RESUMEN
OBJECTIVES: To assess associations between maternal smoking and congenital heart defects (CHDs) in offspring. STUDY DESIGN: We performed a retrospective case-control study using data for cases of CHD (n = 8339) and nonmalformed controls (n = 11 020) from all years (1997-2011) of the National Birth Defects Prevention Study. Maternal self-reported smoking 1 month before through 3 months after conception was evaluated as a binary (none, any) and categorical (light, medium, heavy) exposure. Multivariable logistic regression was used to estimate aOR and 95% CIs. Stratified analyses were performed for septal defects according to maternal age, prepregnancy body mass index, and maternal race/ethnicity. RESULTS: Multiple CHDs displayed modest associations with any level of maternal periconceptional smoking independent of potential confounders; the strongest associations were for aggregated septal defects (OR, 1.5; 95% CI, 1.3-1.7), tricuspid atresia (OR, 1.7; 95% CI, 1.0-2.7), and double outlet right ventricle (DORV) (OR, 1.5; 95% CI, 1.1-2.1). Tricuspid atresia and DORV also displayed dose-response relationships. Among heavy smokers, the highest odds were again observed for tricuspid atresia (aOR 3.0; 95% CI, 1.5-6.1) and DORV (aOR 1.5; 95% CI, 1.1-2.2). Heavy smokers ≥35 years old more frequently had a child with a septal defect when compared with similarly aged nonsmokers (aOR 2.3; 95% CI, 1.4-3.9). CONCLUSIONS: Maternal periconceptional smoking is most strongly associated with septal defects, tricuspid atresia, and DORV; the risk for septal defects is modified by maternal age.
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Cannabis , Cardiopatías Congénitas , Efectos Tardíos de la Exposición Prenatal , Adulto , Anciano , Estudios de Casos y Controles , Niño , Femenino , Cardiopatías Congénitas/epidemiología , Cardiopatías Congénitas/etiología , Humanos , Lactante , Embarazo , Efectos Tardíos de la Exposición Prenatal/epidemiología , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Fumar/efectos adversosRESUMEN
OBJECTIVES: To assess international trends and patterns of prenatal diagnosis of critical congenital heart defects (CCHDs) and their relation to total and live birth CCHD prevalence and mortality. SETTING: Fifteen birth defect surveillance programmes that participate in the International Clearinghouse for Birth Defects Surveillance and Research from 12 countries in Europe, North and South America and Asia. PARTICIPANTS: Live births, stillbirths and elective terminations of pregnancy for fetal anomaly diagnosed with 1 of 12 selected CCHD, ascertained by the 15 programmes for delivery years 2000 to 2014. RESULTS: 18 243 CCHD cases were reported among 8 847 081 births. The median total prevalence was 19.1 per 10 000 births but varied threefold between programmes from 10.1 to 31.0 per 10 000. CCHD were prenatally detected for at least 50% of the cases in one-third of the programmes. However, prenatal detection varied from 13% in Slovak Republic to 87% in some areas in France. Prenatal detection was consistently high for hypoplastic left heart syndrome (64% overall) and was lowest for total anomalous pulmonary venous return (28% overall). Surveillance programmes in countries that do not legally permit terminations of pregnancy tended to have higher live birth prevalence of CCHD. Most programmes showed an increasing trend in prenatally diagnosed CCHD cases. DISCUSSION AND CONCLUSIONS: Prenatal detection already accounts for 50% or more of CCHD detected in many programmes and is increasing. Local policies and access likely account for the wide variability of reported occurrence and prenatal diagnosis. Detection rates are high especially for CCHD that are more easily diagnosed on a standard obstetric four-chamber ultrasound or for fetuses that have extracardiac anomalies. These ongoing trends in prenatal diagnosis, potentially in combination with newborn pulse oximetry, are likely to modify the epidemiology and clinical outcomes of CCHD in the near future.
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Cardiopatías Congénitas/diagnóstico , Cardiopatías Congénitas/epidemiología , Diagnóstico Prenatal , Asia/epidemiología , Europa (Continente)/epidemiología , Femenino , Cardiopatías Congénitas/mortalidad , Humanos , Recién Nacido , Masculino , América del Norte/epidemiología , Embarazo , Diagnóstico Prenatal/estadística & datos numéricos , Diagnóstico Prenatal/tendencias , Prevalencia , Estudios Retrospectivos , América del Sur/epidemiologíaAsunto(s)
Anomalías Congénitas/prevención & control , Salud Global , Promoción de la Salud/métodos , Femenino , Educación en Salud , Accesibilidad a los Servicios de Salud , Humanos , Recién Nacido , Comunicación Interdisciplinaria , Cooperación Internacional , Medios de Comunicación de Masas , Pobreza , Embarazo , Riesgo , Naciones UnidasRESUMEN
BACKGROUND: Quality control and improvement are a key part of the implementation of an effective surveillance program. Data quality indicators (DQI) are key tools but have not been widely used, especially in a low-resource setting. METHODS: We developed a list of data quality indicators of birth defects surveillance. These DQI address ascertainment, description, coding, and classification. RESULTS: We developed 40 DQI that can be used widely to assess the quality of data relative to birth defects of major clinical and public health impact. CONCLUSIONS: DQI have to be both comprehensive (e.g., assess all main surveillance processes) and practical (not require sophisticated or costly data elements), so that they can be used effectively in many different settings. We propose this list of DQI for use in surveillance program as a way to document the quality of the program; detect variations within and between programs, and support quality improvements.
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Anomalías Congénitas/diagnóstico , Anomalías Congénitas/epidemiología , Exactitud de los Datos , Recolección de Datos/métodos , Recolección de Datos/normas , Indicadores de Calidad de la Atención de Salud/normas , Argentina/epidemiología , Humanos , Vigilancia de la PoblaciónRESUMEN
BACKGROUND: In Argentina, birth defects are a leading cause of infant deaths. In 2009, the National Network for Congenital Anomalies of Argentina (RENAC) was established as a hospital-based surveillance system of major structural birth defects. To assess and enhance the system's data quality, we previously developed data quality indicators (DQI). Our aim was to evaluate quality indicators in RENAC. METHODS: We applied the DQI presented in a related publication to the 2016 RENAC data. RESULTS: Among the DQI of description, spina bifida coverage and talipes had the lowest results. Regarding prevalence of hypospadias, it was lower than the defined threshold. RENAC did not achieve the ascertainment threshold of a prevalence of 21.5 per 10,000 for critical congenital heart defects. There was a high ratio of spina bifida to anencephaly. CONCLUSIONS: DQI provide a focus for improving quality, making decisions, and advocating for interventions. Examples include advocating for newborn screening of critical congenital heart defects with pulse oximetry; developing training programs for clinicians to improve the detection of isolated hypospadias; and developing visual tools and checklists to improve the completeness and accuracy of case description for spina bifida, talipes, and other major malformations. After the interventions, it is important to track the impact by measuring again the DQI.
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Anomalías Congénitas/diagnóstico , Anomalías Congénitas/epidemiología , Recolección de Datos/métodos , Recolección de Datos/normas , Indicadores de Calidad de la Atención de Salud/normas , Argentina/epidemiología , Humanos , Vigilancia de la PoblaciónRESUMEN
OBJECTIVE: To assess longitudinal estimates of inpatient costs through early childhood in patients with critical congenital heart defects (CCHDs), for whom reliable estimates are scarce, using a population-based cohort of clinically validated CCHD cases. STUDY DESIGN: Longitudinal retrospective cohort of infants with CCHDs live born from 1997 to 2012 in Utah. Cases identified from birth defect registry data were linked to inpatient discharge abstracts and vital records to track inpatient days and costs through age 10 years. Costs were adjusted for inflation and discounted by 3% per year to generate present value estimates. Multivariable models identified infant and maternal factors potentially associated with higher resource utilization and were used to calculate adjusted costs by defect type. RESULTS: The final statewide cohort included 1439 CCHD cases among 803 509 livebirths (1.8/1000). The average cost per affected child through age 10 years was $136 682 with a median of $74 924 because of a small number of extremely high cost children; costs were highest for pulmonary atresia with ventricular septal defect and hypoplastic left heart syndrome. Inpatient costs increased by 1.6% per year during the study period. A single birth year cohort (~50 000 births/year) had estimated expenditures of $11 902 899 through age 10 years. Extrapolating to the US population, inpatient costs for a single birth year cohort through age 10 years were ~$1 billion. CONCLUSIONS: Inpatient costs for CCHDs throughout childhood are high and rising. These revised estimates will contribute to comparative effectiveness research aimed at improving the value of care on a patient and population level.
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Costos de la Atención en Salud , Cardiopatías Congénitas/economía , Cardiopatías Congénitas/epidemiología , Tamizaje Neonatal/economía , Tamizaje Neonatal/métodos , Anomalías Congénitas , Bases de Datos Factuales , Femenino , Defectos del Tabique Interventricular/economía , Defectos del Tabique Interventricular/epidemiología , Hospitalización/economía , Humanos , Síndrome del Corazón Izquierdo Hipoplásico/economía , Síndrome del Corazón Izquierdo Hipoplásico/epidemiología , Lactante , Recién Nacido , Pacientes Internos , Estudios Longitudinales , Masculino , Análisis Multivariante , Atresia Pulmonar/economía , Atresia Pulmonar/epidemiología , Sistema de Registros , Estudios Retrospectivos , Utah/epidemiologíaRESUMEN
OBJECTIVE: To evaluate the frequency of Turner syndrome in a population-based, statewide cohort of girls with coarctation of the aorta. STUDY DESIGN: The Utah Birth Defects Network was used to ascertain a cohort of girls between 1997 and 2011 with coarctation of the aorta. Livebirths with isolated coarctation of the aorta or transverse arch hypoplasia were included and patients with complex congenital heart disease not usually seen in Turner syndrome were excluded. RESULTS: Of 244 girls with coarctation of the aorta, 77 patients were excluded, leaving a cohort of 167 girls; 86 patients (51%) had chromosomal studies and 21 (12.6%) were diagnosed with Turner syndrome. All patients were diagnosed within the first 4 months of life and 5 (24%) were diagnosed prenatally. Fifteen patients (71%) had Turner syndrome-related findings in addition to coarctation of the aorta. Girls with mosaicism were less likely to have Turner syndrome-associated findings (3/6 mosaic girls compared with 12/17 girls with non-mosaic 45,X). Twelve girls (57%) diagnosed with Turner syndrome also had a bicommissural aortic valve. CONCLUSION: At least 12.6% of girls born with coarctation of the aorta have karyotype-confirmed Turner syndrome. Such a high frequency, combined with the clinical benefits of an early diagnosis, supports genetic screening for Turner syndrome in girls presenting with coarctation of the aorta.
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Coartación Aórtica/complicaciones , Síndrome de Turner/complicaciones , Adolescente , Coartación Aórtica/diagnóstico , Niño , Preescolar , Femenino , Pruebas Genéticas , Humanos , Incidencia , Estudios Retrospectivos , Síndrome de Turner/epidemiología , Síndrome de Turner/genética , Utah/epidemiologíaRESUMEN
Sirenomelia is a very rare limb anomaly in which the normally paired lower limbs are replaced by a single midline limb. This study describes the prevalence, associated malformations, and maternal characteristics among cases with sirenomelia. Data originated from 19 birth defect surveillance system members of the International Clearinghouse for Birth Defects Surveillance and Research, and were reported according to a single pre-established protocol. Cases were clinically evaluated locally and reviewed centrally. A total of 249 cases with sirenomelia were identified among 25,290,172 births, for a prevalence of 0.98 per 100,000, with higher prevalence in the Mexican registry. An increase of sirenomelia prevalence with maternal age less than 20 years was statistically significant. The proportion of twinning was 9%, higher than the 1% expected. Sex was ambiguous in 47% of cases, and no different from expectation in the rest. The proportion of cases born alive, premature, and weighting less than 2,500 g were 47%, 71.2%, and 88.2%, respectively. Half of the cases with sirenomelia also presented with genital, large bowel, and urinary defects. About 10-15% of the cases had lower spinal column defects, single or anomalous umbilical artery, upper limb, cardiac, and central nervous system defects. There was a greater than expected association of sirenomelia with other very rare defects such as bladder exstrophy, cyclopia/holoprosencephaly, and acardia-acephalus. The application of the new biological network analysis approach, including molecular results, to these associated very rare diseases is suggested for future studies.