title: Inclusion of early fetal deaths in a birth defects surveillance system.
abstract: This investigation evaluated the impact of collecting data on early fetal deaths (less than 20 weeks' gestation) on a birth defects surveillance system. Data were obtained from the Hawaii Birth Defects Program (HBDP), a statewide registry for Hawaii with active case ascertainment methodology. In 1986 through 1997, 257 early fetal deaths with birth defects were identified, representing 2.2% of the total birth defects cases. Two hundred sixteen (84.1%) of the early fetal deaths had chromosomal defects (mainly trisomies, polyploidies, and Turner syndrome) and 59 (23.0%) had structural defects. Most (65.4%) of the early fetal deaths with chromosomal defects occurred at 8-12 weeks' gestation, and 62.3% of the early fetal deaths with structural defects occurred at 16-19 weeks' gestation. For half of the 26 specific birth defects examined, early fetal deaths accounted for at least 4% of all cases. The proportion of total birth defects cases accounted for by early fetal deaths increased over the 12-year period of the study (p = 0.003). Most of this secular trend appeared to result from an increase over time in early fetal deaths where a birth defect was prenatally detected (p = 0.004). Although ascertainment of early fetal deaths is not believed to be complete, their inclusion in a birth defects registry may be beneficial because of confusion about the pregnancy outcome and/or gestational age reported in the medical record, their importance in cluster investigations, and their contribution to birth defects prevention strategies.
authors.affiliation: Hawaii Birth Defects Program, Honolulu, Hawaii 96817, USA.
authors.forename: M B
authors.initials: MB
authors.lastname: Forrester
authors.forename: R D
authors.initials: RD
authors.lastname: Merz
mesh_terms: D002869:Chromosome Aberrations; D016000:Cluster Analysis; D000013:Congenital Abnormalities / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D005313:Fetal Death; D006254:Hawaii; D006801:Humans; D008297:Male; D011159:Population Surveillance; D011247:Pregnancy; D011256:Pregnancy Outcome; D012042:Registries; D013997:Time Factors