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Judith Rankin - One of the best experts on this subject based on the ideXlab platform.
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Congenital ANOMALIES IN THE BRITISH ISLES
Environmental Science and Technology Library, 2020Co-Authors: Judith RankinAbstract:The first Congenital Anomaly register in the British Isles was established in 1949, with a national system for England and Wales introduced in 1969 in the wake of the thalidomide epidemic. There are now 14 regional Congenital Anomaly registers and three disease-specific registers. These registers involve an extensive local network of notifiers, use multiple sources of case ascertainment, consistent coding, and include cases resulting in termination of pregnancy for fetal Anomaly following prenatal diagnosis. They have optimised the coverage, completeness and ascertainment of Congenital anomalies within their population, and are therefore able to provide better quality data than the national system. There are notable variations in the prevalence of Congenital Anomaly subtypes within these regions that cannot be accounted for in terms of differences in case ascertainment or registration practices. This underlying variation in prevalence should be recognised and taken into consideration in the design of epidemiological studies that are investigating the contribution of environmental influences to Congenital Anomaly risk, to ensure correct interpretation of the findings. Local Congenital Anomaly register data has been used to investigate Congenital Anomaly risk in populations within the British Isles living close to landfill sites and incinerators, and to possible contaminants in drinking water. Whilst the inclusion of high quality data from established Congenital Anomaly registers enhances the quality of outcome data, such studies are currently limited by the lack of detailed information on exposure. Causal pathways will only be determined if future studies combine high quality Congenital Anomaly data with increased information on exposure assessment.
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the association of h1n1 pandemic influenza with Congenital Anomaly prevalence in europe an ecological time series study
Epidemiology, 2015Co-Authors: J M Luteijn, Babak Khoshnood, Marieclaude Addor, Larraitz Arriola, Fabrizio Bianchi, Ester Garne, Vera Nelen, Amanda J Neville, Annette Queisserluft, Judith RankinAbstract:BACKGROUND: In the context of the European Surveillance of Congenital Anomalies (EUROCAT) surveillance response to the 2009 influenza pandemic, we sought to establish whether there was a detectable increase of Congenital Anomaly prevalence among pregnancies exposed to influenza seasons in general, and whether any increase was greater during the 2009 pandemic than during other seasons. METHODS: We performed an ecologic time series analysis based on 26,967 pregnancies with nonchromosomal Congenital Anomaly conceived from January 2007 to March 2011, reported by 15 EUROCAT registries. Analysis was performed for EUROCAT-defined Anomaly subgroups, divided by whether there was a prior hypothesis of association with influenza. Influenza season exposure was based on World Health Organization data. Prevalence rate ratios were calculated comparing pregnancies exposed to influenza season during the Congenital Anomaly-specific critical period for embryo-fetal development to nonexposed pregnancies. RESULTS: There was no evidence for an increased overall prevalence of Congenital anomalies among pregnancies exposed to influenza season. We detected an increased prevalence of ventricular septal defect and tricuspid atresia and stenosis during pandemic influenza season 2009, but not during 2007-2011 influenza seasons. For Congenital anomalies, where there was no prior hypothesis, the prevalence of tetralogy of Fallot was strongly reduced during influenza seasons. CONCLUSIONS: Our data do not suggest an overall association of pandemic or seasonal influenza with Congenital Anomaly prevalence. One interpretation is that apparent influenza effects found in previous individual-based studies were confounded by or interacting with other risk factors. The associations of heart anomalies with pandemic influenza could be strain specific.
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Regional variation in the prevalence of Congenital anomalies in England and Wales, 2005-2009
Archives of Disease in Childhood-fetal and Neonatal Edition, 2012Co-Authors: A. Springett, C. Rounding, D Wellesley, David Tucker, Judith Rankin, Es Draper, Joan K MorrisAbstract:Aim The British Isles Network of Congenital Anomaly Registers (BINOCAR) provides surveillance of Congenital anomalies in England and Wales.1 The aim of this study is to investigate if there is regional variation in 11 major Congenital Anomaly subgroups between five registers. Methods All cases of Congenital anomalies belonging to 11 major subgroups were extracted from five registers to calculate birth prevalence rates for 2005-2009. Differences between the registers for each Congenital Anomaly subgroup were assessed using chi-squared tests and regional variation depicted using maps. Results In 2005-2009, the overall prevalence of Congenital anomalies was 230 per 10,000 births [95% CI: 227–233]. The regional reported prevalence of Congenital anomalies ranged from 188 per 10,000 births [95% CI: 181-195] in Thames Valley to 331 per 10,000 births in Wales [95% CI: 322-339]. These are both significantly different to the reported prevalence for the five registers together. There was significant regional variation in all major Congenital Anomaly subgroups except for abdominal wall defects. Wales had the highest reported prevalence in all subgroups except for chromosomal anomalies. The East Midlands & South Yorkshire and Thames Valley had the lowest reported prevalence in all but two subgroups. Conclusion There is regional variation in the reported prevalence of ten major Congenital Anomaly subgroups. This variation requires investigation to determine any additional influences other than ascertainment and the underlying true prevalence which may vary regionally.
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peri conception hyperglycaemia and nephropathy are associated with risk of Congenital Anomaly in women with pre existing diabetes a population based cohort study
Diabetologia, 2012Co-Authors: R Bell, P. W.g. Tennant, S. V. Glinianaia, Rudolf W. Bilous, Judith RankinAbstract:Aims The aim of this study was to quantify the risk of major Congenital Anomaly, and to assess the influence of peri-conception HbA1c and other clinical and socio-demographic factors on the risk of Congenital Anomaly occurrence in offspring of women with type 1 and type 2 diabetes diagnosed before pregnancy.
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Sex differences in the prevalence of Congenital anomalies: a population-based study.
Birth Defects Research Part A-clinical and Molecular Teratology, 2011Co-Authors: P. W.g. Tennant, S. Dilhani Samarasekera, Tanja Pless-mulloli, Judith RankinAbstract:BACKGROUND: Limited data is available concerning the sex distribution of various Congenital Anomaly subtypes. This study investigated sex differences in the prevalence of Congenital anomalies, overall and by subtype, using high quality population-based data from the North of England. METHODS: Information on Congenital anomalies occurring among singleton pregnancies during 1985-2003 were extracted from the Northern Congenital Abnormality Survey (NorCAS). Anomalies were categorized by groups, subtypes, and syndromes according to the European Surveillance of Congenital Anomalies guidelines. Relative risks (RRs) comparing the prevalences in males to that in females were calculated for a range of Congenital Anomaly subtypes. RESULTS: A total of 12,795 eligible cases of Congenital Anomaly were identified during the study period, including 7019 (54.9%) males and 5776 (45.1%) females. Overall, male fetuses were significantly more prevalent in pregnancies affected by a Congenital Anomaly than female fetuses (RR, male vs. female = 1.15; 95% confidence interval [CI], 1.11-1.19), but there was significant heterogeneity between subtypes (p < 0.001). Forty-four of 110 (40%) unique subtypes were at least 40% more prevalent in males than females, with affected subtypes occurring across all major Anomaly groups. Thirteen of 110 (12%) unique subtypes were at least 40% more prevalent in females than males, but the female-biased RR of a neural tube defect was less pronounced than previously reported (RR = 0.84; 95% CI, 0.73-0.95). CONCLUSION: This study adds to the growing evidence of sex-specific differences in the prevalence of a wide range of Congenital Anomaly subtypes.
Joan K Morris - One of the best experts on this subject based on the ideXlab platform.
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insulin analogues use in pregnancy among women with pregestational diabetes mellitus and risk of Congenital Anomaly a retrospective population based cohort study
BMJ Open, 2018Co-Authors: Hao Wang, Maria Loane, Hermien E K De Walle, Miriam Gatt, Ester Garne, Joan K Morris, Ewa Wenderozegowska, Margery Morgan, Marian K Bakker, Sue JordanAbstract:Objectives To evaluate the risk of major Congenital Anomaly associated with first-trimester exposure to insulin analogues compared with human insulin in offspring of women with pregestational diabetes. Design and setting A population-based cohort of women with pregestational diabetes (n=1661) who delivered between 1996 and 2012 was established retrospectively from seven European regions covered bythe European Surveillance of Congenital Anomalies (EUROCAT) Congenital Anomaly registries. Primary outcome measures The risk of non-chromosomal major Congenital Anomaly in live births, fetal deaths and terminations for a fetal Anomaly exposed to insulin analogues in the first trimester of pregnancy was compared with the risk in those exposed to human insulin only. Results During the first trimester, 870 fetuses (52.4%) were exposed to human insulin only, 397 fetuses (23.9%) to insulin analogues only and 394 fetuses (23.7%) to both human insulin and insulin analogues. The risk of major Congenital Anomaly in fetuses exposed to insulin analogues only was lower than those exposed to human insulin only; the relative risk adjusted for glycaemic control and region was 0.56 (95% CI 0.29 to 1.06). The significantly lower risk related to exposure of insulin analogues only was observed in Congenital heart defects: adjusted relative risk 0.14 (95% CI 0.03 to 0.62). Conclusions In this retrospective population-based cohort study across Europe, first-trimester exposure to insulin analogues did not increase the risk of major Congenital Anomaly compared with exposure to human insulin. A possible lower risk of Congenital heart defects among fetuses exposed to insulin analogues only deserves further investigation.
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euromedicat signal detection an evaluation of selected Congenital Anomaly medication associations
British Journal of Clinical Pharmacology, 2016Co-Authors: Joanne Given, Maria Loane, Marieclaude Addor, Ingeborg Barisic, Hermien E K De Walle, J M Luteijn, Ester Garne, Joan K Morris, Lolkje T W De Jongvan Den Berg, Miriam GattAbstract:Aims To evaluate Congenital Anomaly (CA)-medication exposure associations produced by the new EUROmediCAT signal detection system and determine which require further investigation. Methods Data from 15 EUROCAT registries (1995–2011) with medication exposures at the chemical substance (5th level of Anatomic Therapeutic Chemical classification) and chemical subgroup (4th level) were analysed using a 50% false detection rate. After excluding antiepileptics, antidiabetics, antiasthmatics and SSRIs/psycholeptics already under investigation, 27 associations were evaluated. If evidence for a signal persisted after data validation, a literature review was conducted for prior evidence of human teratogenicity. Results Thirteen out of 27 CA-medication exposure signals, based on 389 exposed cases, passed data validation. There was some prior evidence in the literature to support six signals (gastroschisis and levonorgestrel/ethinylestradiol (OR 4.10, 95% CI 1.70–8.53; Congenital heart disease/pulmonary valve stenosis and nucleoside/tide reverse transcriptase inhibitors (OR 5.01, 95% CI 1.99–14.20/OR 28.20, 95% CI 4.63–122.24); complete absence of a limb and pregnen (4) derivatives (OR 6.60, 95% CI 1.70–22.93); hypospadias and pregnadien derivatives (OR 1.40, 95% CI 1.10–1.76); hypospadias and synthetic ovulation stimulants (OR 1.89, 95% CI 1.28–2.70). Antipropulsives produced a signal for syndactyly while the literature revealed a signal for hypospadias. There was no prior evidence to support the remaining six signals involving the ordinary salt combinations, propulsives, bulk-forming laxatives, hydrazinophthalazine derivatives, gonadotropin releasing hormone analogues and selective serotonin agonists. Conclusion Signals which strengthened prior evidence should be prioritized for further investigation, and independent evidence sought to confirm the remaining signals. Some chance associations are expected and confounding by indication is possible.
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Regional variation in the prevalence of Congenital anomalies in England and Wales, 2005-2009
Archives of Disease in Childhood-fetal and Neonatal Edition, 2012Co-Authors: A. Springett, C. Rounding, D Wellesley, David Tucker, Judith Rankin, Es Draper, Joan K MorrisAbstract:Aim The British Isles Network of Congenital Anomaly Registers (BINOCAR) provides surveillance of Congenital anomalies in England and Wales.1 The aim of this study is to investigate if there is regional variation in 11 major Congenital Anomaly subgroups between five registers. Methods All cases of Congenital anomalies belonging to 11 major subgroups were extracted from five registers to calculate birth prevalence rates for 2005-2009. Differences between the registers for each Congenital Anomaly subgroup were assessed using chi-squared tests and regional variation depicted using maps. Results In 2005-2009, the overall prevalence of Congenital anomalies was 230 per 10,000 births [95% CI: 227–233]. The regional reported prevalence of Congenital anomalies ranged from 188 per 10,000 births [95% CI: 181-195] in Thames Valley to 331 per 10,000 births in Wales [95% CI: 322-339]. These are both significantly different to the reported prevalence for the five registers together. There was significant regional variation in all major Congenital Anomaly subgroups except for abdominal wall defects. Wales had the highest reported prevalence in all subgroups except for chromosomal anomalies. The East Midlands & South Yorkshire and Thames Valley had the lowest reported prevalence in all but two subgroups. Conclusion There is regional variation in the reported prevalence of ten major Congenital Anomaly subgroups. This variation requires investigation to determine any additional influences other than ascertainment and the underlying true prevalence which may vary regionally.
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ascertainment and accuracy of down syndrome cases reported in Congenital Anomaly registers in england and wales
Archives of Disease in Childhood-fetal and Neonatal Edition, 2008Co-Authors: George M Savva, Joan K MorrisAbstract:OBJECTIVE: Congenital Anomaly registers allow the rates of anomalies to be monitored and are essential for understanding their epidemiology. We estimate the ascertainment and accuracy of records of Down syndrome (DS) on national and regional registers in England and Wales. METHODS: Probabilistic record linkage was used to match records of DS from three sources: the National Down Syndrome Cytogenetic Register (NDSCR), seven regional members of the British Isles Network of Congenital Anomaly Registers (BINOCAR) and the National Congenital Anomaly System (NCAS). Capture-recapture methods were then used to estimate the ascertainment of each register. RESULTS: The NDSCR and BINOCAR registers ascertain around 95% of both pre-natally and post-natally diagnosed cases of DS. NCAS collects data only on births and ascertains 55% of cases of DS births, which is currently around 25% of all DS diagnoses. NCAS ascertainment varies according to whether a BINOCAR register covering the same area contributes information to NCAS, varying from 80% in areas where regional registers contribute to 50% where regional registers do not. CONCLUSIONS: Active case finding through regional registers is essential for monitoring Congenital anomalies. The ascertainment of the NDSCR and BINOCAR is sufficient to provide reliable epidemiology and surveillance of Congenital anomalies, whereas that of NCAS is not.
Ester Garne - One of the best experts on this subject based on the ideXlab platform.
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insulin analogues use in pregnancy among women with pregestational diabetes mellitus and risk of Congenital Anomaly a retrospective population based cohort study
BMJ Open, 2018Co-Authors: Hao Wang, Maria Loane, Hermien E K De Walle, Miriam Gatt, Ester Garne, Joan K Morris, Ewa Wenderozegowska, Margery Morgan, Marian K Bakker, Sue JordanAbstract:Objectives To evaluate the risk of major Congenital Anomaly associated with first-trimester exposure to insulin analogues compared with human insulin in offspring of women with pregestational diabetes. Design and setting A population-based cohort of women with pregestational diabetes (n=1661) who delivered between 1996 and 2012 was established retrospectively from seven European regions covered bythe European Surveillance of Congenital Anomalies (EUROCAT) Congenital Anomaly registries. Primary outcome measures The risk of non-chromosomal major Congenital Anomaly in live births, fetal deaths and terminations for a fetal Anomaly exposed to insulin analogues in the first trimester of pregnancy was compared with the risk in those exposed to human insulin only. Results During the first trimester, 870 fetuses (52.4%) were exposed to human insulin only, 397 fetuses (23.9%) to insulin analogues only and 394 fetuses (23.7%) to both human insulin and insulin analogues. The risk of major Congenital Anomaly in fetuses exposed to insulin analogues only was lower than those exposed to human insulin only; the relative risk adjusted for glycaemic control and region was 0.56 (95% CI 0.29 to 1.06). The significantly lower risk related to exposure of insulin analogues only was observed in Congenital heart defects: adjusted relative risk 0.14 (95% CI 0.03 to 0.62). Conclusions In this retrospective population-based cohort study across Europe, first-trimester exposure to insulin analogues did not increase the risk of major Congenital Anomaly compared with exposure to human insulin. A possible lower risk of Congenital heart defects among fetuses exposed to insulin analogues only deserves further investigation.
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euromedicat signal detection an evaluation of selected Congenital Anomaly medication associations
British Journal of Clinical Pharmacology, 2016Co-Authors: Joanne Given, Maria Loane, Marieclaude Addor, Ingeborg Barisic, Hermien E K De Walle, J M Luteijn, Ester Garne, Joan K Morris, Lolkje T W De Jongvan Den Berg, Miriam GattAbstract:Aims To evaluate Congenital Anomaly (CA)-medication exposure associations produced by the new EUROmediCAT signal detection system and determine which require further investigation. Methods Data from 15 EUROCAT registries (1995–2011) with medication exposures at the chemical substance (5th level of Anatomic Therapeutic Chemical classification) and chemical subgroup (4th level) were analysed using a 50% false detection rate. After excluding antiepileptics, antidiabetics, antiasthmatics and SSRIs/psycholeptics already under investigation, 27 associations were evaluated. If evidence for a signal persisted after data validation, a literature review was conducted for prior evidence of human teratogenicity. Results Thirteen out of 27 CA-medication exposure signals, based on 389 exposed cases, passed data validation. There was some prior evidence in the literature to support six signals (gastroschisis and levonorgestrel/ethinylestradiol (OR 4.10, 95% CI 1.70–8.53; Congenital heart disease/pulmonary valve stenosis and nucleoside/tide reverse transcriptase inhibitors (OR 5.01, 95% CI 1.99–14.20/OR 28.20, 95% CI 4.63–122.24); complete absence of a limb and pregnen (4) derivatives (OR 6.60, 95% CI 1.70–22.93); hypospadias and pregnadien derivatives (OR 1.40, 95% CI 1.10–1.76); hypospadias and synthetic ovulation stimulants (OR 1.89, 95% CI 1.28–2.70). Antipropulsives produced a signal for syndactyly while the literature revealed a signal for hypospadias. There was no prior evidence to support the remaining six signals involving the ordinary salt combinations, propulsives, bulk-forming laxatives, hydrazinophthalazine derivatives, gonadotropin releasing hormone analogues and selective serotonin agonists. Conclusion Signals which strengthened prior evidence should be prioritized for further investigation, and independent evidence sought to confirm the remaining signals. Some chance associations are expected and confounding by indication is possible.
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use of hierarchical models to analyze european trends in Congenital Anomaly prevalence
Birth Defects Research Part A-clinical and Molecular Teratology, 2016Co-Authors: Alana Cavadino, Ruth Greenlees, Marieclaude Addor, Larraitz Arriola, Fabrizio Bianchi, Elizabeth S Draper, Ester Garne, David Prietomerino, Martin Haeusler, Babak KhoshnoodAbstract:Background: Surveillance of Congenital anomalies is important to identify potential teratogens. Despite known associations between different anomalies, current surveillance methods examine trends within each subgroup separately. We aimed to evaluate whether hierarchical statistical methods that combine information from several subgroups simultaneously would enhance current surveillance methods using data collected by EUROCAT, a European network of population-based Congenital Anomaly registries. Methods: Ten-year trends (2003 to 2012) in 18 EUROCAT registries over 11 countries were analyzed for the following groups of anomalies: neural tube defects, Congenital heart defects, digestive system, and chromosomal anomalies. Hierarchical Poisson regression models that combined related subgroups together according to EUROCAT's hierarchy of subgroup coding were applied. Results from hierarchical models were compared with those from Poisson models that consider each Congenital Anomaly separately. Results: Hierarchical models gave similar results as those obtained when considering each Anomaly subgroup in a separate analysis. Hierarchical models that included only around three subgroups showed poor convergence and were generally found to be over-parameterized. Larger sets of Anomaly subgroups were found to be too heterogeneous to group together in this way. Conclusion: There were no substantial differences between independent analyses of each subgroup and hierarchical models when using the EUROCAT Anomaly subgroups. Considering each Anomaly separately, therefore, remains an appropriate method for the detection of potential changes in prevalence by surveillance systems. Hierarchical models do, however, remain an interesting alternative method of analysis when considering the risks of specific exposures in relation to the prevalence of Congenital anomalies, which could be investigated in other studies.
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Insulin analogues in pregnancy and specific Congenital anomalies: a literature review.
Diabetes-metabolism Research and Reviews, 2015Co-Authors: Josta De Jong, Ester Garne, Margery Morgan, Ewa Wender-ozegowska, Lolkje T. W. De Jong-van Den Berg, Hao WangAbstract:BACKGROUND: Insulin analogues are commonly used in pregnant women with diabetes. It is not known if the use of insulin analogues in pregnancy is associated with any higher risk of Congenital anomalies in the offspring compared with use of human insulin. METHODS: We performed a literature search for studies of pregnant women with pregestational diabetes using insulin analogues in the first trimester and information on Congenital anomalies. The studies were analyzed to compare the Congenital Anomaly rate among fetuses of mothers using insulin analogues with fetuses of mothers using human insulin. RESULTS: Of 29 studies we included 1286 fetuses of mothers using short-acting insulin analogues with 1089 references of mothers using human insulin and 768 fetuses of mothers using long-acting insulin analogues with 685 references of mothers using long-acting human insulin (Neutral Protamine Hagedorn; NPH). The Congenital Anomaly rate was 4.84% and 4.29% among the fetuses of mothers using lispro and aspart. For glargine and detemir the Congenital Anomaly rate was 2.86% and 3.47% respectively. No studies on the use of insulin glulisine and degludec in pregnancy were found. There was no statistically significant difference in the Congenital Anomaly rate among fetuses exposed to insulin analogues (lispro, aspart, glargine or detemir) compared to those exposed to human insulin or NPH insulin. CONCLUSION: The total prevalence of Congenital anomalies was not increased for fetuses exposed to insulin analogues. The small samples in the included studies provided insufficient statistical power to identify a moderate increased risk of specific Congenital anomalies. This article is protected by copyright. All rights reserved.
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the association of h1n1 pandemic influenza with Congenital Anomaly prevalence in europe an ecological time series study
Epidemiology, 2015Co-Authors: J M Luteijn, Babak Khoshnood, Marieclaude Addor, Larraitz Arriola, Fabrizio Bianchi, Ester Garne, Vera Nelen, Amanda J Neville, Annette Queisserluft, Judith RankinAbstract:BACKGROUND: In the context of the European Surveillance of Congenital Anomalies (EUROCAT) surveillance response to the 2009 influenza pandemic, we sought to establish whether there was a detectable increase of Congenital Anomaly prevalence among pregnancies exposed to influenza seasons in general, and whether any increase was greater during the 2009 pandemic than during other seasons. METHODS: We performed an ecologic time series analysis based on 26,967 pregnancies with nonchromosomal Congenital Anomaly conceived from January 2007 to March 2011, reported by 15 EUROCAT registries. Analysis was performed for EUROCAT-defined Anomaly subgroups, divided by whether there was a prior hypothesis of association with influenza. Influenza season exposure was based on World Health Organization data. Prevalence rate ratios were calculated comparing pregnancies exposed to influenza season during the Congenital Anomaly-specific critical period for embryo-fetal development to nonexposed pregnancies. RESULTS: There was no evidence for an increased overall prevalence of Congenital anomalies among pregnancies exposed to influenza season. We detected an increased prevalence of ventricular septal defect and tricuspid atresia and stenosis during pandemic influenza season 2009, but not during 2007-2011 influenza seasons. For Congenital anomalies, where there was no prior hypothesis, the prevalence of tetralogy of Fallot was strongly reduced during influenza seasons. CONCLUSIONS: Our data do not suggest an overall association of pandemic or seasonal influenza with Congenital Anomaly prevalence. One interpretation is that apparent influenza effects found in previous individual-based studies were confounded by or interacting with other risk factors. The associations of heart anomalies with pandemic influenza could be strain specific.
R Bell - One of the best experts on this subject based on the ideXlab platform.
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peri conception hyperglycaemia and nephropathy are associated with risk of Congenital Anomaly in women with pre existing diabetes a population based cohort study
Diabetologia, 2012Co-Authors: R Bell, P. W.g. Tennant, S. V. Glinianaia, Rudolf W. Bilous, Judith RankinAbstract:Aims The aim of this study was to quantify the risk of major Congenital Anomaly, and to assess the influence of peri-conception HbA1c and other clinical and socio-demographic factors on the risk of Congenital Anomaly occurrence in offspring of women with type 1 and type 2 diabetes diagnosed before pregnancy.
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Peri-conception hyperglycaemia and nephropathy are associated with risk of Congenital Anomaly in women with pre-existing diabetes: A population-based cohort study
Diabetologia, 2012Co-Authors: R Bell, P. W.g. Tennant, S. V. Glinianaia, Rudolf W. Bilous, J. RankinAbstract:\n{AIMS}: The aim of this study was to quantify the risk of major Congenital Anomaly, and to assess the influence of peri-conception {HbA}(1c) and other clinical and socio-demographic factors on the risk of Congenital Anomaly occurrence in offspring of women with type 1 and type 2 diabetes diagnosed before pregnancy. {METHODS}: This was a population-based cohort study using linked data from registers of Congenital Anomaly and diabetes in pregnancy. A total of 401,149 singleton pregnancies (1,677 in women with diabetes) between 1996 and 2008 resulting in live birth, fetal death at ≥20 weeks' gestation or termination of pregnancy for fetal Anomaly were included. {RESULTS}: The rate of non-chromosomal major Congenital Anomaly in women with diabetes was 71.6 per 1,000 pregnancies (95% {CI} 59.6, 84.9), a relative risk of 3.8 (95% {CI} 3.2, 4.5) compared with women without diabetes. There was a three- to sixfold increased risk across all common Anomaly groups. In a multivariate analysis, peri-conception glycaemic control (adjusted {OR} [{aOR}] 1.3 [95% {CI} 1.2, 1.4] per 1% [11 mmol/mol] linear increase in {HbA}(1c) above 6.3% [45 mmol/mol]) and pre-existing nephropathy ({aOR} 2.5 [95% {CI} 1.1, 5.3]) were significant independent predictors of Congenital Anomaly. Associations with gestation at booking ({aOR} 1.1 [95% {CI} 1.0, 1.1]) and parity ({aOR} 1.6 [95% {CI} 1.0, 2. 5]) were not significant. Unadjusted risk was higher for women from deprived areas or who did not take folate. Type and duration of diabetes, ethnicity, age, {BMI}, preconception care, smoking and fetal sex were not associated with Congenital Anomaly risk. {CONCLUSIONS}: Peri-conception glycaemia is the most important modifiable risk factor for Congenital Anomaly in women with diabetes. The association with nephropathy merits further study.\n
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maternal body mass index and Congenital Anomaly risk a cohort study
International Journal of Obesity, 2010Co-Authors: Judith Rankin, P. W.g. Tennant, M. Bythell, K. J. Stothard, Carolyn D Summerbell, R BellAbstract:To investigate the association between maternal body mass index (BMI) and major, structural Congenital anomalies. Cohort study using prospectively collected data. Data on all singleton pregnancies booked at five maternity units in the north of England between 01 January 2003 and 31 December 2005 and data on Congenital anomalies notified to the Northern Congenital Abnormality Survey were linked using key variables. Maternal pre-gestational diabetic status was derived from the Northern Diabetes in Pregnancy Survey. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated by maximum-likelihood logistic regression models, with missing values modelled as explicit categories. There was a total of 41 013 singleton pregnancies during the study period, of which 682 were affected by a structural Congenital Anomaly, a total prevalence of 166 (95% CI: 154, 179) per 10 000 registered births. Overall, the risk of a Congenital Anomaly was significantly increased among the maternal underweight (BMI⩽18.5 kg m–2; aOR=1.60, 95% CI: 1.09, 2.36; P=0.02) and maternal obese groups (BMI⩾30 kg m–2; aOR=1.30, 95% CI: 1.03, 1.63; P=0.03), but not for maternal overweight (BMI=25–29.9 kg m–2; aOR=0.85, 95% CI: 0.68, 1.06; P=0.15), compared with mothers of recommended BMI. Maternal obesity was associated with significantly increased risk of ventricular septal defect (aOR=1.56, 95% CI: 1.01, 2.40; P=0.04), cleft lip (aOR=3.71, 95% CI: 1.05, 13.10; P=0.04) and eye anomalies (aOR=11.36, 95% CI: 2.25, 57.28; P=0.003). Maternal underweight was associated with significantly increased risks of atrial septal defect (aOR=2.86, 95% CI: 1.18, 6.96; P=0.02), genital anomalies (aOR=6.30, 95% CI: 1.58, 25.08; P=0.009) and hypospadias (aOR=8.77, 95% CI: 1.42, 54.29; P=0.02). We found an overall increased risk of Congenital anomalies in women who are obese and women who are underweight compared with women of recommended weight. Women should be made aware of these risks and supported to optimize their weight before pregnancy.
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Maternal body mass index and Congenital Anomaly risk: A cohort study
International Journal of Obesity, 2010Co-Authors: J. Rankin, P. W.g. Tennant, M. Bythell, K. J. Stothard, Carolyn D Summerbell, R BellAbstract:Objective: To investigate the association between maternal body mass index (BMI) and major, structural Congenital anomalies. Design: Cohort study using prospectively collected data. Methods: Data on all singleton pregnancies booked at five maternity units in the north of England between 01 January 2003 and 31 December 2005 and data on Congenital anomalies notified to the Northern Congenital Abnormality Survey were linked using key variables. Maternal pre-gestational diabetic status was derived from the Northern Diabetes in Pregnancy Survey. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated by maximum-likelihood logistic regression models, with missing values modelled as explicit categories. Results: There was a total of 41013 singleton pregnancies during the study period, of which 682 were affected by a structural Congenital Anomaly, a total prevalence of 166 (95% CI: 154, 179) per 10000 registered births. Overall, the risk of a Congenital Anomaly was significantly increased among the maternal underweight (BMIp18.5 kgm–2; aOR¼1.60, 95% CI: 1.09, 2.36; P¼0.02) and maternal obese groups (BMIX30kgm–2; aOR¼1.30, 95% CI: 1.03, 1.63; P¼0.03), but not for maternal overweight (BMI¼25–29.9 kgm–2; aOR¼0.85, 95% CI: 0.68, 1.06; P¼0.15), compared with mothers of recommended BMI. Maternal obesity was associated with significantly increased risk of ventricular septal defect (aOR¼1.56, 95% CI: 1.01, 2.40; P¼0.04), cleft lip (aOR¼3.71, 95% CI: 1.05, 13.10; P¼0.04) and eye anomalies (aOR¼11.36, 95% CI: 2.25, 57.28; P¼0.003). Maternal underweight was associated with significantly increased risks of atrial septal defect (aOR¼2.86, 95% CI: 1.18, 6.96; P¼0.02), genital anomalies (aOR¼6.30, 95% CI: 1.58, 25.08; P¼0.009) and hypospadias (aOR¼8.77, 95% CI: 1.42, 54.29; P¼0.02). Conclusions: We found an overall increased risk of Congenital anomalies in women who are obese and women who are underweight compared with women of recommended weight. Women should be made aware of these risks and supported to optimize their weight before pregnancy.
P. W.g. Tennant - One of the best experts on this subject based on the ideXlab platform.
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peri conception hyperglycaemia and nephropathy are associated with risk of Congenital Anomaly in women with pre existing diabetes a population based cohort study
Diabetologia, 2012Co-Authors: R Bell, P. W.g. Tennant, S. V. Glinianaia, Rudolf W. Bilous, Judith RankinAbstract:Aims The aim of this study was to quantify the risk of major Congenital Anomaly, and to assess the influence of peri-conception HbA1c and other clinical and socio-demographic factors on the risk of Congenital Anomaly occurrence in offspring of women with type 1 and type 2 diabetes diagnosed before pregnancy.
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Peri-conception hyperglycaemia and nephropathy are associated with risk of Congenital Anomaly in women with pre-existing diabetes: A population-based cohort study
Diabetologia, 2012Co-Authors: R Bell, P. W.g. Tennant, S. V. Glinianaia, Rudolf W. Bilous, J. RankinAbstract:\n{AIMS}: The aim of this study was to quantify the risk of major Congenital Anomaly, and to assess the influence of peri-conception {HbA}(1c) and other clinical and socio-demographic factors on the risk of Congenital Anomaly occurrence in offspring of women with type 1 and type 2 diabetes diagnosed before pregnancy. {METHODS}: This was a population-based cohort study using linked data from registers of Congenital Anomaly and diabetes in pregnancy. A total of 401,149 singleton pregnancies (1,677 in women with diabetes) between 1996 and 2008 resulting in live birth, fetal death at ≥20 weeks' gestation or termination of pregnancy for fetal Anomaly were included. {RESULTS}: The rate of non-chromosomal major Congenital Anomaly in women with diabetes was 71.6 per 1,000 pregnancies (95% {CI} 59.6, 84.9), a relative risk of 3.8 (95% {CI} 3.2, 4.5) compared with women without diabetes. There was a three- to sixfold increased risk across all common Anomaly groups. In a multivariate analysis, peri-conception glycaemic control (adjusted {OR} [{aOR}] 1.3 [95% {CI} 1.2, 1.4] per 1% [11 mmol/mol] linear increase in {HbA}(1c) above 6.3% [45 mmol/mol]) and pre-existing nephropathy ({aOR} 2.5 [95% {CI} 1.1, 5.3]) were significant independent predictors of Congenital Anomaly. Associations with gestation at booking ({aOR} 1.1 [95% {CI} 1.0, 1.1]) and parity ({aOR} 1.6 [95% {CI} 1.0, 2. 5]) were not significant. Unadjusted risk was higher for women from deprived areas or who did not take folate. Type and duration of diabetes, ethnicity, age, {BMI}, preconception care, smoking and fetal sex were not associated with Congenital Anomaly risk. {CONCLUSIONS}: Peri-conception glycaemia is the most important modifiable risk factor for Congenital Anomaly in women with diabetes. The association with nephropathy merits further study.\n
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Sex differences in the prevalence of Congenital anomalies: a population-based study.
Birth Defects Research Part A-clinical and Molecular Teratology, 2011Co-Authors: P. W.g. Tennant, S. Dilhani Samarasekera, Tanja Pless-mulloli, Judith RankinAbstract:BACKGROUND: Limited data is available concerning the sex distribution of various Congenital Anomaly subtypes. This study investigated sex differences in the prevalence of Congenital anomalies, overall and by subtype, using high quality population-based data from the North of England. METHODS: Information on Congenital anomalies occurring among singleton pregnancies during 1985-2003 were extracted from the Northern Congenital Abnormality Survey (NorCAS). Anomalies were categorized by groups, subtypes, and syndromes according to the European Surveillance of Congenital Anomalies guidelines. Relative risks (RRs) comparing the prevalences in males to that in females were calculated for a range of Congenital Anomaly subtypes. RESULTS: A total of 12,795 eligible cases of Congenital Anomaly were identified during the study period, including 7019 (54.9%) males and 5776 (45.1%) females. Overall, male fetuses were significantly more prevalent in pregnancies affected by a Congenital Anomaly than female fetuses (RR, male vs. female = 1.15; 95% confidence interval [CI], 1.11-1.19), but there was significant heterogeneity between subtypes (p < 0.001). Forty-four of 110 (40%) unique subtypes were at least 40% more prevalent in males than females, with affected subtypes occurring across all major Anomaly groups. Thirteen of 110 (12%) unique subtypes were at least 40% more prevalent in females than males, but the female-biased RR of a neural tube defect was less pronounced than previously reported (RR = 0.84; 95% CI, 0.73-0.95). CONCLUSION: This study adds to the growing evidence of sex-specific differences in the prevalence of a wide range of Congenital Anomaly subtypes.
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maternal body mass index and Congenital Anomaly risk a cohort study
International Journal of Obesity, 2010Co-Authors: Judith Rankin, P. W.g. Tennant, M. Bythell, K. J. Stothard, Carolyn D Summerbell, R BellAbstract:To investigate the association between maternal body mass index (BMI) and major, structural Congenital anomalies. Cohort study using prospectively collected data. Data on all singleton pregnancies booked at five maternity units in the north of England between 01 January 2003 and 31 December 2005 and data on Congenital anomalies notified to the Northern Congenital Abnormality Survey were linked using key variables. Maternal pre-gestational diabetic status was derived from the Northern Diabetes in Pregnancy Survey. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated by maximum-likelihood logistic regression models, with missing values modelled as explicit categories. There was a total of 41 013 singleton pregnancies during the study period, of which 682 were affected by a structural Congenital Anomaly, a total prevalence of 166 (95% CI: 154, 179) per 10 000 registered births. Overall, the risk of a Congenital Anomaly was significantly increased among the maternal underweight (BMI⩽18.5 kg m–2; aOR=1.60, 95% CI: 1.09, 2.36; P=0.02) and maternal obese groups (BMI⩾30 kg m–2; aOR=1.30, 95% CI: 1.03, 1.63; P=0.03), but not for maternal overweight (BMI=25–29.9 kg m–2; aOR=0.85, 95% CI: 0.68, 1.06; P=0.15), compared with mothers of recommended BMI. Maternal obesity was associated with significantly increased risk of ventricular septal defect (aOR=1.56, 95% CI: 1.01, 2.40; P=0.04), cleft lip (aOR=3.71, 95% CI: 1.05, 13.10; P=0.04) and eye anomalies (aOR=11.36, 95% CI: 2.25, 57.28; P=0.003). Maternal underweight was associated with significantly increased risks of atrial septal defect (aOR=2.86, 95% CI: 1.18, 6.96; P=0.02), genital anomalies (aOR=6.30, 95% CI: 1.58, 25.08; P=0.009) and hypospadias (aOR=8.77, 95% CI: 1.42, 54.29; P=0.02). We found an overall increased risk of Congenital anomalies in women who are obese and women who are underweight compared with women of recommended weight. Women should be made aware of these risks and supported to optimize their weight before pregnancy.
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Maternal body mass index and Congenital Anomaly risk: A cohort study
International Journal of Obesity, 2010Co-Authors: J. Rankin, P. W.g. Tennant, M. Bythell, K. J. Stothard, Carolyn D Summerbell, R BellAbstract:Objective: To investigate the association between maternal body mass index (BMI) and major, structural Congenital anomalies. Design: Cohort study using prospectively collected data. Methods: Data on all singleton pregnancies booked at five maternity units in the north of England between 01 January 2003 and 31 December 2005 and data on Congenital anomalies notified to the Northern Congenital Abnormality Survey were linked using key variables. Maternal pre-gestational diabetic status was derived from the Northern Diabetes in Pregnancy Survey. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated by maximum-likelihood logistic regression models, with missing values modelled as explicit categories. Results: There was a total of 41013 singleton pregnancies during the study period, of which 682 were affected by a structural Congenital Anomaly, a total prevalence of 166 (95% CI: 154, 179) per 10000 registered births. Overall, the risk of a Congenital Anomaly was significantly increased among the maternal underweight (BMIp18.5 kgm–2; aOR¼1.60, 95% CI: 1.09, 2.36; P¼0.02) and maternal obese groups (BMIX30kgm–2; aOR¼1.30, 95% CI: 1.03, 1.63; P¼0.03), but not for maternal overweight (BMI¼25–29.9 kgm–2; aOR¼0.85, 95% CI: 0.68, 1.06; P¼0.15), compared with mothers of recommended BMI. Maternal obesity was associated with significantly increased risk of ventricular septal defect (aOR¼1.56, 95% CI: 1.01, 2.40; P¼0.04), cleft lip (aOR¼3.71, 95% CI: 1.05, 13.10; P¼0.04) and eye anomalies (aOR¼11.36, 95% CI: 2.25, 57.28; P¼0.003). Maternal underweight was associated with significantly increased risks of atrial septal defect (aOR¼2.86, 95% CI: 1.18, 6.96; P¼0.02), genital anomalies (aOR¼6.30, 95% CI: 1.58, 25.08; P¼0.009) and hypospadias (aOR¼8.77, 95% CI: 1.42, 54.29; P¼0.02). Conclusions: We found an overall increased risk of Congenital anomalies in women who are obese and women who are underweight compared with women of recommended weight. Women should be made aware of these risks and supported to optimize their weight before pregnancy.