Lebanon - Congenital Anomalies Prevalence and Risk Factors
Lebanon - Congenital Anomalies Prevalence and Risk Factors
Lebanon - Congenital Anomalies Prevalence and Risk Factors
Evaluat ion of safet y of A/H1N1 pandemic vaccinat ion during pregnancy: cohort st udy
Mauro Venegoni
Umbilical cord act ivin A concent rat ion in pregnancies complicat ed by mild preeclampsia and relat ions…
Gokhan Acmaz
Universal Journal of Public Health 2(2): 58-63, 2014 http://www.hrpub.org
DOI: 10.13189/ ujph.2014.020204
1
Department of Life and Earth Sciences, Faculty of Sciences, Branch II, Lebanese University, Beirut, Lebanon
2
Laboratory of Clinical and Epidemiological Research, Faculty of Pharmacy, Lebanese University, Beirut, Lebanon
3
Department of Biology, Faculty of Sciences II, Lebanese University, Fanar, Lebanon
*Corresponding author: aline.hamade@ul.edu.lb
Abstract Objective: The aim of this study is to assess the Based on the World Health Organization (WHO) report,
incidence, types and correlates of congenital anomalies (CA) about 3 million fetuses and infants are born each year with
among stillborn and liveborn infants in two Lebanese major CA. They are found in approximately 3% of newborns
hospitals in Mount-Lebanon. Methods: In this [3]. Worldwide surveys have shown that birth prevalence of
cross-sectional study, all the newborns who were born congenital anomalies varies greatly from country to country.
during 9 months period from January to December 2009 It is reported to be as low as 1.07% in Japan and as high as
(n=1000) at two hospitals setting in Mount-Lebanon hospital, 4.3% in Taiwan [4]. In the US, a 2-3% birth prevalence of
Lebanon were studied. The newborns were assessed for CA. congenital anomalies has been reported. The birth
Neonatal data were extracted from medical records of the prevalence of congenital anomalies in England is 2% and in
nursery. The classification of malformations was based upon South Africa it is 1.49% [5]. In Lebanon, the incidence of
the anatomical system affected according to the WHO major congenital anomalies has been reported as 1.64 % in
classification of CA. Results: Of the all 1000 single births, Southern Beirut [6]. The variation in rates may be explained
24 (2.4%) were diagnosed as being congenitally malformed. by social, racial, ecological, and economical influences [4, 5].
Cardiovascular system defects and limbs anomalies (4/1000) The most common serious congenital disorders are
were mostly detected, followed by genitourinary system congenital heart defects [7], neural tube defects [8] and
(2/1000), nervous system (2/1000), respiratory system Down syndrome [9].
(2/1000) malformations and chromosomal anomalies CA can be a cause of infant mortality; among infants with
(1/1000). A marked association of parental consanguinity malformation who do not survive, more than 70% die in the
and alcohol consumption of the mother during the pregnancy first month of life. Approximately 40% to 60% of CA are of
with increased CA rates was found (p= 0.015 and p=0.027 unknown origin. The etiology of Congenital Malformation is
respectively). Conclusions: The frequency of malformations genetic (30-40%) and environmental (5 to 10%). Among the
in the study was approximately similar to previous genetic etiology, chromosomal abnormality constitutes 6%,
investigations. The increased incidence of CA in cases of single gene disorders 25% and multifactorial 20- 30%;
parental consanguinity prompts the necessity of establishing however, for nearly 50% of CA, the cause is yet to be known
educational programs to avoid these complications in the [10] . Consanguineous marriages have been described as an
offspring. important factor contributing to increased CM. Studies have
shown a significantly higher incidence of malformations in
Keywords Newborn, Defects, Epidemiology, offspring of consanguineous parents [11].
Consanguinity, Lebanon The main objective of this study is to establish the
prevalence and pattern of CA in neonates in two hospitals in
Mount Lebanon between January 2009 and December 2009,
and to evaluate their correlates, in order to identify the
appropriate strategies for prevention.
1. Introduction Accurate quantification of congenital anomalies within a
Congenital anomalies (CA) can be defined as structural or given population is essential for estimating their burden and
functional abnormalities including metabolic disorders, documenting the need for prevention, for public health
present at birth. These defects of prenatal origin result from policy development, for planning and implementation of
defective embryogenesis or intrinsic abnormalities in the services needed by children with malformations and for
development process. Birth defects can be isolated evaluating the effects of preventive measures and treatment
abnormalities or part of a syndrome and continue to be an services. Differences in birth defect rates in different
important cause of neonatal and infant morbidity and countries and studies could be attributed to true differences
mortality [1, 2] . among different populations or to different definitions of
Universal Journal of Public Health 2(2): 58-63, 2014 59
birth defects, different methods, and different time periods Malformation, apgar score, baby’s weight and cranial
for ascertainment. perimeter were considered as dependent variables whereas
baby’s sex, parental consanguinity, mother’s professional
status, sibling’s malformation, mother’s smoking during
2. Methods pregnancy, mother’s alcohol consumption during pregnancy,
baby conception by in vitro fertilization, prematurity, birth
by caesarean section, mother’s iron intake during pregnancy,
2.1. Type of the Study
mother’s calcium intake during pregnancy, mother’s
This is a retrospective hospital based records, vitamins intake during pregnancy, mother’s drug intake
cross-sectional study with consecutive sampling of during pregnancy, mother’s gestity, number of abortions,
newborns babies, who had been delivered in two Lebanese number of children and mother’s age were taken as
Hospital, based in Mount-Lebanon, Lebanon. These independent variables. Stillbirth was also taken as a
hospitals serve mainly urban areas in the region and were dependent variable, with similar independent variables as
therefore chosen as an example of an average public health above, in addition to the major independent variable of
maternity hospital. The survey included 1000 neonates congenital malformation.
delivered between January 2009 and December 2009. All the
charts identified from the Medical Birth Registry of the
deliveries taking place at the hospital were reviewed for the 3. Results
presence of CA, based on medical records of antenatal care,
delivery care, and pediatric examination of the newborn [12].
3.1. Sample Description
All singletons newborns delivered in this hospital during the
study period were examined at birth and screened for major One thousand births were recorded: 862 (86.2 %) in the
CA. one hospital, and 138 (13.8 %) in the other hospital. 512
Variables recorded included demographic data: date of (51.2%) were males and 488 (48.8%) were females. Out of
birth, sex of the newborn and age of the mother as well as 1000 births, 24 (2.4%) had a malformation, while 44 (4.4%)
weight, length, head circumference and apgar scores of the were stillborn or died perinatally. No information was
newborn [13]. available about 2 birth (0.2%).
Malformations were classified into systems according to The mean maternal age was observed to be 25.97±9.7. 632
World Health Organization (WHO) recommendations [11]. (63.2%) and 368 (36.8%) newborns were delivered by
The abnormalities were divided into several groups relative natural vaginal delivery (NVD) and cesarean section (CS)
to the following systems: Genitourinary, Musculoskeletal, respectively.
Nervous, Gastrointestinal, Cardiovascular and Pulmonary The prevalence of CA among 1000 hospital live births was
systems and to limbs abnormalities and miscellaneous 2.4% (24/1000 total births). The frequency distribution of the
disorders. 24 cases of newborns with birth defects according to the
diagnosis of the affected system or abnormality is shown in
2.2. Statistical Analysis Table 1. The commonest detected anomalies were those of
the congenital cardiovascular disease (16.6%) and limb
Data were entered and analyzed using SPSS, version 18.0. anomalies (16.6%); polydactyly (12.5%) and abnormal
Descriptive results were presented using mean and standard palmar creases (4,16%). Musculoskeletal system,
deviation for continuous variables and percentages for genitourinary system, central nervous system and respiratory
qualitative variables. Bivariate analyses were also conducted: system involved 8.4% of the cases for each system.
Chi-square test was used to compare between two or more Chromosomal anomalies represented by Down’s syndrome,
percentages when fulfillment conditions were satisfied. were found in 1 of the 24 CA cases (4.16%).
When an expected count was lower than 5 in a cell, Fisher
Exact test was used. In addition, Student test was used to
compare between two means, after ensuring that variances 3.2. Comparison between Births with and without
were homogeneous in both groups of comparison. Congenital Malformation
Multivariate analyses were carried out: when the
Parents’ consanguinity (p=0.015), mother’s alcohol
dependent variable was dichotomous, a logistic regression
consumption during pregnancy (p=0.027), stillbirth or
was performed using a stepwise descending likelihood ratio
perinatal death (p<0.001), and mother’s drugs intake during
method; here we used the Hosmer & Lemeshow test to
pregnancy (p<0.001) were all positively associated with
ensure sample adequacy. When the dependent variable was
congenital malformation; meanwhile, mother’s calcium
quantitative, we used a multiple regression using the
intake during pregnancy (p=0.013) was inversely associated
stepwise method, after ensuring residual normality,
with congenital malformation (Table 2).
homoscedasticity and absence of colinearity.
60 Congenital Anomalies: Prevalence and Risk Factors
Table 1. Systemic distribution and percentage of congenital malformations (CA) among 1000 birth
Number of births with the corresponding Percentage of distribution of the
Malformation/System malformation corresponding malformation
(/24 cases) (/24 cases)
Cardiovascular system 4 16.66
Nervous system 2 8.4
Respiratory system 2 8.4
Genitourinary system 2 8.4
Musculoskeletal system 2 8.4
Anomalies of limbs 4 16.66
Eye, ear, face, Neck 1 4.1
Behcet syndrome 1 4.1
Cephalohematoma 1 4.1
Chromosomal Abnormalities 1 4.1
Miscellaneous 4 16.66
Total 24 (100%)
Table 2b. Characteristics of births with and without congenital malformation (continued)
No congenital l malformation Congenital malformation
Characteristics N=974 N=24
p-value
Mean (SD) Mean (SD)
Mother’s age 28.54(6.02) 28.74(6.30) 0.874
However, hospital, sex, mother’s working status, siblings baby’s height, there was a trend towards lower height in
congenital malformation, mother’s smoking during babies with congenital malformation (p=0.058) (Table 2).
pregnancy, baby’s conception by in vitro fertilization,
premature birth, birth by caesarean section, and mother’s 3.3. Multivariate Analyses
iron and vitamins intakes during pregnancy were not
significantly associated with congenital malformation Parents consanguinity (ORa=1.72), mother’s consumption
(p>0.05) (Table 2) of alcohol and drugs (ORa=10.42, ORa=5.23 respectively)
Moreover, congenital malformation was significantly were associated with higher risk of congenital malformation.
associated with relatively low weight of the baby (p=0.027) Factors correlated with perinatal death/stillbirth included CA
and relatively low apgar scores at 5 minutes (p<0.001). (ORa=7.63), delivery by caesarian section (ORa=1.86),
However, mean mother’s age, gestity, number of abortions mother’s lower gestity (ORa=1.72) and increased number of
and of live children, and baby’s cranial perimeter did not abortions (ORa=1.73) (Table 3).
significantly when comparing between babies with or Apgar score correlates positively to mother’s number of
without congenital malformation. Additionally, concerning live children, vitamins and iron intakes during pregnancy;
62 Congenital Anomalies: Prevalence and Risk Factors
whereas, it was significantly decreased by mother’s smoking should be thoroughly examined and investigated for CA. In
during pregnancy, in vitro fertilization and parents’ addition, a Lebanese registry of CA is needed; appropriate
consanguinity. Baby’s weight was negatively affected by health education about consanguinity and genetic counseling
mother’s smoking during pregnancy and inversely correlated for consanguineous couples should also be established
to the caesarean section delivery. Baby’s cranial perimeter before marriage.
was increased by siblings’ CA, mother’s number of In addition to this, there is a need for more extensive,
abortions; and was decreased by mother’s smoking during nationwide screening studies to determine the birth
pregnancy and prematurity. However, for all models, the prevalence, types and distribution of congenital anomalies in
dependent variables variance percentages explained by the the Lebanese population and the establishment of an ongoing
model were relatively low. surveillance system for congenital anomalies.
4. Discussion Acknowledgments
Our population-based study involved 1000 newborns in 2 We would like to thank the hospitals that participated in
hospitals in Mount-Lebanon between January and December the study. We would also like to thank Stéphanie Atallah and
2009. Our data was based on the hospital's medical records. Roland Abi Nahed for their collaboration, effort and
Out of 1000 infants, 24 were born with CA, thereby the contribution to this study.
incidence rate of CA is 2.4%. Most of the malformed
stillbirths in the present study were cases with cardiovascular
congenital anomalies (16.6%) and limb anomalies (16.6 %)
including polydactyly (12.2%) and abnormal palmar crease
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