromes, RADEME Maladies Rares du Développement Et du Métabolisme, Université Lille, 7364, Lille, EA, France
| | - Jérémie Botton
- EPI-PHARE Scientific Interest Group in Epidemiology of Health Products from the French National Agency for the Safety of Medicines and Health Products and the French National Health Insurance, Saint-Denis, France
- Faculty of Pharmacy, Paris-Saclay University, Orsay, France
| | - Claire Philippat
- Institute for Advanced Biosciences, INSERM U1209, CNRS UMR 5309, University Grenoble Alpes, Grenoble, France
| | - Fleur Delva
- INSERM, BPH, UMR1219, EPICENE Team, University of Bordeaux, Bordeaux, France
- Environmental and Occupational Health Department, Bordeaux University Hospital, 33000, Bordeaux, France
| | | | | | - Sylvie Odent
- Reference Centre of Developmental Anomalies and Defect Syndromes, Hôpital Sud, CHU de Rennes, Rennes, France
| | - Isabelle Perthus
- Auvergne registry of congenital anomalies (CEMC-Auvergne), Department of clinical genetics, Centre de Référence des Maladies Rares, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Hanitra Randrianaivo
- La Réunion registry of congenital anomalies, Centre Hospitalier Universitaire de La Réunion, Île de la Réunion, France
| | - Sylvie Babajko
- Molecular Oral Pathophysiology Laboratory, Centre de Recherche des Cordeliers, INSERM UMRS, Université Paris Cité, Sorbonne Université, 1138, Paris, France
- Fédération Hospitalo-Universitaire DDS-ParisNet, INSERM, Université Paris Cité, Assistance Publique-Hôpitaux de Paris, Paris, France
- UR2496, Biomedical Research in Odontology, Université Paris Cité, Montrouge, France
| | - Tiphaine Barjat
- Department of Gynecology and Obstetrics, Centre Hospitalier Universitaire de Saint-Étienne, Saint-Étienne, France
- INSERM U1059 SAINBIOSE, Université Jean Monnet, Saint-Étienne, France
| | - Claire Beneteau
- Department of Human Genetics, University Hospital Hôtel Dieu, Nantes, France
| | - Naima Brennetot
- French National Reference for Children Limb Defect, Hôpitaux de Saint-Maurice, Saint Maurice, France
| | - Ester Garne
- Department of Pediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | | | - Mounia Hocine
- Conservatoire National des Arts et Métiers, Paris, France
| | - Isabelle Lacroix
- REGARDs Network, Pharmacologie Médicale et Clinique, CERPOP INSERM UMR 1295-SPHERE team, Faculté de Médecine Université de Toulouse, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Klervi Leuraud
- Institute for Radiological Protection and Nuclear Safety (IRSN), Fontenay-aux-Roses, France
| | - Michel Mench
- INRAE, BIOGECO, UMR 1202, University of Bordeaux, F‑33615, Pessac, France
| | - Joan Morris
- Population Health Research Institute, St George's University of London, London, UK
| | - Sophie Patrier
- Department of Pathology, Rouen University Hospital, Rouen, France
| | - Arnaud Sartelet
- Clinical Department of Ruminant, University of Liège, 4000, Liège, Belgium
| | - Alain Verloes
- Genetics Department, APHP, Robert-Debré University Hospital, Paris, France
| | - Christophe Bonaldi
- Methodology and Biostatistics Department, Santé Publique France, Saint Maurice, France
| | - Mélina Le Barbier
- Environment and Work Department, Santé Publique France, Saint Maurice, Health, France
| | | | - Philippe Pépin
- Cellule Auvergne-Rhône-Alpes, Santé Publique France, Clermont-Ferrand, France
| | - Ronan Ollivier
- Cellule Pays-de-la Loire, Santé Publique France,, Nantes, France
| | - Monique Bitoun
- Cellule Pays-de-la Loire, Santé Publique France,, Nantes, France
| | - Lisa King
- Cellule Pays-de-la Loire, Santé Publique France,, Nantes, France
| | | | - Eugenia Gomes
- Non-Communicable Diseases and Injuries Department, Santé Publique France, Saint Maurice, France
| | | | - Nolwenn Regnault
- Non-Communicable Diseases and Injuries Department, Santé Publique France, Saint Maurice, France
| | - Alexandra Benachi
- Department of Obstetrics and Gynecology, DMU Santé des femmes et des nouveau-nés, Hopital Antoine Béclère, Assistance Publique-Hôpitaux de Paris, Université Paris Saclay, Clamart, France
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Danielsson B, Vargesson N, Danielsson C. Teratogenicity and Reactive Oxygen Species after transient embryonic hypoxia: Experimental and clinical evidence with focus on drugs causing failed abortion in humans. Reprod Toxicol 2023; 122:108488. [PMID: 37852333 DOI: 10.1016/j.reprotox.2023.108488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/08/2023] [Accepted: 10/11/2023] [Indexed: 10/20/2023]
Abstract
Teratogenicity and Reactive Oxygen Species after transient embryonic hypoxia: Experimental and clinical evidence with focus on drugs with human abortive potential. Reactive Oxygen Species (ROS) can be harmful to embryonic tissues. The adverse embryonic effects are dependent on the severity and duration of the hypoxic event and when during organongenesis hypoxia occurs. The vascular endothelium of recently formed arteries in the embryo is highly susceptible to ROS damage. Endothelial damage results in vascular disruption, hemorrhage and maldevelopment of organs, which normally should have been supplied by the artery. ROS can also induce irregular heart rhythm in the embryo resulting in alterations in blood flow and pressure from when the tubular heart starts beating. Such alterations in blood flow and pressure during cardiogenesis can result in a variety of cardiovascular defects, for example transpositions and ventricular septal defects. One aim of this article is to review and compare the pattern of malformations produced by transient embryonic hypoxia of various origins in animal studies with malformations associated with transient embryonic hypoxia in human pregnancy due to a failed abortion process. The results show that transient hypoxia and compounds with potential to cause failed abortion in humans, such as misoprostol and hormone pregnancy tests (HPTs) like Primodos, have been associated with a similar spectrum of teratogenicity. The spectrum includes limb reduction-, cardiovascular- and central nervous system defects. The hypoxia-ROS related teratogenicity of misoprostol and HPTs, is likely to be secondary to uterine contractions and compression of uterinoplacental/embryonic vessels during organogenesis.
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Affiliation(s)
- Bengt Danielsson
- BeDa Consulting AB, Upplandsgatan 6, SE-111 23 Stockholm, Sweden.
| | - Neil Vargesson
- Institute of Medical Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Foresterhill, Aberdeen AB25 2ZD, UK
| | - Christian Danielsson
- Department of Patient Safety, Swedish National Board of Health and Welfare, SE-106 30 Stockholm, Sweden
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Tavakolian N, Hassan Lotfi M, Taheri Soodejani M, Madadizadeh F, Kalantari F. The trend of marriage, childbearing, and divorce and its determinants of socio-economic factors on divorce in Yazd province 2016-2021: A cross-sectional study. Int J Reprod Biomed 2023; 21:657-666. [PMID: 37885975 PMCID: PMC10598468 DOI: 10.18502/ijrm.v21i8.14021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/06/2023] [Accepted: 06/19/2023] [Indexed: 10/28/2023] Open
Abstract
Background In recent decades, families and their stability as an important social institution have changed significantly. Objective This study aimed to investigate the marriage trends, childbearing, and divorce changes in Yazd province from 2016 to 2021 to estimate the effect of socioeconomic factors on divorce. Materials and Methods A cross-sectional study was done in 2 phases. In the first phase, an ecological (time trend) was conducted to investigate the 5 yr trend in the occurrence of marriage, childbearing, and divorce, as well as the factors affecting the occurrence of divorce in the second phase. For the second phase of the study, 600 participants were selected. 300 divorced and 300 married applicants were chosen between 2016 and 2021. A binary logistic regression model was used to find the related factors affecting the occurrence of divorce. Results The results showed a declining marriage (p = 0.05) and childbearing trend (p = 0.84), as well as an increasing trend in divorces (p = 0.02) in Yazd. Logistic regression analysis showed that college education (OR = 0.22, CI: 0.116-0.430, p < 0.001) and being self-employed (OR = 0.48, CI: 0.255-0.934, p = 0.03) could reduce the odds of divorce. In addition, nonresidents (OR = 2.1, CI: 1.314-3.562, p < 0.001), with > 10-yr age differences (OR = 3.8, CI: 1.803-8.213, p < 0.001) or the woman being older than her husband (OR = 3.4, CI: 1.981-5.848, p < 0.001) could increase the odds of divorce. Conclusion Our results confirmed that a combination of socioeconomic characteristics affects the stability of family institutions.
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Affiliation(s)
- Nastaran Tavakolian
- Center for Healthcare Data Modeling, Departments of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Mohammad Hassan Lotfi
- Center for Healthcare Data Modeling, Departments of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Moslem Taheri Soodejani
- Center for Healthcare Data Modeling, Departments of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Farzan Madadizadeh
- Center for Healthcare Data Modeling, Departments of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Foroozandeh Kalantari
- Deputy for Health Affairs, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Nikuei P, Ph.D., Khashavy Z, Ali Farazi Fard M, Tabasi S, Zeidi5 B.Sc. Student A, Pourkashani P, Tabatabaei Z, Eftekhar E, Saberi M, Mahjoubi F. Prenatal diagnosis of Sex determining region Y -box transcription factor 2 anophthalmia syndrome caused by germline mosaicism using next-generation sequencing: A case report. Int J Reprod Biomed 2023; 21:667-672. [PMID: 37885978 PMCID: PMC10598473 DOI: 10.18502/ijrm.v21i8.14022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 04/06/2023] [Accepted: 07/15/2023] [Indexed: 10/28/2023] Open
Abstract
Background Sex determining region Y box transcription factor 2 (SOX2) mutations lead to bilateral anophthalmia with autosomal dominant human inheritance. SOX2 mutations could result in severe ocular phenotypes usually associated with variable systemic defects. Most patients described with SOX2 anophthalmia syndrome possessed de novo mutations in this gene. Case Presentation In this case report, we describe 2 brothers with mental retardation and bilateral anophthalmia caused due to SOX2 germline mosaicism in unaffected parents. Next-generation DNA sequencing was carried out to determine the family's possible cause of genetic mutation. Sanger sequencing was performed on the patients and their parents. Prenatal diagnosis was done in both pregnancies of the older brother's wife via chorionic villus sampling. A novel heterozygous pathogenic frameshift deletion variant (exon1:c.58_80del:p.G20fs) was identified in the SOX2 gene, which was confirmed by Sanger sequencing in both affected brothers and did not exist in healthy parents, indicating germline mosaicism. Conclusion Most SOX2 mutations known look to arise de novo in probands and are diagnosed through anophthalmia or microphthalmia. Prenatal diagnosis should be offered to healthy parents with a child with SOX2 mutation every pregnancy.
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Affiliation(s)
- Pooneh Nikuei
- Hormozgan State of Welfare Organization, Bandar Abbas, Iran
| | | | | | | | | | - Ari Zeidi5 B.Sc. Student
- Department of Clinical Pharmacy, Faculty of Pharmacy, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | | | | | - Ebrahim Eftekhar
- Molecular Medicine Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Mozhgan Saberi
- Department of Medical Genetics, Institute of Medical Biotechnology, National Institute of Genetic Engineering and Biotechnology, Tehran, Iran
| | - Frouzandeh Mahjoubi
- Department of Medical Genetics, Institute of Medical Biotechnology, National Institute of Genetic Engineering and Biotechnology, Tehran, Iran
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5
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Asemi-Rad A, Heidari Z, Mahmoudzadeh-Sagheb H, Mehdipour Y, Moudi B, Sheibak N, Ebrahimi S. Prevalence of congenital anomalies and related factors in live births in Zahedan, Southeast of Iran: A cross-sectional study. Int J Reprod Biomed 2023; 21:647-656. [PMID: 37885977 PMCID: PMC10598469 DOI: 10.18502/ijrm.v21i8.14020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 06/20/2023] [Accepted: 07/22/2023] [Indexed: 10/28/2023] Open
Abstract
Background The term congenital anomalies (CAs) refers to structural or functional abnormalities at the time of conception. Approximately 12 deaths related to congenital disabilities occur in every 10,000 babies born. Objective This study aimed to evaluate the prevalence and associated factors of single and multiple CAs in live births in Zahedan, Southeast Iran. Materials and Methods This cross-sectional study was conducted on 59,087 live births in a referral hospital in Zahedan located in the southeast of Iran from 2009 to 2019. All live births were examined by pediatricians and the CAs and categorized based on the international classification of diseases. Results Of 59,085 live births, at least 883 had a significant anomaly, and the prevalence rate of CAs was about 149 per 10,000. Anomalies of the nervous (24.1%) and cardiovascular systems (21.10%) were the most frequent, occurring in 213 and 187 of the live births, respectively. Spina bifida is the most common anomaly of the central nervous system. The most common anomalies in the cardiovascular system were unspecified heart malformations (17.1%), cardiovascular malformations (18.7%), and patent ductus arteriosus (11.7%). Significant correlations were found between the parent's consanguinity marriage, the mother's age, an existing anomaly in the family, and relatives in single and multiple CAs (p = 0.02, p = 0.02, p < 0.001, p = 0.01, respectively). Conclusion The prevalence of CAs was 149 per 10,000 live births. The highest prevalence of CAs was related to the central nervous system. Increasing the public's knowledge about fetal defects can reduce the prevalence of CAs.
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Affiliation(s)
- Azam Asemi-Rad
- Department of Anatomical Sciences, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
- Cellular and Molecular Research Center, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Zahra Heidari
- Department of Histology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
- Infectious Diseases and Tropical Medicine Research Center, Resistant Tuberculosis Institute, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Hamidreza Mahmoudzadeh-Sagheb
- Department of Histology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
- Infectious Diseases and Tropical Medicine Research Center, Resistant Tuberculosis Institute, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Yousef Mehdipour
- Department of Health Information Technology, School of Paramedical Sciences, Torbat Heydarieh University of Medical Sciences, Torbat Heydarieh, Iran
| | - Bita Moudi
- Department of Histology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
- Infectious Diseases and Tropical Medicine Research Center, Resistant Tuberculosis Institute, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Nadia Sheibak
- Department of Histology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Saeid Ebrahimi
- Department of Health Information Technology, Zahedan University of Medical Sciences, Zahedan, Iran
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Morris JK, Garne E, Loane M, Barisic I, Densem J, Latos-Bieleńska A, Neville A, Pierini A, Rankin J, Rissmann A, de Walle H, Tan J, Given JE, Claridge H. EUROlinkCAT protocol for a European population-based data linkage study investigating the survival, morbidity and education of children with congenital anomalies. BMJ Open 2021; 11:e047859. [PMID: 34183346 PMCID: PMC8240574 DOI: 10.1136/bmjopen-2020-047859] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Congenital anomalies (CAs) are a major cause of infant mortality, childhood morbidity and long-term disability. Over 130 000 children born in Europe every year will have a CA. This paper describes the EUROlinkCAT study, which is investigating the health and educational outcomes of children with CAs for the first 10 years of their lives. METHODS AND ANALYSIS EUROCAT is a European network of population-based registries for the epidemiological surveillance of CAs. EUROlinkCAT is using the EUROCAT infrastructure to support 22 EUROCAT registries in 14 countries to link their data on births with CAs to mortality, hospital discharge, prescription and educational databases. Once linked, each registry transforms their case data into a common data model (CDM) format and they are then supplied with common STATA syntax scripts to analyse their data. The resulting aggregate tables and analysis results are submitted to a central results repository (CRR) and meta-analyses are performed to summarise the results across all registries. The CRR currently contains data on 155 594 children with a CA followed up to age 10 from a population of 6 million births from 1995 to 2014. ETHICS The CA registries have the required ethics permissions for routine surveillance and transmission of anonymised data to the EUROCAT central database. Each registry is responsible for applying for and obtaining additional ethics and other permissions required for their participation in EUROlinkCAT. DISSEMINATION The CDM and associated documentation, including linkage and standardisation procedures, will be available post-EUROlinkCAT thus facilitating future local, national and European-level analyses to improve healthcare. Recommendations to improve the accuracy of routinely collected data will be made.Findings will provide evidence to inform parents, health professionals, public health authorities and national treatment guidelines to optimise diagnosis, prevention and treatment for these children with a view to reducing health inequalities in Europe.
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Affiliation(s)
- Joan K Morris
- Population Health Research Institute, St George's University of London, London, UK
| | - Ester Garne
- Paediatric Department, Hospital Lillebaelt, Kolding, Denmark
| | - Maria Loane
- Faculty of Life and Health Sciences, Ulster University, Coleraine, UK
| | - Ingeborg Barisic
- Children's Hospital Zagreb, Centre of Excellence for Reproductive and Regenerative Medicine, Medical School University of Zagreb, Zagreb, Croatia
| | | | - Anna Latos-Bieleńska
- Polish Registry of Congenital Malformations, Chair and Department of Medical Genetics, Poznan University of Medical Sciences, Poznan, Poland
| | - Amanda Neville
- IMER Registry (Emila Romagna Registry of Birth Defects), University Hospital of Ferrara, Emilia-Romagna, Italy
| | - Anna Pierini
- Instituto di Fisiologia Clinica, Consiglio Nazionale delle Ricerche, Pisa, Italy
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Otto von Guericke University Medical Faculty, Magdeburg, Germany
| | - Hermien de Walle
- Department of Genetics, University Medical Centre Groningen, Groningen, The Netherlands
| | - Joachim Tan
- Population Health Research Institute, St George's University of London, London, UK
| | - Joanne Emma Given
- Faculty of Life and Health Sciences, Ulster University, Coleraine, UK
| | - Hugh Claridge
- Population Health Research Institute, St George's University of London, London, UK
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Gnansia E, Michon L, Amar E, Estève J. Evidence for a cluster of rare birth defects in the Ain department (France). Birth Defects Res 2021; 113:1015-1025. [PMID: 33565281 DOI: 10.1002/bdr2.1876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/12/2021] [Accepted: 01/28/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND REMERA (REgistre des Malformations En Rhône-Alpes) is a registry of congenital malformations that covers 58,000 births annually in Central-East France. In 2010, the registry raised an alarm to the health authorities (Santé publique France, SpF) about three cases of a unilateral isolated transverse upper limb reduction defect (UITULRD) in a small subarea; the general prevalence of this defect is one case in 10,000 births. In the following years, more infants were born with the same malformation in the same territory of the Ain department. Public health authorities, supported by an expert committee, rejected the existence of a cluster, but we aim here at providing evidence for this cluster. METHODS Geocoded data for all UITULRD cases (ICD-10 codes Q71.2 and Q71.3) were extracted from the REMERA database. We conducted a Kulldorff cluster analysis of these data, using the spatial SaTScanTM algorithm. RESULTS The analysis found a cluster of eight cases of UITULRD among the 8,204 births occurring between 2009 and 2014 within a circle of 16.24 km radius centered on a village of the Ain department, whereas 0.82 cases were expected under a uniform probability of such a birth throughout the registry territory. This represents an almost 10fold excess over the expected number of cases (p = .0057). CONCLUSIONS The arguments used to deny the cluster are disputed and we present the evidence supporting its reality. The controversy that has followed the alarm has compromised the search for the cause(s) of this excess of rare malformations.
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Affiliation(s)
| | | | | | - Jacques Estève
- Hospices Civils de Lyon, Université Lyon 1, CNRS, UMR 5558, Lyon, France
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Dolejs J, Homolková H. Why Does Child Mortality Decrease With Age? Modeling the Age-Associated Decrease in Mortality Rate Using WHO Metadata From 14 European Countries. Front Pediatr 2020; 8:527811. [PMID: 33194882 PMCID: PMC7653179 DOI: 10.3389/fped.2020.527811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 09/28/2020] [Indexed: 11/26/2022] Open
Abstract
Background: Mortality rate rapidly decreases with age after birth, and, simultaneously, the spectrum of death causes show remarkable changes with age. This study analyzed age-associated decreases in mortality rate from diseases of all main chapters of the 10th revision of the International Classification of Diseases. Methods: The number of deaths was extracted from the mortality database of the World Health Organization. As zero cases could be ascertained for a specific age category, the Halley method was used to calculate the mortality rates in all possible calendar years and in all countries combined. Results: All causes mortality from the 1st day of life to the age of 10 years can be represented by an inverse proportion model with a single parameter. High coefficients of determination were observed for total mortality in all populations (arithmetic mean = 0.9942 and standard deviation = 0.0039). Slower or no mortality decrease with age was detected in the 1st year of life, while the inverse proportion method was valid for the age range [1, 10) years in most of all main chapters with three exceptions. The decrease was faster for the chapter "Certain conditions originating in the perinatal period" (XVI).The inverse proportion was valid already from the 1st day for the chapter "Congenital malformations, deformations and chromosomal abnormalities" (XVII).The shape of the mortality decrease was very different for the chapter "Neoplasms" (II) and the rates of mortality from neoplasms were age-independent in the age range [1, 10) years in all populations. Conclusion: The theory of congenital individual risks of death is presented and can explain the results. If it is valid, latent congenital impairments may be present among all cases of death that are not related to congenital impairments. All results are based on published data, and the data are presented as a supplement.
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Affiliation(s)
- Josef Dolejs
- Department of Informatics and Quantitative Methods, University of Hradec Králové, Hradec Králové, Czechia
| | - Helena Homolková
- Division of Pediatric Neurosurgery, Department of Pediatric and Trauma Surgery, Thomayer's Teaching Hospital and Third Faculty of Medicine, Charles University in Prague, Prague, Czechia
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Bouchghoul H, Saada J, Etienne M, Cordier AG, Benachi A. [How I do… an ultrasound scan of a fetus with a congenital diaphragmatic hernia?]. ACTA ACUST UNITED AC 2020; 49:143-146. [PMID: 32622010 DOI: 10.1016/j.gofs.2020.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Indexed: 10/23/2022]
Affiliation(s)
- H Bouchghoul
- Service de gynécologie obstétrique, AP-HP, hôpital Bicêtre, Le Kremlin-Bicêtre, France; Centre de référence maladies rares hernie de coupole diaphragmatique, hopital Antoine-Béclère, Clamart, France.
| | - J Saada
- Centre de référence maladies rares hernie de coupole diaphragmatique, hopital Antoine-Béclère, Clamart, France; Service de gynécologie obstétrique, AP-HP, hôpital Antoine-Béclère, Clamart, France
| | - M Etienne
- Service de gynécologie obstétrique, AP-HP, hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - A-G Cordier
- Service de gynécologie obstétrique, AP-HP, hôpital Bicêtre, Le Kremlin-Bicêtre, France; Centre de référence maladies rares hernie de coupole diaphragmatique, hopital Antoine-Béclère, Clamart, France
| | - A Benachi
- Centre de référence maladies rares hernie de coupole diaphragmatique, hopital Antoine-Béclère, Clamart, France; Service de gynécologie obstétrique, AP-HP, hôpital Antoine-Béclère, Clamart, France
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10
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Bruckner TA, Singh P, Lelong N, Khoshnood B. Down syndrome among primiparae at older maternal age: A test of the relaxed filter hypothesis. Birth Defects Res 2019; 111:1611-1617. [PMID: 31321913 DOI: 10.1002/bdr2.1553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 06/30/2019] [Accepted: 07/02/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND Down syndrome (DS) ranks as one of the most common birth defects in the United States. The relaxed filter hypothesis (RFH) asserts that mothers with no previous children but nearing reproductive senescence reduce fetal selectivity against DS pregnancies in the first trimester given the high probability of having no offspring at all if the DS pregnancy is not carried to term. We test the parity prediction of RFH-specifically, that pregnancies to older mothers with no previous live births show an elevated prevalence of DS above values expected from the separate contributions of older maternal age and primiparity. METHODS We retrieved maternal age and parity information on 2,748 DS cases (live, stillborn, or terminated due to anomaly) from the Paris Birth Defects Registry, 1983-2015. We used two waves of the Enquête Fertility Survey (n = 5,460) and counts of stillbirths to calculate total prevalence of DS by maternal age and parity. RESULTS Primiparous mothers 35+ years show the greatest prevalence of any parity group (9.78 cases per 1,000 deliveries). Tests for additive interaction of primiparity and older maternal age reject the null (relative excess risk due to interaction = 1.01; 95% confidence interval: 0.33, 1.69; null value on additive scale is 0). CONCLUSIONS Relaxed selection may account for 10% of the increase in the prevalence, among older primiparous mothers, of DS detected during or after the 11th week. Future work may hold implications for understanding, among older mothers, the strength of this maternal screen against other defects.
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Affiliation(s)
- Tim A Bruckner
- Program in Public Health, University of California Irvine (UCI), Irvine, California
| | - Parvati Singh
- Program in Public Health, University of California Irvine (UCI), Irvine, California
| | - Nathalie Lelong
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology, Research Team (EPOPé), Center for Epidemiology and Statistics, Sorbonne, Paris Cité (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Babak Khoshnood
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology, Research Team (EPOPé), Center for Epidemiology and Statistics, Sorbonne, Paris Cité (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
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11
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Pacchierotti F, Masumura K, Eastmond DA, Elhajouji A, Froetschl R, Kirsch-Volders M, Lynch A, Schuler M, Tweats D, Marchetti F. Chemically induced aneuploidy in germ cells. Part II of the report of the 2017 IWGT workgroup on assessing the risk of aneugens for carcinogenesis and hereditary diseases. MUTATION RESEARCH-GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2019; 848:403023. [PMID: 31708072 DOI: 10.1016/j.mrgentox.2019.02.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/01/2019] [Accepted: 02/20/2019] [Indexed: 12/18/2022]
Abstract
As part of the 7th International Workshops on Genotoxicity Testing held in Tokyo, Japan in November 2017, a workgroup of experts reviewed and assessed the risk of aneugens for human health. The present manuscript is one of three manuscripts from the workgroup and reports on the unanimous consensus reached on the evidence for aneugens affecting germ cells, their mechanisms of action and role in hereditary diseases. There are 24 chemicals with strong or sufficient evidence for germ cell aneugenicity providing robust support for the ability of chemicals to induce germ cell aneuploidy. Interference with microtubule dynamics or inhibition of topoisomerase II function are clear characteristics of germ cell aneugens. Although there are mechanisms of chromosome segregation that are unique to germ cells, there is currently no evidence for germ cell-specific aneugens. However, the available data are heavily skewed toward chemicals that are aneugenic in somatic cells. Development of high-throughput screening assays in suitable animal models for exploring additional targets for aneuploidy induction, such as meiosis-specific proteins, and to prioritize chemicals for the potential to be germ cell aneugens is encouraged. Evidence in animal models support that: oocytes are more sensitive than spermatocytes and somatic cells to aneugens; exposure to aneugens leads to aneuploid conceptuses; and, the frequencies of aneuploidy are similar in germ cells and zygotes. Although aneuploidy in germ cells is a significant cause of infertility and pregnancy loss in humans, there is currently limited evidence that aneugens induce hereditary diseases in human populations because the great majority of aneuploid conceptuses die in utero. Overall, the present work underscores the importance of protecting the human population from exposure to chemicals that can induce aneuploidy in germ cells that, in contrast to carcinogenicity, is directly linked to an adverse outcome.
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Affiliation(s)
- Francesca Pacchierotti
- Health Protection Technology Division, Laboratory of Biosafety and Risk Assessment, ENEA, CR Casaccia, Rome, Italy
| | - Kenichi Masumura
- Division of Genetics and Mutagenesis, National Institute of Health Sciences, Kanagawa, Japan
| | - David A Eastmond
- Department of Molecular, Cell and System Biology, University of California, Riverside, CA, USA
| | - Azeddine Elhajouji
- Novartis Institutes for Biomedical Research, Preclinical Safety, Basel, Switzerland
| | | | - Micheline Kirsch-Volders
- Laboratory for Cell Genetics, Faculty of Sciences and Bio-Engineering, Vrije Universiteit Brussel, Brussels, Belgium
| | | | | | | | - Francesco Marchetti
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, ON K1A 0K9, Canada.
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12
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Justina VD, Gonçalves JS, David FL, Giachini FR, Lima VV. Evaluation of drug prescriptions for pregnant women in the Legal Amazon Region. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2018. [DOI: 10.1590/1806-93042018000400004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objectives: to evaluate the drug prescriptions for pregnant women in the Legal Amazon during prenatal care. Methods: this is a pharmacoepidemiological, descriptive, retrospective and cross-sectional study. Medical records included sociodemographic variables, prenatal care, most frequent pharmacological classes prescribed, risk classification of drugs and possible drug-drug interactions among pregnant women. Results: a total of 159 records from pregnant women, enrolled in the Unified Health System were used. Most pregnant women began prenatal consultations in the first trimester of pregnancy (53.3%) whereas most of the drugs were prescribed in the second gestational trimester (55.5%). The most used pharmacological classes, classified according to the National List of Essential Drugs were: antianemic preparations (52.9%), vitamins (12.5%) and analgesic (10.6%). According to the risk classification, the highest prevalence of prescribed drugs belongs to category A (46.8%), followed by category C (28.9%), category B (20.0%) and category D (4.3%). Eight possible drug-drug interactions were found, being considered with mild severity, and six classified with moderate risk. Conclusions: the results demonstrate a lack of information regarding prescription drugs for pregnant women and this may endanger maternal and fetal health. It is essential that medical records be an effective therapeutic tool, which should be read, analyzed and reviewed in order to ensure effective and safe medical treatment.
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13
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Jansen-van der Weide MC, Gaasterland CMW, Roes KCB, Pontes C, Vives R, Sancho A, Nikolakopoulos S, Vermeulen E, van der Lee JH. Rare disease registries: potential applications towards impact on development of new drug treatments. Orphanet J Rare Dis 2018; 13:154. [PMID: 30185208 PMCID: PMC6126025 DOI: 10.1186/s13023-018-0836-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 06/05/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Low prevalence, lack of knowledge about the disease course, and phenotype heterogeneity hamper the development of drugs for rare diseases. Rare disease registries (RDRs) can be helpful by playing a role in understanding the course of the disease, and providing information necessary for clinical trial design, if designed and maintained properly. We describe the potential applications of a RDR and what type of information should be incorporated to support the design of clinical trials in the process of drug development, based on a broad inventory of registry experience. We evaluated two existing RDRs in more detail to check the completeness of these RDRs for trial design. RESULTS Before and during the application for regulatory approval a RDR can improve the efficiency and quality in clinical trial design by informing the sample size calculation and expected disease course. In exceptional circumstances information from RDRs has been used as historical controls for a one-armed clinical trial, and high quality RDRs may be used for registry-based randomized controlled trials. In the post marketing phase of (conditional) drug approval a disease-specific RDR is likely to provide more relevant information than a product-specific registry. CONCLUSIONS A RDR can be very helpful to improve the efficiency and quality of clinical trial design in several ways. To enable the applicability and optimal use of a RDR longitudinal data collection is indispensable, and specific data collection, prepared for repeated measurement, is needed. The developed checklist can help to define the appropriate variables to include. Attention should be paid to the inclusion of patient-relevant outcome measures in the RDR from the start. More research and experience is needed on the possibilities and limitations of combining RDR information with clinical trial data to maximize the availability of relevant evidence for regulatory decisions in rare diseases.
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Affiliation(s)
- Marijke C Jansen-van der Weide
- Pediatric Clinical Research Office, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. .,Academic Medical Center, H8-236, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
| | - Charlotte M W Gaasterland
- Pediatric Clinical Research Office, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Kit C B Roes
- Department of Biostatistics and Research Support, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Caridad Pontes
- Clinical Pharmacology Unit, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain
| | - Roser Vives
- Clinical Pharmacology Unit, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain
| | - Arantxa Sancho
- Clinical Pharmacology Unit, Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain.,Servicio de Farmacología Clínica - Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Stavros Nikolakopoulos
- Department of Biostatistics and Research Support, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University of Utrecht, Utrecht, The Netherlands
| | - Eric Vermeulen
- Pediatric Clinical Research Office, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Johanna H van der Lee
- Pediatric Clinical Research Office, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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14
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Dolejs J, Homolkova H, Maresova P. Modeling the Age-Associated Decrease in Mortality Rate for Congenital Anomalies of the Central Nervous System Using WHO Metadata From Nine European Countries. Front Neurol 2018; 9:585. [PMID: 30087651 PMCID: PMC6067090 DOI: 10.3389/fneur.2018.00585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 06/28/2018] [Indexed: 12/26/2022] Open
Abstract
Background: In humans, the mortality rate dramatically decreases with age after birth, and the causes of death change significantly during childhood. In the present study, we attempted to explain age-associated decreases in mortality for congenital anomalies of the central nervous system (CACNS), as well as decreases in total mortality with age. We further investigated the age trajectory of mortality in the biologically related category "diseases of the nervous system" (DNS). Methods: The numbers of deaths were extracted from the mortality database of the World Health Organization (WHO) for the following nine countries: Denmark, Finland, Norway, Sweden, Austria, the Czech Republic, Hungary, Poland, and Slovakia. Because zero cases could be ascertained over the age of 30 years in a specific age category, the Halley method was used to calculate the mortality rates in all possible calendar years and in all countries combined. Results: Total mortality from the first day of life up to the age of 10 years and mortality due to CACNS within the age interval of [0, 90) years can be represented by an inverse proportion with a single parameter. High coefficients of determination were observed for both total mortality (R2 = 0.996) and CACNS mortality (R2 = 0.990). Our findings indicated that mortality rates for DNS slowly decrease with age during the first 2 years of life, following which they decrease in accordance with an inverse proportion up to the age of 10 years. The theory of congenital individual risk (TCIR) may explain these observations based on the extinction of individuals with more severe impairments, as well as the bent curve of DNS, which exhibited an adjusted coefficient of determination of R ¯ 2 = 0.966. Conclusion: The coincidence between the age trajectories of all-cause and CACNS-related mortality may indicate that the overall decrease in mortality after birth is due to the extinction of individuals with more severe impairments. More deaths unrelated to congenital anomalies may be caused by the manifestation of latent congenital impairments during childhood.
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Affiliation(s)
- Josef Dolejs
- Department of Informatics and Quantitative Methods, University of Hradec Králové, Hradec Králové, Czechia
| | - Helena Homolkova
- Department of Pediatric Neurosurgery, Charles University, Thomayer's Teaching Hospital, Prague, Czechia
| | - Petra Maresova
- Department of Economics, University of Hradec Králové, Hradec Králové, Czechia
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15
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Tucker FD, Morris JK, Neville A, Garne E, Kinsner-Ovaskainen A, Lanzoni M, Loane MA, Martin S, Nicholl C, Rankin J, Rissmann AK. EUROCAT: an update on its functions and activities. J Community Genet 2018; 9:407-410. [PMID: 29736796 DOI: 10.1007/s12687-018-0367-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 04/19/2018] [Indexed: 02/08/2023] Open
Abstract
This paper provides an outline of the development and growth of EUROCAT, the European network of congenital anomaly registers. In recent years the network has been through a period of transition and change. The Central Register of data has transferred from the Ulster University to the EU Joint-Research-Centre, Ispra, Italy.The benefits of combining data from across Europe, from different populations and countries are described by the uses to which these data can be put. These uses include:. surveillance of anomalies at a local, regional or pan-European level. pharmacovigilance. registration of rare diseasesNew studies and projects are underway, including EUROlinkCAT (a Horizon 2020 funded data-linkage project), promising a fruitful future in further research of congenital anomalies.
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Affiliation(s)
- F D Tucker
- Congenital Anomaly Register & Information Service for Wales (CARIS) Public Health Wales, Swansea, UK.
| | - J 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
| | | | - A Neville
- IMER Registry (Emilia Romagna Registry of Birth Defects), University of Ferrara and Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
| | - E Garne
- Paediatric Department, Hospital Lillebaelt, Kolding, Denmark
| | - A Kinsner-Ovaskainen
- DG Joint Research Centre, Directorate F - Health Consumers and Reference Materials, Ispra, Italy
| | - M Lanzoni
- DG Joint Research Centre, Directorate F - Health Consumers and Reference Materials, Ispra, Italy
| | - M A Loane
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - S Martin
- DG Joint Research Centre, Directorate F - Health Consumers and Reference Materials, Ispra, Italy
| | - C Nicholl
- DG Joint Research Centre, Directorate F - Health Consumers and Reference Materials, Ispra, Italy
| | - J Rankin
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - A K Rissmann
- Institute of Health and Society, Newcastle University, Newcastle, UK.,Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
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16
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Morris JK, Springett AL, Greenlees R, Loane M, Addor MC, Arriola L, Barisic I, Bergman JEH, Csaky-Szunyogh M, Dias C, Draper ES, Garne E, Gatt M, Khoshnood B, Klungsoyr K, Lynch C, McDonnell R, Nelen V, Neville AJ, O'Mahony M, Pierini A, Queisser-Luft A, Randrianaivo H, Rankin J, Rissmann A, Kurinczuk J, Tucker D, Verellen-Dumoulin C, Wellesley D, Dolk H. Trends in congenital anomalies in Europe from 1980 to 2012. PLoS One 2018; 13:e0194986. [PMID: 29621304 PMCID: PMC5886482 DOI: 10.1371/journal.pone.0194986] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 03/14/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Surveillance of congenital anomalies is important to identify potential teratogens. METHODS This study analysed the prevalence of 61 congenital anomaly subgroups (excluding chromosomal) in 25 population-based EUROCAT registries (1980-2012). Live births, fetal deaths and terminations of pregnancy for fetal anomaly were analysed with multilevel random-effects Poisson regression models. RESULTS Seventeen anomaly subgroups had statistically significant trends from 2003-2012; 12 increasing and 5 decreasing. CONCLUSIONS The annual increasing prevalence of severe congenital heart defects, single ventricle, atrioventricular septal defects and tetralogy of Fallot of 1.4% (95% CI: 0.7% to 2.0%), 4.6% (1.0% to 8.2%), 3.4% (1.3% to 5.5%) and 4.1% (2.4% to 5.7%) respectively may reflect increases in maternal obesity and diabetes (known risk factors). The increased prevalence of cystic adenomatous malformation of the lung [6.5% (3.5% to 9.4%)] and decreased prevalence of limb reduction defects [-2.8% (-4.2% to -1.5%)] are unexplained. For renal dysplasia and maternal infections, increasing trends may be explained by increased screening, and deceases in patent ductus arteriosus at term and increases in craniosynostosis, by improved follow up period after birth and improved diagnosis. For oesophageal atresia, duodenal atresia/stenosis and ano-rectal atresia/stenosis recent changes in prevalence appeared incidental when compared with larger long term fluctuations. For microcephaly and congenital hydronephrosis trends could not be interpreted due to discrepancies in diagnostic criteria. The trends for club foot and syndactyly disappeared once registries with disparate results were excluded. No decrease in neural tube defects was detected, despite efforts at prevention through folic acid supplementation.
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Affiliation(s)
- Joan K Morris
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Anna L Springett
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Ruth Greenlees
- Faculty Life & Health Sciences, University of Ulster, Newtownabbey, United Kingdom
| | - Maria Loane
- Faculty Life & Health Sciences, University of Ulster, Newtownabbey, United Kingdom
| | - Marie-Claude Addor
- Department of Woman-Mother-Child, University Hospital Center CHUV, Lausanne, Switzerland
| | - Larraitz Arriola
- Public Health Division of, Biodonostia Research Institute, San Sebastián, Spain
| | - Ingeborg Barisic
- Department of Medical Genetics and Reproductive Health,Children's Hospital Zagreb, Medical School University of Zagreb, Zagreb, Croatia
| | - Jorieke E H Bergman
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Melinda Csaky-Szunyogh
- National Public Health and Medical Officer Service, Hungarian Congenital Abnormality Registry, Budapest, Hungary
| | - Carlos Dias
- Centro de Estudos e registo de A C, Lisbon, Portugal
| | - Elizabeth S Draper
- Department of Health Sciences, University of Leicester, Leicester, United Kingdom
| | - Ester Garne
- Paediatric department, Hospital Lillebaelt, Kolding, Denmark
| | - Miriam Gatt
- Directorate for Health Information and Research, Guardamangia, Malta
| | - Babak Khoshnood
- Paris Registry of Congenital Anomalies, Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France
| | - Kari Klungsoyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Division for mental and physical health, Norwegian Institute of Public Health, Bergen, Norway
| | - Catherine Lynch
- Department of Public Health, Health Service Executive, Kilkenny, Ireland
| | - Robert McDonnell
- Department of Public Health, Health Service Executive, Dublin, Ireland
| | - Vera Nelen
- Provincial Institute for Hygiene, Antwerp, Belgium
| | - Amanda J Neville
- IMER Registry, Center for Clinical and Epidemiological Research, University of Ferrara, Ferrara, Italy.,Azienda Ospedaliero- Universitaria di Ferrara, Ferrara, Italy
| | - Mary O'Mahony
- Department of Public Health, Health Service Executive, Cork, Ireland
| | - Anna Pierini
- CNR Institute of Clinical Physiology, Pisa, Italy
| | - Annette Queisser-Luft
- Center for child and adolescence medicine, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
| | - Hanitra Randrianaivo
- Registre des Malformations Congenitales de la Reunion, St Pierre, Ile de la Reunion, France
| | - Judith Rankin
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Jennifer Kurinczuk
- National Perinatal and Epidemiology Unit, University of Oxford, Oxford, United Kingdom
| | | | | | - Diana Wellesley
- University of Southampton and Wessex Clinical Genetics Service, Southampton, United Kingdom
| | - Helen Dolk
- Faculty Life & Health Sciences, University of Ulster, Newtownabbey, United Kingdom
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17
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Singh P, Yang W, Shaw GM, Catalano R, Bruckner TA. Selected birth defects among males following the United States terrorist attacks of 11 September 2001. Birth Defects Res 2017; 109:1277-1283. [DOI: 10.1002/bdr2.1072] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 05/18/2017] [Accepted: 05/29/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Parvati Singh
- University of California Irvine, Program in Public Health; Irvine California
| | - Wei Yang
- Stanford University, School of Medicine; Stanford California
| | - Gary M. Shaw
- Stanford University, School of Medicine; Stanford California
| | - Ralph Catalano
- University of California Berkeley, School of Public Health; Berkeley California
| | - Tim A. Bruckner
- University of California Irvine, Program in Public Health; Irvine California
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18
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Congenital Anomalies: Cluster Detection and Investigation. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1031:535-557. [PMID: 29214591 DOI: 10.1007/978-3-319-67144-4_29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
This work summarizes the main aspects to be considered around birth defects (or congenital anomalies) clusters. Most birth defects (BD), considered individually, fall into the definition of rare diseases (RD), according to their low frequency. Likewise, many RD are congenital, because their manifestations are present at birth or can be even evident before the delivery. It has been estimated that overall 7.9 million children are born each year with serious BD of genetic or partially genetic origin, and additional hundreds of thousands more are born with serious BD of post-conception origin.A "birth defect cluster" can be defined as an unusual aggregation of cases (grouped in place and time) that is suspected to be greater than expected, even though the expected number may not be known. These clusters are incidents or occurrences that let us turn the challenge of identifying the causal agent(s) involved in the origin of such clusters, into an opportunity to exert primary prevention, and thus achieve the ultimate goal of enabling infants being born healthy. Therefore, any program or system involved in BD surveillance and research should devote part of its activities to detect and investigate clusters, to ensure that such opportunity for primary prevention will be conveniently leveraged. Regardless the type of cluster, there are several phases that must be undertaken sequentially for proper control and the maximum benefit for the population: cluster detection, evaluation and investigation, management, adoption of preventive measures, and communication of the results to the public or target population.
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19
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Fernández N, Lorenzo A, Bägli D, Zarante I. Altitude as a risk factor for the development of hypospadias. Geographical cluster distribution analysis in South America. J Pediatr Urol 2016; 12:307.e1-307.e5. [PMID: 27267992 DOI: 10.1016/j.jpurol.2016.03.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 03/12/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Hypospadias is the most common congenital anomaly affecting the genitals. It has been established as a multifactorial disease with increasing prevalence. Many risk factors have been identified such as prematurity, birth weight, mother's age, and exposure to endocrine disruptors. In recent decades multiple authors using surveillance systems have described an increase in prevalence of hypospadias, but most of the published literature comes from developed countries in Europe and North America and few of the published studies have involved cluster analysis. Few large-scale studies have been performed addressing the effect of altitude and other geographical aspects on the development of hypospadias. Acknowledging this limitation, we present novel results of a multinational spatial scan statistical analysis over a 30-year period in South America and an altitude analysis of hypospadias distribution on a continent level. METHOD A retrospective review was performed of the Latin American collaborative study of congenital malformations (ECLAMC). A total of 4,020,384 newborns was surveyed between 1982 and December 2011 in all participating centers. We selected all patients with hypospadias. All degrees of clinical severity were included in the analysis. Each participating center was geographically identified with its coordinates and altitude above sea level. A spatial scan statistical analysis was performed using Kulldorf's methodology and a prevalence trend analysis over time in centers below and above 2000 m. RESULTS During the study period we found 159 hospitals in six different countries (Colombia, Bolivia, Brazil, Argentina, Chile, and Uruguay) with 4,537 cases of hypospadias and a global prevalence rate of 11.3/10,000 newborns. Trend analysis showed that centers below 2000 m had an increasing trend with an average of 10/10,000 newborns as opposed to those centers above 2000 m that showed a reducing trend with an average prevalence of 7.8 (p = 0.1246). We identified clusters with significant increases of prevalence in five centers along the coast at an average altitude of 219.8 m above sea level (p > 0.0000). Reduction in prevalence was found in clusters located in two centers on the Andes mountains. Altitude of 2,000 m was associated with hypospadias (Figure), with an OR 0.59 (0.5-0.69). There are ethnic arguments to support our results supported by protective polymorphism distribution in high lands. CONCLUSION Altitude above 2,000 m is suggested to have a protective effect for hypospadias. Specific clusters have been identified with increased risk for hypospadias. Environmental risk factors in these areas need to be further studied given the association seen between altitude and the distribution of more severe cases.
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Affiliation(s)
| | - Armando Lorenzo
- Division of Urology, Hospital for Sick Children and University of Toronto, Toronto
| | - Darius Bägli
- Division of Urology, Hospital for Sick Children and University of Toronto, Toronto
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20
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Dolk H. Preventing birth defects: The value of the NBDPS case-control approach. ACTA ACUST UNITED AC 2015; 103:670-9. [PMID: 26172859 DOI: 10.1002/bdra.23404] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Revised: 06/05/2015] [Accepted: 06/08/2015] [Indexed: 12/18/2022]
Abstract
Birth Defect Registries provide a basis for epidemiological research into risk factors, thus facilitating a growing understanding of what causes congenital anomalies and how one might target preventive public health actions and reduce inequalities. The National Birth Defects Prevention Study (NBDPS) has used 10 U.S. registries as a basis for a large case-control study. This commentary reviews its methodology and selected areas of output. The strengths of NBDPS lie in the quality of diagnostic coding and classification of birth defects and its size. The sources of bias in NBDPS data relate particularly to retrospective exposure ascertainment entailing a long period of recall, incomplete ascertainment of terminations of pregnancy for fetal anomaly, and unknown bias in case selection. NBDPS results have shown the protective effect of healthy dietary patterns, but have not been as informative as expected in relation to furthering understanding of the protective effect of folic acid. NBDPS medication studies are making important contributions to addressing the gap in existing evidence systematically across a wide range of birth defects, but are challenged by the quality of information on exposure, dose and underlying disease condition, and the interpretation of results of multiple testing. Studies of environmental contaminants in collaboration with experts in exposure assessment have linked addresses to residential exposure measures, using the advantages of information on residential history and confounders, but are challenged by the need to consider exposure mixtures. NBDPS could increase its public health impact by placing more emphasis on socioeconomic inequalities.
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Affiliation(s)
- Helen Dolk
- Centre for Maternal, Fetal and Infant Research, Institute for Nursing and Health Research, Ulster University, United Kingdom
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Teljeur C, Kelly A, Loane M, Densem J, Dolk H. Using scan statistics for congenital anomalies surveillance: the EUROCAT methodology. Eur J Epidemiol 2015; 30:1165-73. [PMID: 26026722 DOI: 10.1007/s10654-015-0044-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 05/14/2015] [Indexed: 01/09/2023]
Abstract
Scan statistics have been used extensively to identify temporal clusters of health events. We describe the temporal cluster detection methodology adopted by the EUROCAT (European Surveillance of Congenital Anomalies) monitoring system. Since 2001, EUROCAT has implemented variable window width scan statistic for detecting unusual temporal aggregations of congenital anomaly cases. The scan windows are based on numbers of cases rather than being defined by time. The methodology is imbedded in the EUROCAT Central Database for annual application to centrally held registry data. The methodology was incrementally adapted to improve the utility and to address statistical issues. Simulation exercises were used to determine the power of the methodology to identify periods of raised risk (of 1-18 months). In order to operationalize the scan methodology, a number of adaptations were needed, including: estimating date of conception as unit of time; deciding the maximum length (in time) and recency of clusters of interest; reporting of multiple and overlapping significant clusters; replacing the Monte Carlo simulation with a lookup table to reduce computation time; and placing a threshold on underlying population change and estimating the false positive rate by simulation. Exploration of power found that raised risk periods lasting 1 month are unlikely to be detected except when the relative risk and case counts are high. The variable window width scan statistic is a useful tool for the surveillance of congenital anomalies. Numerous adaptations have improved the utility of the original methodology in the context of temporal cluster detection in congenital anomalies.
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Affiliation(s)
- Conor Teljeur
- Department of Public Health and Primary Care, Trinity College, Dublin, Ireland
| | - Alan Kelly
- Department of Public Health and Primary Care, Trinity College, Dublin, Ireland
| | - Maria Loane
- EUROCAT Central Registry, WHO Collaborating Centre for Surveillance of Congenital Anomalies, Institute for Nursing and Health Research, University of Ulster, Shore Rd, Newtownabbey, BT370QB, UK
| | | | - Helen Dolk
- EUROCAT Central Registry, WHO Collaborating Centre for Surveillance of Congenital Anomalies, Institute for Nursing and Health Research, University of Ulster, Shore Rd, Newtownabbey, BT370QB, UK.
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