Twenty-year trends in the prevalence of Down syndrome and other trisomies in Europe: impact of maternal age and prenatal screening.
This study examines trends and geographical differences in total and live birth prevalence of trisomies 21, 18 and 13 with regard to increasing maternal age and prenatal diagnosis in Europe. Twenty-one population-based EUROCAT registries covering 6.1 million births between 1990 and 2009 participated. Trisomy cases included live births, fetal deaths from 20 weeks gestational age and terminations of pregnancy for fetal anomaly. We present correction to 20 weeks gestational age (ie, correcting early terminations for the probability of fetal survival to 20 weeks) to allow for artefactual screening-related differences in total prevalence. Poisson regression was used. The proportion of births in the population to mothers aged 35+ years in the participating registries increased from 13% in 1990 to 19% in 2009. Total prevalence per 10000 births was 22.0 (95% CI 21.7-22.4) for trisomy 21, 5.0 (95% CI 4.8-5.1) for trisomy 18 and 2.0 (95% CI 1.9-2.2) for trisomy 13; live birth prevalence was 11.2 (95% CI 10.9-11.5) for trisomy 21, 1.04 (95% CI 0.96-1.12) for trisomy 18 and 0.48 (95% CI 0.43-0.54) for trisomy 13. There was an increase in total and total corrected prevalence of all three trisomies over time, mainly explained by increasing maternal age. Live birth prevalence remained stable over time. For trisomy 21, there was a three-fold variation in live birth prevalence between countries. The rise in maternal age has led to an increase in the number of trisomy-affected pregnancies in Europe. Live birth prevalence has remained stable overall. Differences in prenatal screening and termination between countries lead to wide variation in live birth prevalence.
Institute of Nursing Research, University of Ulster, Jordanstown, UK.
Maria
M
Loane
Joan K
JK
Morris
Marie-Claude
MC
Addor
Larraitz
L
Arriola
Judith
J
Budd
Berenice
B
Doray
Ester
E
Garne
Miriam
M
Gatt
Martin
M
Haeusler
Babak
B
Khoshnood
Kari
K
Klungsøyr Melve
Anna
A
Latos-Bielenska
Bob
B
McDonnell
Carmel
C
Mullaney
Mary
M
O'Mahony
Annette
A
Queisser-Wahrendorf
Judith
J
Rankin
Anke
A
Rissmann
Catherine
C
Rounding
Joaquin
J
Salvador
David
D
Tucker
Diana
D
Wellesley
Lyubov
L
Yevtushok
Helen
H
Dolk
D000028:Abortion, Induced / Q000706:statistics & numerical data; D000328:Adult; D017677:Age Distribution; D002882:Chromosomes, Human, Pair 13; D002887:Chromosomes, Human, Pair 18; D004314:Down Syndrome / Q000175:diagnosis* / Q000453:epidemiology* / Q000235:genetics; D005060:Europe / Q000453:epidemiology; D005260:Female; D005313:Fetal Death / Q000453:epidemiology; D006801:Humans; D050498:Live Birth / Q000453:epidemiology / Q000235:genetics; D008423:Maternal Age; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D011296:Prenatal Diagnosis; D012042:Registries; D014314:Trisomy / Q000175:diagnosis*