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Prenatal screening for clubfoot: what factors predict prenatal detection?
Susan T Mahan1, Mahsa M Yazdy, James R Kasser
1Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
Insights
Prenatal diagnosis of clubfoot varied by state and socioeconomic factors. Older mothers, those with other birth defects, and those in Massachusetts had higher detection rates.
Area of Science:
- Medical Epidemiology
- Congenital Abnormalities
- Prenatal Diagnosis
Background:
- Routine prenatal ultrasound aids in detecting musculoskeletal disorders.
- Clubfoot is a common congenital condition requiring early intervention.
Purpose of the Study:
- To identify socioeconomic factors associated with prenatal detection of clubfoot.
- To analyze variations in clubfoot diagnosis rates across different states.
Main Methods:
- Infants with clubfoot were identified in Massachusetts, New York, and North Carolina.
- Mothers were interviewed, and medical records were analyzed using logistic regression.
Main Results:
- Prenatal detection of clubfoot was 62.3% overall, with significant state-level variation.
- Predictors for prenatal detection included maternal age ≥35 years, presence of other birth defects, and residence in Massachusetts.
- Lower detection rates were observed for non-Hispanic black mothers and younger mothers.
Conclusions:
- Prenatal detection rates for clubfoot are influenced by sociodemographic variables.
- Higher detection rates were noted in Massachusetts, older mothers, and cases with additional birth defects.
- Targeted screening strategies may improve early detection rates for clubfoot.
Objective:
Routine prenatal ultrasound has often resulted in the early detection of musculoskeletal disorders. The purpose of this study was to determine which socioeconomic factors are associated with prenatal detection of clubfoot.
Methods:
The Slone Epidemiology Center at Boston University identified infants in three states (Massachusetts, New York, and North Carolina) who were reported as having a clubfoot. Mothers of these children were contacted and interviewed, and medical records obtained. Data were analyzed by using logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs).
Results:
Overall detection of the clubfoot prenatally was 62.3% (421/676) but this varied considerably by state, 81.1% in Massachusetts (154/190), 58.5% in New York (124/212), and 52.2% in North Carolina (143/274). Multivariate analysis revealed that the strongest predictors for prenatal detection were maternal age ≥35 years (OR: 3.54), non-Hispanic black race (OR: 0.49), the presence of another birth defect (OR: 2.61), residing in Massachusetts (OR: 2.64), and the presence of a bilateral clubfoot (OR: 1.90).
Conclusions:
We found a statistically significantly higher rate of prenatal detection of clubfoot in Massachusetts and lower rate in younger mothers (age <35) and black mothers, even after adjustment for other sociodemographic variables.
