Neural tube defects in rural Ireland

Congenital malformations at birth in Central India: A rural medical college hospital based data

OBJECTIVE

To study the incidence of congenital anomalies and the associated risk factors in Department of Pediatrics at Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha, a rural medical college hospital in central Maharashtra.

MATERIALS AND METHODS

All the intramural deliveries between 1 January 2005 and 31 July 2007 comprised 9386 births and their 9324 mothers (62 mothers gave birth to twin babies). The newborns were examined and assessed systematically for the presence of congenital anomalies, system wise distribution of anomalies and risk factors attributable.

RESULTS

Out of the total 9386 deliveries, 9194 were live births and 192 were stillbirths. The total number of babies with congenital malformations was 179 (1.91%). Out of the 9262 singleton births, 177 (1.05%) were malformed, whereas 2 of the 62 pairs of twins had birth defects. Nine of the 179 malformed babies (5.02%) were still born. Prematurity, increased maternal age, increasing birth order and low birth weight were found to have a higher risk of congenital anomalies. Cardiovascular malformations were most common in live births, followed by musculoskeletal and genitourinary anomalies.

CONCLUSION

Congenital anomalies are a major cause of stillbirths and infant mortality. Evaluation of cardiovascular system to rule out congenital heart disease in high-risk mothers' babies is the important factor to be considered.

Neural tube defects in Pondicherry

OBJECTIVE

This study was carried out to identify the trend and the frequency of neural tube defects from July 1998 to June 2004.

METHODS

A total of 310 babies were born with neural tube defects with the overall frequency of 5.7/1000 births compared to 2.3/1000 births observed earlier in our hospital.

RESULTS

The most common defect was spina bifida (54.8%) followed by anencephaly (31.6%), and encephalocele (11.6%). More neural tube defects were observed in female and low birth weight babies, still births and unbooked mothers. Neural tube defect was significantly higher among babies born to parents of consanguineous marriage (p< 0.01). Associated congenital defects were observed in thirty nine (12.6%) cases.

CONCLUSION

The rise in the frequency of NTDS may indicate the current trend of NTDs in Southern India. A further prospective study is desired to measure the effectiveness of regular folic acid supplementation in bringing down this frequency.

A UK general practice database study of prevalence and mortality of people with neural tube defects

OBJECTIVE

To investigate the prevalence of neural tube defects (NTDs) in the UK and to compare the mortality rate with that of the general population.

METHODS

A cross-sectional study. The General Practice Research Database (GPRD) contains the prescribing and diagnostic records since 1990 of over 4 million people from throughout the UK. All patients aged 10-69 and registered on the database in the years 1994-1997 were included in the study. Patients with a diagnosis of NTD were identified from the database and prevalence and standardized mortality ratios in each year were calculated.

RESULTS

The size of the GPRD reduced during the study period - there were 2116452 patients aged 10-69 years on the database in 1994, of whom 1751 had a prior record of NTD. In 1997 there were 998368 patients, of whom 842 had an NTD. The age standardized prevalence between 1994 and 1997 for NTDs ranged between 7.8 and 8.4 per 10000 for males and 9.0 and 9.4 per 10000 for females aged 10-69 years. There were 27 deaths in patients with a record of NTD over the four-year study period. The standardized mortality ratio for the years 1994 to 1997 for NTDs ranged between 1.9 and 2.9.

CONCLUSIONS

These data give an estimate of the prevalence of NTDs in the general population. They also show that those who have survived to age 10 years still have double the mortality of the general population.

East Ireland 1980-1994: epidemiology of neural tube defects

STUDY OBJECTIVE

The objective of the study was to describe the epidemiology of neural tube defects (NTD) in the eastern region of Ireland using the EUROCAT register of congenital malformations.

DESIGN, SETTING AND PATIENTS

EUROCAT registries monitor the prevalence of congenital anomalies in defined populations using multiple sources for case ascertainment. All cases of NTD on the Dublin EUROCAT register born between 1980 and 1994 were extracted and analysed. The crude birth prevalence rate for all NTD, spina bifida, anencephaly and encephalocoele were calculated for each year. Parameters measured were: sex ratio, stillbirth rate, proportion of low birth-weight babies (< 2500 g) and the proportion who were premature (< 37 weeks gestation).

MAIN RESULTS

Of 821 NTD cases, 419 (51.0%) had spina bifida, 322 (39.2%) had anencephaly, 69 (8.4%) had encephalocoele and 11 (1.3%) were iniencephalic. The crude birth prevalence of NTD decreased fourfold from 46.9/10,000 births in 1980 to 11.6/10,000 in 1994. The downward trend ceased during the early 1990's. Younger mothers had significantly higher rates of NTD affected births. Twenty two per cent of NTD cases had additional non-central nervous system anomalies. In 40 cases, there was a previous family history of NTD in siblings. Seasonal effects in birth prevalence were observed. Birth notification was the most frequent mechanism of ascertainment.

CONCLUSION

There was a marked fall in the birth prevalence of NTD during the 15 year period. This change was real and not accounted for by pre-natal screening and diagnostic practises with termination of pregnancy, which is not legally permissible in Ireland. Dietary factors may have had an influence. Rates of NTD in this region are still higher than many other parts of Europe. Primary prevention strategies through increased folic acid intake are necessary to further reduce NTD affected births.

Major birth defects at King Fahd Hofuf Hospital: Prevalence, risk factors and outcome

We analyzed the medical records of all live birth infants (LBs) born with major birth defects (MBDs) at King Fahd Hofuf Hospital (KFHH) during a three-year period. Our objectives were to determine defect prevalence rate, patterns, geographic differences, associated maternal and infant risk factors, and the contribution of the defects to mortality in our Neonatal Intensive Care Unit (NICU). Out of 30,159 infants born alive during the study period, 687 (2.27%) had one or more MBDs. Systems most commonly affected were the cardiac (20.8%), musculoskeletal (18.7%), and central nervous (18.3%) systems. We observed higher rates/1000 LBs of life-threatening CNS and cardiac defects and diaphragmatic hernia than rates reported from other countries. Rate of defects/1000 LBs increased from 0.79% in the birth-weight group >/=4000 g to 15.2% in the birth-weight category <1500 g. Fifty-six infants with MBDs were born to diabetic mothers; diabetes was the only identified maternal disease associated with birth defects. Diabetic mothers and those of infants with chromosomal anomalies had higher means of age and parity than the control mothers ( 33.5 yrs (SD 5.2), 31.4 yrs (7.5), and 8.8 (3.8), 7.39 (3.8), for age and parity of diabetic and chromosomal anomalies respectively vs. 26.8 yrs (6.4) and 5.2 (3.7) in the controls, P<0.01). Out of the 687 infants, 254 (36.97%) died; and MBDs were the most common disease- specific cause of death in our NICU throughout the study period.