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Morris JK, Bergman JEH, Barisic I, Wellesley D, Tucker D, Limb E, Addor MC, Cavero-Carbonell C, Matias Dias C, Draper ES, Echevarría-González-de-Garibay LJ, Gatt M, Klungsøyr K, Lelong N, Luyt K, Materna-Kiryluk A, Nelen V, Neville A, Perthus I, Pierini A, Randrianaivo-Ranjatoelina H, Rankin J, Rissmann A, Rouget F, Sayers G, Wertelecki W, Kinsner-Ovaskainen A, Garne E. Surveillance of multiple congenital anomalies; searching for new associations. Eur J Hum Genet 2024; 32:407-412. [PMID: 38052905 PMCID: PMC10999451 DOI: 10.1038/s41431-023-01502-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 10/09/2023] [Accepted: 11/16/2023] [Indexed: 12/07/2023] Open
Abstract
Many human teratogens are associated with a spectrum of congenital anomalies rather than a single defect, and therefore the identification of congenital anomalies occurring together more frequently than expected may improve the detection of teratogens. Thirty-two EUROCAT congenital anomaly registries covering 6,599,765 births provided 123,566 cases with one or more major congenital anomalies (excluding chromosomal and genetic syndromes) for the birth years 2008-2016. The EUROCAT multiple congenital anomaly algorithm identified 8804 cases with two or more major congenital anomalies in different organ systems, that were not recognized as part of a syndrome or sequence. For each pair of anomalies, the odds of a case having both anomalies relative to having only one anomaly was calculated and the p value was estimated using a two-sided Fisher's exact test. The Benjamini-Hochberg procedure adjusted p values to control the false discovery rate and pairs of anomalies with adjusted p values < 0.05 were identified. A total of 1386 combinations of two anomalies were analyzed. Out of the 31 statistically significant positive associations identified, 20 were found to be known associations or sequences already described in the literature and 11 were considered "potential new associations" by the EUROCAT Coding and Classification Committee. After a review of the literature and a detailed examination of the individual cases with the anomaly pairs, six pairs remained classified as new associations. In summary, systematically searching for congenital anomalies occurring together more frequently than expected using the EUROCAT database is worthwhile and has identified six new associations that merit further investigation.
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Affiliation(s)
- Joan K Morris
- Population Health Research Institute, St George's, University of London, London, UK.
| | - Jorieke E H Bergman
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ingeborg Barisic
- Children's Hospital Zagreb, Centre of Excellence for Reproductive and Regenerative Medicine, Medical School University of Zagreb, Zagreb, Croatia
| | - Diana Wellesley
- Clinical Genetics, University of Southampton and Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, UK
| | - David Tucker
- Congenital Anomaly Register & Information Service for Wales (CARIS) Public Health Knowledge and Research, Public Health Wales, Swansea, Wales, UK
| | - Elizabeth Limb
- Population Health Research Institute, St George's, University of London, London, UK
| | - Marie-Claude Addor
- Department of Woman-Mother-Child, University Medical Center CHUV, Lausanne, Switzerland
| | - Clara Cavero-Carbonell
- Rare Diseases Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, Valencia, Spain
| | - Carlos Matias Dias
- Epidemiology Department, National Institute of Health Doutor Ricardo Jorge, Lisboa, Portugal
| | - Elisabeth S Draper
- Department of Population Health Sciences, Georg Davies Centre, University of Leicester, Leicester, UK
| | | | - Miriam Gatt
- Malta Congenital Anomalies Registry, Directorate for Health Information and Research, Guardamangia, Malta
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Nathalie Lelong
- Université Paris Cité, CRESS, Équipe de recherche en épidémiologie obstétricale périnatale et pédiatrique (EPOPé), INSERM, INRA, Paris, France
| | - Karen Luyt
- South West Congenital Anomaly Register, Bristol Medical School, University of Bristol, Bristol, UK
| | - Anna Materna-Kiryluk
- Polish Registry of Congenital Malformations, Chair and Department of Medical Genetics, University of Medical Sciences, 61-701, Poznan, Poland
| | - Vera Nelen
- Provincial Institute for Hygiene, Antwerp, Belgium
| | - Amanda Neville
- Center for Clinical and Epidemiological Research, University of Ferrara, Ferrara, Italy
| | - Isabelle Perthus
- Auvergne Registry of Congenital Anomalies (CEMC-Auvergne), Department of Clinical Genetics, Centre de Référence des Maladies Rares, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France
| | - Anna Pierini
- Unit of Epidemiology of Rare diseases and Congenital anomalies, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | | | - Judith Rankin
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty Otto-von-Guericke University-Magdeburg, Magdeburg, Germany
| | - Florence Rouget
- Brittany Registry of Congenital Anomalies, CHU Rennes, Univ Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000, Rennes, France
| | - Geraldine Sayers
- Health Intelligence, Research and Development Health Service Executive, Dublin, Ireland
| | | | | | - Ester Garne
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
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Schaffer KE, Chambers CD, Garfein RS, Wertelecki W, Bandoli G. Breastfeeding and neurodevelopment in infants with prenatal alcohol exposure. Pediatr Res 2024; 95:819-826. [PMID: 37845525 DOI: 10.1038/s41390-023-02848-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Few studies have evaluated the differential benefits of breastfeeding on infant neurodevelopment at varying levels of prenatal alcohol exposure (PAE). This study examined whether the association between breastfeeding and neurodevelopment is modified by prenatal drinking pattern. METHODS The study included 385 infants from Ukraine born to women prospectively enrolled in a cohort study during pregnancy. Neurodevelopment was assessed at six and 12 months using the Bayley Scales of Infant Development II (BSID-II) Mental Developmental Index (MDI) and Psychomotor Developmental Index (PDI). Linear regression modeling with interaction terms and stratification by PAE group was used to determine the relationship between breastfeeding, PAE, and neurodevelopment. RESULTS A significant interaction between PAE and breastfeeding was observed for the MDI and PDI at six and 12 months. Infants with high PAE who were breastfed at least four months had BSID-II scores 14 or more points higher compared to those never breastfed. Counterintuitively, those with moderate PAE had poorer performance on the BSID-II at 12 months when breastfed longer. CONCLUSION There was a significant joint effect of PAE and breastfeeding on infant neurodevelopment at six and 12 months. Breastfeeding may provide distinct benefits to infants exposed to high levels of PAE. IMPACT We found a positive effect of breastfeeding on infant neurodevelopment among infants with prenatal alcohol exposure (PAE), particularly those exposed to higher levels during gestation. This study is one of the first to evaluate whether breastfeeding mitigates harm caused by PAE. Breastfeeding may provide distinct benefits to infants with higher levels of PAE.
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Affiliation(s)
- Kristen E Schaffer
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Christina D Chambers
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Richard S Garfein
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA
| | - Wladimir Wertelecki
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
- Omni-Net for Children International Charitable Fund and Rivne Regional Medical Diagnostic Center, Rivne, Ukraine
- Omni-Net for Children International Charitable Fund and Khmelnytsky Perinatal Center, Khmelnytsky, Ukraine
| | - Gretchen Bandoli
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, La Jolla, CA, USA.
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA.
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Bandoli G, Coles C, Kable J, Jones KL, Wertelecki W, Yevtushok L, Zymak-Zakutnya N, Granovska I, Plotka L, Chambers C. Predicting fetal alcohol spectrum disorders in preschool-aged children from early life factors. Alcohol Clin Exp Res (Hoboken) 2024; 48:122-131. [PMID: 38206285 PMCID: PMC10786333 DOI: 10.1111/acer.15233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/01/2023] [Accepted: 11/14/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Early life factors, including parental sociodemographic characteristics, pregnancy exposures, and physical and neurodevelopmental features measured in infancy are associated with fetal alcohol spectrum disorders (FASD). The objective of this study was to evaluate the performance of a classifier model for diagnosing FASD in preschool-aged children from pregnancy and infancy-related characteristics. METHODS We analyzed a prospective pregnancy cohort in Western Ukraine enrolled between 2008 and 2014. Maternal and paternal sociodemographic factors, maternal prenatal alcohol use and smoking behaviors, reproductive characteristics, birth outcomes, infant alcohol-related dysmorphic and physical features, and infant neurodevelopmental outcomes were used to predict FASD. Data were split into separate training (80%: n = 245) and test (20%: n = 58; 11 FASD, 47 no FASD) datasets. Training data were balanced using data augmentation through a synthetic minority oversampling technique. Four classifier models (random forest, extreme gradient boosting [XGBoost], logistic regression [full model] and backward stepwise logistic regression) were evaluated for accuracy, sensitivity, and specificity in the hold-out sample. RESULTS Of 306 children evaluated for FASD, 61 had a diagnosis. Random forest models had the highest sensitivity (0.54), with accuracy of 0.86 (95% CI: 0.74, 0.94) in hold-out data. Boosted gradient models performed similarly, however, sensitivity was less than 50%. The full logistic regression model performed poorly (sensitivity = 0.18 and accuracy = 0.65), while stepwise logistic regression performed similarly to the boosted gradient model but with lower specificity. In a hold-out sample, the best performing algorithm correctly classified six of 11 children with FASD, and 44 of 47 children without FASD. CONCLUSIONS As early identification and treatment optimize outcomes of children with FASD, classifier models from early life characteristics show promise in predicting FASD. Models may be improved through the inclusion of physiologic markers of prenatal alcohol exposure and should be tested in different samples.
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Affiliation(s)
| | | | | | | | - Wladimir Wertelecki
- Department of Pediatrics, University of California San Diego
- OMNI-Net Ukraine Birth Defects Program
| | - Lyubov Yevtushok
- OMNI-Net Ukraine Birth Defects Program
- Rivne Regional Medical Diagnostic Center, Rivne, Ukraine
- Lviv National Medical University, Lviv, Ukraine
| | - Natalya Zymak-Zakutnya
- OMNI-Net Ukraine Birth Defects Program
- Khmelnytsky Perinatal Center, Khmelnytsky, Ukraine
| | - Iryna Granovska
- OMNI-Net Ukraine Birth Defects Program
- Rivne Regional Medical Diagnostic Center, Rivne, Ukraine
| | - Larysa Plotka
- OMNI-Net Ukraine Birth Defects Program
- Rivne Regional Medical Diagnostic Center, Rivne, Ukraine
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Claridge H, Tan J, Loane M, Garne E, Barisic I, Cavero-Carbonell C, Dias C, Gatt M, Jordan S, Khoshnood B, Kiuru-Kuhlefelt S, Klungsoyr K, Mokoroa Carollo O, Nelen V, Neville AJ, Pierini A, Randrianaivo H, Rissmann A, Tucker D, de Walle H, Wertelecki W, Morris JK. Ethics and legal requirements for data linkage in 14 European countries for children with congenital anomalies. BMJ Open 2023; 13:e071687. [PMID: 37500278 PMCID: PMC10387628 DOI: 10.1136/bmjopen-2023-071687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION Linking healthcare data sets can create valuable resources for research, particularly when investigating rare exposures or outcomes. However, across Europe, the permissions processes required to access data can be complex. This paper documents the processes required by the EUROlinkCAT study investigators to research the health and survival of children with congenital anomalies in Europe. METHODS Eighteen congenital anomaly registries in 14 countries provided information on all the permissions required to perform surveillance of congenital anomalies and to link their data on live births with available vital statistics and healthcare databases for research. Small number restrictions imposed by data providers were also documented. RESULTS The permissions requirements varied substantially, with certain registries able to conduct congenital anomaly surveillance as part of national or regional healthcare provision, while others were required to obtain ethics approvals or informed consent. Data linkage and analysis for research purposes added additional layers of complexity for registries, with some required to obtain several permissions, including ethics approvals to link the data. Restrictions relating to small numbers often resulted in a registry's data on specific congenital anomalies being unusable. CONCLUSION The permissions required to obtain and link data on children with congenital anomalies varied greatly across Europe. The variation and complexity present a significant obstacle to the use of such data, especially in large data linkage projects. Furthermore, small number restrictions severely limited the research that could be performed for children with specific rare congenital anomalies.
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Affiliation(s)
- Hugh Claridge
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Joachim Tan
- Population Health Research Institute, St George's, University of London, London, UK
| | - Maria Loane
- Faculty of Life and Health Sciences, Ulster University, Belfast, UK
| | - Ester Garne
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
| | - Ingeborg Barisic
- Children's Hospital Zagreb, Centre of Excellence for Reproductive and Regenerative Medicine, Medical School University of Zagreb, Zagreb, Croatia
| | - Clara Cavero-Carbonell
- Rare Diseases Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain
| | - Carlos Dias
- Epidemiology Department, National Registry of Congenital Anomalies, National Institute of Health Doctor Ricardo Jorge (Instituto Nacional de Saúde Doutor Ricardo Jorge), Lisbon, Portugal
| | - Miriam Gatt
- Malta Congenital Anomalies Registry, Directorate for Health Information and Research, Pieta, Malta
| | - Susan Jordan
- Faculty of Medicine, Health and Life Sciences, Swansea University, Swansea, UK
| | - Babak Khoshnood
- Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Center of Research in Epidemiology and Statistics (CRESS), Institut National de la Santé et de la Recherche Médicale (INSERM), INRA, Université de Paris, Paris, France
| | | | - Kari Klungsoyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Divison of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Olatz Mokoroa Carollo
- Public Health Division of Gipuzkoa, BioDonostia Health Research Institute, San Sebastian, Spain
| | - Vera Nelen
- Provincial Institute for Hygiene, Antwerp, Belgium
| | - Amanda J Neville
- Registro IMER, University of Ferrara, Ferrara, Emilia-Romagna, Italy
| | - Anna Pierini
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Hanitra Randrianaivo
- Register of Congenital Malformations, Centre Hospitalier Universitaire de La Réunion, Île de la Réunion, France
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
| | - David Tucker
- Public Health Wales National Health Service Trust, Cardiff, UK
| | - Hermien de Walle
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Joan K Morris
- Population Health Research Institute, St George's, University of London, London, UK
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5
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Goldrick NM, Revie G, Groisman B, Hurtado-Villa P, Sipek A, Khoshnood B, Rissmann A, Dastgiri S, Landau D, Tagliabue G, Pierini A, Gatt M, Mutchinick OM, Martínez L, de Walle HE, Szabova E, Camelo JL, Källén K, Morgan M, Wertelecki W, Nance A, Stallings EB, Nembhard WN, Mossey P. A multi-program analysis of cleft lip with cleft palate prevalence and mortality using data from 22 International Clearinghouse for Birth Defects Surveillance and Research programs, 1974-2014. Birth Defects Res 2023; 115:980-997. [PMID: 37186369 PMCID: PMC10405782 DOI: 10.1002/bdr2.2176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/16/2023] [Accepted: 03/31/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Cleft lip with cleft palate (CLP) is a congenital condition that affects both the oral cavity and the lips. This study estimated the prevalence and mortality of CLP using surveillance data collected from birth defect registries around the world. METHODS Data from 22 population- and hospital-based surveillance programs affiliated with the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR) in 18 countries on live births (LB), stillbirths (SB), and elective terminations of pregnancy for fetal anomaly (ETOPFA) for CLP from 1974 to 2014 were analyzed. Prevalence and survival (survival for LB only) estimates were calculated for total and subclassifications of CLP and by pregnancy outcome. RESULTS The pooled prevalence of total CLP cases was 6.4 CLP per 10,000 births. The prevalence of CLP and all of the pregnancy outcomes varied across programs. Higher ETOPFA rates were recorded in most European programs compared to programs in other continents. In programs reporting low ETOPFA rates or where there was no ascertainment of ETOPFA, the rate of CLP among LB and SB was higher compared to those where ETOPFA rates were ascertained. Overall survival for total CLP was 91%. For isolated CLP, the survival was 97.7%. CLP associated with multiple congenital anomalies had an overall survival of 77.1%, and for CLP associated with genetic/chromosomal syndromes, overall survival was 40.9%. CONCLUSIONS Total CLP prevalence reported in this study is lower than estimates from prior studies, with variation by pregnancy outcomes between programs. Survival was lower when CLP was associated with other congenital anomalies or syndromes compared to isolated CLP.
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Affiliation(s)
| | - Gavin Revie
- School of Dentistry, University of Dundee, Dundee, Scotland, UK
| | - Boris Groisman
- National Network of Congenital Anomalies of Argentina (RENAC), National Institute of Epidemiology (INE), ANLIS, National Ministry of Health, National Center of Medical Genetics, Ciudad de Buenos Aires, Argentina
| | - Paula Hurtado-Villa
- Facultad de Ciencias de la Salud, Pontificia Universidad Javeriana, Cali, Colombia
| | - Antonin Sipek
- Department of Medical Genetics, Thomayer University Hospital, Prague, Czech Republic
| | - Babak Khoshnood
- Université Paris Cité, Inserm, INRAE, Centre for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team, EPOPé, Paris, France
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Saeed Dastgiri
- Tabriz Health Services Management Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Danielle Landau
- Israel Birth Defects Surveillance Program, NICU Soroka University Medical Center, Beer Sheva, Israel
| | - Giovanna Tagliabue
- Cancer Registry Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Lombardy birth defects registry, Lombardy, Italy
| | - Anna Pierini
- Institute of Clinical Physiology, National Research Council and Fondazione Toscana Gabriele Monasterio, Tuscany Registry of Congenital Defects, Pisa, Italy
| | - Miriam Gatt
- Malta Congenital Anomalies Registry, Directorate for Health Information and Research, Tal-Pietà, Malta
| | - Osvaldo M. Mutchinick
- Registry and Epidemiological Surveillance of Congenital Malformations (RYVEMCE), National Institute of Medical Sciences and Nutrition, Mexico City, Mexico
| | - Laura Martínez
- Genetics Department University Hospital, Universidad Autonoma de Nuevo Leon, Nuevo Leon, Mexico
| | - Hermein E.K. de Walle
- Department of Genetics, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
| | - Elena Szabova
- Faculty of Public Health, Slovak Medical University, Bratislava, Slovakia
| | - Jorge Lopez Camelo
- ECLAMC: The Latin-American collaborative study of congenital malformations, Centro de Educacion Médica e Investigaciones Clínicas (CEMIC-CONICET), Buenos Aires, Argentina
| | | | - Karin Källén
- Institute of Clinical Sciences, Lund University and National Board of Health and Welfare, Lund, Sweden
| | - Margery Morgan
- Congenital anomaly register and information service, Public Health Wales, Cardiff, Wales, UK
| | | | - Amy Nance
- Utah Department of Health, Utah Birth Defect Network, Salt Lake City, Utah, USA
| | - Erin B. Stallings
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Development Disabilities, US Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Wendy N. Nembhard
- Department of Epidemiology and The Arkansas Reproductive Health Monitoring System, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Peter Mossey
- School of Dentistry, University of Dundee, Dundee, Scotland, UK
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Kancherla V, Sundar M, Lucita T, Lux A, Bakker MK, Bergman JEH, Bermejo-Sánchez E, Canfield MA, Dastgiri S, Feldkamp ML, Gatt M, Groisman B, Hurtado-Villa P, Kallen K, Landau D, Lelong N, Lopez-Camelo J, Martinez LE, Mastroiacovo P, Morgan M, Mutchinick OM, Nance AE, Nembhard WN, Pierini A, Sipek A, Stallings EB, Szabova E, Tagliabue G, Wertelecki W, Zarante I, Rissmann A. Prevalence and mortality among children with anorectal malformation: A multi-country analysis. Birth Defects Res 2023; 115:390-404. [PMID: 36401554 PMCID: PMC9898144 DOI: 10.1002/bdr2.2129] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 10/04/2022] [Accepted: 11/02/2022] [Indexed: 11/21/2022]
Abstract
PURPOSE We examined the total prevalence, trends in prevalence, and age-specific mortality among individuals with anorectal malformation (ARM) METHODS: We conducted a retrospective cohort study using data from 24 population- and hospital-based birth defects surveillance programs affiliated with the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR) from 18 countries and for births from 1974 to 2014. We estimated pooled and program-specific total prevalence per 10,000 total births. Poisson regression was used to assess time trends in prevalence from 2001 to 2012 when most programs contributed data. We calculated selected age-specific proportions of deaths, stratified by case status RESULTS: The pooled total prevalence of ARM was 3.26 per 10,000 total births (95% Confidence Interval = 3.19, 3.32) for birth years 1974-2014. About 60% of cases were multiple or syndromic. Prevalence of multiple, syndromic, and stillborn cases decreased from 2001 to 2012. The first week mortality proportion was 12.5%, 3.2%, 28.3%, and 18.2% among all, isolated, multiple, and syndromic cases, respectively CONCLUSIONS: ARM is relatively rare, with multiple and syndromic cases showing decreasing prevalence during the study period. Mortality is a concern during the first week of life, and especially among multiple and syndromic cases. Our descriptive epidemiological findings increase our understanding of geographic variation in the prevalence of ARM and can be used to plan needed clinical services. Exploring factors influencing prevalence and mortality among individuals with ARM could inform future studies.
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Affiliation(s)
- Vijaya Kancherla
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Manasvi Sundar
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Tandaki Lucita
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty, Otto-von-Guericke-University, Magdeburg, Germany
| | - Anke Lux
- Institute for Biometrics and Medical Informatics, Medical Faculty, Otto-von-Guericke-University, Magdeburg, Germany
| | - Marian K Bakker
- Department of Genetics, University of Groningen, University Medical Center Groningen, Eurocat Northern Netherlands, Groningen, The Netherlands
| | - Jorieke EH Bergman
- Department of Genetics, University of Groningen, University Medical Center Groningen, Eurocat Northern Netherlands, Groningen, The Netherlands
| | - Eva Bermejo-Sánchez
- ECEMC (Spanish Collaborative Study of Congenital Malformations), UIAC (Unidad de Investigación sobre Anomalías Congénitas), Instituto de Investigación de Enfermedades Raras (IIER), Instituto de Salud Carlos III, Madrid, Spain
| | - Mark A. Canfield
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas, USA
| | - Saeed Dastgiri
- Tabriz Health Services Management Research Center, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Marcia L. Feldkamp
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Miriam Gatt
- Malta Congenital Anomalies Registry, Directorate for Health Information and Research, Guardamangia, Malta
| | - Boris Groisman
- National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Administration of Laboratories and Health Institutes (ANLIS), National Ministry of Health, Buenos Aires, Argentina
| | - Paula Hurtado-Villa
- Department of Basic Sciences of Health, School of Health, Pontificia Universidad Javeriana Cali, Cali, Colombia
| | - Kärin Kallen
- National Board of Health and Welfare, Stockholm, Sweden
| | - Danielle Landau
- Department of Neonatology, Soroka Medical Center, Beer-Sheva, Israel
| | - Nathalie Lelong
- Université de Paris, Inserm U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), Paris, France
| | - Jorge Lopez-Camelo
- ECLAMC, Center for Medical Education and Clinical Research (CEMIC-CONICET), Buenos Aires, Argentina
| | - Laura Elia Martinez
- Registro DAN (Registro de Defectos al Nacimiento), Departamento de Genética, Hospital Universitario Dr. José E. González, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Pierpaolo Mastroiacovo
- International Center on Birth Defects, International Clearinghouse for Birth Defects Surveillance and Research, Rome, Italy
| | - Margery Morgan
- CARIS, the Congenital Anomaly Register for Wales, Public Health Wales, Singleton Hospital, Swansea, UK
| | - Osvaldo M. Mutchinick
- RYVEMCE, Department of Genetics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Amy E. Nance
- Utah Department of Health, Bureau of Children with Special Health Care Needs, Utah Birth Defects Network, Salt Lake City, Utah, USA
| | - Wendy N. Nembhard
- Arkansas Center for Birth Defects Research and Prevention and Arkansas Reproductive Health Monitoring System, Fay Boozman College of Public Health, Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Anna Pierini
- Institute of Clinical Physiology, National Research Council and Fondazione Toscana Gabriele Monasterio, Tuscany Registry of Congenital Defects, Pisa, Italy
| | - Antonin Sipek
- Department of Medical Genetics, Thomayer Hospital, Prague, Czech Republic
| | - Erin B. Stallings
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Development Disabilities, US Centers for Disease Control, Atlanta, Georgia, USA
| | - Elena Szabova
- Slovak Teratologic Information Centre (FPH), Slovak Medical University, Bratislava, Slovak Republic
| | - Giovanna Tagliabue
- Cancer Registry Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Lombardy, Italy
| | | | - Ignacio Zarante
- Human Genetics Institute, Pontificia Universidad Javeriana, Bogota, Colombia and Hospital Universitario San Ignacio, Bogota, Colombia
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty, Otto-von-Guericke-University, Magdeburg, Germany
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7
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Bandoli G, Coles C, Kable J, Jones KL, Delker E, Wertelecki W, Yevtushok L, Zymak-Zakutnya N, Granovska I, Plotka L, Chambers C. Alcohol-related dysmorphic features as predictors of neurodevelopmental delay in infants and preschool-aged children: Results from a birth cohort in Ukraine. Alcohol Clin Exp Res 2022; 46:2236-2244. [PMID: 36308058 PMCID: PMC10187054 DOI: 10.1111/acer.14966] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/14/2022] [Accepted: 10/25/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Cardinal and non-cardinal dysmorphic features are associated with prenatal alcohol exposure (PAE); however, their association with neurodevelopment is less clear. The objective of this study was to determine whether alcohol-related dysmorphic features predict neurodevelopmental delay in infants and toddlers. METHODS We analyzed a prospective pregnancy cohort in western Ukraine enrolled between 2008 and 2014. A dysmorphology examination comprising body size and three cardinal and 14 non-cardinal dysmorphic features was performed at approximately 6 to 12 months of age. PAE was self-reported and operationalized as absolute ounces of alcohol per day around the time of conception. Neurodevelopment was assessed at 6 to 12 months with the Bayley Scales of Infant Development-II (BSID-II), and at 3.5 to 4.5 years of age with the Differential Ability Scales-II, the Child Behavior Checklist, and multiple measures that were used to create an executive functioning factor score. We performed logistic regression to predict children's neurodevelopment from dysmorphic features, growth measures, sex, and PAE. RESULTS From an analytic sample of 582 unique children, 566 had BSID-II scores in infancy, and 289 completed the preschool battery. Models with all cardinal and non-cardinal dysmorphic features, growth measures, sex, and PAE performed better than models with subsets of those inputs. In general, models had poor performance classifying delays in infancy (area under the curve (AUC) <0.7) and acceptable performance on preschool-aged outcomes (AUC ~0.75). When the sample was limited to children with moderate-to-high PAE, predictive ability improved on preschool-aged outcomes (AUC 0.76 to 0.89). Sensitivity was relatively low for all models (12% to 63%), although other metrics of performance were higher. CONCLUSION Predictive analysis based on dysmorphic features and measures of growth performed modestly in this sample. As these features are more reliably measured than neurodevelopment at an earlier age, the inclusion of dysmorphic features and measures of growth in predictive models should be further explored and validated in different settings and populations.
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Affiliation(s)
| | | | | | | | - Erin Delker
- Department of Pediatrics, University of California San Diego
| | - Wladimir Wertelecki
- Department of Pediatrics, University of California San Diego
- OMNI-Net Ukraine Birth Defects Program
| | - Lyubov Yevtushok
- OMNI-Net Ukraine Birth Defects Program
- Rivne Regional Medical Diagnostic Center, Rivne, Ukraine
- Lviv National Medical University, Lviv, Ukraine
| | - Natalya Zymak-Zakutnya
- OMNI-Net Ukraine Birth Defects Program
- Khmelnytsky Perinatal Center, Khmelnytsky, Ukraine
| | - Iryna Granovska
- OMNI-Net Ukraine Birth Defects Program
- Rivne Regional Medical Diagnostic Center, Rivne, Ukraine
| | - Larysa Plotka
- OMNI-Net Ukraine Birth Defects Program
- Rivne Regional Medical Diagnostic Center, Rivne, Ukraine
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8
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Aguilar-Rivera M, Kable JA, Yevtushok L, Kulikovsky Y, Zymak-Zakutnya N, Dubchak I, Akhmedzhanova D, Wertelecki W, Chambers C, Coleman TP. Wireless Heart Sensor for Capturing Cardiac Orienting Response for Prediction of Neurodevelopmental Delay in Infants. Sensors (Basel) 2022; 22:9140. [PMID: 36501842 PMCID: PMC9739526 DOI: 10.3390/s22239140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 11/09/2022] [Accepted: 11/18/2022] [Indexed: 06/17/2023]
Abstract
Early identification of infants at risk of neurodevelopmental delay is an essential public health aim. Such a diagnosis allows early interventions for infants that maximally take advantage of the neural plasticity in the developing brain. Using standardized physiological developmental tests, such as the assessment of neurophysiological response to environmental events using cardiac orienting responses (CORs), is a promising and effective approach for early recognition of neurodevelopmental delay. Previous CORs have been collected on children using large bulky equipment that would not be feasible for widespread screening in routine clinical visits. We developed a portable wireless electrocardiogram (ECG) system along with a custom application for IOS tablets that, in tandem, can extract CORs with sufficient physiologic and timing accuracy to reflect the well-characterized ECG response to both auditory and visual stimuli. The sensor described here serves as an initial step in determining the extent to which COR tools are cost-effective for the early screening of children to determine who is at risk of developing neurocognitive deficits and may benefit from early interventions. We demonstrated that our approach, based on a wireless heartbeat sensor system and a custom mobile application for stimulus display and data recording, is sufficient to capture CORs from infants. The COR monitoring approach described here with mobile technology is an example of a desired standardized physiologic assessment that is a cost-and-time efficient, scalable method for early recognition of neurodevelopmental delay.
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Affiliation(s)
- Marcelo Aguilar-Rivera
- Department of Bioengineering, University of California San Diego, La Jolla, CA 92093, USA
| | - Julie A. Kable
- Departments of Psychiatry and Behavioral Science and Pediatrics, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | - Lyubov Yevtushok
- OMNI-Net Ukraine Birth Defects Program, 33028 Rivne, Ukraine
- Post-Graduate Extension Program, Rivne Regional Medical Diagnostic Center, Lviv National Medical University, 79010 Lviv, Ukraine
| | - Yaroslav Kulikovsky
- OMNI-Net Ukraine Birth Defects Program, 33028 Rivne, Ukraine
- Post-Graduate Extension Program, Rivne Regional Medical Diagnostic Center, Lviv National Medical University, 79010 Lviv, Ukraine
| | - Natalya Zymak-Zakutnya
- OMNI-Net Ukraine Birth Defects Program, 33028 Rivne, Ukraine
- Khmelnytsky City Perinatal Center, 29008 Khmelnytskyi, Ukraine
| | - Iryna Dubchak
- OMNI-Net Ukraine Birth Defects Program, 33028 Rivne, Ukraine
- Khmelnytsky City Perinatal Center, 29008 Khmelnytskyi, Ukraine
| | | | | | - Christina Chambers
- Department of Pediatrics, School of Medicine, University of California San Diego, La Jolla, CA 92093, USA
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA 92093, USA
| | - Todd P. Coleman
- Department of Bioengineering, University of California San Diego, La Jolla, CA 92093, USA
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9
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Santoro M, Coi A, Pierini A, Rankin J, Glinianaia SV, Tan J, Reid A, Garne E, Loane M, Given J, Aizpurua A, Astolfi G, Barisic I, Cavero‐Carbonell C, de Walle HEK, Den Hond E, García‐Villodre L, Gatt M, Gissler M, Jordan S, Khoshnood B, Kiuru‐Kuhlefelt S, Klungsøyr K, Lelong N, Lutke R, Mokoroa O, Nelen V, Neville AJ, Odak L, Rissmann A, Scanlon I, Urhoj SK, Wellesley D, Wertelecki W, Yevtushok L, Morris JK. Temporal and geographical variations in survival of children born with congenital anomalies in Europe: A multi-registry cohort study. Paediatr Perinat Epidemiol 2022; 36:792-803. [PMID: 35675091 PMCID: PMC9796712 DOI: 10.1111/ppe.12884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/22/2022] [Accepted: 04/03/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Congenital anomalies are a major cause of perinatal, neonatal and infant mortality. OBJECTIVES The aim was to investigate temporal changes and geographical variation in survival of children with major congenital anomalies (CA) in different European areas. METHODS In this population-based linkage cohort study, 17 CA registries members of EUROCAT, the European network for the surveillance of CAs, successfully linked data on 115,219 live births with CAs to mortality records. Registries estimated Kaplan-Meier survival at 28 days and 5 years of age and fitted Cox's proportional hazards models comparing mortality at 1 year and 1-9 years of age for children born during 2005-2014 with those born during 1995-2004. The hazard ratios (HR) from each registry were combined centrally using a random-effects model. The 5-year survival conditional on having survived to 28 days of age was calculated. RESULTS The overall risk of death by 1 year of age for children born with any major CA in 2005-2014 decreased compared to 1995-2004 (HR 0.68, 95% confidence interval [CI] 0.53, 0.89). Survival at 5 years of age ranged between registries from 97.6% to 87.0%. The lowest survival was observed for the registry of OMNI-Net (Ukraine) (87.0%, 95% CI 86.1, 87.9). CONCLUSIONS Survival of children with CAs improved for births in 2005-2014 compared with 1995-2004. The use of CA registry data linked to mortality data enables investigation of survival of children with CAs. Factors such as defining major CAs, proportion of terminations of pregnancy for foetal anomaly, source of mortality data and linkage methods are important to consider in the design of future studies and in the interpretation of the results on survival of children with CAs.
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Affiliation(s)
- Michele Santoro
- Unit of Epidemiology of Rare diseases and Congenital anomalies, Institute of Clinical PhysiologyNational Research CouncilPisaItaly
| | - Alessio Coi
- Unit of Epidemiology of Rare diseases and Congenital anomalies, Institute of Clinical PhysiologyNational Research CouncilPisaItaly
| | - Anna Pierini
- Unit of Epidemiology of Rare diseases and Congenital anomalies, Institute of Clinical PhysiologyNational Research CouncilPisaItaly
- Fondazione Toscana Gabriele MonasterioPisaItaly
| | - Judith Rankin
- Population Health Sciences Institute, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
| | - Svetlana V. Glinianaia
- Population Health Sciences Institute, Faculty of Medical SciencesNewcastle UniversityNewcastle upon TyneUK
| | - Joachim Tan
- Population Health Research Institute, St George'sUniversity of LondonLondonUK
| | - Abigail Reid
- Population Health Research Institute, St George'sUniversity of LondonLondonUK
| | - Ester Garne
- Paediatric DepartmentHospital LillebaeltKoldingDenmark
| | - Maria Loane
- Faculty of Life and Health SciencesUlster UniversityColeraineUK
| | - Joanne Given
- Faculty of Life and Health SciencesUlster UniversityColeraineUK
| | - Amaia Aizpurua
- Public Health Division of GipuzkoaBioDonostia Research InstituteSan SebastianSpain
| | - Gianni Astolfi
- IMER RegistryDepartment of Neuroscience and RehabilitationUniversity of FerraraFerraraItaly
| | - Ingeborg Barisic
- Children's Hospital Zagreb, Centre of Excellence for Reproductive and Regenerative MedicineMedical School University of ZagrebZagrebCroatia
| | - Clara Cavero‐Carbonell
- Rare Diseases Research UnitFoundation for the Promotion of Health and Biomedical Research in the Valencian RegionValenciaSpain
| | - Hermien E. K. de Walle
- Department of Genetics, University Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | | | - Laura García‐Villodre
- Rare Diseases Research UnitFoundation for the Promotion of Health and Biomedical Research in the Valencian RegionValenciaSpain
| | - Miriam Gatt
- Malta Congenital Anomalies RegistryDirectorate for Health Information and ResearchPietaMalta
| | - Mika Gissler
- THL Finnish Institute for Health and WelfareInformation Services DepartmentHelsinkiFinland
| | - Sue Jordan
- Faculty of Medicine, Health & Life ScienceSwansea UniversitySwanseaUK
| | | | - Sonja Kiuru‐Kuhlefelt
- THL Finnish Institute for Health and WelfareInformation Services DepartmentHelsinkiFinland
| | - Kari Klungsøyr
- Department of Global Public Health and Primary CareUniversity of BergenBergenNorway
- Division of Mental and Physical HealthNorwegian Institute of Public HealthBergenNorway
| | | | - Renée Lutke
- Department of Genetics, University Medical Center GroningenUniversity of GroningenGroningenthe Netherlands
| | - Olatz Mokoroa
- Public Health Division of GipuzkoaBioDonostia Research InstituteSan SebastianSpain
| | - Vera Nelen
- Provincial Institute for HygieneAntwerpBelgium
| | - Amanda J. Neville
- Imer registry Centre for Epidemiology and Clinical Research University of Ferrara and Azienda Ospedaliera Universitaria di FerraraFerraraItaly
| | - Ljubica Odak
- Children's Hospital Zagreb, Centre of Excellence for Reproductive and Regenerative MedicineMedical School University of ZagrebZagrebCroatia
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony‐AnhaltMedical Faculty Otto‐von‐Guericke‐University MagdeburgMagdeburgGermany
| | - Ieuan Scanlon
- Faculty of Medicine, Health & Life ScienceSwansea UniversitySwanseaUK
| | | | - Diana Wellesley
- Faculty of MedicineUniversity of Southampton and Wessex Clinical Genetics Service, Princess Anne HospitalSouthamptonUK
| | | | | | - Joan K. Morris
- Population Health Research Institute, St George'sUniversity of LondonLondonUK
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10
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Kancherla V, Tandaki L, Sundar M, Lux A, Bakker MK, Bergman JEH, Bermejo-Sánchez E, Canfield MA, Feldkamp ML, Groisman B, Hurtado-Villa P, Källén K, Landau D, Lelong N, Lopez-Camelo J, Mastroiacovo P, Morgan M, Mutchinick OM, Nance AE, Nembhard WN, Pierini A, Šípek A, Stallings EB, Szabova E, Wertelecki W, Zarante I, Rissmann A. A Multicountry Analysis of Prevalence and Mortality among Neonates and Children with Bladder Exstrophy. Am J Perinatol 2022:10.1055/s-0042-1748318. [PMID: 35644130 PMCID: PMC9827371 DOI: 10.1055/s-0042-1748318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Bladder exstrophy (BE) is a rare but severe birth defect affecting the lower abdominal wall and genitourinary system. The objective of the study is to examine the total prevalence, trends in prevalence, and age-specific mortality among individuals with BE. STUDY DESIGN We conducted a retrospective cohort study. Data were analyzed from 20 birth defects surveillance programs, members of the International Clearinghouse for Birth Defects Surveillance and Research in 16 countries. Live births, stillbirths, and elective terminations of pregnancy for fetal anomaly (ETOPFA) diagnosed with BE from 1974 to 2014. Pooled and program-specific prevalence of BE per 100,000 total births was calculated. The 95% confidence intervals (CI) for prevalence were estimated using Poisson approximation of binomial distribution. Time trends in prevalence of BE from 2000 to 2014 were examined using Poisson regression. Proportion of deaths among BE cases was calculated on the day of birth, day 2 to 6, day 7 to 27, day 28 to 364, 1 to 4 years, and ≥5 years. Mortality analysis was stratified by isolated, multiple, and syndromic case status. RESULTS The pooled total prevalence of BE was 2.58 per 100,000 total births (95% CI = 2.40, 2.78) for study years 1974 to 2014. Prevalence varied over time with a decreasing trend from 2000 to 2014. The first-week mortality proportion was 3.5, 17.3, and 14.6% among isolated, multiple, and syndromic BE cases, respectively. The majority of first-week mortality occurred on the first day of life among isolated, multiple, and syndromic BE cases. The proportion of first-week deaths was higher among cases reported from programs in Latin America where ETOPFA services were not available. CONCLUSIONS Prevalence of BE varied by program and showed a decreasing trend from 2000 to -2014. Mortality is a concern among multiple and syndromic cases, and a high proportion of deaths among cases occurred during the first week of life. KEY POINTS · Total prevalence of BE was 2.58 per 100,000 births.. · Prevalence decreased from 2000 to 2014.. · The first-week mortality was 9.3%..
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Affiliation(s)
- Vijaya Kancherla
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Lucita Tandaki
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty, Otto-von-Guericke-University, Magdeburg, Germany
| | - Manasvi Sundar
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Anke Lux
- Institute for Biometrics and Medical Informatics, Medical Faculty, Otto-von-Guericke-University, Magdeburg, Germany
| | - Marian K Bakker
- Department of Genetics, University of Groningen, University Medical Center Groningen, Eurocat Northern The Netherlands, Groningen, The Netherlands
| | - Jorieke EH Bergman
- Department of Genetics, University of Groningen, University Medical Center Groningen, Eurocat Northern The Netherlands, Groningen, The Netherlands
| | - Eva Bermejo-Sánchez
- ECEMC (Spanish Collaborative Study of Congenital Malformations), UIAC (Unidad de Investigación sobre Anomalías Congénitas), Instituto de Investigación de Enfermedades Raras (IIER). Instituto de Salud Carlos III. Madrid, Spain
| | - Mark A Canfield
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas
| | - Marcia L Feldkamp
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah
| | - Boris Groisman
- National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Administration of Laboratories and Health Institutes (ANLIS), National Ministry of Health, Buenos Aires, Argentina
| | - Paula Hurtado-Villa
- Department of Basic Sciences of Health, School of Health, Pontificia Universidad Javeriana Cali, Colombia and Clfnica Imbanaco, Cali, Colombia
| | - Karin Källén
- National Board of Health and Welfare, Stockholm, Sweden
| | - Danielle Landau
- Department of Neonatology, Soroka Medical Center, Beer-Sheva, Israel
| | - Nathalie Lelong
- Université de Paris, Inserm U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité (CRESS) Paris, France
| | - Jorge Lopez-Camelo
- ECLAMC, Center for Medical Education and Clinical Research (CEMIC-CONICET), Buenos Aires, Argentina
| | - Pierpaolo Mastroiacovo
- International Center on Birth Defects, International Clearinghouse for Birth Defects Surveillance and Research, Rome, Italy
| | - Margery Morgan
- CARIS, the Congenital Anomaly Register for Wales, Singleton Hospital, Swansea, Wales, United Kingdom
| | - Osvaldo M Mutchinick
- RYVEMCE (Registry and Epidemiologie Surveillance of Congenital Malformations), Department of Cenetics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Amy E Nance
- Utah Department of Health, Bureau of Children with Special Health Care Needs, Utah Birth Defects Network, Salt Lake City, Utah
| | - Wendy N Nembhard
- Arkansas Center for Birth Defects Research and Prevention and Arkansas Reproductive Health Monitoring System, University of Arkansas for Medical Sciences, Fay Boozman College of Public Health, Department of Epidemiology, Little Rock, Arkansas
| | - Anna Pierini
- Institute of Clinical Physiology, National Research Council and Fondazione Toscana Gabriele Monasterio, Tuscany Registry of Congenital Defects, Pisa, Italy
| | - Antonin Šípek
- Department of Medical Genetics, Thomayer Hospital, Prague, Czech Republic
| | - Erin B Stallings
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Elena Szabova
- Slovak Teratologie Information Centre (FPH), Slovak Medical University, Bratislava, Slovak Republic
| | | | - Ignacio Zarante
- Human Genetics Institute, Pontificia Universidad Javeriana, Bogotá, Colombia and Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty, Otto-von-Guericke-University, Magdeburg, Germany
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11
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Gili JA, López-Camelo JS, Nembhard WN, Bakker M, de Walle HEK, Stallings EB, Kancherla V, Contiero P, Dastgiri S, Feldkamp ML, Nance A, Gatt M, Martínez L, Canessa MA, Groisman B, Hurtado-Villa P, Källén K, Landau D, Lelong N, Morgan M, Arteaga-Vázquez J, Pierini A, Rissmann A, Sipek A, Szabova E, Wertelecki W, Zarante I, Canfield MA, Mastroiacovo P. Analysis of early neonatal case fatality rate among newborns with congenital hydrocephalus, a 2000-2014 multi-country registry-based study. Birth Defects Res 2022; 114:631-644. [PMID: 35633200 DOI: 10.1002/bdr2.2045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/05/2022] [Accepted: 04/29/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Congenital hydrocephalus (CH) comprises a heterogeneous group of birth anomalies with a wide-ranging prevalence across geographic regions and registry type. The aim of the present study was to analyze the early neonatal case fatality rate (CFR) and total birth prevalence of newborns diagnosed with CH. METHODS Data were provided by 25 registries from four continents participating in the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR) on births ascertained between 2000 and 2014. Two CH rates were calculated using a Poisson distribution: early neonatal CFR (death within 7 days) per 100 liveborn CH cases (CFR) and total birth prevalence rate (BPR) per 10,000 births (including live births and stillbirths) (BPR). Heterogeneity between registries was calculated using a meta-analysis approach with random effects. Temporal trends in CFR and BPR within registries were evaluated through Poisson regression modeling. RESULTS A total of 13,112 CH cases among 19,293,280 total births were analyzed. The early neonatal CFR was 5.9 per 100 liveborn cases, 95% confidence interval (CI): 5.4-6.8. The CFR among syndromic cases was 2.7 times (95% CI: 2.2-3.3) higher than among non-syndromic cases (10.4% [95% CI: 9.3-11.7] and 4.4% [95% CI: 3.7-5.2], respectively). The total BPR was 6.8 per 10,000 births (95% CI: 6.7-6.9). Stratified by elective termination of pregnancy for fetal anomalies (ETOPFA), region and system, higher CFR were observed alongside higher BPR rates. The early neonatal CFR and total BPR did not show temporal variation, with the exception of a CFR decrease in one registry. CONCLUSIONS Findings of early neonatal CFR and total BPR were highly heterogeneous among registries participating in ICBDSR. Most registries with higher CFR also had higher BPR. Differences were attributable to type of registry (hospital-based vs. population-based), ETOPFA (allowed yes or no) and geographical regions. These findings contribute to the understanding of regional differences of CH occurrence and early neonatal deaths.
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Affiliation(s)
- Juan Antonio Gili
- ECLAMC, Centro de Educación Médica e Investigaciones Clínicas (CEMIC-CONICET), Buenos Aires, Argentina.,Instituto Académico Pedagógico de Ciencias Humanas, Universidad Nacional de Villa María, Córdoba, Argentina
| | | | - Wendy N Nembhard
- Department of Epidemiology, Arkansas Center for Birth Defects Research and Prevention and Arkansas Reproductive Health Monitoring System, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Marian Bakker
- Department of Genetics, University of Groningen, University Medical Center Groningen, EUROCAT Northern Netherlands, Groningen, The Netherlands
| | - Hermien E K de Walle
- Department of Genetics, University of Groningen, University Medical Center Groningen, EUROCAT Northern Netherlands, Groningen, The Netherlands
| | - Erin B Stallings
- Metro Atlanta Congenital Defects Program (MACDP), Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, CDC, Atlanta, Georgia, USA
| | - Vijaya Kancherla
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
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- As listed in http://www.fundacion1000.es/Estructura-del-ECEMC for year 2021, Spain
| | - Paolo Contiero
- Lombardy Congenital Anomalies Registry, Cancer Registry Unit, Fondazione IRCCS, Istituto Nazionale Tumori, Milan, Italy
| | - Saeed Dastgiri
- Health Services Management Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Marcia L Feldkamp
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Amy Nance
- Utah Birth Defect Network, Bureau of Children with Special Health Care Needs, Division of Family Health and Preparedness, Utah Department of Health, Salt Lake City, Utah, USA
| | - Miriam Gatt
- Malta Congenital Anomalies Registry, Directorate for Health Information and Research, Tal-Pietà, Malta
| | - Laura Martínez
- Genetics Department, Hospital Universitario Dr. José E. González, Universidad Autonóma de Nuevo León, San Nicolás de los Garza, Mexico
| | - María Aurora Canessa
- Regional Register Congenital Malformation Maule Health Service (RRMC-SSM), Maule, Chile
| | - Boris Groisman
- National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Administration of Laboratories and Health Institutes (ANLIS), National Ministry of Health and Social Development, Buenos Aires, Argentina
| | - Paula Hurtado-Villa
- Department of Basic Sciences of Health, School of Health, Pontificia Universidad Javeriana, Cali, Colombia
| | - Karin Källén
- National Board of Health and Welfare, Stockholm, Sweden
| | - Danielle Landau
- Department of Neonatology, Soroka Medical Center, Beer-Sheva, Israel
| | - Nathalie Lelong
- Université de Paris, CRESS Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRA, Paris, France
| | - Margery Morgan
- CARIS, The Congenital Anomaly Register for Wales, Singleton Hospital, Swansea, Wales, UK
| | - Jazmín Arteaga-Vázquez
- Department of Genetics, RYVEMCE, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico
| | - Anna Pierini
- Institute of Clinical Physiology, National Research Council and Fondazione Toscana Gabriele Monasterio, Tuscany Registry of Congenital Defects, Pisa, Italy
| | - Anke Rissmann
- Medical Faculty, Malformation Monitoring Centre Saxony-Anhalt, Otto-von-Guericke University, Magdeburg, Germany
| | - Antonin Sipek
- Department of Medical Genetics, Thomayer University Hospital, Prague, Czech Republic
| | - Elena Szabova
- Slovak Teratologic Information Centre (FPH), Slovak Medical University, Bratislava, Slovak Republic
| | | | - Ignacio Zarante
- Human Genetics Institute, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Mark A Canfield
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas, USA
| | - Pierpaolo Mastroiacovo
- International Center on Birth Defects, International Clearinghouse for Birth Defects Surveillance and Research, Rome, Italy
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12
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Kable JA, Coles CD, Keen CL, Uriu-Adams JY, Jones KL, Yevtushok L, Kulikovsky Y, Zymak-Zakutnya N, Dubchak I, Akhmedzhanova D, Wertelecki W, Chambers CD. The impact of micronutrient supplementation in alcohol-exposed pregnancies on reaction time responses of preschoolers in Ukraine. Alcohol 2022; 99:49-58. [PMID: 34942330 PMCID: PMC8844237 DOI: 10.1016/j.alcohol.2021.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 12/03/2021] [Accepted: 12/10/2021] [Indexed: 12/12/2022]
Abstract
The potential of micronutrients to ameliorate the impact of prenatal alcohol exposure (PAE) on attentional regulation skills was explored in a randomized clinical trial conducted in Ukraine. Women who differed in prenatal alcohol use were recruited during pregnancy and assigned to one of three groups [No study-provided supplements, Multivitamin/Mineral Supplement (MVM), or MVM plus Choline]. Their offspring were seen in the preschool period and a reaction time task was administered. Participants were asked to press a response button as quickly as possible as 30 stimuli from the same category (animals) were presented consecutively and then followed by six stimuli from a novel category (vehicles). Number correct, mean latency of the response over trials, and variability in the latency were analyzed separately by sex. During the initial animal trials, boys whose mothers received MVM during pregnancy had more correct responses and reduced response latency compared to boys whose mothers had no MVM treatment. During vehicle trials, maternal choline supplementation was associated with increased response speed in males without a PAE history. Females receiving supplements did not show the same benefits from micronutrient supplementation and were more adversely impacted by prenatal alcohol exposure. Relationships between maternal levels of choline, betaine, and dimethylglycine (DMG) and task performance were also assessed. Although no effects were found for choline after adjusting for multiple comparisons, lower baseline DMG level was associated with greater accuracy and shorter latency of responses in the initial animal trials and shorter latency in the vehicle trials in female preschoolers. Level of betaine in Trimester 3 was associated with reduced variability in the latency of male responses during the animal trials. Maternal micronutrient supplementation in pregnancy appears to improve preschool reaction time performance, but the effects varied as a function of sex and PAE exposure status.
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Affiliation(s)
- JA Kable
- Departments of Psychiatry and Behavioral Science, Emory University School of Medicine,,Pediatrics, Emory University School of Medicine
| | - CD Coles
- Departments of Psychiatry and Behavioral Science, Emory University School of Medicine,,Pediatrics, Emory University School of Medicine
| | - CL Keen
- Department of Nutrition, University of California, Davis
| | - JY Uriu-Adams
- Department of Nutrition, University of California, Davis
| | - KL Jones
- Departments of Pediatrics, University of California San Diego,,Family Medicine and Public Health, University of California San Diego
| | - L Yevtushok
- Rivne Regional Medical Diagnostic Center, Rivne, Ukraine,,Lviv National Medical University, Lviv, Ukraine,,OMNI-Net Ukraine Birth Defects Program
| | - Y Kulikovsky
- Rivne Regional Medical Diagnostic Center, Rivne, Ukraine,,OMNI-Net Ukraine Birth Defects Program
| | - N. Zymak-Zakutnya
- Khmelnytsky Perinatal Center, Khmelnytsky, Ukraine,,OMNI-Net Ukraine Birth Defects Program
| | - Iryna Dubchak
- Khmelnytsky Perinatal Center, Khmelnytsky, Ukraine,,OMNI-Net Ukraine Birth Defects Program
| | - D Akhmedzhanova
- Khmelnytsky Perinatal Center, Khmelnytsky, Ukraine,,OMNI-Net Ukraine Birth Defects Program
| | - W Wertelecki
- Departments of Pediatrics, University of California San Diego,,OMNI-Net Ukraine Birth Defects Program
| | - CD Chambers
- Departments of Pediatrics, University of California San Diego,,Family Medicine and Public Health, University of California San Diego
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13
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Kautz-Turnbull C, Petrenko CLM, Handley ED, Coles CD, Kable JA, Wertelecki W, Yevtushok L, Zymak-Zakutnya N, Chambers CD. Partner influence as a factor in maternal alcohol consumption and depressive symptoms, and maternal effects on infant neurodevelopmental outcomes. Alcohol Clin Exp Res 2021; 45:1265-1275. [PMID: 33999430 DOI: 10.1111/acer.14612] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/16/2021] [Accepted: 03/26/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Few studies have investigated the partner's influence on risk factors such as alcohol consumption and depression during pregnancy. Partner substance use and lower relationship satisfaction predict higher maternal alcohol use and depressive symptoms. Because prenatal alcohol use and maternal depression affect infant outcomes, it is imperative to examine how the partner affects these maternal risk factors. The current study examined the effect of a latent construct of partner influence on maternal alcohol use and depressive symptoms, and the effects on infant development of these maternal factors. METHODS Participants were 246 pregnant women from 2 sites in Western Ukraine from whom longitudinal data were collected as part of a multisite study. In the first trimester, mothers reported on relationship satisfaction, partner substance use, and socioeconomic status (SES). In the third trimester, they reported on alcohol use and depressive symptoms. Infants were assessed using the Bayley Scale of Infant Development (average age = 6.93 months). A latent construct titled partner influence was formed using partner substance use and measures of relationship satisfaction, including the frequency of quarreling, happiness in the relationship, and the ease of talking with the partner. Using structural equation modeling, a model was specified in which partner influence and SES predicted maternal alcohol use and depressive symptoms, which in turn predicted infant neurodevelopmental outcomes. RESULTS Higher partner influence significantly predicted lower prenatal alcohol use and lower depressive symptoms, controlling for the effect of SES. Higher maternal prenatal alcohol use significantly predicted lower infant mental and psychomotor development. Maternal depressive symptoms did not predict infant development over and above the effect of alcohol use. CONCLUSIONS Partner influence is an important contributor to prenatal alcohol use and maternal depressive symptoms, over and above the effect of SES. The significant paths from prenatal alcohol exposure to infant neurodevelopmental outcomes underscore the importance of partner influence during pregnancy.
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Affiliation(s)
| | | | | | - Claire D Coles
- Departments of Psychiatry and Pediatrics, Emory University School of Medicine, Atlanta, GA, USA.,Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Julie A Kable
- Departments of Psychiatry and Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Wladimir Wertelecki
- Department of Medical Genetics, University of South Alabama, Mobile, AL, USA.,OMNI-Net for Children International Charitable Fund, Rivne Regional Medical Diagnostic Center, Rivne, Rivne Province, Ukraine.,OMNI-Net for Children International Charitable Fund, Khmelnytsky Perinatal Center, Khmelnytsky, Khmelnytsky Province, Ukraine
| | | | - Natalya Zymak-Zakutnya
- OMNI-Net for Children International Charitable Fund, Khmelnytsky Perinatal Center, Khmelnytsky, Khmelnytsky Province, Ukraine
| | - Christina D Chambers
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
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14
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Coles CD, Kable JA, Granovska IV, Pashtepa AO, Wertelecki W, Chambers CD. Measurement of neurodevelopmental effects of prenatal alcohol exposure in Ukrainian preschool children. Child Neuropsychol 2021; 27:1088-1103. [PMID: 33982636 DOI: 10.1080/09297049.2021.1919298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Effects of prenatal alcohol exposure (PAE) are rarely measured in preschool children due to relative insensitivity of assessment methods at this age. To examine the potential of a nonverbal battery in early identification of cognitive problems in alcohol-exposed children, 291 prospectively identified Ukrainian children were evaluated using a test battery focusing on early executive functioning (EF) and visuospatial skills, areas of cognitive development particularly sensitive to PAE in older children. Tests included the Differential Ability Scales, 2nd Edition (DAS-2) and several NEPSY/NEPSY-II subtests, standardized in the United States. Others were adapted from commonly used non-standardized neuropsychological measures of EF (Preschool Spatial Span, Imitation Hand Game, A not B, Delayed Attention, Subject Ordered Pointing). Children in two sites in Ukraine, Rivne and Khmelnitsky, were tested at 3 ½-4 ½ years to identify effects of PAE. Although most children performed within the average range, Alcohol-Exposed preschoolers had lower scores on DAS-II Summary Scores as well as on specific subtests. To evaluate the effects of alcohol dose during the pre-pregnancy recognition period and during mid-gestation of pregnancy, generalized linear regression models were used controlling for demographic and individual variables. In addition to DAS-II variables, measures reflecting sustained attention, working memory and ability to shift cognitive set were impacted by alcohol dose. Early executive function appears to subsume these performance differences. In conclusion, findings indicate that the effects of PAE can be identified in the preschool period and reliably measured using tests assessing nonverbal and spatial skills supported by executive functioning.
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Affiliation(s)
- Claire D Coles
- Departments of Psychiatry and Behavioral Sciences and Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Julie A Kable
- Departments of Psychiatry and Behavioral Sciences and Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Iryna V Granovska
- OMNet, Rivne, Ukraine.,Rivne Regional Medical Diagnostic Center, Rivne, Ukraine
| | - Ala O Pashtepa
- OMNet, Rivne, Ukraine.,Khmelnitsky Perinatal Center, Khmelnitsky, Ukraine
| | - Wladimir Wertelecki
- OMNet, Rivne, Ukraine.,Department of Pediatrics and Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, CA, USA
| | - Christina D Chambers
- Department of Pediatrics and Herbert Wertheim School of Public Health and Longevity Science, University of California San Diego, La Jolla, CA, USA
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- Collaborative Initiative for Fetal Alcohol Spectrum Disorders
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15
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Patskun E, Yevtushok L, Zymak-Zakutnia N, Lapchenko S, Akhmedzhanova D, Wertelecki W. A teratology information system in vernacular: Closing an information gap. Birth Defects Res 2021; 113:1152-1155. [PMID: 33893758 DOI: 10.1002/bdr2.1901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/10/2021] [Indexed: 11/12/2022]
Abstract
BACKGROUND Leading Teratology Information Systems (TIS) arose in major industrial nations and are mostly in English. The prevalence of anglophone speakers in Ukraine is among the lowest in Europe. A TIS in Ukrainian (UTIS) seeks to diminish an information gap concerning teratogens. The process and results related to UTIS are applicable to formulations of other TIS in vernacular languages. METHODS Implementation of a free-access UTIS and analysis of utilization patterns. UTIS provides access to articles in Ukrainian (AU) which are summaries extracted from leading international TIS and other sources. AU are revised at least tri-annually. RESULTS UTIS provides access to over 1,100 AU accrued since 2016 to the present. The number AU views increased from nearly 30,000 (2016) to over 80,000 (2020); the number of visitors increased from 3,500 to 58,000 during the same periods. The highest percent of users per urban population (2.09, 1.77, and 1.72) was in Ternopil, Ivano-Frankivsk, and Kyiv (capital), respectively; the lowest was in Odesa (0.17). CONCLUSIONS UTIS reduced an information gap in Ukraine concerning teratogenic risk factors. The process can be implemented elsewhere relying on generally available local resources.
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Affiliation(s)
- Erika Patskun
- OMNI-Net Ukraine Birth Defects Program, Rivne, Ukraine.,Uzhhorod National University, Uzhhorod, Ukraine
| | - Lyubov Yevtushok
- OMNI-Net Ukraine Birth Defects Program, Rivne, Ukraine.,Rivne Regional Medical Diagnostic Center, Rivne, Ukraine
| | - Nataliia Zymak-Zakutnia
- OMNI-Net Ukraine Birth Defects Program, Rivne, Ukraine.,Khmelnytsky City Children's Hospital, Khmelnytsky, Ukraine
| | - Serhiy Lapchenko
- OMNI-Net Ukraine Birth Defects Program, Rivne, Ukraine.,Volyn Regional Territorial Medical Mother and Child Health Care Center, Lutsk, Ukraine
| | - Diana Akhmedzhanova
- OMNI-Net Ukraine Birth Defects Program, Rivne, Ukraine.,Khmelnytsky City Children's Hospital, Khmelnytsky, Ukraine
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16
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Kable JA, Coles CD, Jones KL, Yevtushok L, Kulikovsky Y, Zymak-Zakutnya N, Dubchak I, Akhmedzhanova D, Wertelecki W, Chambers CD. Infant Cardiac Orienting Responses Predict Later FASD in the Preschool Period. Alcohol Clin Exp Res 2021; 45:386-394. [PMID: 33277942 PMCID: PMC7887046 DOI: 10.1111/acer.14525] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/19/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND Prenatal alcohol exposure (PAE) has been identified as one of the leading preventable causes of developmental disabilities, but early identification of those impacted has been challenging. This study evaluated the use of infant cardiac orienting responses (CORs), which assess neurophysiological encoding of environmental events and are sensitive to the impact of PAE, to predict later fetal alcohol spectrum disorder (FASD) status. METHODS Mother-infant dyads from Ukraine were recruited during pregnancy based on the mother's use of alcohol. Participants (n = 120) were then seen at 6 and 12 months when CORs were collected and in the preschool period when they were categorized as having (i) fetal alcohol syndrome (FAS), (ii) partial FAS (pFAS), (iii) alcohol-related neurodevelopmental disorder (ARND), (iv) PAE and no diagnosis, or (v) no PAE and no diagnosis. To assess CORs, stimuli (auditory tones and pictures) were presented using a fixed-trial habituation/dishabituation paradigm. Heart rate (HR) responses were aggregated across the first 3 habituation and dishabituation trials and converted to z-scores relative to the sample's mean response at each second by stimuli. Z-scores greater than 1 were then counted by condition (habituation or dishabituation) to compute a total risk index. RESULTS Significant group differences were found on total deviation scores of the CORs elicited from visual but not auditory stimuli. Those categorized as pFAS/FAS had significantly higher total deviation scores than did those categorized as ARND or as having no alcohol-related diagnosis with or without a history of PAE. Receiver operating characteristic curve analysis of the visual response yielded an area under the curve value of 0.765 for predicting to pFAS/FAS status. CONCLUSIONS A score reflecting total deviation from typical HR during CORs elicited using visual stimuli in infancy may be useful in identifying individuals who need early intervention as a result of their PAE.
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Affiliation(s)
- Julie A Kable
- From the Department of Psychiatry and Behavioral Science (JAK, CDC), Emory University School of Medicine, Atlanta, Georgia, USA
- Department of and Pediatrics (JAK, CDC), Emory University School of Medicine, Atlanta, Georgia, USA
| | - Claire D Coles
- From the Department of Psychiatry and Behavioral Science (JAK, CDC), Emory University School of Medicine, Atlanta, Georgia, USA
- Department of and Pediatrics (JAK, CDC), Emory University School of Medicine, Atlanta, Georgia, USA
| | - Kenneth L Jones
- Department of Pediatrics (KLJ, WW, ChDC), University of California San Diego, La Jolla, California, USA
- Department of Family Medicine and Public Health (KLJ, ChDC), University of California San Diego, La Jolla, California, USA
| | - Lyubov Yevtushok
- OMNI-Net Ukraine Birth Defects Program (LY, YK, NZ-Z, ID, DA, WW), Rivne, Ukraine
- Rivne Regional Medical Diagnostic Center (LY, YK), Rivne, Ukraine
- Lviv National Medical University (LY), Lviv, Ukraine
| | - Yaroslav Kulikovsky
- OMNI-Net Ukraine Birth Defects Program (LY, YK, NZ-Z, ID, DA, WW), Rivne, Ukraine
- Rivne Regional Medical Diagnostic Center (LY, YK), Rivne, Ukraine
| | - Natalya Zymak-Zakutnya
- OMNI-Net Ukraine Birth Defects Program (LY, YK, NZ-Z, ID, DA, WW), Rivne, Ukraine
- Khmelnytsky Perinatal Center (NZ-Z, ID, DA), Khmelnytsky, Ukraine
| | - Iryna Dubchak
- OMNI-Net Ukraine Birth Defects Program (LY, YK, NZ-Z, ID, DA, WW), Rivne, Ukraine
- Khmelnytsky Perinatal Center (NZ-Z, ID, DA), Khmelnytsky, Ukraine
| | - Diana Akhmedzhanova
- OMNI-Net Ukraine Birth Defects Program (LY, YK, NZ-Z, ID, DA, WW), Rivne, Ukraine
- Khmelnytsky Perinatal Center (NZ-Z, ID, DA), Khmelnytsky, Ukraine
| | - Wladimir Wertelecki
- Department of Pediatrics (KLJ, WW, ChDC), University of California San Diego, La Jolla, California, USA
- OMNI-Net Ukraine Birth Defects Program (LY, YK, NZ-Z, ID, DA, WW), Rivne, Ukraine
| | - Christina D Chambers
- Department of Pediatrics (KLJ, WW, ChDC), University of California San Diego, La Jolla, California, USA
- Department of Family Medicine and Public Health (KLJ, ChDC), University of California San Diego, La Jolla, California, USA
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17
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Morris JK, Addor MC, Ballardini E, Barisic I, Barrachina-Bonet L, Braz P, Cavero-Carbonell C, Den Hond E, Garne E, Gatt M, Haeusler M, Khoshnood B, Lelong N, Kinsner-Ovaskainen A, Kiuru-Kuhlefelt S, Klungsoyr K, Latos-Bielenska A, Limb E, O'Mahony MT, Perthus I, Pierini A, Rankin J, Rissmann A, Rouget F, Sayers G, Sipek A, Stevens S, Tucker D, Verellen-Dumoulin C, de Walle HEK, Wellesley D, Wertelecki W, Bermejo-Sanchez E. Prevention of Neural Tube Defects in Europe: A Public Health Failure. Front Pediatr 2021; 9:647038. [PMID: 34249803 PMCID: PMC8264257 DOI: 10.3389/fped.2021.647038] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 05/06/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Thirty years ago it was demonstrated that folic acid taken before pregnancy and in early pregnancy reduced the risk of a neural tube defect (NTD). Despite Public Health Initiatives across Europe recommending that women take 0.4 mg folic acid before becoming pregnant and during the first trimester, the prevalence of NTD pregnancies has not materially decreased in the EU since 1998, in contrast to the dramatic fall observed in the USA. This study aimed to estimate the number of NTD pregnancies that would have been prevented if flour had been fortified with folic acid in Europe from 1998 as it had been in the USA. Design and Setting: The number of NTD pregnancies from 1998 to 2017 that would have been prevented if folic acid fortification had been implemented in the 28 countries who were members of the European Union in 2019 was predicted was predicted using data on NTD prevalence from 35 EUROCAT congenital anomaly registries and literature searches for population serum folate levels and folic acid supplementation. Results: From 1998 to 2017 an estimated 95,213 NTD pregnancies occurred amongst 104 million births in the 28 countries in the EU, a prevalence of 0.92 per 1,000 births. The median serum folate level in Europe over this time period was estimated to be 14.1 μg/L. There is a lack of information about women taking folic acid supplements before becoming pregnant and during the first trimester of pregnancy, with one meta-analysis indicating that around 25% of women did so. An estimated 14,600 NTD pregnancies may have been prevented if the European countries had implemented fortification at the level adopted by the USA in 1998 and 25% of women took folic acid supplements. An estimated 19,500 NTD pregnancies would have been prevented if no women took folic acid supplements. Conclusions: This study suggests that failure to implement mandatory folic acid fortification in the 28 European countries has caused, and continues to cause, neural tube defects to occur in almost 1,000 pregnancies every year.
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Affiliation(s)
- Joan K Morris
- Population Health Research Institute, St. George's, University of London, London, United Kingdom
| | - Marie-Claude Addor
- Department of Woman-Mother-Child, University Hospital Center, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
| | - Elisa Ballardini
- Indagine Sulle Malformazioni Congenite in Emilia-Romagna (IMER) Registry (Emilia Romagna Registry of Birth Defects) Neonatal Intensive Care Unit, Pediatric Section Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Ingeborg Barisic
- Centre of Excellence for Reproductive and Regenerative Medicine, Children's Hospital Zagreb, Medical School University of Zagreb, Zagreb, Croatia
| | - Laia Barrachina-Bonet
- Rare Diseases Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, Valencia, Spain
| | - Paula Braz
- Epidemiology Department, National Institute of Health Doutor Ricardo Jorge, Lisboa, Portugal
| | - Clara Cavero-Carbonell
- Rare Diseases Research Unit, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region, Valencia, Spain
| | - Elly Den Hond
- Health Department, Provincial Institute of Hygiene, Antwerp, Belgium
| | - Ester Garne
- Paediatric Department, Hospital Lillebaelt Kolding, Kolding, Denmark
| | - Miriam Gatt
- Directorate for Health Information and Research, Pietà, Malta
| | - Martin Haeusler
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria
| | - Babak Khoshnood
- Université de Paris, Center of Research in Epidemiology and StatisticS/CRESS/Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRA, Paris, France
| | - Nathalie Lelong
- Université de Paris, Center of Research in Epidemiology and StatisticS/CRESS/Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), INSERM, INRA, Paris, France
| | | | - Sonja Kiuru-Kuhlefelt
- Finnish Institute for Health and Welfare Terveyden Ja Hyvinvoinnin Laitos (THL), Register of Congenital Malformations, Helsinki, Finland
| | - Kari Klungsoyr
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Anna Latos-Bielenska
- Department of Medical Genetics, Poznan University of Medical Sciences, Poznan, Poland
| | - Elizabeth Limb
- Population Health Research Institute, St. George's, University of London, London, United Kingdom
| | - Mary T O'Mahony
- Health Service Executive-South, Department of Public Health, St. Finbarr's Hospital, Cork, Ireland
| | - Isabelle Perthus
- Auvergne Registry of Congenital Anomalies (CEMC-Auvergne), Department of Clinical Genetics, Centre de Référence des Maladies Rares, CHU Estaing, Clermont-Ferrand, France
| | - Anna Pierini
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Judith Rankin
- Population Health Sciences Institute, Newcastle University, Newcastle, United Kingdom
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty Otto-von-Guericke-University, Magdeburg, Germany
| | - Florence Rouget
- Brittany Registry of Congenital Anomalies, CHU Rennes, Univ Rennes, INSERM, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, Rennes, France
| | - Gerardine Sayers
- Health Intelligence R&D Health Service Executive, Dublin, Ireland
| | - Antonin Sipek
- Department of Medical Biology and Genetics, 1st Faculty of Medicine, General University Hospital, Charles University, Prague, Czechia
| | | | - David Tucker
- Congenital Anomaly Register and Information Service for Wales, Public Health Wales Knowledge Directorate, Singleton Hospital, Swansea, United Kingdom
| | | | - Hermien E K de Walle
- Department of Genetics, Eurocat Northern Netherlands, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Diana Wellesley
- Wessex Clinical Genetics Service, Princess Anne Hospital, Southampton, United Kingdom
| | | | - Eva Bermejo-Sanchez
- Spanish Collaborative Study of Congenital Malformations (ECEMC), Unidad de Investigación sobre Anomalías Congénitas, Institute of Rare Diseases Research (IIER), Instituto de Salud Carlos III, Madrid, Spain
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18
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Wertelecki W. Chornobyl radiation-congenital anomalies: A persisting dilemma. Congenit Anom (Kyoto) 2021; 61:9-13. [PMID: 33405251 DOI: 10.1111/cga.12388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 07/07/2020] [Accepted: 07/26/2020] [Indexed: 11/27/2022]
Abstract
We report population prevalence rates of neural tube defects (NDT) and microcephaly (MIC) as well as levels of incorporated Cs137 by pregnant women in two areas of the Rivne Province of Ukraine, a northern half (Polissia) polluted by Chornobyl radiation and not-Polissia areas. Monitoring of congenital malformations was conducted with adherence to methods adopted by a European surveillance network (EUROCAT). Incorporated Cs137 (Bq/kg) by pregnant women residing in the Polissia and not-Polissia areas were obtained concurrently with prenatal ultrasound examinations. In Polissia, the incorporated Cs137 levels by pregnant women as well as the prevalence rates of NDTs and MIC are significantly higher than in not-Polissia. In Polissia, the prevalence rates of NDTs and MIC are among the highest in Europe. The debate concerning the teratogenic impact of chronic exposures to low levels of ionizing radiation was re-ignited by our 2010 report. Health agencies uphold the notion that exposure to Chornobyl radiation levels are too low to be teratogenic, which is inconsistent with our observations. Further investigations in Rivne by international teams can, we believe, contribute facts to the ongoing debate. Our monitoring system, experience and data can facilitate concurrent investigations of teratogenic risks from exposures to other sources of ionizing radiation, alcohol, folate, and zinc deficiencies, among other risk factors. Study of genomic impacts can likewise be undertaken.
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19
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Politis MD, Bermejo-Sánchez E, Canfield MA, Contiero P, Cragan JD, Dastgiri S, de Walle HEK, Feldkamp ML, Nance A, Groisman B, Gatt M, Benavides-Lara A, Hurtado-Villa P, Kallén K, Landau D, Lelong N, Lopez-Camelo J, Martinez L, Morgan M, Mutchinick OM, Pierini A, Rissmann A, Šípek A, Szabova E, Wertelecki W, Zarante I, Bakker MK, Kancherla V, Mastroiacovo P, Nembhard WN. Prevalence and mortality in children with congenital diaphragmatic hernia: a multicountry study. Ann Epidemiol 2020; 56:61-69.e3. [PMID: 33253899 DOI: 10.1016/j.annepidem.2020.11.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/09/2020] [Accepted: 11/10/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE This study determined the prevalence, mortality, and time trends of children with congenital diaphragmatic hernia (CDH). METHODS Twenty-five hospital- and population-based surveillance programs in 19 International Clearinghouse for Birth Defects Surveillance and Research member countries provided birth defects mortality data between 1974 and 2015. CDH cases included live births, stillbirths, or elective termination of pregnancy for fetal anomalies. Prevalence, cumulative mortality rates, and 95% confidence intervals (CIs) were calculated using Poisson regression and a Kaplan-Meier product-limit method. Joinpoint regression analyses were conducted to assess time trends. RESULTS The prevalence of CDH was 2.6 per 10,000 total births (95% CI: 2.5-2.7), slightly increasing between 2001 and 2012 (average annual percent change = 0.5%; 95% CI:-0.6 to 1.6). The total percent mortality of CDH was 37.7%, with hospital-based registries having more deaths among live births than population-based registries (45.1% vs. 33.8%). Mortality rates decreased over time (average annual percent change = -2.4%; 95% CI: -3.8 to 1.1). Most deaths due to CDH occurred among 2- to 6-day-old infants for both registry types (36.3%, hospital-based; 12.1%, population-based). CONCLUSIONS The mortality of CDH has decreased over time. Mortality remains high during the first week and varied by registry type.
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Affiliation(s)
- Maria D Politis
- Arkansas Center for Birth Defects Research and Prevention, and Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Eva Bermejo-Sánchez
- ECEMC (Spanish Collaborative Study of Congenital Malformations), CIAC (Research Center on Congenital Anomalies), Institute of Rare Diseases Research (IIER), Instituto de Salud Carlos III, Madrid, Spain
| | - Mark A Canfield
- Texas Department of State Health Services, Birth Defects Epidemiology and Surveillance Branch, Austin, TX
| | - Paolo Contiero
- Lombardy Congenital Anomalies Registry, Cancer Registry Unit, Fondazione IRCCS, Istituto Nazionale Tumori, Italy
| | - Janet D Cragan
- Metropolitan Atlanta Congenital Defects Program, National Center on Birth Defects and Development Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Saeed Dastgiri
- Health Services Management Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hermien E K de Walle
- Department of Genetics, University of Groningen, University Medical Center Groningen, Eurocat Northern Netherlands, Groningen, the Netherlands
| | - Marcia L Feldkamp
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Amy Nance
- Division of Family Health and Preparedness, Utah Department of Health, Utah Birth Defect Network, Bureau of Children with Special Health Care Needs, Salt Lake City, UT
| | - Boris Groisman
- National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Ministry of Health, Buenos Aires, Argentina
| | - Miriam Gatt
- Malta Congenital Anomalies Registry, Directorate for Health Information and Research, Malta
| | - Adriana Benavides-Lara
- Costa Rican Birth Defects Registry (CREC), Costa Rican Institute of Research and Education in Nutrition and Health (INCIENSA), Cartago, Costa Rica
| | - Paula Hurtado-Villa
- Department of Basic Sciences of Health, School of Health, Pontificia Universidad Javeriana Cali, Colombia
| | - Kärin Kallén
- National Board of Health and Welfare, Stockholm, Sweden
| | - Danielle Landau
- Department of Neonatology, Soroka Medical Center, Beer-Sheva, Israel
| | - Nathalie Lelong
- REMAPAR, Paris Registry of Congenital Malformations, Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, France
| | - Jorge Lopez-Camelo
- ECLAMC, Center for Medical Education and Clinical Research (CEMIC-CONICET), Buenos Aires, Argentina
| | - Laura Martinez
- Genetics Department, Hospital Universitario Dr Jose E. Gonzalez, Universidad Autonóma de Nuevo León, Mexico
| | - Margery Morgan
- CARIS, the Congenital Anomaly Register for Wales, Singleton Hospital, Swansea, Wales, UK
| | - Osvaldo M Mutchinick
- Department of Genetics, RYVEMCE, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México City, Mexico
| | - Anna Pierini
- Institute of Clinical Physiology, National Research Council and Fondazione Toscana Gabriele Monasterio, Tuscany Registry of Congenital Defects, Pisa, Italy
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
| | - Antonin Šípek
- Department of Medical Genetics, Thomayer Hospital, Prague, Czech Republic
| | - Elena Szabova
- Slovak Teratologic Information Centre (FPH), Slovak Medical University, Bratislava, Slovak Republic
| | | | | | - Marian K Bakker
- Department of Genetics, University of Groningen, University Medical Center Groningen, Eurocat Northern Netherlands, Groningen, the Netherlands
| | - Vijaya Kancherla
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA
| | - Pierpaolo Mastroiacovo
- International Center on Birth Defects, International Clearinghouse for Birth Defects Surveillance and Research, Rome, Italy
| | - Wendy N Nembhard
- Arkansas Center for Birth Defects Research and Prevention and Arkansas Reproductive Health Monitoring System and Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR.
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20
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Nembhard WN, Bergman JEH, Politis MD, Arteaga-Vázquez J, Bermejo-Sánchez E, Canfield MA, Cragan JD, Dastgiri S, de Walle HEK, Feldkamp ML, Nance A, Gatt M, Groisman B, Hurtado-Villa P, Kallén K, Landau D, Lelong N, Lopez-Camelo J, Martinez L, Morgan M, Pierini A, Rissmann A, Šípek A, Szabova E, Tagliabue G, Wertelecki W, Zarante I, Bakker MK, Kancherla V, Mastroiacovo P. A multi-country study of prevalence and early childhood mortality among children with omphalocele. Birth Defects Res 2020; 112:1787-1801. [PMID: 33067932 DOI: 10.1002/bdr2.1822] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/30/2020] [Accepted: 10/05/2020] [Indexed: 11/05/2022]
Abstract
BACKGROUND Omphalocele is the second most common abdominal birth defect and often occurs with other structural and genetic defects. The objective of this study was to determine omphalocele prevalence, time trends, and mortality during early childhood, by geographical region, and the presence of associated anomalies. METHODS We conducted a retrospective study with 23 birth defect surveillance systems in 18 countries who are members of the International Clearinghouse for Birth Defects Surveillance and Research that submitted data on cases ascertained from 2000 through 2012, approximately 16 million pregnancies were surveyed that resulted in live births, stillbirths, or elective terminations of pregnancy for fetal anomalies (ETOPFA) and cases with omphalocele were included. Overall prevalence and mortality rates for specific ages were calculated (day of birth, neonatal, infant, and early childhood). We used Kaplan-Meier estimates with 95% confidence intervals (CI) to calculate cumulative mortality and joinpoint regression for time trend analyses. RESULTS The prevalence of omphalocele was 2.6 per 10,000 births (95% CI: 2.5, 2.7) and showed no temporal change from 2000-2012 (average annual percent change = -0.19%, p = .52). The overall mortality rate was 32.1% (95% CI: 30.2, 34.0). Most deaths occurred during the neonatal period and among children with multiple anomalies or syndromic omphalocele. Prevalence and mortality varied by registry type (e.g., hospital- vs. population-based) and inclusion or exclusion of ETOPFA. CONCLUSIONS The prevalence of omphalocele showed no temporal change from 2000-2012. Approximately one-third of children with omphalocele did not survive early childhood with most deaths occurring in the neonatal period.
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Affiliation(s)
- Wendy N Nembhard
- Arkansas Center for Birth Defects Research and Prevention, Fay W. Boozman College of Public Health, Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Little Rock, Arkansas, USA.,Arkansas Reproductive Health Monitoring System, Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Jorieke E H Bergman
- Department of Genetics, EUROCAT Northern Netherlands, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maria D Politis
- Arkansas Center for Birth Defects Research and Prevention, Fay W. Boozman College of Public Health, Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Jazmín Arteaga-Vázquez
- RYVEMCE (Mexican Registry and Epidemiological Surveillance of Congenital Malformations), Department of Genetics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Eva Bermejo-Sánchez
- ECEMC (Spanish Collaborative Study of Congenital Malformations) and ECEMC's Clinical Network, Research Unit on Congenital Anomalies, Institute of Rare Diseases Research (IIER), Instituto de Salud Carlos III, Madrid, Spain
| | - Mark A Canfield
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas, USA
| | - Janet D Cragan
- Metropolitan Atlanta Congenital Defects Program, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Saeed Dastgiri
- Health Services Management Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hermien E K de Walle
- Department of Genetics, EUROCAT Northern Netherlands, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marcia L Feldkamp
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Amy Nance
- Utah Birth Defect Network, Bureau of Children with Special Health Care Needs, Division of Family Health and Preparedness, Utah Department of Health, Salt Lake City, Utah, USA
| | - Miriam Gatt
- Malta Congenital Anomalies Registry, Directorate for Health Information and Research, Valletta, Malta
| | - Boris Groisman
- National Network of Congenital Anomalies of Argentina (RENAC), National Center of Medical Genetics, National Administration of Laboratories and Health Institutes, National Ministry of Health and Social Development, Buenos Aires, Argentina
| | - Paula Hurtado-Villa
- Department of Basic Sciences of Health, School of Health, Pontificia Universidad Javeriana Cali, Cali, Colombia
| | - Kärin Kallén
- National Board of Health and Welfare, Stockholm, Sweden
| | - Danielle Landau
- Department of Neonatology, Soroka Medical Center, Beer-Sheva, Israel
| | - Nathalie Lelong
- REMAPAR, Paris Registry of Congenital Malformations, Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics Sorbonne Paris Cité, DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Jorge Lopez-Camelo
- ECLAMC, Center for Medical Education and Clinical Research (CEMIC-CONICET), Buenos Aires, Argentina
| | - Laura Martinez
- Genetics Department, Hospital Universitario Dr Jose E. Gonzalez, Universidad Autonóma de Nuevo León, Nuevo León, Mexico
| | - Margery Morgan
- The Congenital Anomaly Register and Information Service for Wales, Singleton Hospital, Swansea, Wales, UK
| | - Anna Pierini
- Institute of Clinical Physiology, National Research Council/Fondazione Toscana Gabriele Monasterio, Tuscany Registry of Congenital Defects, Pisa, Italy
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty, Otto-von-Guericke University, Magdeburg, Germany
| | - Antonin Šípek
- Department of Medical Genetics, Thomayer Hospital, Prague, Czech Republic
| | - Elena Szabova
- Slovak Teratologic Information Centre (FPH), Slovak Medical University, Bratislava, Slovakia
| | - Giovanna Tagliabue
- Lombardy Congenital Anomalies Registry, Cancer Registry Unit, Fondazione IRCCS, Istituto Nazionale dei tumori, Milan, Italy
| | | | - Ignacio Zarante
- Human Genetics Institute, Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Marian K Bakker
- Department of Genetics, EUROCAT Northern Netherlands, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Vijaya Kancherla
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Pierpaolo Mastroiacovo
- International Center on Birth Defects, International Clearinghouse for Birth Defects Surveillance and Research, Rome, Italy
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21
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Bandoli G, Jones K, Wertelecki W, Yevtushok L, Zymak-Zakutnya N, Granovska I, Plotka L, Chambers C. Patterns of Prenatal Alcohol Exposure and Alcohol-Related Dysmorphic Features. Alcohol Clin Exp Res 2020; 44:2045-2052. [PMID: 32772389 PMCID: PMC7722075 DOI: 10.1111/acer.14430] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 07/31/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND In animal models, it is possible to induce different alcohol-related dysmorphic abnormalities based on the timing of prenatal alcohol exposure (PAE). Our objective was to assess whether patterns of PAE differentially predict alcohol-related dysmorphic features in 415 infants. METHODS We analyzed a prospective pregnancy cohort in western Ukraine enrolled between 2008 and 2014. Five distinct trajectories were previously identified to summarize PAE: (i) minimal/no PAE (n = 253), (ii) low/moderate PAE with reduction early in gestation (n = 78), (iii) low/moderate sustained PAE (n = 20), (iv) moderate/high PAE with reduction early in gestation (n = 45), and (v) high sustained PAE (n = 19). A dysmorphology examination of body size, 3 cardinal, and 15 noncardinal dysmorphic features was performed at approximately 6 to 12 months of age. A modified dysmorphology score was created based on previously published weights. Univariate comparisons were made between each dysmorphic feature and trajectory group. Features that differed by trajectory group were assessed in multivariable analyses. Models were adjusted for maternal age, prenatal vitamin use, socioeconomic status, smoking, and child's age at dysmorphology examination, with censoring weights for losses to follow-up. RESULTS The 3 highest trajectories predicted total dysmorphology score, with larger effects in sustained exposure groups. Cardinal features: The 3 highest trajectories were each associated with a 2- to 3-fold increased risk of having 2 + cardinal facial features. When assessed individually, there were no consistent associations between the individual trajectories and each cardinal feature. Noncardinal features: The 3 highest trajectories were associated with increased risk of hypotelorism. Only the highest trajectory was associated with heart murmur. The highest trajectory predicted <10th centile for sex and age on height, weight, and head circumference; and moderate/high with reduction trajectory also predicted height. CONCLUSIONS While we did not observe differential results based on specific trajectories of exposure, findings support the wide range of dysmorphic features associated with PAE, particularly at high and sustained levels.
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Affiliation(s)
| | - Ken Jones
- Department of Pediatrics, University of California San Diego
| | - Wladimir Wertelecki
- Department of Pediatrics, University of California San Diego
- OMNI-Net Ukraine Birth Defects Program
| | - Lyubov Yevtushok
- OMNI-Net Ukraine Birth Defects Program
- Rivne Regional Medical Diagnostic Center, Rivne, Ukraine
- Lviv National Medical University, Lviv, Ukraine
| | - Natalya Zymak-Zakutnya
- OMNI-Net Ukraine Birth Defects Program
- Khmelnytsky Perinatal Center, Khmelnytsky, Ukraine
| | - Iryna Granovska
- OMNI-Net Ukraine Birth Defects Program
- Rivne Regional Medical Diagnostic Center, Rivne, Ukraine
| | - Larysa Plotka
- OMNI-Net Ukraine Birth Defects Program
- Rivne Regional Medical Diagnostic Center, Rivne, Ukraine
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22
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Wertelecki W. Josef Warkany's gestation of the teratology society. Birth Defects Res 2020; 112:885-889. [DOI: 10.1002/bdr2.1684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/01/2020] [Indexed: 11/09/2022]
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23
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Sowell KD, Holt RR, Uriu-Adams JY, Chambers CD, Coles CD, Kable JA, Yevtushok L, Zymak-Zakutnya N, Wertelecki W, Keen CL. Altered Maternal Plasma Fatty Acid Composition by Alcohol Consumption and Smoking during Pregnancy and Associations with Fetal Alcohol Spectrum Disorders. J Am Coll Nutr 2020; 39:249-260. [PMID: 32240041 DOI: 10.1080/07315724.2020.1737984] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective: Polyunsaturated fatty acids are vital for optimal fetal neuronal development. The relationship between maternal alcohol consumption and smoking with third trimester plasma fatty acids were examined and their association with Fetal Alcohol Spectrum Disorders (FASD).Methods: Moderate to heavy alcohol-using and low/unexposed comparison women were recruited during mid-pregnancy from two prenatal clinics in Ukraine. The participants' infants underwent physical and neurobehavioral exams prior to one-year of age and classified as having FASD by maternal alcohol consumption and neurobehavioral scores. A subset of mother-child pairs was selected representing three groups of cases and controls: Alcohol-Exposed with FASD (AE-FASD, n = 30), Alcohol-Exposed Normally Developing (AE-ND, n = 33), or Controls (n = 46). Third trimester maternal plasma samples were analyzed for fatty acids and levels were compared across groups.Results: The percent of C18:0 (p < 0.001), arachidonic acid (AA, C20:4n-6, p = 0.017) and C22:5n-6 (p = 0.001) were significantly higher in AE-FASD women than controls or AE-ND women. Alcohol-exposed women who smoked had lower C22:5n-3 (p = 0.029) and docosahexaenoic acid (DHA, C22:6n-3, p = 0.005) and higher C22:5n-6 (p = 0.013) than women consuming alcohol alone or abstainers.Conclusion: Alterations in fatty acid profiles were observed in moderate to heavy alcohol-consuming mothers with infants classified with FASD compared to alcohol-exposed normally developing infants or controls.
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Affiliation(s)
- Krista D Sowell
- Department of Health, Physical Education, and Sport Studies, Winston-Salem State University, Winston Salem, North Carolina, USA
| | - Roberta R Holt
- Department of Nutrition, University of California, Davis, Davis, California, USA
| | - Janet Y Uriu-Adams
- Department of Nutrition, University of California, Davis, Davis, California, USA
| | - Christina D Chambers
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA.,Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California, USA
| | - Claire D Coles
- Departments of Psychiatry and Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Julie A Kable
- Departments of Psychiatry and Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Lyubov Yevtushok
- OMNI-Net, Rivne & the Rivne Diagnostic Center, Rivne, Ukraine.,Department of Therapy No.1 and Medical Diagnostics, Lviv National Medical University, Lviv, Ukraine
| | | | - Wladimir Wertelecki
- Department of Pediatrics, University of California, San Diego, La Jolla, California, USA
| | - Carl L Keen
- Department of Nutrition, University of California, Davis, Davis, California, USA
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24
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Bodnar TS, Raineki C, Wertelecki W, Yevtushok L, Plotka L, Granovska I, Zymak-Zakutnya N, Pashtepa A, Wells A, Honerkamp-Smith G, Coles CD, Kable JA, Chambers CD, Weinberg J. Immune network dysregulation associated with child neurodevelopmental delay: modulatory role of prenatal alcohol exposure. J Neuroinflammation 2020; 17:39. [PMID: 31992316 PMCID: PMC6988366 DOI: 10.1186/s12974-020-1717-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 01/14/2020] [Indexed: 12/19/2022] Open
Abstract
Background Evidence suggests that cytokine imbalances may be at the root of deficits that occur in numerous neurodevelopmental disorders, including schizophrenia and autism spectrum disorder. Notably, while clinical studies have demonstrated maternal cytokine imbalances with alcohol consumption during pregnancy—and data from animal models have identified immune disturbances in alcohol-exposed offspring—to date, immune alterations in alcohol-exposed children have not been explored. Thus, here we hypothesized that perturbations in the immune environment as a result of prenatal alcohol exposure will program the developing immune system, and result in immune dysfunction into childhood. Due to the important role of cytokines in brain development/function, we further hypothesized that child immune profiles might be associated with their neurodevelopmental status. Methods As part of a longitudinal study in Ukraine, children of mothers reporting low/no alcohol consumption or moderate-to-heavy alcohol consumption during pregnancy were enrolled in the study and received neurodevelopmental assessments. Group stratification was based on maternal alcohol consumption and child neurodevelopmental status resulting in the following groups: A/TD, alcohol-consuming mother, typically developing child; A/ND, alcohol-consuming mother, neurodevelopmental delay in the child; C/TD, control mother (low/no alcohol consumption), typically development child; and C/ND, control mother, neurodevelopmental delay in the child. Forty cytokines/chemokines were measured in plasma and data were analyzed using regression and constrained principle component analysis. Results Analyses revealed differential cytokine network activity associated with both prenatal alcohol exposure and neurodevelopmental status. Specifically, alcohol-exposed children showed activation of a cytokine network including eotaxin-3, eotaxin, and bFGF, irrespective of neurodevelopmental status. However, another cytokine network was differentially activated based on neurodevelopmental outcome: A/TD showed activation of MIP-1β, MDC, and MCP-4, and inhibition of CRP and PlGF, with opposing pattern of activation/inhibition detected in the A/ND group. By contrast, in the absence of alcohol-exposure, activation of a network including IL-2, TNF-β, IL-10, and IL-15 was associated with neurodevelopmental delay. Conclusions Taken together, this comprehensive assessment of immune markers allowed for the identification of unique immune milieus that are associated with alcohol exposure as well as both alcohol-related and alcohol-independent neurodevelopmental delay. These findings are a critical step towards establishing unique immune biomarkers for alcohol-related and alcohol-independent neurodevelopmental delay.
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Affiliation(s)
- Tamara S Bodnar
- Department of Cellular and Physiological Sciences, University of British Columbia, 3307 - 2350 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.
| | - Charlis Raineki
- Department of Cellular and Physiological Sciences, University of British Columbia, 3307 - 2350 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
| | | | - Lyubov Yevtushok
- OMNI-Net for Children International Charitable Fund, Rivne Oblast Medical Diagnostic Center, Rivne, Ukraine
| | - Larisa Plotka
- OMNI-Net for Children International Charitable Fund, Rivne Oblast Medical Diagnostic Center, Rivne, Ukraine
| | - Irina Granovska
- OMNI-Net for Children International Charitable Fund, Rivne Oblast Medical Diagnostic Center, Rivne, Ukraine
| | - Natalya Zymak-Zakutnya
- OMNI-Net for Children International Charitable Fund, Khmelnytsky Perinatal Center, Khmelnytsky, Ukraine
| | - Alla Pashtepa
- OMNI-Net for Children International Charitable Fund, Khmelnytsky Perinatal Center, Khmelnytsky, Ukraine
| | - Alan Wells
- Department of Pediatrics, University of California San Diego, La Jolla, USA
| | | | - Claire D Coles
- Department of Psychiatry and Behavioral Sciences; Department of Pediatrics, Emory University School of Medicine, Atlanta, USA
| | - Julie A Kable
- Department of Psychiatry and Behavioral Sciences; Department of Pediatrics, Emory University School of Medicine, Atlanta, USA
| | - Christina D Chambers
- Department of Pediatrics, University of California San Diego, La Jolla, USA.,Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Joanne Weinberg
- Department of Cellular and Physiological Sciences, University of British Columbia, 3307 - 2350 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada
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25
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Bakker MK, Kancherla V, Canfield MA, Bermejo‐Sanchez E, Cragan JD, Dastgiri S, De Walle HEK, Feldkamp ML, Groisman B, Gatt M, Hurtado‐Villa P, Kallen K, Landau D, Lelong N, Lopez Camelo JS, Martínez L, Morgan M, Mutchinick OM, Nembhard WN, Pierini A, Rissmann A, Sipek A, Szabova E, Tagliabue G, Wertelecki W, Zarante I, Mastroiacovo P. Analysis of Mortality among Neonates and Children with Spina Bifida: An International Registry-Based Study, 2001-2012. Paediatr Perinat Epidemiol 2019; 33:436-448. [PMID: 31637749 PMCID: PMC6899817 DOI: 10.1111/ppe.12589] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/26/2019] [Accepted: 08/24/2019] [Indexed: 01/06/2023]
Abstract
BACKGROUND Medical advancements have resulted in better survival and life expectancy among those with spina bifida, but a significantly increased risk of perinatal and postnatal mortality for individuals with spina bifida remains. OBJECTIVES To examine stillbirth and infant and child mortality among those affected by spina bifida using data from multiple countries. METHODS We conducted an observational study, using data from 24 population- and hospital-based surveillance registries in 18 countries contributing as members of the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR). Cases of spina bifida that resulted in livebirths or stillbirths from 20 weeks' gestation or elective termination of pregnancy for fetal anomaly (ETOPFA) were included. Among liveborn spina bifida cases, we calculated mortality at different ages as number of deaths among liveborn cases divided by total number of liveborn cases with spina bifida. As a secondary outcome measure, we estimated the prevalence of spina bifida per 10 000 total births. The 95% confidence interval for the prevalence estimate was estimated using the Poisson approximation of binomial distribution. RESULTS Between years 2001 and 2012, the overall first-week mortality proportion was 6.9% (95% CI 6.3, 7.7) and was lower in programmes operating in countries with policies that allowed ETOPFA compared with their counterparts (5.9% vs. 8.4%). The majority of first-week mortality occurred on the first day of life. In programmes where information on long-term mortality was available through linkage to administrative databases, survival at 5 years of age was 90%-96% in Europe, and 86%-96% in North America. CONCLUSIONS Our multi-country study showed a high proportion of stillbirth and infant and child deaths among those with spina bifida. Effective folic acid interventions could prevent many cases of spina bifida, thereby preventing associated childhood morbidity and mortality.
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Affiliation(s)
- Marian K. Bakker
- University of GroningenUniversity Medical Center GroningenDepartment of GeneticsEurocat Northern NetherlandsGroningenThe Netherlands
| | - Vijaya Kancherla
- Department of EpidemiologyEmory University Rollins School of Public HealthAtlantaGAUSA
| | - Mark A. Canfield
- Birth Defects Epidemiology and Surveillance BranchTexas Department of State Health ServicesAustinTXUS
| | - Eva Bermejo‐Sanchez
- ECEMC (Spanish Collaborative Study of Congenital Malformations)CIACInstituto de Investigación de Enfermedades Raras (IIER)Instituto de Salud Carlos IIIMadridSpain
| | - Janet D. Cragan
- Division of Congenital and Developmental DisordersNational Center on Birth Defects and Development DisabilitiesCenters for Disease ControlAtlantaGAUSA
| | - Saeed Dastgiri
- Health Services Management Research CentreTabriz University of Medical SciencesTabrizIran
| | - Hermien E. K. De Walle
- University of GroningenUniversity Medical Center GroningenDepartment of GeneticsEurocat Northern NetherlandsGroningenThe Netherlands
| | - Marcia L. Feldkamp
- Department of PediatricsUniversity of Utah School of Medicine and the Utah Birth Defect NetworkSalt Lake CityUTUSA
| | - Boris Groisman
- National Network of Congenital Anomalies of Argentina (RENAC)National Center of Medical GeneticsNational Administration of Laboratories and Health Institutes (ANLIS)National Ministry of HealthBuenos AiresArgentina
| | - Miriam Gatt
- Malta Congenital Anomalies RegistryDirectorate for Health Information and ResearchValettaMalta
| | - Paula Hurtado‐Villa
- Department of Basic Sciences of HealthSchool of HealthPontificia Universidad Javeriana CaliCaliColombia
| | - Karin Kallen
- National Board of Health and Welfare and University of LundStockholmSweden
| | - Daniella Landau
- Department of NeonatologySoroka Medical CenterBeer‐ShevaIsrael
| | - Nathalie Lelong
- Inserm UMR 1153ObstetricalPerinatal and Pediatric Epidemiology Research Team (Epopé)Center for Epidemiology and Statistics Sorbonne Paris CitéDHU Risks in PregnancyParis Descartes UniversityParisFrance
| | - Jorge S. Lopez Camelo
- ECLAMCCenter for Medical Education and Clinical Research (CEMIC‐CONICET)Buenos AiresArgentina
| | - Laura Martínez
- Genetics DepartmentHospital Universitario Dr Jose E. GonzalezUniversidad Autonóma de Nuevo LeónSan Nicolás de los GarzaMexico
| | - Margery Morgan
- CARIS, The Congenital Anomaly Register for WalesSingleton HospitalSwanseaUK
| | - Osvaldo M. Mutchinick
- RYVEMCEDepartment of GeneticsInstituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico CityMexico
| | - Wendy N. Nembhard
- Department of Epidemiology, Arkansas Center for Birth Defects Research and Prevention and Arkansas Reproductive Health Monitoring SystemFay Boozman College of Public HealthUniversity of Arkansas for Medical SciencesLittle RockARUSA
| | - Anna Pierini
- Institute of Clinical PhysiologyNational Research Council and Fondazione Toscana Gabriele MonasterioTuscany Registry of Congenital DefectsPisaItaly
| | - Anke Rissmann
- Malformation Monitoring Centre Saxony‐AnhaltMedical FacultyOtto‐von‐Guericke UniversityMagdeburgGermany
| | - Antonin Sipek
- Department of Medical GeneticsThomayer HospitalPragueCzech Republic
| | - Elena Szabova
- Slovak Teratologic Information Centre (FPH)Slovak Medical UniversityBratislavaSlovak Republic
| | - Giovanna Tagliabue
- Lombardy Congenital Anomalies RegistryCancer Registry UnitFondazione IRCCSIstituto Nazionale tumoriMilanItaly
| | | | - Ignacio Zarante
- Human Genetics InstitutePontificia Universidad JaverianaBogotáColombia
| | - Pierpaolo Mastroiacovo
- International Center on Birth DefectsInternational Clearinghouse for Birth Defects Surveillance and ResearchRomeItaly
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26
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Sarkar DK, Gangisetty O, Wozniak JR, Eckerle JK, Georgieff MK, Foroud TM, Wetherill L, Wertelecki W, Chambers CD, Riley E, Zymak-Zakutnya N, Yevtushok L. Persistent Changes in Stress-Regulatory Genes in Pregnant Women or Children Exposed Prenatally to Alcohol. Alcohol Clin Exp Res 2019; 43:1887-1897. [PMID: 31329297 PMCID: PMC6722014 DOI: 10.1111/acer.14148] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 07/10/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND We have recently shown that binge or heavy levels of alcohol drinking increase deoxyribonucleic acid (DNA) methylation and reduce gene expression of proopiomelanocortin (POMC) and period 2 (PER2) in adult human subjects (Gangisetty et al., Alcohol Clin Exp Res, 43, 2019, 212). One hypothesis would be that methylation of these 2 genes is consistently associated with alcohol exposure and could be used as biomarkers to predict risk of prenatal alcohol exposure (PAE). Results of the present study provided some support for this hypothesis. METHODS We conducted a series of studies to determine DNA methylation changes in stress regulatory genes proopiomelanocortin (POMC) and period 2 (PER2) using biological samples from 3 separate cohorts of patients: (i) pregnant women who consumed moderate-to-high levels of alcohol or low/unexposed controls, (ii) children with PAE and non-alcohol-exposed controls, and (iii) children with PAE treated with or without choline. RESULTS We found pregnant women who consumed moderate-to-high levels of alcohol and gave birth to PAE children had higher DNA methylation of POMC and PER2. PAE children also had increased methylation of POMC and PER2. The differences in the gene methylation of PER2 and POMC between PAE and controls did not differ by maternal smoking status. PAE children had increased levels of stress hormone cortisol and adrenocorticotropic hormone. Choline supplementation reduced DNA hypermethylation and increased expression of POMC and PER2 in children with PAE. CONCLUSIONS These data suggest that PAE significantly elevates DNA methylation of POMC and PER2 and increases levels of stress hormones. Furthermore, these results suggest the possibility that measuring DNA methylation levels of PER2 and POMC in biological samples from pregnant women or from children may be useful for identification of a woman or a child with PAE.
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Affiliation(s)
- Dipak K. Sarkar
- Rutgers Endocrine Research Program. Department of Animal Sciences, Rutgers University, 67 Poultry Farm Lane, New Brunswick, NJ 08901, USA
| | - Omkaram Gangisetty
- Rutgers Endocrine Research Program. Department of Animal Sciences, Rutgers University, 67 Poultry Farm Lane, New Brunswick, NJ 08901, USA
| | - Jeffrey R. Wozniak
- Department of Psychiatry, University of Minnesota Twin Cities, F282/2A West, 2450 Riverside Ave, Minneapolis, MN 55454, USA
| | - Judith K. Eckerle
- Department Pediatrics, University of Minnesota, Minneapolis, MN 55414, USA
| | - Michael K. Georgieff
- Division of Pediatric Neonatology, University of Minnesota, Minneapolis, MN 55414, USA
| | - Tatiana M Foroud
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, 46202, USA
| | - Leah Wetherill
- Department of Medical and Molecular Genetics, Indiana University School of Medicine, Indianapolis, 46202, USA
| | - Wladimir Wertelecki
- Department of Pediatrics, University of California San Diego, La Jolla, CA, 92054, USA
| | - Christina D. Chambers
- Department of Pediatrics, University of California San Diego, La Jolla, CA, 92054, USA
| | - Edward Riley
- Department of Psychology, Center for Behavioral Teratology, San Diego State University, San Diego, California, 92120, USA
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27
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Sowell K, Holt R, Uriu-Adams J, Chambers C, Coles C, Kable J, Yevtushok L, Zymak-Zakutnya N, Wertelecki W, Keen C. Alcohol Consumption and Smoking During Pregnancy Alters Maternal Plasma Fatty Acid Composition: Association with Fetal Alcohol Spectrum Disorders (P11-028-19). Curr Dev Nutr 2019. [DOI: 10.1093/cdn/nzz048.p11-028-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objectives
Polyunsaturated fatty acids (PUFA) are vital for optimal fetal neuronal development. This study examined the relationship between maternal alcohol consumption and smoking with plasma fatty acids measured in the third trimester and their association with Fetal Alcohol Spectrum Disorders (FASD).
Methods
In the parent study, moderate to heavy alcohol-using and low/unexposed comparison women were recruited during mid-pregnancy from two prenatal clinics in Ukraine. The participants’ live-born infants underwent physical and neurobehavioral exams prior to one-year of age. Infants were classified as having FASD if their mothers reported moderate to heavy alcohol consumption and the infant had at least one standardized score below 85 on the Bayley Scales of Infant Development II (BISD-II) with or without physical features of FASD. From the overall cohort, a subset of mother-child pairs was selected representing three groups of cases and controls: Alcohol-Exposed with FASD (n = 30), Alcohol-Exposed Normally Developing (n = 33), or low/unexposed Controls (n = 46). Third trimester maternal plasma samples were analyzed for fatty acids and levels were compared across groups.
Results
Plasma compositions of omega-6 fatty acids were altered in mothers with FASD infants compared to other groups. More specifically, the % of stearic acid (C18:0), arachidonic acid (AA, C20:4n6) and docosapentaenoic acid (DPAn6, C22:5n6) were significantly higher in mothers with FASD infants than low/unexposed controls or alcohol-exposed mothers with typically developing infants. Alcohol-exposed women who smoked had lower n3-docosapentaenoic acid (DPAn3, C22:5n3) and docosahexaenoic acid (DHA, C22:6n3) and higher DPAn6 than women consuming alcohol alone or abstainers.
Conclusions
Alterations in fatty acid profiles were observed in moderate to heavy alcohol-consuming mothers with infants classified with FASD compared to alcohol-exposed typically developing infants or controls. These results support the idea that maternal fatty acid status can play a role in the etiology of FASD.
Funding Sources
This research was funded by support from NIH Research Grant and conducted in conjunction with the Collaborative Initiative on Fetal Alcohol Spectrum Disorders(CIFASD).
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28
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Bandoli G, Coles CD, Kable JA, Wertelecki W, Yevtushok L, Zymak-Zakutnya N, Wells A, Granovska IV, Pashtepa AO, Chambers CD. Patterns of Prenatal Alcohol Use That Predict Infant Growth and Development. Pediatrics 2019; 143:peds.2018-2399. [PMID: 30610099 PMCID: PMC6361345 DOI: 10.1542/peds.2018-2399] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Previous studies have had inconsistent findings regarding the quantity and frequency of prenatal alcohol exposure (PAE) that lead to deficits in growth and neurodevelopment. This may be due to imprecise methods of exposure classification. Our objective in this study was to employ longitudinal trajectory modeling of maternal drinking patterns associated with infant growth or neurodevelopmental deficits to a homogenous sample of mothers and infants. METHODS From a sample of 471 pregnant women prospectively enrolled in a longitudinal study in the Ukraine, we performed a longitudinal cluster analysis of drinking patterns across gestation. We employed multivariable regression analyses to determine if each trajectory group was associated with infant weight, length, or head circumference at birth or psychomotor or mental deficits in infancy. RESULTS We identified 5 distinct PAE trajectory groups: minimal or no PAE throughout gestation, low-to-moderate PAE with discontinuation early in gestation, low-to-moderate PAE sustained across gestation, moderate-to-high PAE with reduction early in gestation, and high PAE sustained across gestation. The highest-trajectory group was associated with deficits in infant weight and length at birth and deficits in psychomotor and mental performance at 6 to 12 months of age. Although confidence intervals overlapped, low-to-moderate sustained use was more strongly associated with most negative infant outcomes than moderate-to-high PAE with early reduction. CONCLUSIONS With these findings, we confirm that high, sustained PAE confers the highest risk for adverse infant outcomes but demonstrate that even low-to-moderate PAE continued across gestation is associated with certain deficits. This approach may be used to help clinicians identify high-risk infants for targeted early intervention.
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Affiliation(s)
- Gretchen Bandoli
- Departments of Pediatrics and .,Family Medicine and Public Health, University of California, San Diego, La Jolla, California
| | - Claire D. Coles
- Departments of Psychiatry and Pediatrics, School of Medicine, Emory University, Atlanta, Georgia
| | - Julie A. Kable
- Departments of Psychiatry and Pediatrics, School of Medicine, Emory University, Atlanta, Georgia
| | - Wladimir Wertelecki
- Departments of Pediatrics and,Omni-Net for Children International Charitable Fund and Rivne Regional Medical Diagnostic Center, Rivne, Ukraine;,Omni-Net for Children International Charitable Fund and Khmelnytsky Perinatal Center, Khmelnytskyi, Ukraine;,Department of Medical Genetics, University of South Alabama, Mobile, Alabama; and
| | - Lyubov Yevtushok
- Omni-Net for Children International Charitable Fund and Rivne Regional Medical Diagnostic Center, Rivne, Ukraine;,Lviv National Medical University, Lviv, Ukraine
| | - Natalya Zymak-Zakutnya
- Omni-Net for Children International Charitable Fund and Rivne Regional Medical Diagnostic Center, Rivne, Ukraine
| | | | - Irina V. Granovska
- Omni-Net for Children International Charitable Fund and Rivne Regional Medical Diagnostic Center, Rivne, Ukraine
| | - Alla O. Pashtepa
- Omni-Net for Children International Charitable Fund and Khmelnytsky Perinatal Center, Khmelnytskyi, Ukraine
| | - Christina D. Chambers
- Departments of Pediatrics and,Family Medicine and Public Health, University of California, San Diego, La Jolla, California
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29
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Coles CD, Kable JA, Granovska IV, Pashtepa AO, Plotka LD, Dolhov VB, Wertelecki W, Jones KL, Chambers CD. Gestational age and socioeconomic status as mediators for the impact of prenatal alcohol exposure on development at 6 months. Birth Defects Res 2018; 111:789-796. [PMID: 30378744 DOI: 10.1002/bdr2.1408] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Accepted: 09/10/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Of the many negative outcomes associated with gestational alcohol use, one that has received relatively little attention is preterm birth and its possible contribution to effects of prenatal alcohol exposure (PAE) on development. To examine the increased risk for premature delivery associated with PAE and the joint influence of preterm birth and alcohol on child outcomes, analysis was carried out in a longitudinal cohort recruited in Western Ukraine. METHODS Alcohol-using women and low or nondrinking controls were identified prenatally for a clinical trial of multivitamins and minerals (MVM) in ameliorating effects of PAE. Women were interviewed to provide information about medical and social status and other drug use. At delivery, information was collected about infant (N = 686) status including gestational age (GA) in weeks. Finally, 441 infants were followed to 6 months of age and cognitive (Mental Developmental Index [MDI]) and motor development (Psychomotor Developmental Index [PDI]) (measured using the Bayley Scales of Infant Development, second Ed (BSID-II). RESULTS Seven percent infants were born at <37 weeks GA. The odds ratio for preterm delivery for Alcohol Exposed versus Low/No Alcohol was 2.6 (95% Confidence Interval 1.37, 4.94) (p < .003); MVM supplements were associated with a lower rate of preterm delivery overall, but the relative proportion of preterm births did not vary by MVM supplement status between alcohol exposure groups. In mediation models of 6 month cognitive and motor development with reference to Barron and Kenney in 1986, GA significantly mediated alcohol effects (MDI: Z = -2.64, p < .008; PDI: Z = -2.35, p < .02) although PAE independently affected both outcomes (MDI: t = -5.6, p < .000; PDI: t = -3.19, p < .002). CONCLUSION Results suggest that PAE is associated with higher rates of preterm birth and that alcohol's effect on development in infancy may be both direct and mediated by shortened length of gestation.
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Affiliation(s)
- Claire D Coles
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Julie A Kable
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Irina V Granovska
- OMNI-Net for Children International Charitable Fund, Ukraine.,Rivne Regional Medical Diagnostic Center, Rivne, Ukraine
| | - Ala O Pashtepa
- OMNI-Net for Children International Charitable Fund, Ukraine.,Khmelnytsky Perinatal Center, Khmelnytsky, Ukraine
| | - Larisa D Plotka
- OMNI-Net for Children International Charitable Fund, Ukraine.,Rivne Regional Medical Diagnostic Center, Rivne, Ukraine
| | - Victor B Dolhov
- OMNI-Net for Children International Charitable Fund, Ukraine.,Khmelnytsky Perinatal Center, Khmelnytsky, Ukraine
| | - Wladimir Wertelecki
- OMNI-Net for Children International Charitable Fund, Ukraine.,Department of Pediatrics, University of California at San Diego, San Diego, California
| | - Kenneth L Jones
- Department of Pediatrics, University of California at San Diego, San Diego, California
| | - Christina D Chambers
- Department of Pediatrics, University of California at San Diego, San Diego, California
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30
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Bodnar TS, Raineki C, Wertelecki W, Yevtushok L, Plotka L, Zymak-Zakutnya N, Honerkamp-Smith G, Wells A, Rolland M, Woodward TS, Coles CD, Kable JA, Chambers CD, Weinberg J. Altered maternal immune networks are associated with adverse child neurodevelopment: Impact of alcohol consumption during pregnancy. Brain Behav Immun 2018; 73:205-215. [PMID: 29738852 PMCID: PMC6344127 DOI: 10.1016/j.bbi.2018.05.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 05/04/2018] [Accepted: 05/04/2018] [Indexed: 01/10/2023] Open
Abstract
Cytokines and chemokines are potent modulators of brain development and as such, dysregulation of the maternal immune system can result in deviations in the fetal cytokine balance, altering the course of typical brain development, and putting the individual on a "pathway to pathology". In the current study, we used a multi-variate approach to evaluate networks of interacting cytokines and investigated whether alterations in the maternal immune milieu could be linked to alcohol-related and alcohol-independent child neurodevelopmental delay. This was achieved through the measurement of 40 cytokines/chemokines from maternal blood samples collected during the second and third trimesters of pregnancy. Importantly, during the second trimester we identified network enrichment in levels of cytokines including IFN-ɣ, IL-10, TNF-β, TNF-α, and CRP associated with offspring neurodevelopmental delay. However, as elevations in levels of these cytokines have previously been reported in a wide range of neurodevelopmental disorders including autism spectrum disorder and schizophrenia, we suggest that this cytokine profile is likely not disorder specific, but rather may be an indicator of neurodevelopmental delay in general. By contrast, distinct clusters of activated/inhibited cytokines were identified based on maternal alcohol consumption and child neurodevelopmental outcome. Specifically, cytokines including IL-15, IL-10, MDC, and members of the VEGF sub-family were highest in alcohol-consuming mothers of children with neurodevelopmental delay and were identified in both network analyses and examination of individual cytokines, whereas a differential and unique cytokine profile was identified in the case of alcohol-independent child neurodevelopmental delay. We propose that the current findings could provide a critical step towards the development of early biomarkers and possibly interventions for alcohol-related neurodevelopmental delay. Importantly, the current approach could be informative for understanding mechanisms linking maternal immune system dysfunction and adverse child outcomes in a range of other neurodevelopmental disorders.
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Affiliation(s)
- Tamara S. Bodnar
- Department of Cellular and Physiological Sciences,
University of British Columbia, Vancouver, BC, Canada,Corresponding author: Tamara S.
Bodnar, Ph.D., Department of Cellular and Physiological Sciences, University of
British Columbia, 3307 – 2350 Health Sciences Mall, Vancouver, BC V6T
1Z3, Canada, , Phone: +1 (604) 822-4554, FAX:
+1 (604) 822-2316
| | - Charlis Raineki
- Department of Cellular and Physiological Sciences,
University of British Columbia, Vancouver, BC, Canada
| | | | - Lyubov Yevtushok
- OMNI-Net for Children International Charitable Fund, Rivne
Oblast Medical Diagnostic Center, Rivne, Ukraine
| | - Larisa Plotka
- OMNI-Net for Children International Charitable Fund, Rivne
Oblast Medical Diagnostic Center, Rivne, Ukraine
| | - Natalya Zymak-Zakutnya
- OMNI-Net for Children International Charitable Fund,
Khmelnytsky Perinatal Center, Khmelnytsky, Ukraine
| | | | - Alan Wells
- Department of Pediatrics, University of California San
Diego, La Jolla, USA
| | - Matthieu Rolland
- Department of Pediatrics, University of California San
Diego, La Jolla, USA
| | - Todd S. Woodward
- Department of Psychiatry, University of British Columbia,
Vancouver, Canada,Translational Research Unit, BC Mental Health and
Addictions Research Institute, Provincial Health Services Authority, Vancouver, BC,
Canada
| | - Claire D. Coles
- Department of Psychiatry and Behavioral Sciences;
Department of Pediatrics, Emory University School of Medicine, Atlanta, USA
| | - Julie A. Kable
- Department of Psychiatry and Behavioral Sciences;
Department of Pediatrics, Emory University School of Medicine, Atlanta, USA
| | - Christina D. Chambers
- Department of Pediatrics, University of California San
Diego, La Jolla, USA,Department of Family Medicine and Public Health, University
of California San Diego, La Jolla, CA, USA
| | - Joanne Weinberg
- Department of Cellular and Physiological Sciences,
University of British Columbia, Vancouver, BC, Canada
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Wertelecki W, Yevtushok L, Kuznietsov I, Komov O, Lapchenko S, Akhmedzanova D, Ostapchuk L. Incorporated levels of cesium-137 in pregnant women and prevalence rates of neural tube defects and microcephaly. Reprod Toxicol 2018. [DOI: 10.1016/j.reprotox.2018.06.069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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32
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Sowell K, Uriu-Adams J, Van de Water J, Chambers C, Coles C, Kable J, Yevtushok L, Zymak-Zakutnya N, Wertelecki W, Keen C. Implications of altered maternal cytokine concentrations on infant outcomes in children with prenatal alcohol exposure. Alcohol 2018; 68:49-58. [PMID: 29453023 DOI: 10.1016/j.alcohol.2017.08.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 08/09/2017] [Accepted: 08/09/2017] [Indexed: 12/16/2022]
Abstract
Excessive alcohol consumption has been shown to increase serum plasma levels of numerous immune cytokines. Maternal immune activation and elevated cytokines have been implicated in certain neurological disorders (e.g., autism and schizophrenia) in the offspring. We investigated the hypothesis that elevated cytokines during pregnancy are a risk factor in women who gave birth to a child with Fetal Alcohol Spectrum Disorder (FASD) or a child with neurobehavioral impairment, regardless of prenatal alcohol exposure. Moderate to heavy alcohol-exposed (AE) (N = 149) and low or no alcohol-exposed (LNA) (N = 92) women were recruited into the study during mid pregnancy (mean of 19.8 ± 5.8 weeks' gestation) in two regions of Ukraine: Khmelnytsky and Rivne. Maternal blood samples were obtained at enrollment into the study at early to mid-pregnancy and during a third-trimester follow-up visit and analyzed for plasma cytokines. Children were examined at 6 and/or 12 months of age and were classified as having FASD if their mothers reported alcohol use and if they had at least one standardized score (Bayley Scales of Infant Development II Mental Development Index [MDI], or Psychomotor Development Index [PDI]) below 85 with the presence or absence of physical features of FASD. In multivariate analyses of maternal cytokine levels in relation to infant MDI and PDI scores in the entire sample, increases in the ratio of TNF-α/IL-10 and IL-6/IL-10 were negatively associated with PDI scores at 6 months (p = 0.020 and p = 0.036, respectively) and 12 months (p = 0.043 and p = 0.029, respectively), and with MDI scores at 12 months (p = 0.013 and p = 0.050, respectively). A reduction in the odds ratio of having an FASD child was observed with increasing levels of IL-1β, IL-2, IL-4, IL-6, and IL-10 in early to mid-pregnancy and IL-1β and IL-10 during late pregnancy. However, women that failed to increase IL-10 levels in the third trimester in order to maintain the balance of pro- and anti-inflammatory cytokines had an elevated risk of having an FASD child, specifically a significant increase in the odds ratio of FASD with every one-unit log increase in late pregnancy TNF-α/IL-10 levels (aOR: 1.654, CI: 1.096-2.495, p = 0.017). These data support the concept that disruptions in the balance between pro- and anti-inflammatory cytokines may contribute to neurobehavioral impairment and alter the risk of FASD.
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Carlson CR, Uriu-Adams JY, Chambers CD, Yevtushok L, Zymak-Zakutnya N, Chan PH, Schafer JJ, Wertelecki W, Keen CL. Vitamin D Deficiency in Pregnant Ukrainian Women: Effects of Alcohol Consumption on Vitamin D Status. J Am Coll Nutr 2017; 36:44-56. [PMID: 28169608 DOI: 10.1080/07315724.2016.1174091] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Heavy alcohol consumption can alter vitamin D status; however, the relationships between alcohol consumption and vitamin D concentrations in pregnant women have not been well studied. The aim of this study was to investigate the vitamin D status in a population of alcohol-exposed (N = 180) and low/unexposed control (N = 179) Ukrainian pregnant women. METHODS Women who attended prenatal care facilities in 2 regions of Ukraine (Rivne and Khmelnytsky) for a routine prenatal visit were screened for the study. At the time of enrollment (20.4 ± 7.0 weeks of gestation), blood samples and alcohol consumption data (during a typical week around conception and the most recent 2 weeks) were collected. Vitamin D status was assessed by 25-hydroxyvitamin D [25(OH)D] concentrations. RESULTS A high prevalence of suboptimal vitamin D status in pregnant Ukrainian women was observed. Overall, 50.1% and 33.4% of the women were classified as vitamin D deficient [25(OH)D < 20 ng/mL] or insufficient [25(OH)D ≥ 20 ng/mL and ≤30 ng/mL], respectively, based on 2011 Endocrine Society guidelines. Alcohol-exposed women had significantly lower 25(OH)D concentrations than low/unexposed women in Spring (p = 0.006) and Winter (p = 0.022). When vitamin D concentrations were grouped into sunny season (Summer + Fall) compared to not sunny season (Winter + Spring), there was a significant ethanol by season interaction (p = 0.0028), with alcohol-drinking women having lower circulating vitamin D compared to low/unexposed women in seasons of low sun availability. CONCLUSIONS These data suggest that when vitamin D concentrations are generally low (e.g., during seasons of low sun availability), alcohol consumption during pregnancy has a negative impact on vitamin D status.
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Affiliation(s)
- Charles R Carlson
- a Department of Nutrition , University of California, Davis , Davis , California
| | - Janet Y Uriu-Adams
- a Department of Nutrition , University of California, Davis , Davis , California
| | | | - Lyubov Yevtushok
- d Rivne Oblast Medical Diagnostic Center and OMNI-Net Center , Rivne , Ukraine
| | | | - Priscilla H Chan
- c Department of Pediatrics , University of San Diego , La Jolla , California
| | - Jordan J Schafer
- c Department of Pediatrics , University of San Diego , La Jolla , California
| | - Wladimir Wertelecki
- f Department of Medical Genetics , University of South Alabama , Mobile , Alabama
| | - Carl L Keen
- b Department of Internal Medicine , University of California, Davis , Davis , California
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34
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Wertelecki W, Korzhynskyy Y, Yevtushok L, Zymak-Zakutnia N, Liashenko S, Lapchenko S, Lastivka I, Patskun E, Kamut N, Tychkivska O, Akhmedzhanova D, Ostapchuk L, Hohosha I, Tkhorevskyy S. Dysmorphology in practice. Reprod Toxicol 2017. [DOI: 10.1016/j.reprotox.2017.06.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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35
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Yevtushok L, Shustyk R, Sosyniuk Z, Ievtushok B, Zymak-Zakutnia N, Lapchenko S, Akhmedzhanova D, Wertelecki W. Persistence of elevated incorporated cesium-137 in the Polissia region of Ukraine. Reprod Toxicol 2017. [DOI: 10.1016/j.reprotox.2017.06.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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36
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Patskun E, Lapchenko S, Korzhynskyy Y, Yevtushok L, Zymak-Zakutnia N, Lastivka I, Kalynka S, Akhmedzhanova D, Wertelecki W. Adaptation of teratology information systems. Reprod Toxicol 2017. [DOI: 10.1016/j.reprotox.2017.06.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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37
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Wertelecki W, Chambers CD, Yevtushok L, Zymak-Zakutnya N, Sosyniuk Z, Lapchenko S, Ievtushok B, Akhmedzhanova D, Komov O. Chornobyl 30 years later: Radiation, pregnancies, and developmental anomalies in Rivne, Ukraine. Eur J Med Genet 2017; 60:2-11. [DOI: 10.1016/j.ejmg.2016.09.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 09/29/2016] [Indexed: 11/24/2022]
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38
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Mesa DA, Kable JA, Coles CD, Jones KL, Yevtushok L, Kulikovsky Y, Wertelecki W, Coleman TP, Chambers CD. The Use of Cardiac Orienting Responses as an Early and Scalable Biomarker of Alcohol-Related Neurodevelopmental Impairment. Alcohol Clin Exp Res 2016; 41:128-138. [PMID: 27883195 DOI: 10.1111/acer.13261] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 10/06/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Considered the leading cause of developmental disabilities worldwide, fetal alcohol spectrum disorders (FASD) are a global health problem. To take advantage of neural plasticity, early identification of affected infants is critical. The cardiac orienting response (COR) has been shown to be sensitive to the effects of prenatal alcohol exposure and is an inexpensive, easy to administer assessment tool. The purpose of this study was to evaluate the COR effectiveness in assessing individual risk of developmental delay. METHODS As part of an ongoing longitudinal cohort study in Ukraine, live-born infants of women with some to heavy amounts of alcohol consumption in pregnancy were recruited and compared to infants of women who consumed low or no alcohol. At 6 and 12 months, infants were evaluated with the Bayley Scales of Infant Development-II. CORs were also collected during a habituation/dishabituation learning paradigm. Using a supervised logistic regression classifier, we compared the predictive utility of the COR indices to that of the 6-month Bayley scores for identification of developmental delay based on 12-month Bayley scores. Heart rate collected at each second (Standard COR) was compared to key features (Key COR) extracted from the response. RESULTS Negative predictive values (NPV) were 85% for Standard COR, 82% for Key COR, and 77% for the Bayley, and positive predictive values (PPV) were 66% for Standard COR, 62% for Key COR, and 43% for the Bayley. CONCLUSIONS Predictive analysis based on the COR resulted in better NPV and PPV than the 6-month Bayley score. As the resources required to obtain a Bayley score are substantially more than in a COR-based paradigm, the findings are suggestive of its utility as an early scalable screening tool based on the COR. Further work is needed to test its long-term predictive accuracy.
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Affiliation(s)
- Diego A Mesa
- Department of Bioengineering, University of California, San Diego, La Jolla, California
| | - Julie A Kable
- Department of Psychiatry and Behavioral Science, Emory University School of Medicine, Atlanta, Georgia.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Claire D Coles
- Department of Psychiatry and Behavioral Science, Emory University School of Medicine, Atlanta, Georgia.,Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Kenneth Lyons Jones
- Department of Pediatrics, University of California, San Diego, La Jolla, California
| | - Lyubov Yevtushok
- OMNI-Net for Children International Charitable Fund, Rivne Regional Medical Diagnostic Center, Rivne, Ukraine
| | - Yaroslav Kulikovsky
- OMNI-Net for Children International Charitable Fund, Rivne Regional Medical Diagnostic Center, Rivne, Ukraine
| | - Wladimir Wertelecki
- Department of Pediatrics, University of California, San Diego, La Jolla, California.,Department of Medical Genetics, University of South Alabama, Mobile, Alabama, California
| | - Todd P Coleman
- Department of Bioengineering, University of California, San Diego, La Jolla, California
| | - Christina D Chambers
- Department of Pediatrics, University of California, San Diego, La Jolla, California.,Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California
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Kable JA, Coles CD, Jones KL, Yevtushok L, Kulikovsky Y, Wertelecki W, Chambers CD. Cardiac Orienting Responses Differentiate the Impact of Prenatal Alcohol Exposure in Ukrainian Toddlers. Alcohol Clin Exp Res 2016; 40:2377-2384. [PMID: 27650880 PMCID: PMC5073038 DOI: 10.1111/acer.13221] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Accepted: 08/18/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Prenatal alcohol exposure (PAE) has been found to impact neurophysiological encoding of environmental events negatively in the first year of life but has not been evaluated in older infants or toddlers. Cardiac orienting responses (ORs) collected during a habituation/dishabituation learning paradigm were obtained from 12- to 18-month-olds to assess the impact of PAE beyond the first year of life. METHODS Participants included women and their toddlers who differed in PAE histories and enrolled in a randomized clinical trial of multivitamin/mineral usage during pregnancy. Those who were randomly assigned to the no intervention group were used for this analysis. The habituation/dishabituation paradigm consisted of 10 habituation and 5 dishabituation trials. Baseline heart rate (HR) was collected for 30 seconds prior to stimulus onset, and responses to the stimuli were assessed by sampling HR for 12 seconds poststimulus onset. RESULTS The speed of the OR in response to auditory stimuli in the dishabituation condition was found to be altered as a function of maternal alcohol use around conception. For visual stimuli, positive histories of PAE were predictive of the magnitude but not the speed of the response on habituation and dishabituation trials. A history of binge drinking was associated with reduced magnitude of the OR response on visual encoding trials, and level of alcohol exposure at the time of conception was predictive of the magnitude of the response on visual dishabituation trials. CONCLUSIONS Cardiac ORs collected in the toddler period were sensitive to the effects of PAE. The magnitude of the OR was more sensitive to the impact of PAE than in previous research with younger infants, and this may be a function of brain maturation. Additional research assessing the predictive utility of using ORs in making decisions about individual risk was recommended.
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Affiliation(s)
- Julie A Kable
- Department of Psychiatry and Behavioral Science, Emory University School of Medicine, Atlanta, Georgia.
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia.
| | - Claire D Coles
- Department of Psychiatry and Behavioral Science, Emory University School of Medicine, Atlanta, Georgia
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Kenneth L Jones
- Department of Pediatrics, University of California San Diego, La Jolla, California
| | - Lyubov Yevtushok
- OMNI-Net for Children International Charitable Fund, Rivne Regional Medical Diagnostic Center, Rivne Province, Ukraine
| | - Yaroslav Kulikovsky
- OMNI-Net for Children International Charitable Fund, Rivne Regional Medical Diagnostic Center, Rivne Province, Ukraine
| | - Wladimir Wertelecki
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California
- Department of Medical Genetics, University of South Alabama, Mobile, Alabama
| | - Christina D Chambers
- Department of Pediatrics, University of California San Diego, La Jolla, California
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California
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40
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Montag AC, Hull AD, Yevtushok L, Zymak-Zakutnya N, Sosyniuk Z, Dolhov V, Jones KL, Wertelecki W, Chambers CD. Second-Trimester Ultrasound as a Tool for Early Detection of Fetal Alcohol Spectrum Disorders. Alcohol Clin Exp Res 2016; 40:2418-2425. [PMID: 27688069 DOI: 10.1111/acer.13232] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 09/02/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Early detection of fetal alcohol spectrum disorders (FASDs) is desirable to allow earlier and more comprehensive interventions to be initiated for the mother and infant. We examined prenatal ultrasound as an early method of detecting markers of the physical features and neurobehavioral deficits characteristic of FASD. METHODS A longitudinal cohort of pregnant women in Ukraine was recruited as part of the Collaborative Initiative on Fetal Alcohol Spectrum Disorders. Women were enrolled into a moderately to heavy-alcohol-exposed group or a low- or no-alcohol exposure group and were followed to pregnancy outcome. In the second trimester, a fetal ultrasound was performed to measure transverse cerebellar diameter, occipital frontal diameter (OFD), caval-calvarial distance, frontothalamic distance (FTD), interorbital distance (IOD), outer orbital diameter, and orbital diameter (OD). Live born infants received a dysmorphological examination and a neurobehavioral evaluation using the Bayley Scales of Infant Development. These data were used to classify infants with respect to FASD. Comparisons were made on the ultrasound measures between those with and without features of FASD, adjusting for gestational age at ultrasound and maternal smoking. RESULTS A total of 233 mother/child dyads were included. Children classified as FASD had significantly longer IOD and lower FTD/IOD, OFD/IOD, and FTD/OD ratios (p < 0.05). Children with a Bayley score <85 had significantly shorter FTD, longer IOD, lower OFD/IOD, and FTD/IOD ratios (p < 0.05). In general, mean differences were small. Ultrasound variables alone predicted <10% of the variance in the FASD outcome. CONCLUSIONS Some ultrasound measurements were associated with FASD, selected facial features of the disorder, and lower neurobehavioral scores. However, mean differences were relatively small, making it difficult to predict affected children based solely on these measures. It may be advantageous to combine these easily obtained ultrasound measures with other data to aid in identifying high risk for an FASD outcome.
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Affiliation(s)
- Annika C Montag
- Department of Pediatrics, University of California San Diego, La Jolla, California.
| | - Andrew D Hull
- Department of Reproductive Medicine, University of California San Diego, La Jolla, California
| | - Lyubov Yevtushok
- Rivne Provincial Medical Diagnostic Center and OMNI-Net Center, Rivne, Ukraine
| | | | - Zoryana Sosyniuk
- Rivne Provincial Medical Diagnostic Center and OMNI-Net Center, Rivne, Ukraine
| | - Viktor Dolhov
- Khmelnytsky City Perinatal Center and OMNI-Net Center, Khmelnytsky, Ukraine
| | - Kenneth Lyons Jones
- Department of Pediatrics, University of California San Diego, La Jolla, California.,Rady Children's Hospital, San Diego, California
| | - Wladimir Wertelecki
- Department of Pediatrics, University of California San Diego, La Jolla, California.,Department of Medical Genetics, University of South Alabama, Mobile, Alabama
| | - Christina D Chambers
- Department of Pediatrics, University of California San Diego, La Jolla, California.,Rady Children's Hospital, San Diego, California.,Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California
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Coles CD, Kable JA, Keen CL, Jones KL, Wertelecki W, Granovska IV, Pashtepa AO, Chambers CD. Dose and Timing of Prenatal Alcohol Exposure and Maternal Nutritional Supplements: Developmental Effects on 6-Month-Old Infants. Matern Child Health J 2016; 19:2605-14. [PMID: 26164422 DOI: 10.1007/s10995-015-1779-x] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Fetal alcohol spectrum disorders are more common in disadvantaged populations. Environmental factors, like suboptimal nutrition, may potentiate the developmental effects of prenatal alcohol exposure. To evaluate the impact of micronutrients, including choline, on reduction of effects of exposure, we examined timing and dose of alcohol and effects of nutritional supplementation at two OMNI-Net sites in Western Ukraine that included high and low risk individuals. METHODS Alcohol-using and nondrinking women were randomized to one of three multivitamin/mineral supplement groups: none, multivitamins/minerals (MVM), and multivitamin/minerals plus choline. Children (N = 367) were tested at 6 months with the Bayley Scales of Infant Development (2nd ED) yielding standard scores for Mental Development Index (MDI), Psychomotor Development Index (PDI) and Behavior. RESULTS Generalized linear modeling was used: (1) for factorial analysis of effects of alcohol group, multivitamin/minerals, and choline supplementation; and (2) to examine the relationship between amount and timing of alcohol (ounces of absolute alcohol/day [ozAA/day] peri-conception and on average in the second trimester) and MVM supplementation on developmental outcomes while controlling sex, social class, and smoking. MDI was significantly impacted by peri-conceptual alcohol dose (X2(1), p < .001) with more alcohol associated with lower scores and males more negatively affected than females (X2(1), p < .002). Micronutrient supplementation had a protective effect; those receiving supplements performed better ([Formula: see text], p < .005). The PDI motor scores did not differ by group but were affected by peri-conceptual alcohol dose (X2(1), p < .04). CONCLUSIONS FOR PRACTICE Multivitamin/mineral supplementation can reduce the negative impact of alcohol use during pregnancy on specific developmental outcomes.
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Affiliation(s)
- Claire D Coles
- Departments of Psychiatry and Pediatrics, Emory University School of Medicine, Atlanta, GA, USA. .,Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive, Room 212, Atlanta, GA, 30329, USA.
| | - Julie A Kable
- Departments of Psychiatry and Pediatrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Carl L Keen
- Department of Nutrition, University of California-Davis, Davis, CA, USA
| | - Kenneth Lyons Jones
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Wladimir Wertelecki
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA.,University of South Alabama, Mobile, AL, USA.,OMNI-Net for Children International Charitable Fund, Rivne Regional Medical Diagnostic Center, Rivne, Rivne Province, Ukraine.,OMNI-Net for Children International Charitable Fund, Khmelnytsky Perinatal Center, Khmelnytsky, Khmelnytsky Province, Ukraine
| | - Irina V Granovska
- OMNI-Net for Children International Charitable Fund, Rivne Regional Medical Diagnostic Center, Rivne, Rivne Province, Ukraine
| | - Alla O Pashtepa
- OMNI-Net for Children International Charitable Fund, Khmelnytsky Perinatal Center, Khmelnytsky, Khmelnytsky Province, Ukraine
| | - Christina D Chambers
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
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Bandoli G, Coles CD, Kable JA, Wertelecki W, Granovska IV, Pashtepa AO, Chambers CD. Assessing the Independent and Joint Effects of Unmedicated Prenatal Depressive Symptoms and Alcohol Consumption in Pregnancy and Infant Neurodevelopmental Outcomes. Alcohol Clin Exp Res 2016; 40:1304-11. [PMID: 27129610 DOI: 10.1111/acer.13081] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 03/28/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Prenatal alcohol exposure (PAE) is an established risk factor for neurodevelopmental deficits in the offspring. Prenatal depression has been associated with neurodevelopmental deficits in the offspring, although investigations into unmedicated prenatal depression have been inconsistent. We hypothesized that unmedicated prenatal depressive symptoms would independently and jointly with PAE predict neurodevelopmental outcomes in infant offspring. METHODS We studied 344 participants from a randomized clinical trial of multivitamin supplements in pregnant women in Ukraine. Women were recruited based upon periconceptional alcohol use and followed up to 12 months postpartum. Prenatal depressive symptoms were assessed at approximately 32 weeks of gestation using the Beck Depression Inventory score. Neurodevelopment was assessed with the Bayley Scales of Infant Development II Mental Development Index (MDI) and Psychomotor Development Index (PDI) at 6 and 12 months postpartum. Generalized linear regression models were constructed to assess the independent and joint effects of prenatal depressive symptoms and PAE in models adjusted for sociodemographic and pregnancy characteristics. RESULTS PAE was independently associated with deficits in neurodevelopmental outcomes at 6 and 12 months, however, level of prenatal depressive symptoms was not. We found marginal evidence of synergism of depressive symptoms and PAE, with larger deficits in those with both exposures observed for the PDI-6 months (p = 0.05) and MDI-12 months (p = 0.09). Additionally, there was a suggestion of sexual dimorphism; females had stronger deficits from joint exposures than males (depressive symptom [MDI-6 months] female: -8.28, 95% CI -13.06, -3.49; male: 0.68, 95% CI -4.58, 5.94; p for interaction 0.04). While not statistically significant for the MDI or PDI at 12 months, the trend persisted. CONCLUSIONS Infants exposed to PAE and prenatal depression may be at an increased risk of neurodevelopmental deficits. Healthcare providers should be aware of this possible synergism in their efforts to mitigate the neurodevelopmental effects of these co-occurring exposures.
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Affiliation(s)
- Gretchen Bandoli
- Department of Pediatrics, University of California, San Diego, San Diego, California
| | - Claire D Coles
- Departments of Psychiatry and Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Julie A Kable
- Departments of Psychiatry and Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Wladimir Wertelecki
- Department of Pediatrics, University of California, San Diego, San Diego, California.,OMNI-Net for Children International Charitable Fund, Rivne Regional Medical Diagnostic Center, Rivne, Ukraine.,OMNI-Net for Children International Charitable Fund, Khmelnytsky Perinatal Center, Khmelnytsky, Ukraine.,Department of Medical Genetics, University of South Alabama, Mobile, Alabama
| | - Irina V Granovska
- OMNI-Net for Children International Charitable Fund, Rivne Regional Medical Diagnostic Center, Rivne, Ukraine
| | - Alla O Pashtepa
- OMNI-Net for Children International Charitable Fund, Khmelnytsky Perinatal Center, Khmelnytsky, Ukraine
| | - Christina D Chambers
- Department of Pediatrics, University of California, San Diego, San Diego, California
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Wertelecki W, Koerblein A, Ievtushok B, Zymak-Zakutnia N, Komov O, Kuznietsov I, Lapchenko S, Sosyniuk Z. Elevated congenital anomaly rates and incorporated cesium-137 in the Polissia region of Ukraine. ACTA ACUST UNITED AC 2016; 106:194-200. [PMID: 26871487 DOI: 10.1002/bdra.23476] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 11/20/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND Investigations soon after the 1986 Chornobyl (Chernobyl in Russian) accident of exposed populations residing elsewhere in Europe led government and international agencies to conclude that exposures to cesium-137 (Cs-137) were not teratogenic. Our observations of elevated population rates of neural tube defects (NTDs) and microcephaly and microphthalmia (M/M) in the Rivne Province in Ukraine, which were among the highest in Europe, prompted this follow-up investigation inclusive of whole-body counts (WBCs) of Cs-137 among ambulatory patients and pregnant women residing in Polissia, the most polluted region in Rivne. METHODS Yearly (2000-2012) population rates of NTDs and M/M and WBC patterns of ambulatory patients (2001-2010) and pregnant women (2011-2013) in Polissia and non-Polissia regions of Rivne were analyzed. RESULTS The NTD and M/M population rates in Rivne remain elevated and are statistically significantly higher in Polissia than in non-Polissia. The WBCs among residents in Polissia are statistically significantly higher than among those from non-Polissia. CONCLUSION NTD and M/M rates are highest in the Polissia region of Rivne and are among the highest in Europe. In Polissia, the WBCs of Cs-137 are above officially set permissible upper limits. The results are based on aggregate data of NTDs and M/Ms and average WBC values. Further investigations of causality of the high rates of NTDs and M/Ms are needed and urgent strengthening policies and implementations to reduce exposures to teratogens, in particular radioactive nuclides and alcohol, and consumption of folic acid supplements are indicated.
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Affiliation(s)
| | - Alfred Koerblein
- OMNI-Net for Children International Charitable Fund, Rivne, Ukraine
| | - Bogdana Ievtushok
- OMNI-Net for Children International Charitable Fund, Rivne, Ukraine.,Rivne Province Regional Medical Diagnostic Center, Rivne, Ukraine
| | - Nataliya Zymak-Zakutnia
- OMNI-Net for Children International Charitable Fund, Rivne, Ukraine.,Khmelnytsky City Perinatal Center, Khmelnytsky, Ukraine
| | - Oleksandr Komov
- Rivne Province State Sanitary-and-Epidemiologic Service, Rivne, Ukraine
| | - Illia Kuznietsov
- OMNI-Net for Children International Charitable Fund, Rivne, Ukraine.,Human and Animal Physiology Department, Eastern-European University, Lutsk, Volyn, Ukraine
| | - Serhiy Lapchenko
- OMNI-Net for Children International Charitable Fund, Rivne, Ukraine
| | - Zoriana Sosyniuk
- OMNI-Net for Children International Charitable Fund, Rivne, Ukraine.,Rivne Province Regional Medical Diagnostic Center, Rivne, Ukraine
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44
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Kable JA, Coles CD, Keen CL, Uriu-Adams JY, Jones KL, Yevtushok L, Kulikovsky Y, Wertelecki W, Pedersen TL, Chambers CD. The impact of micronutrient supplementation in alcohol-exposed pregnancies on information processing skills in Ukrainian infants. Alcohol 2015; 49:647-56. [PMID: 26493109 PMCID: PMC4636447 DOI: 10.1016/j.alcohol.2015.08.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Revised: 08/12/2015] [Accepted: 08/13/2015] [Indexed: 12/24/2022]
Abstract
The potential of micronutrients to ameliorate the impact of prenatal alcohol exposure (PAE) was explored in a clinical trial conducted in Ukraine. Cardiac orienting responses (ORs) during a habituation/dishabituation learning paradigm were obtained from 6 to 12 month-olds to assess neurophysiological encoding and memory. Women who differed in prenatal alcohol use were recruited during pregnancy and assigned to a group (No study-provided supplements, multivitamin/mineral supplement, or multivitamin/mineral supplement plus choline supplement). Heart rate was collected for 30 s prior to stimulus onset and 12 s post-stimulus onset. Difference values (∆HR) for the first 3 trials of each condition were aggregated for analysis. Gestational blood samples were collected to assess maternal nutritional status and changes as a function of the intervention. Choline supplementation resulted in a greater ∆HR on the visual habituation trials for all infants and for the infants with no PAE on the dishabituation trials. The latency of the response was reduced in both conditions for all infants whose mothers received choline supplementation. Change in gestational choline level was positively related to ∆HR during habituation trials and levels of one choline metabolite, dimethylglycine (DMG), predicted ∆HR during habituation trials and latency of responses. A trend was found between DMG and ∆HR on the dishabituation trials and latency of the response. Supplementation did not affect ORs to auditory stimuli. Choline supplementation when administered together with routinely recommended multivitamin/mineral prenatal supplements during pregnancy may provide a beneficial impact to basic learning mechanisms involved in encoding and memory of environmental events in alcohol-exposed pregnancies as well as non- or low alcohol-exposed pregnancies. Changes in maternal nutrient status suggested that one mechanism by which choline supplementation may positively impact brain development is through prevention of fetal alcohol-related depletion of DMG, a metabolic nutrient that can protect against overproduction of glycine, during critical periods of neurogenesis.
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Affiliation(s)
- J A Kable
- Department of Psychiatry and Behavioral Science, Emory University School of Medicine, USA; Department of Pediatrics, Emory University School of Medicine, USA.
| | - C D Coles
- Department of Psychiatry and Behavioral Science, Emory University School of Medicine, USA; Department of Pediatrics, Emory University School of Medicine, USA
| | - C L Keen
- Department of Nutrition, University of California, Davis, USA
| | - J Y Uriu-Adams
- Department of Nutrition, University of California, Davis, USA
| | - K L Jones
- Department of Pediatrics, University of California, San Diego, USA
| | - L Yevtushok
- OMNI-Net for Children International Charitable Fund, Rivne Regional Medical Diagnostic Center, Rivne Province, Ukraine
| | - Y Kulikovsky
- OMNI-Net for Children International Charitable Fund, Rivne Regional Medical Diagnostic Center, Rivne Province, Ukraine
| | - W Wertelecki
- Department of Pediatrics, University of California, San Diego, USA; Department of Medical Genetics, University of South Alabama, USA
| | - T L Pedersen
- United States Department of Agriculture, Agricultural Research Service (ARS), Western Human Nutrition Research Center, Davis, CA, USA
| | - C D Chambers
- Department of Pediatrics, University of California, San Diego, USA; Department of Family Medicine and Public Health, University of California, San Diego, USA
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Sowell K, Uriu‐Adams J, Graham J, Chambers C, Coles C, Yevtushok L, Zymak‐Zakutnya N, Wertelecki W, Keen C. Plasma IL‐6 Levels are Elevated During the Third Trimester in Alcohol‐Exposed Women with Children Diagnosed with Fetal Alcohol Spectrum Disorder (FASD) Compared to Alcohol–Exposed Women with Normally Developed Children. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.913.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | | | | | | | - Claire Coles
- Psychiatry and Behavioral Sciences Dept.Emory Univ.AtlantaGA
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McGivern MR, Best KE, Rankin J, Wellesley D, Greenlees R, Addor MC, Arriola L, de Walle H, Barisic I, Beres J, Bianchi F, Calzolari E, Doray B, Draper ES, Garne E, Gatt M, Haeusler M, Khoshnood B, Klungsoyr K, Latos-Bielenska A, O'Mahony M, Braz P, McDonnell B, Mullaney C, Nelen V, Queisser-Luft A, Randrianaivo H, Rissmann A, Rounding C, Sipek A, Thompson R, Tucker D, Wertelecki W, Martos C. Epidemiology of congenital diaphragmatic hernia in Europe: a register-based study. Arch Dis Child Fetal Neonatal Ed 2015; 100:F137-44. [PMID: 25411443 DOI: 10.1136/archdischild-2014-306174] [Citation(s) in RCA: 182] [Impact Index Per Article: 20.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Published prevalence rates of congenital diaphragmatic hernia (CDH) vary. This study aims to describe the epidemiology of CDH using data from high-quality, population-based registers belonging to the European Surveillance of Congenital Anomalies (EUROCAT). METHODS Cases of CDH delivered between 1980 and 2009 notified to 31 EUROCAT registers formed the population-based case series. Prevalence over time was estimated using multilevel Poisson regression, and heterogeneity between registers was evaluated from the random component of the intercept. RESULTS There were 3373 CDH cases reported among 12 155 491 registered births. Of 3131 singleton cases, 353 (10.4%) were associated with a chromosomal anomaly, genetic syndrome or microdeletion, 784 (28.2%) were associated with other major structural anomalies. The male to female ratio of CDH cases overall was 1:0.69. Total prevalence was 2.3 (95% CI 2.2 to 2.4) per 10 000 births and 1.6 (95% CI 1.6 to 1.7) for isolated CDH cases. There was a small but significant increase (relative risk (per year)=1.01, 95% credible interval 1.00-1.01; p=0.030) in the prevalence of total CDH over time but there was no significant increase for isolated cases (ie, CDH cases that did not occur with any other congenital anomaly). There was significant variation in total and isolated CDH prevalence between registers. The proportion of cases that survived to 1 week was 69.3% (1392 cases) for total CDH cases and 72.7% (1107) for isolated cases. CONCLUSIONS This large population-based study found an increase in total CDH prevalence over time. CDH prevalence also varied significantly according to geographical location. No significant association was found with maternal age.
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Affiliation(s)
- Mark R McGivern
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Kate E Best
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Judith Rankin
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
| | - Diana Wellesley
- Faculty of Medicine and Wessex Clinical Genetics Service, University Hospitals Southampton, Southampton, UK
| | | | | | - Larraitz Arriola
- Public Health Division of Gipuzkoa, Instituto Bio-Donostia, Basque Government, CIBER Epidemiología y Salud Pública, CIBERESP, Spain
| | - Hermien de Walle
- Eurocat Northern Netherlands, Department of Genetics, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Ingeborg Barisic
- Children's Hospital Zagreb, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Judit Beres
- Department of Hungarian Congenital Abnormality Registry & Surveillance, National Institute of Health Development, Budapest, Hungary
| | - Fabrizio Bianchi
- Department of Medical Genetics, ARNAS Garibaldi Nesima, Catania, Italy
| | - Elisa Calzolari
- IMER Registry (Emila Romagna Registry of Birth Defects), Ferrara, Italy
| | - Berenice Doray
- Department of de Genetique Medicale, Hopital de Hautepierre, Strasbourg, France
| | | | | | - Miriam Gatt
- Department of Health Information and Research, Guardamangia, Malta
| | | | - Babak Khoshnood
- Paris Registry of Congenital Malformations, INSERM U953, Paris, France
| | - Kari Klungsoyr
- Medical Birth Registry of Norway, Norwegian Institute of Public Health and Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | | | | | - Paula Braz
- Instituto Nacional de Saude Dr Ricardo Jorge, Lisbon, Portugal
| | | | | | - Vera Nelen
- Provinciaal Instituut voor Hygiene, Antwerp, Belgium
| | - Anette Queisser-Luft
- Birth Registry Mainz Model, Childrens Hospital, University Medical Center, Johannes Gutenberg-University, Mainz, Germany
| | | | - Anke Rissmann
- Malformation Monitoring Centre Saxony-Anhalt, Medical Faculty Otto-von-Guericke University, Magdeburg, Germany
| | | | - Antonin Sipek
- National Registry of Congenital Anomalies, Department of Medical Genetics, Thomayer Hospital, Prague, Czech Republic
| | - Rosie Thompson
- South West England Congenital Anomaly Register, Bristol, UK
| | | | | | - Carmen Martos
- Centro Superior de Investigación en Salud Pública-FISABIO, Valencia, Spain
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Chambers CD, Yevtushok L, Zymak-Zakutnya N, Korzhynskyy Y, Ostapchuk L, Akhmedzhanova D, Chan PH, Xu R, Wertelecki W. Prevalence and predictors of maternal alcohol consumption in 2 regions of Ukraine. Alcohol Clin Exp Res 2014; 38:1012-9. [PMID: 24834525 DOI: 10.1111/acer.12318] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Fetal alcohol spectrum disorders are thought to be a leading cause of developmental disabilities worldwide. However, data are lacking on alcohol use among pregnant women in many countries. The purpose of this study was to evaluate the prevalence and predictors of alcohol consumption by pregnant women in Ukraine. METHODS Cross-sectional screening of pregnant women was conducted in 2 regions of Ukraine during the recruitment phase of an ongoing clinical study that is part of the Collaborative Initiative on Fetal Alcohol Spectrum Disorders. Women attending a routine prenatal visit at 1 of 2 participating regional centers were asked about alcohol consumption. Quantity and frequency of alcoholic beverages consumed in the month around conception and in the most recent month of pregnancy were measured using a standard interview instrument. RESULTS Between 2007 and 2012, 11,909 pregnant women were screened on average in the second trimester of pregnancy. Of these, 92.7% reported being ever-drinkers. Among ever-drinkers, 54.8% reported drinking alcohol in the month around conception and 12.9% consumed at least 3 drinks on at least 1 day in that time period. In the most recent month of pregnancy, 46.3% continued to report alcohol use and 9.2% consumed at least 3 drinks per day. Significant predictors of average number of drinks or heavier drinking per day in either time period in pregnancy included lower gravidity, being single, unmarried/living with a partner, or separated, lower maternal education, smoking, younger age at initiation of drinking, and higher score on the TWEAK screening test for harmful drinking. CONCLUSIONS These findings support the need for education/intervention in women of childbearing age in Ukraine and can help inform targeted interventions for women at risk of an alcohol-exposed pregnancy. The initiation of a standard screening protocol in pregnancy is a step in the right direction.
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Wertelecki W, Yevtushok L, Zymak-Zakutnia N, Wang B, Sosyniuk Z, Lapchenko S, Hobart HH. Blastopathies and microcephaly in a Chornobyl impacted region of Ukraine. Congenit Anom (Kyoto) 2014; 54:125-49. [PMID: 24666273 PMCID: PMC4233949 DOI: 10.1111/cga.12051] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 01/05/2014] [Indexed: 12/17/2022]
Abstract
This population-based descriptive epidemiology study demonstrates that rates of conjoined twins, teratomas, neural tube defects, microcephaly, and microphthalmia in the Rivne province of Ukraine are among the highest in Europe. The province is 200 km distant from the Chornobyl site and its northern half, a region known as Polissia, is significantly polluted by ionizing radiation. The rates of neural tube defects, microcephaly and microphthalmia in Polissia are statistically significantly higher than in the rest of the province. A survey of at-birth head size showed that values were statistically smaller in males and females born in one Polissia county than among neonates born in the capital city. These observations provide clues for confirmatory and cause-effect prospective investigations. The strength of this study stems from a reliance on international standards prevalent in Europe and a decade-long population-based surveillance of congenital malformations in two distinct large populations. The limitations of this study, as those of other descriptive epidemiology investigations, is that identified cause-effect associations require further assessment by specific prospective investigations designed to address specific teratogenic factors.
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Affiliation(s)
- Wladimir Wertelecki
- Department of Medical Genetics, College of Medicine, University of South AlabamaMobile, Alabama, USA
- OMNI-Net for Children International Charitable FundRivne, Rivne Province, Ukraine
| | - Lyubov Yevtushok
- OMNI-Net for Children International Charitable FundRivne, Rivne Province, Ukraine
- Rivne Regional Medical Diagnostic CenterRivne, Rivne Province, Ukraine
| | - Natalia Zymak-Zakutnia
- OMNI-Net for Children International Charitable FundRivne, Rivne Province, Ukraine
- Khmelnytsky Perinatal CenterKhmelnytsky, Khmelnytsky Province, Ukraine
| | - Bin Wang
- Department of Mathematics and Statisitcs, University of South AlabamaMobile, Alabama, USA
| | - Zoriana Sosyniuk
- OMNI-Net for Children International Charitable FundRivne, Rivne Province, Ukraine
- Rivne Regional Medical Diagnostic CenterRivne, Rivne Province, Ukraine
| | - Serhiy Lapchenko
- OMNI-Net for Children International Charitable FundRivne, Rivne Province, Ukraine
| | - Holly H Hobart
- Cyto-Genetics Laboratory, Department of Pathology, University of Mississippi Medical CenterJackson, Mississippi, USA
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Jones KL, Hoyme HE, Robinson L, DelCampo M, Manning M, Chambers C, Yevtushok L, Zymak-Zakutnya N, Wertelecki W, Jones KL, Keen CL, Uriu-Adams JY, Coles C, Yevtushok L, Zymak-Zakutnya N, Wertelecki W, Keen CL, Uriu-Adams JY, Kable JA, Jones KL, Chambers CD, Kable J, Coles C, Chambers C, Keen C, Uriu-Adams J, Jones K, Yevtushok L, Wertelecki W. S21 * TOWARD A BETTER UNDERSTANDING OF THE SPECTRUM OF FETAL ALCOHOL SPECTRUM DISORDERS AND THE ROLE OF MATERNAL NUTRITION IN MODIFYING FETAL RISK. Alcohol Alcohol 2013. [DOI: 10.1093/alcalc/agt092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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