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Maugliani A, Baldi F. Surveys as a valid tool for assessing food safety knowledge amongst pregnant women in high-income countries: a rapid review. Reprod Toxicol 2023; 119:108411. [PMID: 37245697 DOI: 10.1016/j.reprotox.2023.108411] [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: 11/22/2022] [Revised: 05/12/2023] [Accepted: 05/18/2023] [Indexed: 05/30/2023]
Abstract
Pregnancy, being a vulnerable period, is the time when woman are most motivated to change their diet and lifestyle. Ensuring food safety during this susceptible time of life is essential for avoiding the related risks. Although a wealth of recommendations and guidelines have been issued for for pregnant women, further evidence is required regarding their effectiveness in implementing the knowledge and changing behaviour on food safety topics are needed. Surveys are often used as a research tool to investigate knowledge and awareness amongst pregnant women. Our main aim is to analyse and describe the results of an ad hoc research approach developed to characterise the main features of surveys identified in the PubMed database. The three major food safety issues - microbiological, chemical and nutritional- were analysed. We identified eight main key features to provide a summary of the evidence with a transparent and reproducible methodology. Our results help summarise the knowledge on the features of for pregnant women, by focusing on high-income countries over the last five years. We observed a high level of heterogeneity and methodological variability in food safety surveys. This is a novel approach that could be used to analyse surveys utilising a robust methodology. The outcomes are useful for guiding new survey design methodology and/or the modification existing surveys. Our findings could help to fill knowledge gaps by improving the use of innovative strategies for recommendations and guidelines on food safety for pregnant women. Non-high-income countries deserve separate and more comprehensive consideration.
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Affiliation(s)
- Antonella Maugliani
- Food Safety, Nutrition and Veterinary Public Health Department, Microbiological Food Safety and Food-borne Diseases Unit, Istituto Superiore di Sanità, Viale Regina Elena, 299 00161 Roma, Italy.
| | - Francesca Baldi
- Food Safety, Nutrition and Veterinary Public Health Department, Nutrition and Health Unit, Istituto Superiore di Sanità, Viale Regina Elena, 299 00161 Roma, Italy
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Leke AZ, Malherbe H, Kalk E, Mehta U, Kisa P, Botto LD, Ayede I, Fairlie L, Maboh NM, Orioli I, Zash R, Kusolo R, Mumpe-Mwanja D, Serujogi R, Bongomin B, Osoro C, Dah C, Sentumbwe–Mugisha O, Shabani HK, Musoke P, Dolk H, Barlow-Mosha L. The burden, prevention and care of infants and children with congenital anomalies in sub-Saharan Africa: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001850. [PMID: 37379291 PMCID: PMC10306220 DOI: 10.1371/journal.pgph.0001850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 03/17/2023] [Indexed: 06/30/2023]
Abstract
The aim of this scoping review was to determine the scope, objectives and methodology of contemporary published research on congenital anomalies (CAs) in sub-Saharan Africa (SSA), to inform activities of the newly established sub-Saharan African Congenital Anomaly Network (sSCAN). MEDLINE was searched for CA-related articles published between January 2016 and June 2021. Articles were classified into four main areas (public health burden, surveillance, prevention, care) and their objectives and methodologies summarized. Of the 532 articles identified, 255 were included. The articles originated from 22 of the 49 SSA countries, with four countries contributing 60% of the articles: Nigeria (22.0%), Ethiopia (14.1%), Uganda (11.7%) and South Africa (11.7%). Only 5.5% of studies involved multiple countries within the region. Most articles included CA as their primary focus (85%), investigated a single CA (88%), focused on CA burden (56.9%) and care (54.1%), with less coverage of surveillance (3.5%) and prevention (13.3%). The most common study designs were case studies/case series (26.6%), followed by cross-sectional surveys (17.6%), retrospective record reviews (17.3%), and cohort studies (17.2%). Studies were mainly derived from single hospitals (60.4%), with only 9% being population-based studies. Most data were obtained from retrospective review of clinical records (56.1%) or via caregiver interviews (34.9%). Few papers included stillbirths (7.5%), prenatally diagnosed CAs (3.5%) or terminations of pregnancy for CA (2.4%).This first-of-a-kind-scoping review on CA in SSA demonstrated an increasing level of awareness and recognition among researchers in SSA of the contribution of CAs to under-5 mortality and morbidity in the region. The review also highlighted the need to address diagnosis, prevention, surveillance and care to meet Sustainable Development Goals 3.2 and 3.8. The SSA sub-region faces unique challenges, including fragmentation of efforts that we hope to surmount through sSCAN via a multidisciplinary and multi-stakeholder approach.
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Affiliation(s)
- Aminkeng Zawuo Leke
- Institute for Nursing and Health Research, Centre for Maternal, Fetal and Infant Research, Ulster University, Newtownabbey, United Kingdom
- Centre for Infant and Maternal Health Research, Health Research Foundation, Buea, Cameroon
| | - Helen Malherbe
- Research & Epidemiology, Rare Diseases South Africa NPC, Bryanston, Sandton, South Africa
| | - Emma Kalk
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Ushma Mehta
- Centre for Infectious Disease Epidemiology & Research, School of Public Health, University of Cape Town, Cape Town, South Africa
| | - Phylis Kisa
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Lorenzo D. Botto
- Division of Medical Genetics, University of Utah, Salt Lake City, Utah, United States of America
- International Center on Birth Defects, University of Utah, Salt Lake City, Utah, United States of America
| | - Idowu Ayede
- Department of Paediatrics, College of Medicine, University of Ibadan and University College Hospital, Ibadan, Nigeria
| | - Lee Fairlie
- Faculty of Health Sciences, Wits Reproductive Health and HIV Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Nkwati Michel Maboh
- Centre for Infant and Maternal Health Research, Health Research Foundation, Buea, Cameroon
| | - Ieda Orioli
- Genetics Department, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
- ReLAMC: Latin American Network for Congenital Malformation Surveillance, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rebecca Zash
- The Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana and Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America
| | - Ronald Kusolo
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Daniel Mumpe-Mwanja
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Robert Serujogi
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Bodo Bongomin
- Gulu University Faculty of Medicine: Gulu, Gulu, UG/ World Health Organization, Kampala, Uganda
| | - Caroline Osoro
- Kenya Medical Research Institute, Centre for Global Health Research, Nairobi, Kenya
| | - Clarisse Dah
- Centre de Recherche en Santé de Nouna, Nouna, Burkina Faso
| | | | | | - Philippa Musoke
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Helen Dolk
- Institute for Nursing and Health Research, Centre for Maternal, Fetal and Infant Research, Ulster University, Newtownabbey, United Kingdom
| | - Linda Barlow-Mosha
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
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Kinney MO, Smith PEM, Craig JJ. Preventing Teratogenicity in Women with Epilepsy. Semin Neurol 2022; 42:679-692. [PMID: 36513097 DOI: 10.1055/s-0042-1759579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Over the last 50 years there has been a significant increase in our understanding of the issues faced by women with epilepsy, in both planning and undertaking pregnancy. The risks of teratogenicity associated with antiseizure medications have emerged slowly. The major pregnancy registers have substantially contributed to our knowledge about teratogenic risk associated with the commonly used antiseizure medications. However, there are substantial gaps in our knowledge about the potential risks associated with many third-generation drugs. The remit of the pregnancy registers and the wider research focus has moved beyond anatomical major congenital malformations. Increasingly neurodevelopmental and behavioral abnormalities have been investigated after in utero exposure to antiseizure medications. Public health approaches can help reduce the risk of teratogenicity. However, neurologists still have a vital role in reducing the risk of teratogenicity at an individual level for women attending their clinic. They also have responsibility to ensure that women with epilepsy are aware of the rationale for the different available options.
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Affiliation(s)
- Michael O Kinney
- Department of Neurology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom.,School of Medicine, Queen's University of Belfast, Belfast, United Kingdom
| | - Phil E M Smith
- Department of Neurology, University Hospital of Wales, Cardiff, United Kingdom
| | - John J Craig
- Department of Neurology, Royal Victoria Hospital, Belfast Health and Social Care Trust, Belfast, United Kingdom
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Bardi F, Bergman JEH, Bouman K, Erwich JJ, Duin LK, Walle HEK, Bakker MK. Effect of prenatal screening on trends in perinatal mortality associated with congenital anomalies before and after the introduction of prenatal screening: A population-based study in the Northern Netherlands. Paediatr Perinat Epidemiol 2021; 35:654-663. [PMID: 34328233 PMCID: PMC8596841 DOI: 10.1111/ppe.12792] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 05/05/2021] [Accepted: 05/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Perinatal mortality in foetuses/children with congenital anomalies remains high. Prenatal diagnosis, essential for risk assessment and organisation of perinatal/postnatal care, offers parents the opportunity to consider the termination of pregnancy. In times of quick changes in prenatal screening programmes, it is relevant to evaluate the effect of prenatal screening on perinatal mortality rates. OBJECTIVES The objective of this study was to study trends in early foetal and perinatal mortality associated with congenital anomalies before/after the introduction of the Dutch prenatal screening programme. METHODS This population-based cohort study included 8535 foetuses/neonates with congenital anomalies born in the Northern Netherlands between 2001 and 2017. Total deaths were defined as sum of early foetal (before 24 weeks' gestation) and perinatal deaths (from 24 weeks' gestation till day 7 post-partum). Foetal deaths were categorised into spontaneous or elective termination of pregnancy for foetal anomalies (TOPFA). Trends in total mortality as well as early foetal and perinatal mortality were studied. Joinpoint regression was used to calculate the average annual percentage chance (AAPC) and identify linear trends in mortality within subperiods. RESULTS Total and perinatal mortality were 17% and 4%. Total mortality was higher in abnormal karyotype and central nervous system anomalies. We observed an increase in total mortality over time: 11.9% in 2001 versus 21.9% in 2017 (AAPC 2.6, 95% confidence interval [CI] 1.5, 3.7), caused by an increase in early foetal mortality from 5.5% to 19.2% (AAPC 8.7, 95% CI 4.7, 12.9) and a decrease in perinatal mortality from 6.4% to 2.7% (AAPC -5.6, 95% CI -10.0, -1.0). The increase in early foetal mortality reflects an increase in TOPFA from 3.6% to 16.9% (AAPC 8.3, 95% CI 4.2, 12.7), mostly occurring at 13-14 and 20-23 weeks' gestation. CONCLUSIONS The introduction of the prenatal screening programme led to a decrease in perinatal mortality among foetuses and neonates with congenital anomalies and a marked increase in early foetal mortality before 24 weeks' gestation due to higher rates of TOPFA.
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Affiliation(s)
- Francesca Bardi
- Department of Obstetrics and GynecologyUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Jorieke E. H. Bergman
- Department of GeneticsEUROCAT Registration Northern NetherlandsUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Katelijne Bouman
- Department of GeneticsEUROCAT Registration Northern NetherlandsUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Jan Jaap Erwich
- Department of Obstetrics and GynecologyUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Leonie K. Duin
- Department of Obstetrics and GynecologyUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Hermien E. K. Walle
- Department of GeneticsEUROCAT Registration Northern NetherlandsUniversity Medical Centre GroningenGroningenThe Netherlands
| | - Marian K. Bakker
- Department of GeneticsEUROCAT Registration Northern NetherlandsUniversity Medical Centre GroningenGroningenThe Netherlands
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Shaping national plans and strategies for rare diseases in Europe: past, present, and future. J Community Genet 2021; 12:207-216. [PMID: 33950416 PMCID: PMC8097119 DOI: 10.1007/s12687-021-00525-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/28/2021] [Indexed: 11/09/2022] Open
Abstract
Addressing the many challenges posed by rare diseases to patients, families, and society at large demands a specific national (as well as transnational) focus. Historically, the practice of elaborating and adopting national plans and strategies for rare diseases, following a request from the European Commission in 2009, has been an essential means of ensuring this focus, with 25 European Member States having adopted a plan or strategy at some stage. However, from the vantage point of late 2020, there are signs that momentum and commitment to the development, implementation, and renewal of national plans is waning, in some cases. In this article, we examine the status quo and explore the trend for national plans and strategies to expire without clear commitments or timelines for replacement. We also examine the factors and institutions which supported the initial drive towards the adoption of national plans and strategies in Europe and consider the very different climate in which the next generation of national policies may—or may not—be shaped.
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Pitt MJ, Morris JK. European trends in mortality in children with congenital anomalies: 2000-2015. Birth Defects Res 2021; 113:958-967. [PMID: 33763989 DOI: 10.1002/bdr2.1892] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/14/2021] [Accepted: 03/08/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To investigate if the survival of children with congenital anomalies has improved from 2000 to 2015 and whether there is heterogeneity in the improvements across Europe. DESIGN Population-based study of routine collected data from the WHO database on mortality and causes. SETTING Data on 31 European countries from 2000 to 2015. MAIN OUTCOME MEASURES All-cause and congenital anomaly mortality rates for infants and children up to age 9 in countries and regions of Europe. RESULTS The relative odds of all-cause mortality in 2015 compared with 2000 was 0.54 (95% CI: 0.50-0.59) for under 1, 0.48 (95% CI: 0.44-0.53) for ages 1-4, and 0.53 (95% CI: 0.49-0.56) for ages 5-9 with the relative odds of mortality from congenital anomalies being 0.49 (95% CI: 0.44-0.55), 0.51 (95% CI: 0.44-0.60), and 0.65 (95% CI: 0.53-0.80), respectively. The proportion of deaths from congenital anomalies remained relatively constant over time (26, 16, and 9% for under 1, ages 1-4, and ages 5-9, respectively) and was similar in all regions of Europe. For mortality from all causes and from congenital anomalies heterogeneity between countries and regions of Europe was high, with the countries in Eastern Europe having higher rates, but also experiencing greater relative reductions in mortality from 2000 to 2015. CONCLUSION There was a large geo-spatial disparity in all cause and congenital anomaly mortality for infants and children up to 9. However, all regions saw a significant decrease in all cause and congenital anomaly mortality rates, with the proportions of deaths from congenital anomalies remaining constant over this time.
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Affiliation(s)
- Matilda J Pitt
- Department of Mathematical Sciences, Durham University, Durham, United Kingdom
| | - Joan K Morris
- Population Health Research Institute, St George's, University of London, London, United Kingdom
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McMullan J, Crowe AL, Bailie C, Moore K, McMullan LS, Shamandi N, McAneney H, McKnight AJ. Improvements needed to support people living and working with a rare disease in Northern Ireland: current rare disease support perceived as inadequate. Orphanet J Rare Dis 2020; 15:315. [PMID: 33168042 PMCID: PMC7649905 DOI: 10.1186/s13023-020-01559-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 09/24/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Many people living and working with rare diseases describe consistent difficulties accessing appropriate information and support. In this study an evaluation of the awareness of rare diseases, alongside related information and educational resources available for patients, their families and healthcare professionals, was conducted in 2018-2019 using an online survey and semi-structured interviews with rare disease collaborative groups (charities, voluntary and community groups) active across Northern Ireland (NI). METHODS This study had 2 stages. Stage 1 was an online survey and stage 2 involved semi-structured interviews both with rare disease collaborative groups in Northern Ireland. The surveys and interviews were used to locate existing resources as well as identify gaps where the development of further resources would be appropriate. RESULTS Ninety-nine rare disease collaborative groups engaged with the survey with 31 providing detailed answers. Resources such as information, communication, 'registries', online services, training and improvements to support services were queried. Excellent communication is an important factor in delivering good rare disease support. Training for health professionals was also highlighted as an essential element of improving support for those with a rare disease to ensure they approach people with these unique and challenging diseases in an appropriate way. Carers were mentioned several times throughout the study; it is often felt they are overlooked in rare disease research and more support should be in place for them. Current care/support for those with a rare disease was highlighted as inadequate. Nine semi-structured interviews were conducted with rare disease collaborative groups. Reoccurring themes included a need for more effective information and communication, training for health professionals, online presence, support for carers, and involvement in research. CONCLUSIONS All rare disease collaborative groups agreed that current services for people living and working with a rare disease are not adequate. An important finding to consider in future research within the rare disease field is the inclusion of carers perceptions and experiences in studies. This research provides insight into the support available for rare diseases across Northern Ireland, highlights unmet needs, and suggests approaches to improve rare disease support.
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Affiliation(s)
- Julie McMullan
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Institute of Clinical Science, Block A, Grosvenor Road, Belfast, BT12 6BA, UK.
| | - Ashleen L Crowe
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Institute of Clinical Science, Block A, Grosvenor Road, Belfast, BT12 6BA, UK
| | - Caitlin Bailie
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Institute of Clinical Science, Block A, Grosvenor Road, Belfast, BT12 6BA, UK
| | - Kerry Moore
- Northern Ireland Rare Disease Partnership, 2 William Street, Newtownards, BT23 4AH, UK
| | - Lauren S McMullan
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Institute of Clinical Science, Block A, Grosvenor Road, Belfast, BT12 6BA, UK
| | - Nahid Shamandi
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Institute of Clinical Science, Block A, Grosvenor Road, Belfast, BT12 6BA, UK
| | - Helen McAneney
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Institute of Clinical Science, Block A, Grosvenor Road, Belfast, BT12 6BA, UK
| | - Amy Jayne McKnight
- Centre for Public Health, School of Medicine Dentistry and Biomedical Sciences, Institute of Clinical Science, Block A, Grosvenor Road, Belfast, BT12 6BA, UK
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Frazzoli C, Mantovani A. Toxicological risk factors in the burden of malnutrition: The case of nutrition (and risk) transition in sub-Saharan Africa. Food Chem Toxicol 2020; 146:111789. [PMID: 33011353 DOI: 10.1016/j.fct.2020.111789] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 09/16/2020] [Accepted: 09/27/2020] [Indexed: 12/11/2022]
Abstract
Toxicant exposures may worsen the micronutrient status, especially during the womb-to-childhood development, impairing organism programming and increasing the risk for health disorders in adulthood. Growing evidence calls for an integrated risk analysis of the interplay of environment, behavior and lifestyle, where a) imbalanced diet and micronutrient deficiencies may increase the vulnerability to toxicants and alter body defence systems and b) intake of antinutrients and contaminants may increase nutritional requirements. Such scenarios are especially evident in communities undergoing a fast nutrition transition, such as in many countries of sub-Saharan Africa. Specific challenges of toxicological risk analysis in sub-Saharan Africa still need a thorough assessment, including: rapid changes of lifestyle and consumers' preferences; dumping of foods and consumer' products; risk management under weak or non-existent awareness, legislation enforcement and infrastructures. The significant and growing literature from Africa-led scientific research should be used to build quality-controlled data repositories supporting regulatory top-down actions. Meanwhile, bottom-up actions (eg consumer's empowerment) could exploit social and economic drivers toward a qualified African presence in the global and local markets. A science-based combination of top-down and bottom-up actions on preventable toxicological risk factors will contribute fighting the new forms of malnutrition and prevent multi-factorial diseases. Exposures to toxicants should be included in the integrated approach proposed by WHO to address the urgent health challenge of simultaneously reduce the risk or burden of both malnutrition (ie deficiency of one or more essential nutrients) and overweight, obesity, and diet-related NCDs.
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Affiliation(s)
- Chiara Frazzoli
- Department of Cardiovascular and Endocrine-metabolic Diseases, and Ageing, Istituto Superiore di Sanita', Rome, Italy.
| | - Alberto Mantovani
- Department of Food Safety, Nutrition, and Veterinary Public Health, Istituto Superiore di Sanita', Rome, Italy
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van de Putte R, de Walle HEK, van Hooijdonk KJM, de Blaauw I, Marcelis CLM, van Heijst A, Giltay JC, Renkema KY, Broens PMA, Brosens E, Sloots CEJ, Bergman JEH, Roeleveld N, van Rooij IALM. Maternal risk associated with the VACTERL association: A case-control study. Birth Defects Res 2020; 112:1495-1504. [PMID: 33179873 PMCID: PMC7689936 DOI: 10.1002/bdr2.1773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 06/28/2020] [Accepted: 07/06/2020] [Indexed: 12/31/2022]
Abstract
Background The VACTERL association (VACTERL) includes at least three of these congenital anomalies: vertebral, anal, cardiac, trachea‐esophageal, renal, and limb anomalies. Assisted reproductive techniques (ART), pregestational diabetes mellitus, and chronic lower obstructive pulmonary disorders (CLOPD) have been associated with VACTERL. We aimed to replicate these findings and were interested in additional maternal risk factors. Methods A case–control study using self‐administered questionnaires was performed including 142 VACTERL cases and 2,135 population‐based healthy controls. Multivariable logistic regression analyses were performed to estimate confounder adjusted odds ratios (aOR) and 95% confidence intervals (95%CI). Results Parents who used invasive ART had an increased risk of VACTERL in offspring (aOR 4.4 [95%CI 2.1–8.8]), whereas the increased risk for mothers with CLOPD could not be replicated. None of the case mothers had pregestational diabetes mellitus. Primiparity (1.5 [1.1–2.1]) and maternal pregestational overweight and obesity (1.8 [1.2–2.8] and 1.8 [1.0–3.4]) were associated with VACTERL. Consistent folic acid supplement use during the advised periconceptional period may reduce the risk of VACTERL (0.5 [0.3–1.0]). Maternal smoking resulted in an almost twofold increased risk of VACTERL. Conclusion We identified invasive ART, primiparity, pregestational overweight and obesity, lack of folic acid supplement use, and smoking as risk factors for VACTERL.
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Affiliation(s)
- Romy van de Putte
- Department for Health Evidence, Radboud Institute for Health SciencesRadboud university medical center (Radboudumc)Nijmegenthe Netherlands
| | - Hermien E. K. de Walle
- Department of Genetics, University Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - Kirsten J. M. van Hooijdonk
- Department for Health Evidence, Radboud Institute for Health SciencesRadboud university medical center (Radboudumc)Nijmegenthe Netherlands
| | - Ivo de Blaauw
- Department for Pediatric SurgeryRadboudumc Amalia Children's HospitalNijmegenthe Netherlands
| | - Carlo L. M. Marcelis
- Department of Human Genetics, Radboud Institute for Molecular Life SciencesRadboudumcNijmegenthe Netherlands
| | - Arno van Heijst
- Department of Pediatrics – NeonatologyRadboudumc Amalia Children's HospitalNijmegenthe Netherlands
| | - Jacques C. Giltay
- Division Laboratories, Pharmacy and Biomedical GeneticsUniversity Medical Center UtrechtUtrechtthe Netherlands
| | - Kirsten Y. Renkema
- Department of Genetics, Center for Molecular Medicine, University Medical Center UtrechtUtrecht UniversityUtrechtthe Netherlands
| | - Paul M. A. Broens
- Department of Surgery, Division of Pediatric Surgery, University Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - Erwin Brosens
- Department of Clinical GeneticsErasmus Medical CentreRotterdamthe Netherlands
- Department of Pediatric SurgeryErasmus Medical Centre Sophia Children's HospitalRotterdamthe Netherlands
| | - Cornelius E. J. Sloots
- Department of Pediatric SurgeryErasmus Medical Centre Sophia Children's HospitalRotterdamthe Netherlands
| | - Jorieke E. H. Bergman
- Department of Genetics, University Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - Nel Roeleveld
- Department for Health Evidence, Radboud Institute for Health SciencesRadboud university medical center (Radboudumc)Nijmegenthe Netherlands
| | - Iris A. L. M. van Rooij
- Department for Health Evidence, Radboud Institute for Health SciencesRadboud university medical center (Radboudumc)Nijmegenthe Netherlands
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Sévère M, Ng P, Messerlian C, Andersen J, Buckley D, Fehlings D, Kirton A, Koclas L, Pigeon N, Van Rensburg E, Wood E, Shevell M, Oskoui M. Congenital Malformations in Children With Cerebral Palsy: Is Prematurity Protective? Pediatr Neurol 2020; 108:70-76. [PMID: 32386793 DOI: 10.1016/j.pediatrneurol.2020.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 01/27/2020] [Accepted: 02/01/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Congenital malformations are more common in children who are born prematurely, and prematurity is the leading risk factor for cerebral palsy. The primary objective of this study was to describe the profile of congenital malformations in a Canadian cohort of children with cerebral palsy. The secondary objectives were to compare the profiles of children with cerebral palsy with and without a congenital malformation and explore the possible role of prematurity. METHODS This retrospective cohort study utilized data from the Canadian Cerebral Palsy Registry, a population based registry of children with a confirmed diagnosis of cerebral palsy. Differences between groups were compared using Pearson's chi-square and Student t test as appropriate. Odds ratios and 95% confidence intervals were calculated RESULTS: Congenital malformations were present in 23% participants. In term-born children, brain malformations were the most common, whereas heart and gastrointestinal malformations were more common in children born prematurely. Children with a malformation had higher odds of being born at term (odds ratio 1.57, 95% confidence interval 1.20 to 2.04); having hypotonic, ataxic, or dyskinetic cerebral palsy (odds ratio 1.92, 95% confidence interval 1.35 to 2.72; being nonambulatory (odds ratio 1.70, 95% confidence interval 1.29 to 2.25); and having cerebral palsy-associated comorbidities. CONCLUSIONS One in four children with cerebral palsy have an associated congenital malformation. Their profile of term birth, higher Apgar scores, and lower frequency of perinatal seizures suggests a distinct causal pathway.
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Affiliation(s)
- Marcel Sévère
- Department of Pediatrics, McGill University, Montreal, Quebec City, Canada
| | - Pamela Ng
- Child Health and Human Development, Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Center, Montreal, Canada
| | - Carmen Messerlian
- Departments of Epidemiology and Environmental Health, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - John Andersen
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - David Buckley
- Department of Pediatrics, Janeway Children's Hospital, St. John's, Newfoundland and Labrador, Canada
| | - Darcy Fehlings
- Department of Paediatrics, University of Toronto, Bloorview Research Institute, Toronto, Ontario, Canada
| | - Adam Kirton
- Departments of Pediatrics and Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Louise Koclas
- Department of Pediatrics, Centre de réadaptation Marie Enfant du CHU Sainte-Justine
| | - Nicole Pigeon
- Department of Pediatrics, Centre hospitalier universitaire de Sherbrooke, Sherbrooke, Quebec City, Canada
| | - Esias Van Rensburg
- Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Ellen Wood
- Department of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Michael Shevell
- Department of Pediatrics, McGill University, Montreal, Quebec City, Canada; Department of Neurology & Neurosurgery, McGill University, Montreal, Canada
| | - Maryam Oskoui
- Department of Pediatrics, McGill University, Montreal, Quebec City, Canada; Department of Neurology & Neurosurgery, McGill University, Montreal, Canada.
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11
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Baynam GS, Groft S, van der Westhuizen FH, Gassman SD, du Plessis K, Coles EP, Selebatso E, Selebatso M, Gaobinelwe B, Selebatso T, Joel D, Llera VA, Vorster BC, Wuebbels B, Djoudalbaye B, Austin CP, Kumuthini J, Forman J, Kaufmann P, Chipeta J, Gavhed D, Larsson A, Stojiljkovic M, Nordgren A, Roldan EJA, Taruscio D, Wong-Rieger D, Nowak K, Bilkey GA, Easteal S, Bowdin S, Reichardt JKV, Beltran S, Kosaki K, van Karnebeek CDM, Gong M, Shuyang Z, Mehrian-Shai R, Adams DR, Puri RD, Zhang F, Pachter N, Muenke M, Nellaker C, Gahl WA, Cederroth H, Broley S, Schoonen M, Boycott KM, Posada M. A call for global action for rare diseases in Africa. Nat Genet 2020; 52:21-26. [PMID: 31873296 DOI: 10.1038/s41588-019-0552-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Gareth S Baynam
- Genetic Services of Western Australia, Department of Health, Government of Western Australia, Perth, Western Australia, Australia.,The Western Australian Register of Developmental Anomalies, Department of Health, Government of Western Australia, Perth, Western Australia, Australia.,School of Medicine, Division of Pediatrics; and Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - Stephen Groft
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, USA
| | | | | | | | - Emily P Coles
- Office of Population Health Genomics, Department of Health, Government of Western Australia, Perth, Western Australia, Australia
| | - Eda Selebatso
- Botswana Organization for Rare Diseases (BORDIS), Gaborone, Botswana
| | - Moses Selebatso
- Botswana Organization for Rare Diseases (BORDIS), Gaborone, Botswana
| | | | - Tebogo Selebatso
- Botswana Organization for Rare Diseases (BORDIS), Gaborone, Botswana.,Botswana University of Agriculture and Natural Resources, Gaborone, Botswana
| | - Dipesalema Joel
- Department of Pediatric and Adolescent Medicine, Faculty of Medicine, University of Botswana School of Medicine, Botswana-Baylor Children's Clinical Centre of Excellence and Princess Marina Hospital, Gaborone, Botswana
| | | | - Barend C Vorster
- Laboratory for Inborn Errors of Metabolism (PLIEM), Center for Human Metabolomics (CHM) at the Potchefstroom Campus of the North-West University, Potchefstroom, South Africa
| | - Barbara Wuebbels
- Professional Patient Advocates in the Life Sciences (PPALS), Danbury, CT, USA
| | - Benjamin Djoudalbaye
- Africa Centres for Disease Control and Prevention, African Union Commission, Addis Ababa, Ethiopia
| | - Christopher P Austin
- National Center for Advancing Translational Sciences, National Institutes of Health, Bethesda, MD, USA
| | - Judit Kumuthini
- Centre for Proteomic & Genomic Research, Observatory, Cape Town, South Africa
| | - John Forman
- Unaffiliated rare-disease advocate, Wellington, New Zealand
| | | | - James Chipeta
- University of Zambia School of Medicine, Department of Pediatrics and Child Health, University Teaching Hospitals-Lusaka Children Hospital, Lusaka, Zambia
| | - Désirée Gavhed
- Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institutet, and Karolinska Center for Rare Diseases, Karolinska University Hospital, Stockholm, Sweden
| | | | - Maja Stojiljkovic
- Laboratory for Molecular Biomedicine, Institute of Molecular Genetics and Genetic Engineering (IMGGE), University of Belgrade, Belgrade, Serbia
| | - Ann Nordgren
- Department of Clinical Genetics, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery and Center for Molecular Medicine, Karolina Institutet, Stockholm, Sweden
| | | | - Domenica Taruscio
- National Centre for Rare Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Durhane Wong-Rieger
- Canadian Organization for Rare Disorders, Toronto, Ontario, Canada.,Rare Diseases International, Geneva, Switzerland
| | - Kristen Nowak
- Office of Population Health Genomics, Department of Health, Government of Western Australia, Perth, Western Australia, Australia
| | - Gemma A Bilkey
- Office of Population Health Genomics, Department of Health, Government of Western Australia, Perth, Western Australia, Australia.,Office of the Chief Health Officer, Public and Aboriginal Health Division, Department of Health, Government of Western Australia, Perth, Western Australia, Australia
| | - Simon Easteal
- John Curtin School of Medical Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Sarah Bowdin
- Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, UK
| | - Juergen K V Reichardt
- Australian Institute of Tropical Health and Medicine (AITHM), James Cook University, Smithfield, Queensland, Australia
| | - Sergi Beltran
- Centro Nacional de Análisis Genómico, Centre for Genomic Regulation (CNAG-CRG), Barcelona Institute of Science and Technology, Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Kenjiro Kosaki
- Center for Medical Genetics, Keio University, Tokyo, Japan
| | - Clara D M van Karnebeek
- Departments of Pediatrics and Clinical Genetics, Emma Children's Hospital, Amsterdam University Medical Centres, University of Amsterdam, Amsterdam, the Netherlands.,Department of Pediatrics, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Mengchun Gong
- National Rare Diseases Registry System of China (NRDRS), Beijing, China
| | - Zhang Shuyang
- Peking Union Medical College Hospital, Beijing, China
| | | | - David R Adams
- Undiagnosed Diseases Program, National Institutes of Health, Bethesda, MD, USA
| | - Ratna D Puri
- Institute of Medical Genetics & Genomics, Sir Ganga Ram Hospital, New Delhi, India
| | - Feng Zhang
- SeekIn. Inc., Yantian, Shenzhen, Guangdong, China
| | - Nicholas Pachter
- Genetic Services of Western Australia, Department of Health, Government of Western Australia, Perth, Western Australia, Australia.,School of Medicine, Division of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.,School of Medicine, Curtin University, Perth, Western Australia, Australia
| | - Maximilian Muenke
- Medical Genetics Branch, National Human Genome Research Institute, National Institutes of Health (NIH), Bethesda, MD, USA
| | - Christoffer Nellaker
- Nuffield Department of Women's and Reproductive Health, University of Oxford, and Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, University of Oxford, Oxford, UK
| | - William A Gahl
- National Human Genome Research Institute and NIH Undiagnosed Diseases Program, National Institutes of Health, Bethesda, MD, USA
| | | | - Stephanie Broley
- Genetic Services of Western Australia, Department of Health, Government of Western Australia, Perth, Western Australia, Australia
| | - Maryke Schoonen
- Mitochondria Research Laboratory, Human Metabolomics, North-West University, Potchefstroom, South Africa
| | - Kym M Boycott
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Manuel Posada
- Instituto de Investigación en Enfermedades Raras & CIBERER, Instituto de Salud Carlos III, Madrid, Spain
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12
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Lin D, Chen J, Lin Z, Li X, Zhang K, Wu X, Liu Z, Huang J, Li J, Zhu Y, Chen C, Zhao L, Xiang Y, Guo C, Wang L, Liu Y, Chen W, Lin H. A practical model for the identification of congenital cataracts using machine learning. EBioMedicine 2020; 51:102621. [PMID: 31901869 PMCID: PMC6948173 DOI: 10.1016/j.ebiom.2019.102621] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 12/29/2022] Open
Abstract
Background Approximately 1 in 33 newborns is affected by congenital anomalies worldwide. We aimed to develop a practical model for identifying infants with a high risk of congenital cataracts (CCs), which is the leading cause of avoidable childhood blindness. Methods This case-control study was performed in the Zhongshan Ophthalmic Center and involved 2005 subjects, including 1274 children with CCs and 731 healthy controls. The CC identification models were established based on birth conditions, family medical history, and family environmental factors using the random forest (RF) and adaptive boosting methods (trained by 1129 CC cases and 609 healthy controls), which were tested by internal 4-fold cross-validation and external validation (145 CC cases and 122 healthy controls). The models were also tested using 4 datasets with gradually reduced proportions of CC patients (bilateral cases) to validate their performance in an approximate simulation of a clinical environment with a relatively low disease prevalence. Findings The CC identification models showed high discrimination in both the 4-fold cross validation (area under the curve (AUC)=0.91 [95% confidence interval: 0.88–0.94] in bilateral cases; 0.82 [0.77–0.89] in unilateral cases) and external validation (AUC=0.93±0.05 in bilateral cases; 0.86±0.01 in unilateral cases), and achieved stable performance in the clinical tests (AUC=0.94–0.96 in the four subgroups by RF). Furthermore, family history of CC, low parental education level, and comorbidity were identified as the top three most relevant factors to both bilateral and unilateral CC diagnosis. Interpretation Our CC identification models can accurately discriminate CC patients from healthy children and have the potential to serve as a complementary screening procedure, especially in undeveloped and remote areas.
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Affiliation(s)
- Duoru Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Jinsui Road #7, Guangzhou, Guangdong 510060, People's Republic of China
| | - Jingjing Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Jinsui Road #7, Guangzhou, Guangdong 510060, People's Republic of China
| | - Zhuoling Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Jinsui Road #7, Guangzhou, Guangdong 510060, People's Republic of China
| | - Xiaoyan Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Jinsui Road #7, Guangzhou, Guangdong 510060, People's Republic of China
| | - Kai Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Jinsui Road #7, Guangzhou, Guangdong 510060, People's Republic of China; School of Computer Science and Technology, Xidian University, Xi'an, Shanxi 710071, People's Republic of China
| | - Xiaohang Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Jinsui Road #7, Guangzhou, Guangdong 510060, People's Republic of China
| | - Zhenzhen Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Jinsui Road #7, Guangzhou, Guangdong 510060, People's Republic of China
| | - Jialing Huang
- School of Public Health, Sun Yat-sen University, Guangzhou, Guangdong 510060, People's Republic of China
| | - Jing Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Jinsui Road #7, Guangzhou, Guangdong 510060, People's Republic of China
| | - Yi Zhu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Jinsui Road #7, Guangzhou, Guangdong 510060, People's Republic of China; Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Chuan Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Jinsui Road #7, Guangzhou, Guangdong 510060, People's Republic of China; Department of Molecular and Cellular Pharmacology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Lanqin Zhao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Jinsui Road #7, Guangzhou, Guangdong 510060, People's Republic of China
| | - Yifan Xiang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Jinsui Road #7, Guangzhou, Guangdong 510060, People's Republic of China
| | - Chong Guo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Jinsui Road #7, Guangzhou, Guangdong 510060, People's Republic of China
| | - Liming Wang
- School of Computer Science and Technology, Xidian University, Xi'an, Shanxi 710071, People's Republic of China
| | - Yizhi Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Jinsui Road #7, Guangzhou, Guangdong 510060, People's Republic of China
| | - Weirong Chen
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Jinsui Road #7, Guangzhou, Guangdong 510060, People's Republic of China.
| | - Haotian Lin
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Jinsui Road #7, Guangzhou, Guangdong 510060, People's Republic of China.
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13
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Goldsmith S, McIntyre S, Hansen M, Badawi N. Congenital Anomalies in Children With Cerebral Palsy: A Systematic Review. J Child Neurol 2019; 34:720-727. [PMID: 31208251 DOI: 10.1177/0883073819854595] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Congenital anomalies are a strong risk factor for cerebral palsy, particularly for children born at term. This systematic review aimed to address gaps in our understanding of the association between congenital anomalies and cerebral palsy. Eight population-based studies (n = 10 081) were identified. Congenital anomalies were reported in 12% to 32% of children with pre/perinatal brain injury and 20% of children with postneonatal brain injury. Variation between studies included study cohort inclusion criteria and the definitions and classification of included anomalies. The most common cerebral anomalies were microcephaly and hydrocephaly, whereas circulatory system anomalies were the most common noncerebral anomalies. The proportion of congenital anomalies was higher in children born at term than preterm. Synthesizing the highest quality data published, this review identified that congenital anomalies are common in cerebral palsy. New collaborative research, addressing sources of variation, is vital to identify pathways to cerebral palsy that include specific congenital anomalies, and explore opportunities for prevention.
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Affiliation(s)
- Shona Goldsmith
- 1 Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Sarah McIntyre
- 1 Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
| | - Michele Hansen
- 2 Telethon Kids Institute, University of Western Australia, West Perth, Western Australia, Australia
| | - Nadia Badawi
- 1 Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, University of Sydney, Sydney, New South Wales, Australia
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14
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Mitchell S, Gomes A, Zelig R, Parker A. Not All Grains Are Created Equal: Gluten-Free Products Not Included in Mandatory Folate Fortification. Curr Dev Nutr 2019; 3:nzz020. [PMID: 31093597 PMCID: PMC6509050 DOI: 10.1093/cdn/nzz020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 02/20/2019] [Accepted: 03/25/2019] [Indexed: 11/14/2022] Open
Abstract
Adequate folate intake during the female reproductive years plays a vital role in fetal neurodevelopment. To address this public health concern, the FDA required enriched cereal grains to be fortified with folic acid. A positive outcome of fortification with folic acid was a reduction in the number of pregnancies affected by neural tube defects (NTDs). However, there are individuals unable to consume these enriched grains, such as those with a gluten allergy or intolerance. The need for folic acid fortification across all grains, those with and without gluten, should be considered in an effort to provide equivalent folic acid to all and further promote public health efforts aimed at decreasing the incidence of NTDs.
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Affiliation(s)
- Stephanie Mitchell
- School of Health Professions, Department of Clinical and Preventive Nutrition Sciences at Rutgers University, Newark, NJ
| | - Allison Gomes
- School of Health Professions, Department of Clinical and Preventive Nutrition Sciences at Rutgers University, Newark, NJ
| | - Rena Zelig
- School of Health Professions, Department of Clinical and Preventive Nutrition Sciences at Rutgers University, Newark, NJ
| | - Anna Parker
- School of Health Professions, Department of Clinical and Preventive Nutrition Sciences at Rutgers University, Newark, NJ
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15
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McCullough N, Dolk H, Loane M, Lagan BM, Casey F, Craig B. The Baby Hearts Study - a case-control methodology with data linkage to evaluate risk and protective factors for congenital heart disease. Int J Popul Data Sci 2019; 4:582. [PMID: 32935022 PMCID: PMC7479919 DOI: 10.23889/ijpds.v4i1.582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction The Baby Hearts study aimed to investigate risk and protective factors for congenital heart disease (CHD), and to investigate the health behaviours of a representative sample of pregnant women in Northern Ireland. Objectives We describe and evaluate the population-based case-control design enhanced with data linkage to administrative health data. Methods Cases (mothers of babies with CHD, n=286) were recruited following diagnosis prenatally or postnatally. Controls (mothers of babies without CHD, n=966) were recruited at 18-22 weeks gestation, from all women attending each maternity unit during a designated month. Hybrid data collection methods were used, including a self-administered iPad/postal questionnaire, and linkage to maternity and prescription records. Results Refusal rates were low (8%). iPad questionnaire completion at clinic or home visit had high acceptability whereas postal questionnaires were poorly returned leading to a further 9-10% loss of eligible cases/controls. In total, 61% of eligible cases and 68% of eligible controls were recruited, closely representative of the Northern Ireland population, with no evidence of selection bias. Of those recruited, 97% gave consent for linkage to medical records. Thirty-three percent of women had an unplanned pregnancy and 76% suspected they were pregnant by 5 weeks gestation, with no significant differences between cases and controls. There was considerable discordance between self-report, maternity and prescription records regarding medications obtained/taken in the first trimester, but no evidence of differences between cases and controls that would indicate substantial recall bias. Although there was high concordance between self-report and maternity records regarding folic acid supplementation, cases had significantly lower concordance than controls. Conclusions Our results suggest hybrid data collection approaches are a useful way forward for aetiological studies to reduce responder burden and address and estimate recall bias, and that the Baby Hearts study protocol is suitable for replication in other populations, modified to the local context.
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Affiliation(s)
- N McCullough
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - H Dolk
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - M Loane
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - B M Lagan
- Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
| | - F Casey
- Paediatric Cardiology Department, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - B Craig
- Paediatric Cardiology Department, Royal Belfast Hospital for Sick Children, Belfast, UK
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16
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Taruscio D, Mantovani A, Salerno P, Granata O. The Italian Registry for congenital anomalies: a tool for surveillance and primary prevention. Reprod Toxicol 2018. [DOI: 10.1016/j.reprotox.2018.06.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Goldsmith S, Garcia Jalon G, Badawi N, Blair E, Garne E, Gibson C, McIntyre S, Scott H, Smithers-Sheedy H, Andersen GL. Comprehensive investigation of congenital anomalies in cerebral palsy: protocol for a European-Australian population-based data linkage study (The Comprehensive CA-CP Study). BMJ Open 2018; 8:e022190. [PMID: 30037879 PMCID: PMC6059266 DOI: 10.1136/bmjopen-2018-022190] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/17/2018] [Accepted: 06/07/2018] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Cerebral palsy (CP), an umbrella term for non-progressive conditions of cerebral origin resulting in motor impairments, is collectively the most common cause of physical disability in childhood. Cerebral and/or non-cerebral congenital anomalies are present in 15%-40% of children with CP. In order to identify effective prevention strategies for this substantial proportion of CP, a comprehensive understanding of the epidemiology of these congenital anomalies is required. International collaboration is needed, as previous attempts have fallen short due to a lack of power, since the anomalies are individually rare and CP comprises many clinical descriptions. The aim of this study is to generate new knowledge about the aetiologies of CP through a focused investigation into the role of congenital anomalies. METHODS AND ANALYSIS This collaborative, population-based data linkage study includes nine geographic regions (six in Europe, three in Australia) served by both congenital anomaly and CP registers. Register data for children with CP (both with and without congenital anomalies) and children with specific congenital anomalies (without CP) born between 1991 and 2009 will be linked and de-identified within each region. The resulting linked data sets will be quality assured, recoded, harmonised and then pooled into one data set. Analysis of the combined data set will include: frequencies/proportions of congenital anomalies and outcomes (type of CP, severity, impairments); descriptive analyses comparing timing of congenital anomaly development and brain injury/abnormality responsible for CP; ORs to calculate the odds of CP following a specific congenital anomaly; and identification of anomalies on causal pathways to CP. ETHICS AND DISSEMINATION Ethics approval for this collaborative study, The Comprehensive CA-CP Study, has been obtained from the Cerebral Palsy Alliance Human Research Ethics Committee (EC00402). Study findings will be disseminated at conferences and published in peer-reviewed journals, and recommendations will be made regarding the collection and classification of congenital anomaly data by CP registers.
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Affiliation(s)
- Shona Goldsmith
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Guiomar Garcia Jalon
- Northern Ireland Cerebral Palsy Register, School of Nursing and Midwifery, Queen’s University Belfast, Royal Group of Hospitals, Belfast, UK
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
- Grace Centre for Newborn Care, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
| | - Eve Blair
- Telethon Kids Institute, University of Western Australia, Perth, Australia
| | - Ester Garne
- Paediatric Department, Hospital Lillebaelt Kolding, Kolding, Denmark
| | - Catherine Gibson
- South Australian Birth Defects Register, Women’s and Children’s Hospital, Women’s and Children’s Health Network, Adelaide, South Australia, Australia
| | - Sarah McIntyre
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Heather Scott
- South Australian Birth Defects Register, Women’s and Children’s Hospital, Women’s and Children’s Health Network, Adelaide, South Australia, Australia
| | - Hayley Smithers-Sheedy
- Cerebral Palsy Alliance Research Institute, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Guro L Andersen
- The Cerebral Palsy Register of Norway, Vestfold Hospital Trust, Tønsberg, Norway
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18
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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: 81] [Impact Index Per Article: 13.5] [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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Boyle B, Addor MC, Arriola L, Barisic I, Bianchi F, Csáky-Szunyogh M, de Walle HEK, Dias CM, Draper E, Gatt M, Garne E, Haeusler M, Källén K, Latos-Bielenska A, McDonnell B, Mullaney C, Nelen V, Neville AJ, O’Mahony M, Queisser-Wahrendorf A, Randrianaivo H, Rankin J, Rissmann A, Ritvanen A, Rounding C, Tucker D, Verellen-Dumoulin C, Wellesley D, Wreyford B, Zymak-Zakutnia N, Dolk H. Estimating Global Burden of Disease due to congenital anomaly: an analysis of European data. Arch Dis Child Fetal Neonatal Ed 2018; 103:F22-F28. [PMID: 28667189 PMCID: PMC5750368 DOI: 10.1136/archdischild-2016-311845] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 03/15/2017] [Accepted: 04/18/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To validate the estimates of Global Burden of Disease (GBD) due to congenital anomaly for Europe by comparing infant mortality data collected by EUROCAT registries with the WHO Mortality Database, and by assessing the significance of stillbirths and terminations of pregnancy for fetal anomaly (TOPFA) in the interpretation of infant mortality statistics. DESIGN, SETTING AND OUTCOME MEASURES EUROCAT is a network of congenital anomaly registries collecting data on live births, fetal deaths from 20 weeks' gestation and TOPFA. Data from 29 registries in 19 countries were analysed for 2005-2009, and infant mortality (deaths of live births at age <1 year) compared with the WHO Mortality Database. Eight EUROCAT countries were excluded from further analysis on the basis that this comparison showed poor ascertainment of survival status. RESULTS According to WHO, 17%-42% of infant mortality was attributed to congenital anomaly. In 11 EUROCAT countries, average infant mortality with congenital anomaly was 1.1 per 1000 births, with higher rates where TOPFA is illegal (Malta 3.0, Ireland 2.1). The rate of stillbirths with congenital anomaly was 0.6 per 1000. The average TOPFA prevalence was 4.6 per 1000, nearly three times more prevalent than stillbirths and infant deaths combined. TOPFA also impacted on the prevalence of postneonatal survivors with non-lethal congenital anomaly. CONCLUSIONS By excluding TOPFA and stillbirths from GBD years of life lost (YLL) estimates, GBD underestimates the burden of disease due to congenital anomaly, and thus declining YLL over time may obscure lack of progress in primary, secondary and tertiary prevention.
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Affiliation(s)
- Breidge Boyle
- EUROCAT: WHO Collaborating Centre for the Surveillance of Congenital Anomalies, University of Ulster, Coleraine, UK,School of Nursing and Midwifery, Queens University Belfast, Belfast, UK
| | | | - Larraitz Arriola
- Registro Anomalías Congénitas CAV Subdirección de Salud Pública Av Navarra, San Sebastian, Spain
| | - Ingeborg Barisic
- Children’s Hospital Zagreb, School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | - Melinda Csáky-Szunyogh
- Hungarian Congenital Abnormality Registry, National Public Health and Medical Officer Service, Budapest, Hungary
| | - Hermien E K de Walle
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Carlos Matias Dias
- Departamento de Epidemiologia, Registo Nacional de Anomalias Congénitas Av Padre Cruz, Lisbon, Portugal
| | - Elizabeth Draper
- Department of Epidemiology Public Health, East Midlands & South Yorkshire (EMSYCAR), University of Leicester, Leicester, UK
| | - Miriam Gatt
- Department of Health Information and Research, Guardamangia, Malta
| | - Ester Garne
- Department of Paediatric, Hospital Lillebaelt, Kolding, Denmark
| | - Martin Haeusler
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Karin Källén
- Swedish National Board of Health and Welfare and Department of Reproduction Epidemiology, Institution of Clinical Sciences, University of Lund, Lund, Sweden
| | | | | | | | - Vera Nelen
- Department of Environment, PIH, Province of Antwerp, Antwerp, Belgium
| | - Amanda J Neville
- Azienda Ospedaliero-Universitaria di Ferrara Corso Giovecca, Ferrara, Italy
| | | | - Annette Queisser-Wahrendorf
- Birth Registry Mainz Model, Children’s Hospital University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Hanitra Randrianaivo
- Register of Reunion Island, Centre Hospitalo-Universitaire, St Pierre La Reunion, Reunion, UK
| | - Judith Rankin
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | - Anke Rissmann
- Malformation Monitoring Centre, Saxony-Anhalt, Medical Faculty Otto-von-Guericke University, Magdeburg, Germany
| | - Annukka Ritvanen
- National Institute for Welfare and Health (THL), Helsinki, Finland
| | | | - David Tucker
- Public Health Wales, Congenital Anomaly Register and Information Service for Wales (CARIS), Swansea, UK
| | - Christine Verellen-Dumoulin
- Centre de Génétique Humaine IPG Institut de Pathologie et de Génétique Avenue G Lemaître, Charleroi, Belgium
| | - Diana Wellesley
- Faculty of Medicine, University of Southampton and Wessex Clinical Genetics Service, Southampton, UK
| | - Ben Wreyford
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - Natalia Zymak-Zakutnia
- Khmelnytsky Perinatal Center, OMNI-Net Ukraine Birth Defects Program, Khmelnytsky, Ukraine
| | - Helen Dolk
- EUROCAT: WHO Collaborating Centre for the Surveillance of Congenital Anomalies, University of Ulster, Coleraine, UK
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20
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Mateus HE, Pérez AM, Mesa ML, Escobar G, Gálvez JM, Montaño JI, Ospina ML, Laissue P. A first description of the Colombian national registry for rare diseases. BMC Res Notes 2017; 10:514. [PMID: 29073918 PMCID: PMC5659024 DOI: 10.1186/s13104-017-2840-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 10/23/2017] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Orphan diseases must be considered a public health concern, underlying country-specific challenges for their accurate and opportune diagnosis, classification and management. Orphan disease registries have not yet been created in South America, a continent having a population of ~ 415 million inhabitants. In Colombia ~ 3 million of patients are affected by rare diseases. The aim of the present study was to establish the first Colombian national registry for rare diseases. The registry was created after the establishment of laws promoting the development of clinical guidelines for diagnosis, management, census and registry of patients suffering rare diseases. RESULTS In total, 13,215 patients were recorded in the Colombian registry. The survey reported 653 rare diseases. The most common diseases were congenital factor VIII deficiency (hemophilia A) (8.5%), myasthenia gravis (6.4%), von Willebrand disease (5.9%), short stature due to growth hormone qualitative anomaly (4.2%), bronchopulmonary dysplasia (3.9%) and cystic fibrosis (3.2%). Although, a marked under-reporting of cases was observed, some pathologies displayed similar behavior to that reported by other initiatives and databases. The data currently available in the registry provides a baseline for improvement regarding local and regional surveys and the start for better understanding rare diseases in Colombia.
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Affiliation(s)
- Heidi Eliana Mateus
- Center For Research in Genetics and Genomics-CIGGUR, GENIUROS Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63C-69, Bogotá, Colombia
| | - Ana María Pérez
- Center For Research in Genetics and Genomics-CIGGUR, GENIUROS Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63C-69, Bogotá, Colombia
| | | | - Germán Escobar
- Ministerio de Salud y Protección Social, Bogotá, Colombia
| | - Jubby Marcela Gálvez
- Center For Research in Genetics and Genomics-CIGGUR, GENIUROS Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63C-69, Bogotá, Colombia
| | | | | | - Paul Laissue
- Center For Research in Genetics and Genomics-CIGGUR, GENIUROS Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63C-69, Bogotá, Colombia.
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21
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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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22
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Primary Prevention of Congenital Anomalies: Special Focus on Environmental Chemicals and other Toxicants, Maternal Health and Health Services and Infectious Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1031:301-322. [PMID: 29214580 DOI: 10.1007/978-3-319-67144-4_18] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Congenital anomalies (CA) represent an important fraction of rare diseases, due to the critical role of non-genetic factors in their pathogenesis. CA are the main group of rare diseases in which primary prevention measures will have a beneficial impact. Indeed, since 2013 the European Union has endorsed a body of evidence-based recommendations for CA primary prevention; the recommendations aim at facilitating the inclusion of primary prevention actions the National Rare Disease Plans of EU Member States and encompass different public health fields, from environment through to maternal diseases and lifestyles.The chapter overviews and discusses the assessment of main risk factors for CA, such as environmental toxicants, maternal health and lifestyles and infections, with a special attention to issues that are emerging or need more knowledge.Overall, the availability of CA registries is important for estimating the health burden of CA, identifying possible hotspots, assessing the impact of interventions and addressing further, fit-to-purpose research.The integration of relevant public health actions that are already in place (e.g., control of noxious chemicals, vaccination programmes, public health services addressing chronic maternal conditions) can increase the affordability and sustainability of CA primary prevention. In developing countries with less primary prevention in place and limited overall resources, a first recognition phase may be pivotal in order to identify priority targets. In the meanwhile, policy makers should be made aware that primary prevention of RD supports publicly endorsed societal values like the knowledge-based promotion of health, empowerment, equity and social inclusiveness.
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23
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Mantovani A, Baldi F. The Food in Pregnancy Decalogue: Ten suggestions to protect the unborn child launched at EXPO 2015. Reprod Toxicol 2016. [DOI: 10.1016/j.reprotox.2016.06.084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Ram D, Gowdappa B, Ashoka HG, Eiman N. Psychopharmacoteratophobia: Excessive fear of malformation associated with prescribing psychotropic drugs during pregnancy: An Indian perspective. Indian J Pharmacol 2016; 47:484-90. [PMID: 26600635 PMCID: PMC4621667 DOI: 10.4103/0253-7613.165186] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
“Psychopharmacoteratophobia is the fear or avoidance of prescribing psychotropic medicine to a pregnant woman on a given indication in anticipation of fetal malformation.” It is rooted in the tragedy associated with thalidomide use and is increasing due to the inability to predict accurately, strict legal provision of consumer protection, ethical and legal issues involved, and pitfalls in the available evidence of teratogenicity. In the Indian setting, the physicians face more challenges as the majority of the patients may ask them to decide, what is the best for their health. Most guidelines emphasize more on what not to do than what to do, and the locus of decision is left to the doctor and the patient. In this review, we have focused on relevant issues related to psychopharmacoteraophobia that may be helpful to understand this phenomenon and help to address the deprivation of a mentally ill woman from the required treatment.
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Affiliation(s)
- Dushad Ram
- Department of Psychiatry, JSS Medical College, JSS University, Mysore, Karnataka, India
| | - Basavnna Gowdappa
- Department of Medicine, JSS Medical College, JSS University, Mysore, Karnataka, India
| | - H G Ashoka
- Department of Medicine, JSS Medical College, JSS University, Mysore, Karnataka, India
| | - Najla Eiman
- Department of Psychiatry, JSS Medical College, JSS University, Mysore, Karnataka, India
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25
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McIntyre S, Blair E, Goldsmith S, Badawi N, Gibson C, Scott H, Smithers-Sheedy H. Congenital anomalies in cerebral palsy: where to from here? Dev Med Child Neurol 2016; 58 Suppl 2:71-5. [PMID: 26762782 DOI: 10.1111/dmcn.13015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2015] [Indexed: 11/29/2022]
Abstract
Proportions of cases of cerebral palsy (CP) with congenital anomalies recorded in Australian CP registers range from 15% to 40%. The anomalies seen in CP are extremely variable. We have identified that CP registers often do not have quality data on congenital anomalies, necessitating linkage with congenital anomaly registers. However, a lack of unified processes and definitions in congenital anomaly registers and data collections means that linkages are complex, need to be carefully planned, and limitations acknowledged. Historically in CP research, congenital anomalies have been classified by International Classification of Disease codes, then combined into brain and other major and minor anomalies. Systems have been developed to classify congenital anomalies into aetiologically related groups, but such a classification has yet to be trialled in CP. It is anticipated that primary prevention of a small proportion of cases of CP is possible through the primary prevention of congenital anomalies, especially those due to teratogens. Owing to the anticipated low prevalence of each subgroup, global collaboration will be required to further these lines of enquiry.
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Affiliation(s)
- Sarah McIntyre
- Cerebral Palsy Alliance, The University of Sydney, Sydney, NSW, Australia.,Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Eve Blair
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia
| | - Shona Goldsmith
- Cerebral Palsy Alliance, The University of Sydney, Sydney, NSW, Australia
| | - Nadia Badawi
- Cerebral Palsy Alliance, The University of Sydney, Sydney, NSW, Australia.,Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.,Grace Centre for Newborn Care, Sydney Children's Hospital Network, Sydney, NSW, Australia
| | - Catherine Gibson
- South Australian Birth Defects Register, Women's and Children's Hospital, Women's and Children's Health Network, Adelaide, SA, Australia
| | - Heather Scott
- South Australian Birth Defects Register, Women's and Children's Hospital, Women's and Children's Health Network, Adelaide, SA, Australia
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26
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Gatt M, England K, Grech V, Calleja N. Contribution of Congenital Anomalies to Neonatal Mortality Rates in Malta. Paediatr Perinat Epidemiol 2015; 29:401-6. [PMID: 26123698 DOI: 10.1111/ppe.12206] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Neonatal mortality is a public health concern, and congenital anomalies contribute significantly to this mortality. This paper describes trends in neonatal mortality in Malta separately for congenital anomaly and non-congenital anomaly causes. METHODS Data for neonatal deaths of 22-week gestation onwards registered between 1994-2013 were obtained from the National Mortality Register. Chi-square tests were used to analyse 5-year time trends and differences in proportions of causes of neonatal deaths. Neonatal mortality was compared with other European countries. RESULTS Between 1994 and 2013, 441 neonatal deaths and 84 821 livebirths were registered, giving a neonatal mortality of 5.2 per 1000 livebirths. Congenital anomalies accounted for 36.7% (n = 162) of the neonatal deaths, while the remaining 63.3% (n = 279) were attributed to non-congenital causes. During the 20-year period, neonatal mortality due to non-congenital causes decreased from 4.6 per 1000 livebirths in 1994-98 to 2.5 per 1000 in 2009-13, while that due to congenital anomalies remained stable (2.0 per 1000 livebirths in 1994-98 and 2.2 per 1000 in 2009-13). This has resulted in comparatively higher proportions of neonatal deaths attributed to congenital anomalies in recent years (45.9% in 2009-13 vs. 29.9% in 1994-98). Comparing neonatal mortality reported from European countries, Malta has a high rate most marked for deaths due to congenital anomalies. CONCLUSIONS During 1994-2013, neonatal mortality has decreased due to a decline of non-congenital causes of death, possibly related to improved health care. The proportionate neonatal mortality attributed to congenital anomalies has increased and is the highest reported from Europe. This may be explained by the fact that termination of pregnancy is illegal in Malta.
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Affiliation(s)
- Miriam Gatt
- Directorate for Health Information and Research, Malta
| | | | - Victor Grech
- Academic Department of Paediatrics, Medical School, Mater Dei Hospital, Malta
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27
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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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28
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Taruscio D, Mantovani A, Carbone P, Barisic I, Bianchi F, Garne E, Nelen V, Neville AJ, Wellesley D, Dolk H. Primary prevention of congenital anomalies: recommendable, feasible and achievable. Public Health Genomics 2015; 18:184-91. [PMID: 25791968 DOI: 10.1159/000379739] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 02/06/2015] [Indexed: 11/19/2022] Open
Abstract
Primary prevention of congenital anomalies was identified as an important action in the field of rare diseases by the European Commission in 2008, but it was not included in the Council Recommendation on an action in the field of rare diseases in 2009. However, primary prevention of congenital anomalies is feasible because scientific evidence points to several risk factors (e.g., obesity, infectious and toxic agents) and protective factors (e.g., folic acid supplementation and glycemic control in diabetic women). Evidence-based community actions targeting fertile women can be envisaged, such as risk-benefit evaluation protocols on therapies for chronic diseases, vaccination policies, regulations on workplace and environmental exposures as well as the empowerment of women in their lifestyle choices. A primary prevention plan can identify priority targets, exploit and integrate ongoing actions and optimize the use of resources, thus reducing the health burden for the new generation. The EUROCAT-EUROPLAN recommendations for the primary prevention of congenital anomalies endorsed in 2013 by the European Union Committee of Experts on Rare Diseases present an array of feasible and evidence-based measures from which national plans can adopt and implement actions based on country priorities. Primary prevention of congenital anomalies can be achieved here and now and should be an integral part of national plans on rare diseases.
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Affiliation(s)
- Domenica Taruscio
- National Center for Rare Diseases, Istituto Superiore di Sanità, Rome, Italy
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