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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
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Population-based birth-defect and risk-factor surveillance: data from the Northern Netherlands.

M C Cornel1, J D Erickson, M J Khoury

  • 1Department of Medical Genetics, University of Groningen, Ant. Deusinglaan 4, 9713 AW Groningen, The Netherlands, Tel.: +31 50 363 32 38; Fax: +31 50 318 72 68.

The International Journal of Risk & Safety in Medicine
|March 21, 2013
PubMed
Summary

This study highlights a new surveillance method for identifying birth defect causes. It found links between maternal psychotropic drug use and cleft lip, and smoking and clubfoot.

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Area of Science:

  • Epidemiology
  • Public Health
  • Teratology

Background:

  • Traditional birth defect monitoring relies on frequency analysis, which has limited power to detect rare teratogenic exposures.
  • An alternative approach involves ongoing analysis of risk-factor data using a case-control method.
  • This study evaluates a novel surveillance strategy for identifying teratogens.

Purpose of the Study:

  • To assess the effectiveness of a risk-factor surveillance system in identifying associations between exposures and birth defects.
  • To investigate potential teratogenic effects of maternal exposures on offspring development.
  • To validate findings across multiple surveillance datasets.

Main Methods:

  • Utilized birth defect and risk-factor surveillance data from the Northern Netherlands (NNL) for births between 1981-1994 (4014 cases).
  • Investigated associations between 32 diagnostic categories and 77 risk factors, applying statistical significance thresholds (P < 0.01 and 0.01-0.05).
  • Cross-validated positive associations with data from the Metropolitan Atlanta Congenital Defects Program (MACDP) and MAternal DRug Exposure surveillance project (MADRE).

Main Results:

  • Identified statistically significant associations for 10 combinations (P < 0.01) and 25 combinations (0.01 < P < 0.05).
  • Consistently found an association between maternal use of psychotropic drugs (psycholeptics) and cleft lip with or without cleft palate (CLP) across NNL, MACDP, and MADRE datasets.
  • Observed an association between maternal smoking and clubfoot in both MACDP and NNL data, with an 11% attributable fraction in NNL.
  • The highest odds ratio was for CLP and maternal oxazepam use in NNL data (OR = 8.17).

Conclusions:

  • The risk-factor surveillance approach demonstrates potential for identifying new teratogens and environmental risks for birth defects.
  • Maternal use of psychotropic drugs and smoking are identified as potential risk factors for specific birth defects (CLP and clubfoot, respectively).
  • Methodological considerations include exposure ascertainment, outcome specificity, and Type I error control, while strengths lie in population-based data and cross-system validation.