Trends in prenatal diagnosis of congenital anomalies among live births over a 30-year period

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Religionsvidenskab og Radical Orthodoxy - Aksetid ifølge Hans J. Lundager Jensen og John Milbank

Artiklen diskuterer brugen af aksetids-teori hos Hans J. Lundager Jensen og John Milbank, samt dens relevans for dialogen mellem universitet og kirke.The article discusses the use of Axial Age Theory in Hans J. Lundager Jensen and John Milbank, as well as its relevance for the dialogue between academia and the church

Use of asthma medication during pregnancy and risk of specific congenital anomalies: A European case-malformed control study

Background. Pregnant women with asthma need to take medication during pregnancy. Objective. We sought to identify whether there is an increased risk of specific congenital anomalies after exposure to antiasthma medication in the first trimester of pregnancy. Methods. We performed a population-based case-malformed control study testing signals identified in a literature review. Odds ratios (ORs) of exposure to the main groups of asthma medication were calculated for each of the 10 signal anomalies compared with registrations with nonchromosomal, nonsignal anomalies as control registrations. In addition, exploratory analyses were done for each nonsignal anomaly. The data set included 76,249 registrations of congenital anomalies from 13 EUROmediCAT registries. Results. Cleft palate (OR, 1.63; 95% CI, 1.05-2.52) and gastroschisis (OR, 1.89; 95% CI, 1.12-3.20) had significantly increased odds of exposure to first-trimester use of inhaled β2-agonists compared with nonchromosomal control registrations. Odds of exposure to salbutamol were similar. Nonsignificant ORs of exposure to inhaled β2-agonists were found for spina bifida, cleft lip, anal atresia, severe congenital heart defects in general, or tetralogy of Fallot. None of the 4 literature signals of exposure to inhaled steroids were confirmed (cleft palate, cleft lip, anal atresia, and hypospadias). Exploratory analyses found an association between renal dysplasia and exposure to the combination of long-acting β2-agonists and inhaled corticosteroids (OR, 3.95; 95% CI, 1.99-7.85). Conclusions. The study confirmed increased odds of first-trimester exposure to inhaled β2-agonists for cleft palate and gastroschisis and found a potential new signal for renal dysplasia associated with combined long-acting β2-agonists and inhaled corticosteroids. Use of inhaled corticosteroids during the first trimester of pregnancy seems to be safe in relation to the risk for a range of specific major congenital anomalies.publishedVersio

EUROlinkCAT: A linked European cohort of children with congenital anomalies

Objective To establish a linked European cohort of children with congenital anomalies (CAs) to evaluate mortality and morbidity outcomes of these children up to the age of 10 years. Method EUROlinkCAT supported 22 EUROCAT population-based congenital anomaly registries in 14 countries to link their data on children with CAs to mortality, vital statistics, hospital discharge and prescription databases. All live births with a CA born 1995-2014 recorded in the registries were followed up to age 10 years or to 31st December 2015. Each registry transformed their local mortality and morbidity data to a Common Data Model (CDM) and ran centrally created syntax scripts and produced tables/outputs in a standard form for meta-analysis. Analyses were performed on 100 different congenital anomaly subgroups for children <1 year,1-4 years, and 5-9 years. Results Sixteen registries linked their data on children with CAs to mortality databases, eleven to regional/national hospital databases, and six to prescription databases. Data on children without a CA born during the same time-period and from the same population area (reference population) were available for seven registries linking to hospital databases and for all six registries linking to prescription databases. For the mortality studies, linked information on survival was available for 96% of children recorded in the anomaly registries (180,00 live births). For the morbidity studies, 89% of children with a CA (n=99,000) and 95% of reference children (n=2 million) were linked. For the prescription studies, 95% of children with a CA (n=60,000) and 95% of reference children (n= 1,700,000) were linked. Conclusion The EUROlinkCAT project was successful in creating a linked cohort of children with and without CAs in Western Europe. More efforts are needed to support data linkage in Eastern European countries. We have developed a set of recommendations for data linkage studies based on our experiences in establishing this cohort

European Monitoring of Congenital Anomalies: JRC-EUROCAT Report on Statistical Monitoring of Congenital Anomalies (2006 – 2015)

Worldwide, congenital anomalies are a leading cause of fetal death, infant mortality and morbidity in childhood. Of the 5.2 million births in the European Union (EU) each year, approximately 104,000 (2.5%) will be born with congenital anomalies. EUROCAT is a European network of population-based registries whose objectives are to provide essential epidemiologic information on congenital anomalies in Europe, to facilitate the early warning of new teratogenic exposures and to evaluate the effectiveness of primary prevention. Each year, EUROCAT performs statistical monitoring for both trends and clusters in time on 82 anomaly subgroups. Statistical monitoring relates to two of EUROCAT’s objectives: to provide essential epidemiologic information on congenital anomalies in Europe and to co-ordinate the detection of, and response to, clusters and early warning of teratogenic exposures. The results of the statistical monitoring are the basis for possible further investigations at the local registry level. In 2015 the Central Registry of EUROCAT was transferred from the University of Ulster to the JRC, and became part of the European Platform on Rare Diseases Registration. This is the first time the statistical monitoring has been performed by the JRC-EUROCAT Central registry. We report here the results of the monitoring performed on data for the birth years 2006-2015. Cases of congenital anomaly among livebirths, fetal deaths from 20 weeks gestational age and terminations of pregnancy for fetal anomaly (TOPFA) at any gestation were included. We report both the statistical results and, where available, the outcome of preliminary investigations conducted by registries. For each anomaly, the trends in prevalence in each registry are shown and in addition the overall pan-European prevalence by single year of birth. Some congenital anomalies take a while to be reported; therefore the prevalence in the latest data is often underreported. Presenting the overall pan-European prevalence by single year allows for the influence of the most recent data (2015) to be evaluated.JRC.F.1-Health in Societ

Risk factors for admission and length of stay in hospital for children with and without congenital anomalies: A EUROlinkCAT study

Objective To explore risk factors for hospital admission, and length of stay (LOS) in hospital, among children with congenital anomalies (CAs) and reference children without CAs in Europe. Method A European population-based data-linkage cohort study was conducted including children with CAs (born 1995-2014) registered in seven EUROCAT CA registries and children without CAs (reference children) living in the same geographical areas. Data on hospitalisation and LOS (1995-2015) for all children aged <1 year and 1-4 years were obtained by linkage to hospital discharge databases. The effects of birth cohort, sex, gestational age, maternal age, multiple birth and socioeconomic status on risk of admission and LOS were estimated using Cox’s Proportional Hazards and negative binomial regression models. Random effects meta-analysis and quantile estimation methods were used to pool the estimates. Results A total of 79,036 children with CAs and 2,016,042 reference children were linked to hospital records. Children with CAs born pre-term (<32 weeks) were more than twice as likely to be admitted (adj. HR 2.35, 95% CI 1.45-3.80) and had almost 8 times longer stays (adj. IRR 7.95, 95% CI 6.12-10.33) compared to children with CAs born at term. Reference children were almost six times as likely to be admitted (adj. HR 5.87, 95% CI 3.10-11.09), and had almost 50 times longer stays (adj. IRR 49.49, 30.92-79.21) compared to reference children born at term. Children with CAs and reference children born preterm were also at increased risk of admission at 1-4 years of age, although the effect was less than for children aged <1 year. Conclusion The impact of risk factors for admission to hospital and LOS were similar between children with CAs and reference children but the impact was often greater in reference children. This study highlights the value of linking to hospital discharge records to obtain population-based information on morbidity for counselling parents