PDF(Pubmed)
Abstract：
BACKGROUND: Birth defects affect 1 in 33 infants in the United States and are a leading cause of infant mortality. Birth defects surveillance is crucial for informing public health action. The Massachusetts Birth Defects Monitoring Program (MBDMP) began collecting other pregnancy losses (OPLs) in 2011, including miscarriages (<20 weeks gestation) or elective terminations (any gestational age), in addition to live births and stillbirths (≥20 weeks gestation). We describe programmatic changes for adding OPLs and their impact on prevalence estimates.
METHODS: Using population-based, statewide, data from the MBDMP (2012-2020), we assessed prevalence per 10,000 live births and 95% confidence intervals (CIs) with and without OPLs overall and for specific birth defects by time period, maternal age, and race/ethnicity.
RESULTS: Including OPLs required amending a state statute and promulgating regulations, new data sources, and additional data processing, cleaning, and verification. Overall prevalence with OPLs increased from 257.4 (95% CI: 253.5-261.4) to 333.9 (95% CI: 329.4-338.4) per 10,000; increases were observed in all time periods, age, and race/ethnicity groups. After including OPLs, the prevalence increased for neural tube defects [3.2 (2.7-3.6) to 8.3 (7.6-9.0)], and trisomies 13 [0.5 (0.3-0.7) to 4.1 (3.6-4.6)], 18 [1.5 (1.2-1.9) to 8.2 (7.5-8.9)], and 21 [12.3 (11.4-13.2) to 28.9 (27.6-30.2)]. Cardiovascular defects increased slightly, while prevalence of eye/ear, respiratory, and gastrointestinal defects remained similar.
CONCLUSIONS: Adding OPLs required substantial programmatic efforts and resulted in more complete case ascertainment, particularly for certain birth defects. More complete case ascertainment will allow for improved research, screening, and resource allocation.
METHODS: Using population-based, statewide, data from the MBDMP (2012-2020), we assessed prevalence per 10,000 live births and 95% confidence intervals (CIs) with and without OPLs overall and for specific birth defects by time period, maternal age, and race/ethnicity.
RESULTS: Including OPLs required amending a state statute and promulgating regulations, new data sources, and additional data processing, cleaning, and verification. Overall prevalence with OPLs increased from 257.4 (95% CI: 253.5-261.4) to 333.9 (95% CI: 329.4-338.4) per 10,000; increases were observed in all time periods, age, and race/ethnicity groups. After including OPLs, the prevalence increased for neural tube defects [3.2 (2.7-3.6) to 8.3 (7.6-9.0)], and trisomies 13 [0.5 (0.3-0.7) to 4.1 (3.6-4.6)], 18 [1.5 (1.2-1.9) to 8.2 (7.5-8.9)], and 21 [12.3 (11.4-13.2) to 28.9 (27.6-30.2)]. Cardiovascular defects increased slightly, while prevalence of eye/ear, respiratory, and gastrointestinal defects remained similar.
CONCLUSIONS: Adding OPLs required substantial programmatic efforts and resulted in more complete case ascertainment, particularly for certain birth defects. More complete case ascertainment will allow for improved research, screening, and resource allocation.
摘要：
背景：出生缺陷影响美国33例婴儿中的1例，是婴儿死亡的主要原因。出生缺陷监测对于告知公共卫生行动至关重要。马萨诸塞州出生缺陷监测计划（MBDMP）于2011年开始收集其他妊娠损失（OPLs），包括流产（妊娠<20周）或选择性终止妊娠（任何胎龄），除了活产和死产（妊娠≥20周）。我们描述了增加OPLs的方案变化及其对患病率估计的影响。
方法：使用基于人口的，全州范围内,来自MBDMP的数据(2012-2020)，我们评估了每10,000例活产的患病率和95％的置信区间（CI），无论是否存在OPLs，以及按时间段划分的特定出生缺陷，产妇年龄,和种族/民族。
结果：包括需要修改州法规和颁布法规的OPL，新的数据源，和额外的数据处理，清洁,和验证。OPL的总体患病率从257.4（95％CI：253.5-261.4）增加到333.9（95％CI：329.4-338.4）/10,000；在所有时间段均观察到增加，年龄,和种族/民族群体。在包括OPLs之后，神经管缺陷的患病率增加[3.2（2.7-3.6）至8.3（7.6-9.0）]，和三体13[0.5（0.3-0.7）至4.1（3.6-4.6）]，18[1.5(1.2-1.9)至8.2(7.5-8.9)],和21[12.3（11.4-13.2）至28.9（27.6-30.2）]。心血管缺陷略有增加，而眼睛/耳朵的患病率，呼吸,和胃肠道缺陷保持相似。
结论：添加OPL需要大量的计划努力，并导致更完整的病例确定，特别是某些出生缺陷。更完整的案例确定将允许改进研究，筛选,和资源分配。
方法：使用基于人口的，全州范围内,来自MBDMP的数据(2012-2020)，我们评估了每10,000例活产的患病率和95％的置信区间（CI），无论是否存在OPLs，以及按时间段划分的特定出生缺陷，产妇年龄,和种族/民族。
结果：包括需要修改州法规和颁布法规的OPL，新的数据源，和额外的数据处理，清洁,和验证。OPL的总体患病率从257.4（95％CI：253.5-261.4）增加到333.9（95％CI：329.4-338.4）/10,000；在所有时间段均观察到增加，年龄,和种族/民族群体。在包括OPLs之后，神经管缺陷的患病率增加[3.2（2.7-3.6）至8.3（7.6-9.0）]，和三体13[0.5（0.3-0.7）至4.1（3.6-4.6）]，18[1.5(1.2-1.9)至8.2(7.5-8.9)],和21[12.3（11.4-13.2）至28.9（27.6-30.2）]。心血管缺陷略有增加，而眼睛/耳朵的患病率，呼吸,和胃肠道缺陷保持相似。
结论：添加OPL需要大量的计划努力，并导致更完整的病例确定，特别是某些出生缺陷。更完整的案例确定将允许改进研究，筛选,和资源分配。
