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Congenital malformations and intrauterine growth retardation: a population study
M J Khoury1, J D Erickson, J F Cordero
1Birth Defects and Genetic Diseases Branch, Centers for Disease Control, Atlanta, GA 30333.
Insights
Congenital malformations significantly increase the risk of intrauterine growth retardation (IUGR). Most birth defects are linked to IUGR, with the risk escalating with more numerous defects.
Area of Science:
- Pediatric Epidemiology
- Perinatal Health
- Developmental Biology
Background:
- Intrauterine growth retardation (IUGR) and congenital malformations are significant concerns in infant health.
- Understanding the relationship between these conditions is crucial for identifying risk factors and improving outcomes.
Purpose of the Study:
- To investigate the association between congenital malformations and intrauterine growth retardation (IUGR).
- To determine the prevalence of IUGR in infants with major structural malformations.
Main Methods:
- Utilized data from the Metropolitan Atlanta Congenital Defects Program (1970-1984).
- Ascertained 13,074 infants with major structural malformations.
- Defined IUGR based on birth weight below the tenth percentile for race, sex, and gestational age.
Main Results:
- 22.3% of malformed infants exhibited IUGR (relative risk 2.6).
- 46 out of 48 defect categories showed increased IUGR, notably chromosomal anomalies (e.g., trisomy 18) and anencephaly.
- IUGR risk increased with the number of defects, from 20% (two defects) to 60% (nine or more defects).
Conclusions:
- Congenital malformations are strongly associated with an increased risk of intrauterine growth retardation.
- The relationship may involve IUGR as a consequence of malformations, IUGR predisposing to malformations, or shared etiologic factors.
- Specific malformations, particularly chromosomal anomalies and anencephaly, carry a high risk of IUGR.
Abstract:
The relationship between congenital malformations and intrauterine growth retardation was investigated using data from the population-based Metropolitan Atlanta Congenital Defects Program. Between 1970 and 1984, the system ascertained 13,074 infants with major structural malformations diagnosed in the first year of life and born to metropolitan Atlanta residents. These infants were classified as having intrauterine growth retardation if their birth weight was below the race-, sex-, and gestational age-specific tenth percentile limits for all Atlanta births. Overall, the frequency of intrauterine growth retardation among malformed infants was 22.3% (relative risk 2.6). Of 48 defect categories evaluated, 46 were associated with excess intrauterine growth retardation, most notably chromosomal anomalies (eg, 83.7% for infants with trisomy 18, relative risk 46) and anencephaly (73.3%, relative risk 25). Only a few isolated defects (such as isolated polydactyly, pyloric stenosis, and congenital hip dislocation) were not associated with excess intrauterine growth retardation. Among infants with multiple malformations, the frequency of intrauterine growth retardation increased markedly with increasing number of defects--from 20% for infants with two defects to 60% for infants with nine or more defects. The relationship between malformations and intrauterine growth retardation can be explained by one or more of three mechanisms: (1) intrauterine growth retardation can be a secondary disturbance to the presence of malformations; (2) intrauterine growth retardation can predispose the fetus to malformations; and (3) intrauterine growth retardation can coexist with malformations because of common etiologic factors.(ABSTRACT TRUNCATED AT 250 WORDS)