Lin A E, Herring A H, Amstutz K S, Westgate M N, Lacro R V, Al-Jufan M, Ryan L, Holmes L B
Department of Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Am J Med Genet. 1999 May 21;84(2):102-10.
Through an ongoing hospital-based active malformation surveillance program, we identified cardiovascular malformations (CVMs) in 3.3 per 1,000 liveborn and stillborn infants, and fetuses from pregnancies terminated electively during a 15-year period. We excluded the children of mothers who had planned delivery elsewhere, but were transferred for care of anomalies that had been detected in prenatal screening. Birth status changed markedly during the study with a significant increase in elective terminations of fetuses with a CVM from 0 to 22% (P < 0.01 based on a test for trend). The proportion of liveborn infants with CVMs decreased from 90% to 73% (P < 0.01); the frequency of stillbirths did not change. During the study period, there was a significant increase in the prevalence of CVMs in all births (P < 0.01) and elective terminations (P < 0.01). The increase in liveborn prevalence was not statistically significant (P = 0.08). Stillborn prevalence was unchanged. The number of mothers having prenatal ultrasonography (P < 0.01 for trend) and amniocentesis (P < 0.01 for trend) increased steadily. There were significant increases in the proportion of mothers having any ultrasound examination (P < 0.01 for trend), the number of initial ultrasound examinations occurring in the second trimester (P < 0.01 for trend), and the proportion of mothers having amniocentesis (P < 0.01 for trend). There was a significant increasing trend in the proportion of mothers who were 35 years and older (10% in 1972-1974, 26% in 1988-1990, P < 0.01). This hospital-based active surveillance program suggests that more frequent elective terminations had a significant effect on overall birth prevalence of CVMs. This trend would not have been detected by most other surveillance systems which determine prevalence of common birth defects from birth certificates and other forms of administrative reporting, and exclude elective terminations of pregnancy.
通过一项正在进行的基于医院的先天性畸形主动监测项目，我们在15年期间每1000例活产、死产婴儿以及因选择性终止妊娠而流产的胎儿中发现了3.3例心血管畸形（CVM）。我们排除了那些计划在其他地方分娩，但因产前筛查中发现异常而转来接受治疗的母亲所生的孩子。在研究期间，出生状况发生了显著变化，患有CVM的胎儿选择性终止妊娠的比例从0显著增加到22%（基于趋势检验，P<0.01）。患有CVM的活产婴儿比例从90%降至73%（P<0.01）；死产频率没有变化。在研究期间，所有出生中CVM的患病率显著增加（P<0.01），选择性终止妊娠的情况也是如此（P<0.01）。活产患病率的增加无统计学意义（P = 0.08）。死产患病率没有变化。进行产前超声检查（趋势P<0.01）和羊膜穿刺术（趋势P<0.01）的母亲数量稳步增加。进行任何超声检查的母亲比例（趋势P<0.01）、在孕中期进行首次超声检查的次数（趋势P<0.01）以及进行羊膜穿刺术母亲的比例（趋势P<0.01）都有显著增加。35岁及以上母亲的比例有显著上升趋势（1972 - 1974年为10%，1988 - 1990年为26%，P<0.01）。这项基于医院的主动监测项目表明，更频繁的选择性终止妊娠对CVM的总体出生患病率有显著影响。大多数其他监测系统通过出生证明和其他行政报告形式确定常见出生缺陷的患病率，并排除选择性终止妊娠的情况，因此无法检测到这种趋势。
