“Overcoming the Defect”:A Perinatal Review of Congenital Anomalies in 6984 Consecutive Deliveries in a Tertiary Care Center in Western Nepal
Introduction: Neonatal congenital anomalies are the 17th leading cause of global disease burden. Congenital anomalies in low-income countries are high due to prevalence of nutritional deficiencies, intrauterine infections, teratogenic exposure and unsupervised self medication. This study aimed to find various antenatal risk factors for birth defects and the delays in health seeking behaviors in cases of still births with birth defects. Methods: In this retrospective study the records of mothers and neonates born with congenital anomalies during the period of 30 months were reviewed. Consanguinity, intrauterine infections, presence of anemia, and history of drug intake were noted. In cases of stillborns with anomalies, mode of delivery, labor complications and the three delays leading to morbidities were also noted. Results: There were 65 congenital anomalies during the study period with an incidence of 9.3 per 1000 births. Out of them, 43 were live births and 22 were still births. The commonest anomaly amongst live births was of musculoskeletal system (n=11, 25.5%) and amongst still births was of nervous system (n=10, 45.4%). Consanguineous marriage was present in 30 (46.1%) parents and folic acid was taken by only 26(40%) of the mothers. In cases of still births with anomalies, most deliveries were vaginal (97%) without any maternal complications. Among the three delays, delay in deciding to seek care was observed in most cases (n=14, 63.6%).Conclusion: Factors like consanguinity and intake of folic acid are modifiable factors useful in preventing congenital anomalies. Encouraging early antenatal visits might help in early detection of anomalies.
Murray CJL, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: A systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2197–223. PMID: 23245608. DOI: https://doi.org/10.1016/S0140-6736(12)61689-4
Aminu M, Unkels R, Mdegela M, Utz B, Adaji S, van den Broek N. Causes of and factors associated with stillbirth in low- and middle-income countries: a systematic literature review. BJOG. 2014;121(Suppl 4):141-53. PMID: 25236649. DOI: https://doi.org/10.1111/1471-0528.12995
World Health Organization. Birth Defects in South-East Asia - A Public Health Challenge: Situation Analysis. WHO, Geneva. Report number: SEA-CAH-13, 2013. Available from: https://apps.who.int/iris/handle/10665/204821
Chen J, Huang X, Wang B, Zhang Y, Rongkavilit C, Zeng D, et al. Epidemiology of birth defects based on surveillance data from 2011–2015 in Guangxi, China: Comparison across five major ethnic groups. BMC Public Health. 2018;18(1):1008. PMID: 30103721. DOI: https://doi.org/10.1186/s12889-018-5947-y
Fatemaq K, Begum F, Akter N, Zaman SMM. Major Congenital Malformation among The Newborns in BSMMU Hospital. Bangladesh Medical Journal. 2011;40(1):7-12. DOI: https://doi.org/10.3329/bmj.v40i1.9955
Ansari I, Rajbhandari R, Chalise S, Shah G, Maskey P, Maharjan R, et al . Congenital malformations at birth in 7,922 consecutive deliveries at Patan Hospital, Nepal. Journal of Patan Academy of Health Sciences. 2014;1(2):4-7. Available from: https://pdfs.semanticscholar.org/30c3/d0e37edbfda5782e6fa87ca7375b64706dc5.pdf
Malla BK. One year review study of congenital anatomical malformation at birth in Maternity Hospital (Prasutigriha), Thapathali, Kathmandu. Kathmandu Univ Med J-(KUMJ). 2007;5(20):557-60. PMID: 18604096
Bhandari S, Sayami JT, KC RR, Banjara MR. Prevalence of congenital defects including selected neural tube defects in Nepal: Results from a health survey. BMC Pediatr. 2015;15:133. PMID: 26391586. DOI: https://doi.org/10.1186/s12887-015-0453-1
Wills V, Abraham J, Sreedevi NS. Congenital anomalies: the spectrum of distribution and associated maternal risk factors in a tertiary teaching hospital. International Journal of Reproduction, Contraception, Obstetrics and Gynecology. 2017;6(4):1555-60. DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20171427
Singh S, Chukwunyere DN, Omembelede J, Onankpa B. Foetal congenital anomalies: An experience from a tertiary health institution in north-west Nigeria (2011-2013). Niger Postgrad Med J. 2015;22(3):174-8. PMID: 26739205. DOI: https://doi.org/10.4103/1117-1936.170743
Ministry of Health and Population, New ERA, ICF International. Nepal demographic and health survey 2011. Population Division, Ministry of Health and Population, Government of Nepal, Kathmandu, Nepal 2012. Available from: https://dhsprogram.com/pubs/pdf/FR257/FR257%5B13April2012%5D.pdf
Shrestha S, Dwa Y, Jaiswal P, Parmar B. Congenital anomalies in antenatal ultrasound scan at a tertiary care teaching hospital. Journal of Patan Academy of Health Sciences. 2018;5(1):26-30. DOI: https://doi.org/10.3126/jpahs.v5i1.24038
Dart AB, Ruth CA, Sellers EA, Au W, Dean HJ. Maternal diabetes mellitus and congental anomalies of the kidney and urinary tract (CAKUT) in the child. Am J Kidney Dis. 2015;65(5):684-91. PMID: 25595566. DOI: https://doi.org/10.1053/j.ajkd.2014.11.017
Rittler M, Liascovich R, López-Camelo J, Castilla EE. Parental consanguinity in specific types of congenital anomalies. Am J Med Genet. 2001;102(1):36-43. PMID: 11471170. DOI: https://doi.org/10.1002/1096-8628(20010722)102:1%3C36::aid-ajmg1394%3E3.0.co;2-m
Stoll C, Alembik Y, Roth MP, Dott B. Parental consanguinity as a cause for increased incidence of births defects in a study of 238,942 consecutive births. Ann Genet. 1999;42(3):133-9. PMID: 10526655
Stoltenberg C, Magnus P, Lie RT, Daltveit AK, Irgens LM. Birth Defects and Parental Consanguinity in Norway. Am J Epidemiol. 1997;145(5):439–48. PMID: 9048518. DOI: https://doi.org/10.1093/oxfordjournals.aje.a009126
Wilson RD, GENETICS COMMITTEE; MOTHERISK. Pre-conceptional Vitamin/Folic Acid Supplementation 2007: The Use of Folic Acid in Combination with a Multivitamin Supplement for the Prevention of Neural Tube Defects and Other Congenital Anomalies. J Obstet Gynecol Can. 2007;29(12):1003-13. PMID: 18053387. DOI: https://doi.org/10.1016/s1701-2163(16)32685-8
McDonald SD, Ferguson S, Tam L, Lougheed J, Walker MC. The prevention of congenital anomalies with periconceptional folic acid supplementation. J Obstet Gynecol Can. 2003;25(2):115-21. PMID: 12577128. DOI: https://doi.org/10.1016/s1701-2163(16)30207-9
Paudel P, Wing K, Silpakar SK. Awareness of periconceptional folic acid supplementation among Nepalese women of childbearing age: A cross-sectional study. Prev Med. 2012;55(5):511-3. PMID: 22975411. DOI: https://doi.org/10.1016/j.ypmed.2012.09.001
Callie AMA, Fiest KM, Frolkis AD, Jette N, Pringsheim T, St Germaine-Smith C, et al. Global Birth Prevalence of Spina Bifida by Folic Acid Fortification Status: A Systematic Review and Meta-Analysis. Am J Public Health. 2016;106(1):e24-34. PMID: 26562127. DOI: https://doi.org/10.2105/AJPH.2015.302902
Victora CG, Barros FC, Assunção MC, Restrepo-Méndez MC, Matijasevich A, Martorell R. Scaling up maternal nutrition programs to improve birth outcomes: A review of implementation issues. Food Nutr Bull. 2012;33(2 Suppl):S6–26. PMID: 22913105. DOI: https://doi.org/10.1177/15648265120332s102
Finnell RH. Teratology: General considerations and principles. J Allergy Clin Immunol. 1999;103(2 Pt2):S337 - S342. PMID: 9949334. DOI: https://doi.org/10.1016/s0091-6749(99)70259-9
Wilmot E, Yotebieng M, Norris A, Ngabo F. Missed Opportunities in Neonatal Deaths in Rwanda: Applying the Three Delays Model in a Cross-Sectional Analysis of Neonatal Death. Mater Child Health J. 2017;21(5):1121-29. PMID: 28214925. DOI: https://doi.org/10.1007/s10995-016-2210-y
Barnes-Josiah D, Myntti C, Augustin A. The "three delays" as a framework for examining maternal mortality in Haiti. Soc Sci Med. 1998;46(8):981-93. PMID: 9579750. DOI: https://doi.org/10.1016/s0277-9536(97)10018-1
Copyright (c) 2020 Shreyashi Aryal, Deepak Shrestha
This work is licensed under a Creative Commons Attribution 4.0 International License.
- The Journal of Lumbini Medical College (JLMC) publishes open access articles under the terms of the Creative Commons Attribution (CC BY) License which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
- JLMC requires an exclusive licence to publish the article first in its journal in print and online.
- The corresponding author should read and agree to the following statement before submission of the manuscript for publication,
- License agreement
- In submitting an article to Journal of Lumbini Medical College (JLMC) I certify that:
- I am authorized by my co-authors to enter into these arrangements.
- I warrant, on behalf of myself and my co-authors, that:
- the article is original, has not been formally published in any other peer-reviewed journal, is not under consideration by any other journal and does not infringe any existing copyright or any other third party rights;
- I am/we are the sole author(s) of the article and have full authority to enter into this agreement and in granting rights to JLMC are not in breach of any other obligation;
- the article contains nothing that is unlawful, libellous, or which would, if published, constitute a breach of contract or of confidence or of commitment given to secrecy;
- I/we have taken due care to ensure the integrity of the article. To my/our - and currently accepted scientific - knowledge all statements contained in it purporting to be facts are true and any formula or instruction contained in the article will not, if followed accurately, cause any injury, illness or damage to the user.
- I, and all co-authors, agree that the article, if editorially accepted for publication, shall be licensed under the Creative Commons Attribution License 4.0. If the law requires that the article be published in the public domain, I/we will notify JLMC at the time of submission, and in such cases the article shall be released under the Creative Commons 1.0 Public Domain Dedication waiver. For the avoidance of doubt it is stated that sections 1 and 2 of this license agreement shall apply and prevail regardless of whether the article is published under Creative Commons Attribution License 4.0 or the Creative Commons 1.0 Public Domain Dedication waiver.
- I, and all co-authors, agree that, if the article is editorially accepted for publication in JLMC, data included in the article shall be made available under the Creative Commons 1.0 Public Domain Dedication waiver, unless otherwise stated. For the avoidance of doubt it is stated that sections 1, 2, and 3 of this license agreement shall apply and prevail.
Please visit Creative Commons web page for details of the terms.