Abstract
Objective: To determine whether congenital anomalies are associated with a high rate of neonatal
morbidity in preterm birth. Study design: 312 singletons (22–36 wk) with congenital anomalies that were delivered preterm were
compared with a random sample of 936 preterm singleton without congenital anomalies.
Data was obtained using the computerized birth discharge records. Statistical analysis
included univariate and multivariate logistic regression analyses. Results: Three thousand five hundred and seventy-eight (3578) women with preterm births met
the inclusion criteria (singleton with prenatal care). The prevalence of congenital
anomalies in the study population was 8.7% (312/3578). Gestational age at delivery
was significantly lower in the congenital anomaly group compared with the control
(32.0±3.7 SD vs. 34.4±2.7 SD; p<0.001). The following pregnancy complications were higher in the group with congenital
anomalies than in those without anomalies: severe pregnancy induced hypertension (PIH),
hydramnions, oligohydramnion, intrauterine growth restriction (IUGR), fetal distress,
cesarean section, malpresentation and mal position, abruption placenta, meconium stained
amniotic fluid, 1 min Apgar score (<2), 5 min Apgar score (<7). Perinatal mortality
rates in 28–32 wk and 33–36 wk were significantly higher in the group with congenital
anomalies than in the control group. Neonatal morbidity data (necrotizing enterocolitis,
respiratory distress syndrome, bronchopulmonary dysplasia, intraventricular hemorrhage,
and sepsis) was available for 909 neonates (239 with congenital anomalies and 670
without congenital anomalies). After adjusting for gestational age, the presence of
congenital anomalies remained strongly associated with neonatal morbidity (having
one or more of the above mentioned conditions) (adjusted OR: 5.3, 95% CI 3.4–9.2).
When adjusting for other confounding variables, congenital anomalies were strongly
associated with neonatal morbidity (OR: 6.44, 95% CI 3.94–10.51), and perinatal mortality
(OR: 3.08, 95% CI 2.04–4.65). In terms of attributable fraction in our population
of preterm births, the proportion of neonatal morbidity and the proportion of perinatal
mortality attributable to congenital malformation is 32% and 15%, respectively. Conclusion: Congenital anomalies in preterm birth are associated with a higher rate of pregnancy
complications and are an independent risk factor for neonatal morbidity and perinatal
mortality.
Keywords
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Article info
Publication history
Accepted:
July 23,
1999
Received in revised form:
June 29,
1999
Received:
January 18,
1999
Footnotes
☆This study is part of J. Linhart’s MD requirements.
Identification
Copyright
© 2000 Elsevier Science Ireland Ltd. Published by Elsevier Inc. All rights reserved.
