title: Prenatal screening for clubfoot: what factors predict prenatal detection?
abstract: OBJECTIVE
  Routine prenatal ultrasound has often resulted in the early detection of musculoskeletal disorders. The purpose of this study was to determine which socioeconomic factors are associated with prenatal detection of clubfoot.
  
  
  METHODS
  The Slone Epidemiology Center at Boston University identified infants in three states (Massachusetts, New York, and North Carolina) who were reported as having a clubfoot. Mothers of these children were contacted and interviewed, and medical records obtained. Data were analyzed by using logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs).
  
  
  RESULTS
  Overall detection of the clubfoot prenatally was 62.3% (421/676) but this varied considerably by state, 81.1% in Massachusetts (154/190), 58.5% in New York (124/212), and 52.2% in North Carolina (143/274). Multivariate analysis revealed that the strongest predictors for prenatal detection were maternal age ≥35 years (OR: 3.54), non-Hispanic black race (OR: 0.49), the presence of another birth defect (OR: 2.61), residing in Massachusetts (OR: 2.64), and the presence of a bilateral clubfoot (OR: 1.90).
  
  
  CONCLUSIONS
  We found a statistically significantly higher rate of prenatal detection of clubfoot in Massachusetts and lower rate in younger mothers (age <35) and black mothers, even after adjustment for other sociodemographic variables.
authors.affiliation: Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Susan T
authors.initials: ST
authors.lastname: Mahan
authors.forename: Mahsa M
authors.initials: MM
authors.lastname: Yazdy
authors.forename: James R
authors.initials: JR
authors.lastname: Kasser
authors.forename: Martha M
authors.initials: MM
authors.lastname: Werler
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000367:Age Factors; D003025:Clubfoot / Q000000981:diagnostic imaging*; D015331:Cohort Studies; D005843:Geography; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008404:Massachusetts; D008423:Maternal Age; D015999:Multivariate Analysis; D009518:New York; D009657:North Carolina; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012959:Socioeconomic Factors; D016216:Ultrasonography, Prenatal / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult