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Brief Reports Indian Pediatrics 2000;37: 998-1001 |
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Congenital Malformations in Rural Maharashtra |
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Congenital malformations occur all over the world and are responsible for about 15% of the perinatal mortality in India(1,2). With advance-ments in perinatal and neonatal care, other causes of perinatal mortality have been controlled and as in the west, the time is not far when the leading cause of perinatal mortality would be malformations. The incidence of congenital malformations in this area studied 12 years back was reported to be 2.72%(3). The aim of the present study was to find out if there has been any difference in the rate and types of congenital malformations in this area over the last decade.
The study was conducted at the Mahatma Gandhi Institute of Medical Sciences, Sewagram, Wardha between April 1998 to April 1999. The study material comprised of 2968 births (live and still) and their 2956 mothers (12 mothers gave birth to twin babies). Detailed antenatal history including drug intake, maternal illness and complications of pregnancy were obtained in all cases. An autopsy of still births as well as neonatal death was performed wherever possible (2 cases in the present study) and findings incorporated in the diagnosis. All newborns were screened for congenital malformations soon after birth and thereafter at the time of discharge. During the follow-up in Well-Baby Clinic the babies were re-examined to detect any other malformations, viz., congential heart diseases, and if any malformation was detected, then the same was incorporated in the diagnosis. A meticulous general and systemic examination was carried out by a consultant at the time of birth to detect any malformations and thereafter depending on the need relevant radiological, hematological and genetic tests were carried out. Defects which caused serious structural, cosmetic and functional disability requiring surgical or medical manage-ment were classified as major anomalies. The rest were categorized as minor anomalies. The major malformations were divided into CNS, Skeletal, Gastro-intestinal, Genitourinary, CVS syndromes and miscellaneous disorders. The babies were followed up only in the well baby clinics and as such a routine followup was not possible in most of the cases. Statistical analysis was done using Z test and Chi-square test.
Out of the total 2968 deliveries, 2869 were live and 99 were still births. The number of babies with congenital malformations diagnosed at birth or within the first week of life was 37 (1.24%), while the total number of malforma-tions were 48. Out of these 26 (70.3%) babies had 34 major anomalies and 11 babies (29.7%) had 14 minor anomalies. Out of the 2956 singleton briths, 31 (1.05%) were malformed whereas none of the 12 pairs of twins had any birth defects. Twenty two of the 37 malformed babies (59.4%) were fullterm whereas 40.5% (15/37) were preterms. Thirteen of the 37 con-genitally malformed babies (35.1%) were very low birth weight (mean ± SD;1314.2 ± 175 g); 13/37 (35.1%) were low birth weights (mean ± SD; 1938.4 ± 268.8 g) and 11 (29.7%) were appropriate for gestational age (2866 ± 298.4 g). Congenital malformations were seen more significantly in still births (p <0.01) as compared to live births, the frequency being 6.06% and 1.08%, respectively. Six of the 37 malformed babies (16.2%) were still born and 3.2% of the apparently normal looking babies were still born (p <0.01). Table I shows frequency and sex distribution of congenital malformations. No difference was observed in the distribution of malformations between the two sexes. Four babies had ambiguous genitalia. Table II shows distribution of congenital malformations accord-ing to the maternal age, there was no correlation of congenital malformations with maternal age. Table III shows the systemic distribution and the incidence of individual congenital malforma-tions. Musculoskeletal malformations were most common in live births followed by gastro-intestinal and CNS defects. The CNS defects were most commonly seen in still borns. There was no history of parental consanguinity even in a single case of congenital malformations. None of the cases had a malformed sibling. Mortality in live births due to congenital malformations per se was 0.38% (11/2869). Table I__ Congenital Malformations : Frequency and Sex Distribution
*Statistically significant. Table II__Distribution According to the Maternal Age
TABLE III– Distribution and Incidence of Individual Congenital Malformations
In the present study, the overall incidence of congenital malformations in the newborns was 1.24% which is nearly half of that reported from this area a decade back(3). In studies from other parts of India, the incidence varied from 0.3% to 3.6%(4-8). The rate in the present study is comparable to the studies from Varanasi(4) and Allahabad(5). A higher incidence of congenital malformations has been reported from centers like Chandigarh and Pondicherry, which may be because of higher autopsy rates at these centers(9). The incidence reported from other countries is 5.5% in Afghanistan(10), 3.4% in Michigan(11) and 0.9% in Northampton-shire(12). The commonest system involved in the present study was the musculoskeletal which is in conformity with the previous study from this area and also data from other parts of India(3,13,14) and world(15). However, some Indian workers have reported CNS defects as hightest(16,17) while one study has reported highest incidence of gastrointestinal malforma-tions(18). In the present study the frequency of neural tube defects was 1.68/1000. Anencephaly was found in 1.34/1000 births. This compares favorably with a study from West Bengal(19). Reports of neural tube defects from various parts of India have given the incidence ranging from 0.5 to 11.8/1000(6,7,14,20), the highest incidence being reported from Davangere in Karnataka. As much as 6 times higher rate of congenital malformations was found among still births which is consistent with earlier reports. However, in the present series, like some of the earlier studies we could not observe any sex predilection of malformations. Heridofamilial and consanguineous marriages are reported to play a major role in the occurrence of congenital malformations as was seen in the previous study(3). However, in the present study none of the malformed babies had been born out of a consanguineous marriage. The other factors which were evaluated in the previous study and found to significantly increase the risk of congenital malformations were presence of hydramnios (7.3% of mothers having congeni-tally malformed babies had hydramnios) maternal febrile illness in the first trimester, past history of abortions (10 mothers) and history of progesterone intake during pregnancy (in 4 mothers out of which 1 had malformed baby). The role of these factors on the overall incidence of malformations in this area needs a good epidemiological study. In the present study none of the mothers had taken progesterone during the antenatal period, whereas there was a history of oligohydramnios in 3/37 (8.1%), polyhydra-mnios in 2/37 (5.4%) cases and 3/37 mothers (8.1%) had a history of previous abortions. In conclusion, the incidence of congenital malformations has nearly halved in this area over the last decade but the spectrum and incidence still remains comparable to studies from other parts of India. Neural tube defects continue to be much less than those reported in studies from northern India.
The authors wish to express their thanks to Dr. N.C. Prajapati for his help during this study. The authors also express their gratitude to the Director and Dean of M.G.I.M.S., Sewagram for allowing us to carry out this study in the Institute. Contributors: PC conceptualized the study, helped in the analysis and interpretation of the data and revised the manuscript critically. She will act as guarantor for the paper. VD participated in data collection, analysis and interpretation of data and also drafted the manuscript. Funding:
None.
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