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Key facts
Congenital anomalies (also referred as birth defects) affect approximately 1 in 33 infants and result in approximately 3.2 million birth defect-related disabilities every year. An estimated 270 000 newborns die during the first 28 days of life every year from congenital anomalies. Congenital anomalies may result in long-term disability, which may have significant impacts on individuals, families, health-care systems and societies. The most common serious congenital disorders are heart defects, neural tube defects and Down syndrome. Congenital anomalies may have a genetic, infectious or environmental origin; although in most of the cases it is difficult identify their cause. About 110 000 cases of babies born with congenital rubella syndrome can be prevented through timely vaccination of the mothers during childhood and the reproductive years. Many birth anomalies can be prevented and treated. An adequate intake of folic acid, iodine, vaccination, and adequate antenatal care are key. Congenital anomalies and preterm birth are important causes of childhood death, chronic illness, and disability in many countries. In 2010 the World Health Assembly adopted a resolution calling all Member States to promote primary prevention and the health of children with congenital anomalies by: developing and strengthening registration and surveillance systems; developing expertise and building capacity; strengthening research and studies on aetiology, diagnosis and prevention; promoting international cooperation.
Source: Adapted from WHO. Born too soon. The global action report on preterm birth. Geneva, World Health Organization, 2012
Definition
Congenital anomalies are also known as birth defects, congenital disorders or congenital malformations. Congenital anomalies can be defined as structural or functional anomalies, including metabolic disorders, which are present at the time of birth.
Prevention
Preventive public health measures administered through pre- and peri-conception and prenatal health care services decrease the frequency of certain congenital anomalies. Primary prevention of congenital anomalies involves: Improving the diet of women throughout their reproductive years, ensuring an adequate dietary intake of vitamins and minerals such as folic acid and iodine, and restricting harmful substances, particularly the abuse of alcohol. Controlling pre-conceptional and gestational diabetes through counselling, weight management, diet and the administration of insulin when needed. Avoiding exposure to hazardous environmental substances (e.g. heavy metals, pesticides, some medicinal drugs) during pregnancy. Improving vaccination coverage, especially with rubella virus, for children and women. This can be prevented through childhood vaccination. The rubella vaccine can also be given at least 1 month prior to pregnancy to women who are not already immune. Increasing and strengthening education to health staff and others interested in promoting birth defects prevention.
Detection
Pre- and peri-conceptional care includes basic reproductive health practices as well as medical genetic screening. Screening can be conducted during the following three periods: Preconception screening is used to identify persons at risk for specific disorders or at risk for passing one on to their children. The strategy includes the use of family histories and carrier screening, and is particularly valuable in countries where consanguineous marriage is common.
Antenatal screening includes screening for advanced maternal age, Rhesus blood group incompatibility, and carrier screening. Ultrasound can be used to detect Down syndrome during the first trimester and serious fetal anomalies during the second trimester; maternal serum screening can also be used for detection of Down syndrome and neural tube defects during the first and second trimesters. Newborn screening includes clinical examination and screening for haematological, metabolic, and hormonal disorders. Screening for deafness and heart defects as well as early detection of birth defects can facilitate lifesaving treatments and prevent the progression towards some physical, intellectual, visual or auditory disabilities.
WHO response
In 2010, the World Health Assembly issued a report on birth defects. The report describes the basic components for creating a national programme for the prevention and care of birth defects before and after birth. It also recommends priorities for the international community to assist in establishing and strengthening of these national programmes. The Global Strategy for Womens and Childrens Health, launched in 2010 by the UN in collaboration with leaders from governments and other organizations like WHO and UNICEF, has been crucial in implementing high-impact and cost-effective interventions to improve neonatal and child health. WHO is also working with the US Centers for Disease Control and Preventions (CDC) National Center on Birth Defects and Developmental Disabilities and other partners to establish a global policy for folate fortification at the country-level and to provide needed technical expertise for the surveillance of neural tube defects, for monitoring folic acid fortification efforts and improve laboratory capacity on folate-preventable birth defects. The International Clearinghouse for Birth Defects Surveillance and Research is a voluntary non-profit international organisation in official relations with WHO. This organization brings together birth defect surveillance and research programmes from around the world in order to investigate and prevent birth defects and to lessen the impact of their consequences. The WHO departments of Reproductive Health and Research and Nutrition for Health and Development in collaboration with International Clearinghouse for Birth Defects Surveillance and Research and CDCs National Center on Birth Defects and Developmental Disabilities convene annual workshops on the surveillance and prevention of birth defects and preterm births. The GAVI Alliance, of which WHO is a partner, is assisting developing countries in improving control and elimination of rubella and congenital rubella syndrome through immunization. WHO develops normative tools, including guidelines and a global plan of action, to strengthen medical care and rehabilitation services to support the implementation of the Convention on the Rights of Persons with Disabilities. Similarly WHO supports countries to integrate medical care and rehabilitation services into overall primary health care, supports the development of community-based rehabilitation programmes and facilitates the strengthening of specialized rehabilitation centres and their links with community-based rehabilitation.