Impact of elective termination on the occurrence of severe birth defects identified in a hospital-based active malformations surveillance program (1999 to 2002).
BACKGROUND
The number of affected infants and the types of malformations identified by a malformation surveillance programs can be impacted if elective terminations for malformations are not included.


METHODS
The occurrence of malformations in all newborn infants was determined in a daily review of the findings in the pediatricians' examinations and those of all consultants. In addition, the findings in autopsies of all elective terminations were reviewed to identify all fetuses with structural abnormalities. A severity scale was used to subdivide the malformations. To establish the impact of elective termination, the malformed infants identified in the Active Malformations Surveillance Program at Brigham and Women's Hospital in Boston were analyzed for the 2 years before and after the hospital decreased significantly the number of elective terminations temporarily (1999-2000 vs. 2001-2002). The effect on the number of malformations identified at birth, as well as malformations of greater severity, was determined.


RESULTS
The number of terminated fetuses with malformations decreased dramatically after termination services were interrupted (p < 0.0001). There were no differences in the prevalence rates of all malformations in the 2 years before and after the change in access to elective terminations. However, there were significant decreases in the number of infants identified with lethal/life-limiting and severe/handicapping malformations.


CONCLUSIONS
In the surveillance for malformations among newborn infants, the inclusion of malformed fetuses from elective terminations had a significant effect on the number of infants with the more severe malformations identified. Birth Defects Research (Part A) 106:659-666, 2016. © 2016 Wiley Periodicals, Inc.
Active Malformations Surveillance Program, Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.|Medical Genetics Unit, MassGeneral Hospital for Children, Harvard Medical School, Boston, Massachusetts.
Emma G
EG
Thomas
Active Malformations Surveillance Program, Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.|Medical Genetics Unit, MassGeneral Hospital for Children, Harvard Medical School, Boston, Massachusetts.
M Hassan
MH
Toufaily
Active Malformations Surveillance Program, Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.|Medical Genetics Unit, MassGeneral Hospital for Children, Harvard Medical School, Boston, Massachusetts.
Marie-Noel
MN
Westgate
Hunt Consulting Associates, Thetford Center, Vermont.
Anne-Therese
AT
Hunt
Active Malformations Surveillance Program, Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.|Medical Genetics Unit, MassGeneral Hospital for Children, Harvard Medical School, Boston, Massachusetts.
Angela E
AE
Lin
Active Malformations Surveillance Program, Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.|Medical Genetics Unit, MassGeneral Hospital for Children, Harvard Medical School, Boston, Massachusetts.
Lewis B
LB
Holmes
D000025:Abortion, Eugenic / Q000706:statistics & numerical data*; D001900:Boston / Q000453:epidemiology; D000013:Congenital Abnormalities / Q000175:diagnosis / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D005333:Fetus; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011296:Prenatal Diagnosis / Q000706:statistics & numerical data; D015995:Prevalence; D062486:Public Health Surveillance
elective termination; malformations surveillance; occurrence of malformations; severity of malformations