Trends in the prevalence, risk and pregnancy outcome of multiple births with congenital anomaly: a registry-based study in 14 European countries 1984-2007
Trends in the prevalence, risk and pregnancy outcome of multiple births with congenital anomaly: a registry-based study in 14 European countries 1984-2007
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DOI：
10.1111/1471-0528.12146
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发表时间：
2013-05-01
影响因子：
5.8
通讯作者：
Dolk, H.
中科院分区：
文献类型：
--
作者：
Boyle, B.;McConkey, R.;Dolk, H.
目的评估先天畸形多胎出生率上升对公共卫生的影响。设计对基于人群的先天性异常登记处的数据进行描述性流行病学分析。设置14个欧洲国家。人口1984 - 2007年共出生540万人，其中3%为多胞胎。方法回顾性分析2010年12月至2011年12月间因胎儿畸形而终止妊娠的病例。主要结果测量每10000例出生的患病率和多胎与单胎先天性畸形的相对风险（1984 - 2007）;产前诊断的比例，妊娠结局的比例（2000 - 07）。双胞胎病例的配对比例。结果多胎先天畸形患病率从5.9/万（198487）上升到10.7/万（200407）。多胎非染色体异常的相对危险度为1.35（95%CI 1.311.39），随时间增加，染色体异常的相对危险度为0.72（95%CI 0.650.80），随时间减少。在11.4%的双胞胎中，两个婴儿都有先天性畸形（200007）。多胎妊娠和单胎妊娠的产前诊断率相似。多胎妊娠的病例因胎儿畸形终止妊娠的可能性较低，比值比为0.41（95%CI为0.350.48），死产和新生儿死亡的可能性较高。结论：多胎妊娠和先天性畸形婴儿的增加对产前和产后服务的提供产生了影响。需要进一步研究辅助生殖技术对风险增加的贡献。多胞胎中染色体异常的缺陷与产前风险咨询有关。
Objective To assess the public health consequences of the rise in multiple births with respect to congenital anomalies. Design Descriptive epidemiological analysis of data from population-based congenital anomaly registries. Setting Fourteen European countries. Population A total of 5.4 million births 19842007, of which 3% were multiple births. Methods Cases of congenital anomaly included live births, fetal deaths from 20weeks of gestation and terminations of pregnancy for fetal anomaly. Main outcome measures Prevalence rates per 10000 births and relative risk of congenital anomaly in multiple versus singleton births (19842007); proportion prenatally diagnosed, proportion by pregnancy outcome (200007). Proportion of pairs where both co-twins were cases. Results Prevalence of congenital anomalies from multiple births increased from 5.9 (198487) to 10.7 per 10000 births (200407). Relative risk of nonchromosomal anomaly in multiple births was 1.35 (95% CI 1.311.39), increasing over time, and of chromosomal anomalies was 0.72 (95% CI 0.650.80), decreasing over time. In 11.4% of affected twin pairs both babies had congenital anomalies (200007). The prenatal diagnosis rate was similar for multiple and singleton pregnancies. Cases from multiple pregnancies were less likely to be terminations of pregnancy for fetal anomaly, odds ratio 0.41 (95% CI 0.350.48) and more likely to be stillbirths and neonatal deaths. Conclusions The increase in babies who are both from a multiple pregnancy and affected by a congenital anomaly has implications for prenatal and postnatal service provision. The contribution of assisted reproductive technologies to the increase in risk needs further research. The deficit of chromosomal anomalies among multiple births has relevance for prenatal risk counselling.