title: Relationship of prenatal diagnosis and pregnancy termination to overall infant mortality in Canada.
abstract: BACKGROUND
  Prenatal diagnosis and termination of affected pregnancies can prevent infant deaths due to congenital anomalies, but an effect at the population level has not been shown.
  
  
  OBJECTIVE
  To examine the impact of recent changes in congenital anomaly-related fetal and infant deaths on overall population-based infant mortality.
  
  
  METHODS
  Birth cohort-based study of all live births, stillbirths, and infant deaths in Canada (excluding Ontario) for 1991-1998.
  
  
  METHODS
  Cause-specific infant mortality rates and gestational age-specific fetal death rates.
  
  
  RESULTS
  The birth cohort-based infant mortality rate fluctuated between 6.4 and 6.1 per 1000 live births between 1991 and 1995, then dropped to 5.4 per 1000 in 1996 and 5.5 per 1000 in 1997. The rate of infant death from congenital anomalies was stable between 1991 and 1995 but declined by 21% (95% confidence interval, 19%-32%) from 1.86 per 1000 in 1995 to 1.47 per 1000 in 1996 and 1997. Fetal deaths due to pregnancy termination at 20 to 23 weeks' gestation increased dramatically in 1994, while fetal deaths due to congenital anomalies at 20 to 21 weeks increased in 1995 and subsequently. Provinces/territories with high rates of fetal death due to pregnancy termination/congenital anomalies at 20 to 23 weeks had fewer infant deaths due to congenital anomalies.
  
  
  CONCLUSIONS
  A large decrease in infant deaths due to congenital anomalies was associated with the most recent decline in infant mortality in Canada, suggesting that increases in prenatal diagnosis and pregnancy termination for congenital anomalies are related to decreases in overall infant mortality at the population level.
authors.affiliation: Health Surveillance and Epidemiology Division, HPB Bldg 7, Tunney's Pasture AL 0701D, Ottawa, Ontario, Canada K1A OL2. shiliang_liu@hc-sc.gc.ca
authors.forename: Shiliang
authors.initials: S
authors.lastname: Liu
authors.forename: K S
authors.initials: KS
authors.lastname: Joseph
authors.forename: Michael S
authors.initials: MS
authors.lastname: Kramer
authors.forename: Alexander C
authors.initials: AC
authors.lastname: Allen
authors.forename: Reg
authors.initials: R
authors.lastname: Sauve
authors.forename: I D
authors.initials: ID
authors.lastname: Rusen
authors.forename: Shi Wu
authors.initials: SW
authors.lastname: Wen
mesh_terms: D000028:Abortion, Induced / Q000706:statistics & numerical data* / Q000639:trends; D002170:Canada / Q000453:epidemiology; D015331:Cohort Studies; D000013:Congenital Abnormalities / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D005313:Fetal Death / Q000453:epidemiology*; D005865:Gestational Age; D006801:Humans; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D011247:Pregnancy; D011296:Prenatal Diagnosis