title: Anorectal malformations and pregnancy-related disorders: a registry-based case-control study in 17 European regions.
abstract: OBJECTIVE
  To identify pregnancy-related risk factors for different manifestations of congenital anorectal malformations (ARMs).
  
  
  METHODS
  A population-based case-control study.
  
  
  METHODS
  Seventeen EUROCAT (European Surveillance of Congenital Anomalies) registries, 1980-2008.
  
  
  METHODS
  The study population consisted of 1417 cases with ARM, including 648 cases of isolated ARM, 601 cases of ARM with additional congenital anomalies, and 168 cases of ARM-VACTERL (vertebral, anal, cardiac, tracheo-esophageal, renal, and limb defects), along with 13 371 controls with recognised syndromes or chromosomal abnormalities.
  
  
  METHODS
  Multiple logistic regression analyses were used to calculate adjusted odds ratios (ORs) for potential risk factors for ARM, such as fertility treatment, multiple pregnancy, primiparity, maternal illnesses during pregnancy, and pregnancy-related complications.
  
  
  METHODS
  Adjusted ORs for pregnancy-related risk factors for ARM.
  
  
  RESULTS
  The ARM cases were more likely to be firstborn than the controls (OR 1.6, 95% CI 1.4-1.8). Fertility treatment and being one of twins or triplets seemed to increase the risk of ARM in cases with additional congenital anomalies or VACTERL (ORs ranging from 1.6 to 2.5). Maternal fever during pregnancy and pre-eclampsia were only associated with ARM when additional congenital anomalies were present (OR 3.9, 95% CI 1.3-11.6; OR 3.4, 95% CI 1.6-7.1, respectively), whereas maternal epilepsy during pregnancy resulted in a five-fold elevated risk of all manifestations of ARM (OR 5.1, 95% CI 1.7-15.6).
  
  
  CONCLUSIONS
  This large European study identified maternal epilepsy, fertility treatment, multiple pregnancy, primiparity, pre-eclampsia, and maternal fever during pregnancy as potential risk factors primarily for complex manifestations of ARM with additional congenital anomalies and VACTERL.
authors.affiliation: Department for Health Evidence, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands. L.Wijers@ebh.umcn.nl
authors.forename: C H W
authors.initials: CH
authors.lastname: Wijers
authors.forename: I A L M
authors.initials: IA
authors.lastname: van Rooij
authors.forename: M K
authors.initials: MK
authors.lastname: Bakker
authors.forename: C L M
authors.initials: CL
authors.lastname: Marcelis
authors.forename: M C
authors.initials: MC
authors.lastname: Addor
authors.forename: I
authors.initials: I
authors.lastname: Barisic
authors.forename: J
authors.initials: J
authors.lastname: Béres
authors.forename: S
authors.initials: S
authors.lastname: Bianca
authors.forename: F
authors.initials: F
authors.lastname: Bianchi
authors.forename: E
authors.initials: E
authors.lastname: Calzolari
authors.forename: R
authors.initials: R
authors.lastname: Greenlees
authors.forename: N
authors.initials: N
authors.lastname: Lelong
authors.forename: A
authors.initials: A
authors.lastname: Latos-Bielenska
authors.forename: C M
authors.initials: CM
authors.lastname: Dias
authors.forename: R
authors.initials: R
authors.lastname: McDonnell
authors.forename: C
authors.initials: C
authors.lastname: Mullaney
authors.forename: V
authors.initials: V
authors.lastname: Nelen
authors.forename: M
authors.initials: M
authors.lastname: O'Mahony
authors.forename: A
authors.initials: A
authors.lastname: Queisser-Luft
authors.forename: J
authors.initials: J
authors.lastname: Rankin
authors.forename: N
authors.initials: N
authors.lastname: Zymak-Zakutnia
authors.forename: I
authors.initials: I
authors.lastname: de Blaauw
authors.forename: N
authors.initials: N
authors.lastname: Roeleveld
authors.forename: H E K
authors.initials: HE
authors.lastname: de Walle
mesh_terms: D000015:Abnormalities, Multiple / Q000453:epidemiology*; D000028:Abortion, Induced / Q000706:statistics & numerical data; D000071056:Anorectal Malformations; D001006:Anus, Imperforate / Q000453:epidemiology*; D016022:Case-Control Studies; D004827:Epilepsy / Q000150:complications / Q000453:epidemiology*; D005060:Europe / Q000453:epidemiology; D005260:Female; D005334:Fever / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D007231:Infant, Newborn; D016017:Odds Ratio; D010298:Parity; D011225:Pre-Eclampsia / Q000453:epidemiology*; D011247:Pregnancy; D011248:Pregnancy Complications; D059285:Pregnancy, Twin / Q000706:statistics & numerical data*; D027724:Reproductive Techniques, Assisted / Q000009:adverse effects / Q000706:statistics & numerical data*; D012307:Risk Factors
keywords: Anal atresia; VACTERL; aetiology; birth defects; maternal; pregnancy