A study by the Oswaldo Cruz Foundation (Fiocruz) reveals associations between newborn conditions and factors such as inadequate prenatal care, maternal age, race, skin color, and low education levels, as well as socioeconomic and biological factors linked to congenital anomalies in Brazil. It indicates that some of these anomalies could be prevented by improving public policies.
The research identified that women who did not have prenatal consultations at the beginning of pregnancy had 47% higher chances of having a baby with anomalies than women who started follow-up in the first trimester.
The investigation was conducted using linked databases from the Live Birth Information System (Sinasc) and Mortality Information System (SIM), from Fiocruz.
The study used data on births in Brazil between 2012 and 2020, totaling about 26 million live births, with around 144,000 having some type of congenital anomaly.
Among the recorded anomalies, priority was given to limb defects, cardiac defects, neural tube defects, oral clefts, genital defects, abdominal wall defects, microcephaly, and Down syndrome, selected as priority anomalies for surveillance in Brazil.
The article – authored by Qeren Hapuk, associate researcher at the Center for Integration of Data and Knowledge for Health (Cidacs) at Fiocruz Bahia – was published in the journal BMC Pregnancy and Childbirth. The work sought to understand how these factors impact baby development, aiming to support targeted preventive strategies for children with congenital anomalies.
Factors
Congenital anomalies are structural and/or functional alterations that significantly contribute to the increased risk of morbidity and mortality observed in children worldwide. These disorders are complex, and their occurrence is influenced by a variety of factors, including socioeconomic conditions that play a significant role.
The investigation also shows that mothers who self-identified as Black had a 16% higher chance of having children with congenital anomalies compared to white mothers.
Another identified risk factor was age. While women over 40 years old had nearly 2.5 times higher chances of having a baby with congenital anomalies, women under 20 years old also had a higher risk (13%) than mothers aged 20 to 34 years.
Education level also emerged as a factor influencing the chance of women having children with anomalies: having low education (0 to 3 years) meant 8% higher chances than having 12 or more years of education.
Some anomalies had stronger associations with certain risk factors. Cases of neural tube defects (embryonic structure that gives rise to the brain and spinal cord) were strongly linked to low education, lack of prenatal care, and multiple gestation.
Cardiac defects were associated with advanced age, fetal loss, and inadequate prenatal care, while Down syndrome cases were strongly associated with maternal age over 40 years.
Disparities
In addition, there were significant variations in the chances of children being born with anomalies across the country’s regions and anomaly groups. The main cause of this variation is underreporting. The Southeast is the region that best reports births with congenital anomalies compared to the others.
The Northeast region concentrates nearly half of Brazil’s population living in poverty, which may help explain the higher likelihood of mothers there having births with neural tube defects, as this condition is highly associated with low income, low education, and poor nutrition (insufficient supplementation).
The Zika virus epidemic in Brazil – between 2015 and 2016 – resulted in an increase in notifications of live births with microcephaly and other congenital anomalies of the nervous system, especially in the Northeast, which may have contributed to the observed results.
“These data show that socioeconomic inequality combined with biological factors directly impacts the health and development of the baby,” said researcher Qeren Hapuk.
For her, the findings indicate that such aggravating factors are avoidable or modifiable. Interventions in maternal education, reproductive planning, nutrition, and, above all, access to prenatal care are essential for preventing congenital anomalies.
Source: Agência Brasil