Asociación entre la multiplicidad del embarazo y anomalías congénitas en el recién nacido: Estudio de casos-controles de base poblacional

Introducción: Los defectos congénitos son un problema de salud pública, anualmente se registran en Colombia alrededor de 3000 casos. Se estima que un 94% de los casos se presentan en países de bajos-medianos ingresos, como Colombia. Tienen una gran carga de morbimortalidad perinatal, causan 1 de cad...

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Autores:
Rubio Duarte, Andrés Felipe
Tipo de recurso:
Fecha de publicación:
2023
Institución:
Universidad Autónoma de Bucaramanga - UNAB
Repositorio:
Repositorio UNAB
Idioma:
spa
OAI Identifier:
oai:repository.unab.edu.co:20.500.12749/20350
Acceso en línea:
http://hdl.handle.net/20.500.12749/20350
https://doi.org/10.29375/tesis.20350
Palabra clave:
Multiple pregancy
Congenital anomaly
Newborn
Medical sciences
Human abnormalities
Abnormalities in the fetus
Multiple pregnancy
Pregnancy period
Ciencias médicas
Anormalidades humanas
Anormalidades en el feto
Embarazo múltiple
Periodo de embarazo
Embarazo múltiple
Anomalía congénita
Recién nacido
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License
http://creativecommons.org/licenses/by-nc-nd/2.5/co/
id UNAB2_efd8064fa350be796720a4e2d07a4745
oai_identifier_str oai:repository.unab.edu.co:20.500.12749/20350
network_acronym_str UNAB2
network_name_str Repositorio UNAB
repository_id_str
dc.title.spa.fl_str_mv Asociación entre la multiplicidad del embarazo y anomalías congénitas en el recién nacido: Estudio de casos-controles de base poblacional
dc.title.translated.spa.fl_str_mv Association between pregnancy multiplicity and congenital anomalies in newborns: a Population-Based case-control study.
title Asociación entre la multiplicidad del embarazo y anomalías congénitas en el recién nacido: Estudio de casos-controles de base poblacional
spellingShingle Asociación entre la multiplicidad del embarazo y anomalías congénitas en el recién nacido: Estudio de casos-controles de base poblacional
Multiple pregancy
Congenital anomaly
Newborn
Medical sciences
Human abnormalities
Abnormalities in the fetus
Multiple pregnancy
Pregnancy period
Ciencias médicas
Anormalidades humanas
Anormalidades en el feto
Embarazo múltiple
Periodo de embarazo
Embarazo múltiple
Anomalía congénita
Recién nacido
title_short Asociación entre la multiplicidad del embarazo y anomalías congénitas en el recién nacido: Estudio de casos-controles de base poblacional
title_full Asociación entre la multiplicidad del embarazo y anomalías congénitas en el recién nacido: Estudio de casos-controles de base poblacional
title_fullStr Asociación entre la multiplicidad del embarazo y anomalías congénitas en el recién nacido: Estudio de casos-controles de base poblacional
title_full_unstemmed Asociación entre la multiplicidad del embarazo y anomalías congénitas en el recién nacido: Estudio de casos-controles de base poblacional
title_sort Asociación entre la multiplicidad del embarazo y anomalías congénitas en el recién nacido: Estudio de casos-controles de base poblacional
dc.creator.fl_str_mv Rubio Duarte, Andrés Felipe
dc.contributor.advisor.none.fl_str_mv Beltran Avendaño, Mónica Andrea
Herrera Galindo, Víctor Mauricio
dc.contributor.author.none.fl_str_mv Rubio Duarte, Andrés Felipe
dc.contributor.cvlac.spa.fl_str_mv Rubio Duarte, Andrés Felipe [0001774484]
Herrera Galindo, Víctor Mauricio [0000068020]
Beltrán Avendaño, Mónica Andrea [0000423319]
dc.contributor.googlescholar.spa.fl_str_mv Rubio Duarte, Andrés Felipe [WII30IAAAAJ&hl=es]
Herrera Galindo, Víctor Mauricio [es&oi=ao]
dc.contributor.orcid.spa.fl_str_mv Rubio Duarte, Andrés Felipe [0000-0001-9091-5367]
Beltrán Avendaño, Mónica Andrea [0000-0001-6973-9557]
dc.contributor.researchgate.spa.fl_str_mv Rubio Duarte, Andrés Felipe [Felipe-Rubio-Duarte]
Beltrán Avendaño, Mónica Andrea [Monica-Andrea-Beltran-Avendano-2194091127]
dc.contributor.apolounab.spa.fl_str_mv Herrera Galindo, Víctor Mauricio [víctor-mauricio-herrera-galindo]
Beltrán Avendaño, Mónica Andrea [mónica-andrea-beltrán-avendaño]
dc.subject.keywords.spa.fl_str_mv Multiple pregancy
Congenital anomaly
Newborn
Medical sciences
Human abnormalities
Abnormalities in the fetus
Multiple pregnancy
Pregnancy period
topic Multiple pregancy
Congenital anomaly
Newborn
Medical sciences
Human abnormalities
Abnormalities in the fetus
Multiple pregnancy
Pregnancy period
Ciencias médicas
Anormalidades humanas
Anormalidades en el feto
Embarazo múltiple
Periodo de embarazo
Embarazo múltiple
Anomalía congénita
Recién nacido
dc.subject.lemb.spa.fl_str_mv Ciencias médicas
Anormalidades humanas
Anormalidades en el feto
Embarazo múltiple
Periodo de embarazo
dc.subject.proposal.spa.fl_str_mv Embarazo múltiple
Anomalía congénita
Recién nacido
description Introducción: Los defectos congénitos son un problema de salud pública, anualmente se registran en Colombia alrededor de 3000 casos. Se estima que un 94% de los casos se presentan en países de bajos-medianos ingresos, como Colombia. Tienen una gran carga de morbimortalidad perinatal, causan 1 de cada 5 muertes en recién nacidos. El embarazo múltiple también tiene un impacto negativo en la salud de la gestante y el recién nacido, incrementando el riesgo de aborto, óbito fetal, parto prematuro, trastornos hipertensivos asociados al embarazo y muerte perinatal. La presencia de defectos congénitos en el embarazo múltiple puede aumentar la morbimortalidad materna y perinatal. Metodología: Estudio tipo casos-controles basado en datos secundarios anonimizados de registros de la ficha de notificación para defectos congénitos del Sistema Nacional de Vigilancia Epidemiológica (SIVIGILA) en el periodo 2016-2021. Los casos fueron todos los recién nacidos elegibles con diagnóstico de anomalía congénita utilizando la Clasificación Internacional de Enfermedades 10ª edición CIE- 10; los controles fueron los recién nacidos vivos registrados en el Departamento Nacional de Estadística (DANE), nacidos en el mismo año y municipio del caso, escogidos aleatoriamente en relación 1:1. Inicialmente fue realizado un análisis descriptivo. Se estimó la prevalencia para el periodo a nivel nacional y por departamentos de todas las anomalías congénitas y para los siguientes grupos: cardiovascular, neurológica, genitales, labio leporino y paladar hendido. El denominador para el cálculo corresponde a la totalidad de nacidos vivos, registrados en el DANE, a nivel nacional y por departamentos. Se graficaron en un mapa geográfico mediante el uso de GeoDa®. Posteriormente se realizó una descripción de los casos y controles en función de la multiplicidad del embarazo y grupo etario materno. Los casos fueron caracterizados de acuerdo al número de anomalías registradas y el grupo CIE-10 al cual pertenecen. Se construyó un modelo de regresión logística condicionada por municipio de residencia y año de registro, estimando el OR con un IC95% de la asociación entre el embarazo múltiple y las anomalías congénitas, estimando el efecto confusor de la edad materna, tratada como variable discreta. El análisis fue realizado en el programa estadístico R. Resultados: Para el periodo de estudio hubo un total de 3,213,606 nacidos vivos reportados ante el DANE y 34,108 casos de anomalías congénitas tipo malformación reportados en el SIVIGILA, con una prevalencia general de 106.1 (IC95%: 105-107.3) casos por cada 10,000 nacidos vivos (nv). Las anomalías cardiovasculares, del sistema urinario, neurológicas y el labio-paladar hendido tienen una mayor prevalencia en la región andina y el centro del país; los departamentos de Santander, Antioquia y Boyacá concentran la mayor prevalencia de este grupo de anomalías. Se parearon un 95.8% de los casos. La prevalencia de embarazo múltiple fue de 2.8%, siendo más frecuente en los recién nacidos con anomalía congénita (4.2%) que en los controles (1.4%) siendo esta una diferencia estadísticamente significativa (p<0.05). El resultado del modelo de regresión logística condicional estima una mayor probabilidad de cualquier anomalía congénita en el embarazo múltiple con respecto al embarazo único (OR=3.16, IC95%: 2.8-3.5), relación que se mantiene luego de incorporar el grupo etario materno en el modelo (OR=3.09, IC95%: 2.8-3.4), siendo la de mayor magnitud la observada para el grupo de anomalías no clasificadas (OR=10.9, IC95%: 4.9-24.3), sistema respiratorio (OR=3.88, IC95%: 1.8-8.6), cardiovascular (OR=3.69, IC95%: 2.9-4.6) y las anomalías genitales (OR=3.32, IC95%: 1.9-5.8). Conclusiones: El embarazo múltiple se asocia a una mayor probabilidad de anomalías congénitas en el recién nacido, independiente del grupo de anomalía y la edad materna. La probabilidad de anomalía congénita en embarazo múltiple aumenta proporcional a la edad materna. Los resultados son concordantes con estudios en población asiática y americana. La distribución de las anomalías congénitas en Colombia es heterogénea con una mayor tasa en la región Andina y centro para cardiopatías, anomalías del sistema nervioso, urinario, neurológico y labio-paladar hendido.
publishDate 2023
dc.date.accessioned.none.fl_str_mv 2023-06-28T16:48:54Z
dc.date.available.none.fl_str_mv 2023-06-28T16:48:54Z
dc.date.issued.none.fl_str_mv 2023-05-15
dc.type.eng.fl_str_mv Thesis
dc.type.driver.spa.fl_str_mv info:eu-repo/semantics/masterThesis
dc.type.local.spa.fl_str_mv Tesis
dc.type.hasversion.spa.fl_str_mv info:eu-repo/semantics/acceptedVersion
dc.type.redcol.spa.fl_str_mv http://purl.org/redcol/resource_type/TM
status_str acceptedVersion
dc.identifier.uri.none.fl_str_mv http://hdl.handle.net/20.500.12749/20350
dc.identifier.instname.spa.fl_str_mv instname:Universidad Autónoma de Bucaramanga - UNAB
dc.identifier.reponame.spa.fl_str_mv reponame:Repositorio Institucional UNAB
dc.identifier.repourl.spa.fl_str_mv repourl:https://repository.unab.edu.co
dc.identifier.doi.none.fl_str_mv https://doi.org/10.29375/tesis.20350
url http://hdl.handle.net/20.500.12749/20350
https://doi.org/10.29375/tesis.20350
identifier_str_mv instname:Universidad Autónoma de Bucaramanga - UNAB
reponame:Repositorio Institucional UNAB
repourl:https://repository.unab.edu.co
dc.language.iso.spa.fl_str_mv spa
language spa
dc.relation.references.spa.fl_str_mv World Health Orgnaization. Congenital anomalies [Internet]. Health topics: Congenital anomalies. 2022 [cited 2022 Jun 30]. Available from: https://www.who.int/health-topics/congenital-anomalies#tab=tab_1
2. Feldkamp ML, Carey JC, Byrne JLB, Krikov S, Botto LD. Etiology and clinical presentation of birth defects: population based study. BMJ. 2017 May 30;j2249.
3. Sitkin NA, Ozgediz D, Donkor P, Farmer DL. Congenital anomalies in low- and middle-income countries: the unborn child of global surgery. World J Surg. 2015 Jan;39(1):36–40.
4. Organización Panamericana de la Salud, Banco Mundial. Present and Future of Birth Defects Surveillance in the Americas. In: Present and Future of Birth Defects Surveillance in the Americas. 1st ed. Washington, D.C; 2020. p. 5–11.
5. Cornel M. Wealth and health in relation to birth defects mortality. J Epidemiol Community Health (1978). 2000 Sep 1;54(9):644–644.
6. Todros T, Capuzzo E, Gaglioti P. Prenatal diagnosis of congenital anomalies. Images Paediatr Cardiol. 2001 Apr;3(2):3–18.
7. Tudorache DRES. Management of Pregnancy and Delivery in Prenatally Diagnosed Congenital Anomalies. In: Congenital Anomalies [Internet]. Rijeka: IntechOpen; 2017. p. Ch. 22. Available from: https://doi.org/10.5772/intechopen.71802
8. Collins J. Global epidemiology of multiple birth. Reprod Biomed Online [Internet]. 2007;15:45–52. Available from: https://www.sciencedirect.com/science/article/pii/S1472648310622511
9. Smith LK, Manktelow BN, Draper ES, Boyle EM, Johnson SJ, Field DJ. Trends in the incidence and mortality of multiple births by socioeconomic deprivation and maternal age in England: population-based cohort study. BMJ Open [Internet]. 2014 Apr 1;4(4):e004514. Available from: http://bmjopen.bmj.com/content/4/4/e004514.abstract
10. Mackie F, Morris K, Kilby M. Multiple Gestation: biology and epidemiology. In: The Global Library of Women’s Medicine’s. 1st ed. London: David Bloomer ; 2016. p. 15–8.
11. Black M, Bhattacharya S. Epidemiology of multiple pregnancy and the effect of assisted conception. Semin Fetal Neonatal Med. 2010 Dec;15(6):306–12.
12. Russell RB, Petrini JR, Damus K, Mattison DR, Schwarz RH. The changing epidemiology of multiple births in the United States. Obstetrics and gynecology. 2003 Jan;101(1):129–35.
13. Kalikkot Thekkeveedu R, Dankhara N, Desai J, Klar AL, Patel J. Outcomes of multiple gestation births compared to singleton: analysis of multicenter KID database. Matern Health Neonatol Perinatol. 2021 Dec 28;7(1):15.
14. Dudenhausen JW, Maier RF. Perinatal Problems in Multiple Births. Dtsch Arztebl Int. 2010 Sep 24;
15. Cheong-See F, Schuit E, Arroyo-Manzano D, Khalil A, Barrett J, Joseph KS, et al. Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis. BMJ. 2016 Sep 6;i4353.
16. Boklage CE. Traces of embryogenesis are the same in monozygotic and dizygotic twins: not compatible with double ovulation. Human Reproduction. 2009 Jun 1;24(6):1255–66.
17. Prabhcharan G, Lende M, van Hook JW. Twin Births [Internet]. 2022 [cited 2022 Aug 14]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493200/?report=classic
18. García Acero M, Plata S. Caracterización de las anomalías congénitas desde la inclusión en el sistema de vigilancia Sivigila en Colombia, 2010-2013. Universitas Médica. 2017 Apr 1;58(1).
19. González González NO. Protocolo de Vigilancia en Salud Pública de Defectos Congénitos. Bogota DC; 2022 Jan.
20. Khalil A, Rodgers M, Baschat A, Bhide A, Gratacos E, Hecher K, et al. ISUOG Practice Guidelines: role of ultrasound in twin pregnancy. Ultrasound in Obstetrics & Gynecology. 2016 Feb;47(2):247–63.
21. D’Addario V, Rossi C. Diagnosis of chorionicity: The role of ultrasound. Diagnóstico Prenatal. 2014 Jul;25(2):58–64.
22. Townsend R, Khalil A. Ultrasound surveillance in twin pregnancy: An update for practitioners. Ultrasound. 2018 Nov 22;26(4):193–205.
23. Joint WHO-March of Dimes Meeting on Management of Birth Defects and Haemoglobin Disorders (2nd : 2006 : Geneva S, Organization WH, Dimes M of. Management of birth defects and haemoglobin disorders : report of a joint WHO-March of Dimes meeting, Geneva, Switzerland, 17-19 May 2006 [Internet]. Geneva: World Health Organization; 2006. Available from: https://apps.who.int/iris/handle/10665/43587
24. World Health Organization, International Clearinghouse for Birth Defects Surveillance and Research, US Centers for Disease Control and Prevention. Birth defects surveillance: a manual for programme managers. 1st ed. Vol. 1. Geneva; 2014. 1–126 p.
25. Cunningham FG, Williams JW. Williams obstetrics. 23rd ed. / [edite... Cunningham FG, Williams JW (John W, editors. New York: McGraw-Hill, Medical Pub. Division; 2010.
26. Institute for Health Metrics and Evaluation (IHME). Global Burden of Disease Study 2019 (GBD 2019) Results [Internet]. 2019 [cited 2022 Jul 25]. Available from: https://vizhub.healthdata.org/gbd-results/.
27. Oumer M, Demissie Kassahun A. Birth prevalence of encephalocele in Africa: a systematic review and meta-analysis. BMJ Paediatr Open. 2021 Dec 7;5(1):e001117.
28. Wonkam A. The Burden of Birth Defects and Genetic Disease in Sub-Saharan Africa. In: Genomics and Health in the Developing World. Oxford University Press; 2012. p. 421–43.
29. Cardoso-dos-Santos AC, Magalhães VS, Medeiros-de-Souza AC, Bremm JM, Alves RFS, Araujo VEM de, et al. Redes internacionais de colaboração para a vigilância das anomalias congênitas: uma revisão narrativa. Epidemiologia e Serviços de Saúde. 2020 Jul;29(4).
30. Sié A, Hanefeld J, Chaponda M, Chico RM, LeDoare K, Mayaud P, et al. Congenital malformations in sub-Saharan Africa—warnings of a silent epidemic? Lancet Infect Dis. 2021 May;21(5):594–6.
31. Avila Mellizo GA. Defectos Congénitos Colombia 2018. Bogota DC; 2018.
32. United Nations Development Programme. The Sustainable Development Goals (SDGs) [Internet]. 2020 [cited 2022 Sep 14]. Available from: https://www.undp.org/sustainable-development-goals#:~:text=The%20Sustainable%20Development%20Goals%20(SDGs)%2C%20also%20known%20as%20the,people%20enjoy%20peace%20and%20prosperity.
33. Organización Panamericana de la Salud. Objetivos de Desarrollo Sostenible - OPS/OMS Material científico técnico [Internet]. 2018 [cited 2022 Sep 3]. Available from: https://www.paho.org/es/temas/determinantes-ambientales-salud/objetivos-desarrollo-sostenible-opsoms-material-cientifico
34. Organización Panamericana de la Salud. Agenda de Salud Sostenible para las Américas 2018-2030 [Internet]. 2019 [cited 2022 Aug 12]. Available from: https://www.paho.org/es/agenda-salud-sostenible-para-americas-2018-2030
35. Ministerio de Salud y Protección Social. Resolución número 1035 de 2022. 1035 Colombia; Jun 22, 2022 p. 51–70.
36. Organización Mundial de la Salud. Comisión sobre Determinantes Sociales de la Salud . Geneva; 2008.
37. Organización Panamericana de la Salud. Determinantes sociales de la salud [Internet]. 2010 [cited 2022 Aug 25]. Available from: https://www.paho.org/es/temas/determinantes-sociales-salud
38. Littleton HL, Bye K, Buck K, Amacker A. Psychosocial stress during pregnancy and perinatal outcomes: a meta-analytic review. Journal of Psychosomatic Obstetrics & Gynecology. 2010 Nov 2;31(4):219–28.
39. Class QA, Lichtenstein P, Långström N, D’Onofrio BM. Timing of Prenatal Maternal Exposure to Severe Life Events and Adverse Pregnancy Outcomes: A Population Study of 2.6 Million Pregnancies. Psychosom Med. 2011 Apr;73(3):234–41.
40. Martini J, Knappe S, Beesdo-Baum K, Lieb R, Wittchen HU. Anxiety disorders before birth and self-perceived distress during pregnancy: Associations with maternal depression and obstetric, neonatal and early childhood outcomes. Early Hum Dev. 2010 May;86(5):305–10.
41. Khashan AS, McNamee R, Abel KM, Mortensen PB, Kenny LC, Pedersen MG, et al. Rates of preterm birth following antenatal maternal exposure to severe life events: a population-based cohort study. Human Reproduction. 2009 Feb 1;24(2):429–37.
42. Hedegaard M, Henriksen TB, Secher NJ, Hatch MC, Sabroe S. Do Stressful Life Events Affect Duration of Gestation and Risk of Preterm Delivery? Epidemiology. 1996 Jul;7(4):339–45.
43. Christianson A, Howson C, Modell B. Global Report of Birth Defects. March of Dimes Birth Defects Foundation, editor. Vol. 1. New York; 2006. 14–34 p.
44. Vrijheid M. Socioeconomic inequalities in risk of congenital anomaly. Arch Dis Child. 2000 May 1;82(5):349–52.
45. Larson CP. Poverty during pregnancy: Its effects on child health outcomes. Paediatr Child Health. 2007 Oct;12(8):673–7.
47. Kucik JE, Nembhard WN, Donohue P, Devine O, Wang Y, Minkovitz CS, et al. Community socioeconomic disadvantage and the survival of infants with congenital heart defects. Am J Public Health. 2014 Nov;104(11):e150-7.
48. Xiang L, Su Z, Liu Y, Zhang X, Li S, Hu S, et al. Effect of family socioeconomic status on the prognosis of complex congenital heart disease in children: an observational cohort study from China. Lancet Child Adolesc Health. 2018 Jun;2(6):430–9.
49. Pawluk MS, Campaña H, Gili JA, Comas B, Giménez LG, Villalba MI, et al. Adverse social determinants and risk for congenital anomalies. Arch Argent Pediatr. 2014;112(3):215–23.
51. Bejarano J. Pobreza multidimensional en Colombia: las cifras de 2021 muestran una mejoría. 2021 [cited 2022 Sep 15]; Available from: https://www.elespectador.com/economia/macroeconomia/pobreza-multidimensional-en-colombia-las-cifras-de-2021-muestran-una-mejoria/
51. Bejarano J. Pobreza multidimensional en Colombia: las cifras de 2021 muestran una mejoría. 2021 [cited 2022 Sep 15]; Available from: https://www.elespectador.com/economia/macroeconomia/pobreza-multidimensional-en-colombia-las-cifras-de-2021-muestran-una-mejoria/
52. Departamento Administrativo Nacional de Estadística. Metodología: Índice de Pobreza Multidimensional (IPM) [Internet]. Bogota; 2014 [cited 2022 Sep 5]. Available from: http://microdatos.dane.gov.co/index.php/catalog/330/related_materials
53. Callander EJ, Schofield DJ, Shrestha RN. Chronic health conditions and poverty: a cross-sectional study using a multidimensional poverty measure. BMJ Open. 2013 Nov;3(11):e003397.
54. Peyvandi S, Baer RJ, Chambers CD, Norton ME, Rajagopal S, Ryckman KK, et al. Environmental and Socioeconomic Factors Influence the Live‐Born Incidence of Congenital Heart Disease: A Population‐Based Study in California. J Am Heart Assoc. 2020 Apr 21;9(8).
55. Smith LK, Manktelow BN, Draper ES, Boyle EM, Johnson SJ, Field DJ. Trends in the incidence and mortality of multiple births by socioeconomic deprivation and maternal age in England: population-based cohort study. BMJ Open. 2014 Apr;4(4):e004514.
56. Collins J. Global epidemiology of multiple birth. Reprod Biomed Online. 2007 Jan;15:45–52.
57. Lee KS, Choi YJ, Cho J, Lee H, Lee H, Park SJ, et al. Environmental and Genetic Risk Factors of Congenital Anomalies: an Umbrella Review of Systematic Reviews and Meta-Analyses. J Korean Med Sci. 2021;36(28).
58. Ekelund CK, Skibsted L, Søgaard K, Main KM, Dziegiel MH, Schwartz M, et al. Dizygotic monochorionic twin pregnancy conceived following intracytoplasmic sperm injection treatment and complicated by twin-twin transfusion syndrome and blood chimerism. Ultrasound in Obstetrics and Gynecology. 2008 Nov;32(6):832–4.
59. Santana DS, Silveira C, Costa ML, Souza RT, Surita FG, Souza JP, et al. Perinatal outcomes in twin pregnancies complicated by maternal morbidity: evidence from the WHO Multicountry Survey on Maternal and Newborn Health. BMC Pregnancy Childbirth. 2018 Dec 20;18(1):449.
46. American Heart Association News. Congenital heart disease linked to neighborhood pollution, poverty. 2019.
60. Dudenhausen JW, Maier RF. Perinatal Problems in Multiple Births. Dtsch Arztebl Int. 2010 Sep 24;
61. Wen SW, Demissie K, Yang Q, Walker MC. Maternal morbidity and obstetric complications in triplet pregnancies and quadruplet and higher-order multiple pregnancies. Am J Obstet Gynecol. 2004 Jul;191(1):254–8.
62. Sairam S. Prospective risk of stillbirth in multiple-gestation pregnancies: a population-based analysis. Obstetrics & Gynecology. 2002 Oct;100(4):638–41.
63. The National Institute for Health and Care Excellence. Draft quality standard for multiple pregnancy. 2013.
64. Lemos E v., Zhang D, van Voorhis BJ, Hu XH. Healthcare expenses associated with multiple vs singleton pregnancies in the United States. Am J Obstet Gynecol. 2013 Dec;209(6):586.e1-586.e11.
65. Vogel JP, Torloni MR, Seuc A, Betrán AP, Widmer M, Souza JP, et al. Maternal and Perinatal Outcomes of Twin Pregnancy in 23 Low- and Middle-Income Countries. PLoS One. 2013 Aug 1;8(8):e70549.
66. Smits J, Monden C. Twinning across the Developing World. PLoS One. 2011 Sep 28;6(9):e25239.
67. Jonsson H, Magnusdottir E, Eggertsson HP, Stefansson OA, Arnadottir GA, Eiriksson O, et al. Differences between germline genomes of monozygotic twins. Nat Genet. 2021 Jan 7;53(1):27–34.
68. Lancaster PAL. Causes of birth defects: Lessons from history. Congenit Anom (Kyoto). 2011 Mar;51(1):2–5.
69. Vargesson N. Thalidomide‐induced teratogenesis: History and mechanisms. Birth Defects Res C Embryo Today. 2015 Jun 4;105(2):140–56.
70. Harris BS, Bishop KC, Kemeny HR, Walker JS, Rhee E, Kuller JA. Risk Factors for Birth Defects. Obstet Gynecol Surv. 2017 Feb;72(2):123–35.
71. Centro Nacional de Defectos Congénitos y Discapacidades del Desarrollo. Guía para prevenir defectos de nacimiento [Internet]. 2020 [cited 2022 Aug 15]. Available from: https://www.cdc.gov/ncbddd/Spanish/birthdefects/prevention.html
72. Kancherla V, Botto LD, Rowe LA, Shlobin NA, Caceres A, Arynchyna-Smith A, et al. Preventing birth defects, saving lives, and promoting health equity: an urgent call to action for universal mandatory food fortification with folic acid. Lancet Glob Health. 2022 Jul;10(7):e1053–7.
73. Czeizel AE. Birth Defects Are Preventable. Int J Med Sci. 2005;91–2.
74. Howley MM, Browne ML, van Zutphen AR, Richardson SD, Blossom SJ, Broussard CS, et al. Maternal autoimmune disease and birth defects in the National Birth Defects Prevention Study. Birth Defects Res A Clin Mol Teratol. 2016 Nov;106(11):950–62.
75. Parimi M, Nitsch D. A Systematic Review and Meta-Analysis of Diabetes During Pregnancy and Congenital Genitourinary Abnormalities. Kidney Int Rep. 2020 May;5(5):678–93.
76. Zhang TN, Huang XM, Zhao XY, Wang W, Wen R, Gao SY. Risks of specific congenital anomalies in offspring of women with diabetes: A systematic review and meta-analysis of population-based studies including over 80 million births. PLoS Med. 2022 Feb 1;19(2):e1003900.
77. Rohde C, Thiele AG, Baerwald C, Ascherl RG, Lier D, Och U, et al. Preventing maternal phenylketonuria (PKU) syndrome: important factors to achieve good metabolic control throughout pregnancy. Orphanet J Rare Dis. 2021 Dec 18;16(1):477.
78. Wen J, Jiang J, Ding C, Dai J, Liu Y, Xia Y, et al. Birth defects in children conceived by in vitro fertilization and intracytoplasmic sperm injection: a meta-analysis. Fertil Steril. 2012 Jun;97(6):1331-1337.e4.
79. Zheng Z, Chen L, Yang T, Yu H, Wang H, Qin J. Multiple pregnancies achieved with IVF/ICSI and risk of specific congenital malformations: a meta-analysis of cohort studies. Reprod Biomed Online. 2018 Apr;36(4):472–82.
80. Massaro PA, MacLellan DL, Anderson PA, Romao RLP. Does Intracytoplasmic Sperm Injection Pose an Increased Risk of Genitourinary Congenital Malformations in Offspring Compared to In Vitro Fertilization? A Systematic Review and Meta-Analysis. Journal of Urology. 2015 May;193(5S):1837–42.
81. Lacamara C, Ortega C, Villa S, Pommer R, Schwarze JE. Are children born from singleton pregnancies conceived by ICSI at increased risk for congenital malformations when compared to children conceived naturally? A systematic review and meta-analysis. JBRA Assist Reprod. 2017;21(3).
82. Yu D, Feng Y, Yang L, Da M, Fan C, Wang S, et al. Maternal Socioeconomic Status and the Risk of Congenital Heart Defects in Offspring: A Meta-Analysis of 33 Studies. PLoS One. 2014 Oct 27;9(10):e111056.
83. Deguen S, Kihal W, Jeanjean M, Padilla C, Zmirou-Navier D. Neighborhood Deprivation and Risk of Congenital Heart Defects, Neural Tube Defects and Orofacial Clefts: A Systematic Review and Meta-Analysis. PLoS One. 2016 Oct 26;11(10):e0159039.
84. Anyanwu LJC, Ade-Ajayi N, Rolle U. Major abdominal wall defects in the low- and middle-income setting: current status and priorities. Pediatr Surg Int. 2020 May 21;36(5):579–90.
85. Vu GH, Warden C, Zimmerman CE, Kalmar CL, Humphries LS, McDonald-McGinn DM, et al. Poverty and Risk of Cleft Lip and Palate: An Analysis of United States Birth Data. Plast Reconstr Surg. 2022 Jan 21;149(1):169–82.
86. Prescott KR, Wilkie AOM. Genetic aspects of birth defects: new understandings of old problems. Arch Dis Child Fetal Neonatal Ed. 2007 Jan 24;92(4):F308–14.
87. Hobbs CA, Chowdhury S, Cleves MA, Erickson S, MacLeod SL, Shaw GM, et al. Genetic Epidemiology and Nonsyndromic Structural Birth Defects. JAMA Pediatr. 2014 Apr 1;168(4):371.
88. Akhtar F, Bokhari S. Down Syndrome [Internet]. 1st ed. Vol. 1. 2021 [cited 2022 Sep 9]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526016/
89. Coppedè F. Risk factors for Down syndrome. Arch Toxicol. 2016 Dec 7;90(12):2917–29.
90. World Health Organization. International Statistical Classification of Diseases and Related Health Problems [Internet]. 2nd ed. Vol. 2. 2004 [cited 2022 Sep 15]. Available from: https://apps.who.int/iris/bitstream/handle/10665/42980/9241546530_eng.pdf?sequence=1&isAllowed=y
91. DANE. Geovisor de Consulta de Codificación de la Divipola [Internet]. 2022 [cited 2022 Sep 12]. Available from: https://geoportal.dane.gov.co/geovisores/territorio/consulta-divipola-division-politico-administrativa-de-colombia/
92. Norwitz ER, Edusa V, Park JS. Maternal Physiology and Complications of Multiple Pregnancy. Semin Perinatol. 2005 Oct;29(5):338–48.
93. Soma-Pillay P, Nelson-Piercy C, Tolppanen H, Mebazaa A. Physiological changes in pregnancy. Cardiovasc J Afr. 2016 May 18;27(2):89–94.
94. Lee KS, Choi YJ, Cho J, Lee H, Lee H, Park SJ, et al. Environmental and Genetic Risk Factors of Congenital Anomalies: an Umbrella Review of Systematic Reviews and Meta-Analyses. J Korean Med Sci. 2021;36(28).
95. Toufaily MH, Westgate MN, Lin AE, Holmes LB. Causes of Congenital Malformations. Birth Defects Res. 2018 Jan;110(2):87–91.
96. Verma RP. Evaluation and Risk Assessment of Congenital Anomalies in Neonates. Children. 2021 Sep 28;8(10):862.
97. Gijtenbeek M, Shirzada MR, Ten Harkel ADJ, Oepkes D, C. Haak M. Congenital Heart Defects in Monochorionic Twins: A Systematic Review and Meta-Analysis. J Clin Med. 2019 Jun 24;8(6):902.
98. Panagiotopoulou O, Fouzas S, Sinopidis X, Mantagos SP, Dimitriou G, Karatza AA. Congenital heart disease in twins: The contribution of type of conception and chorionicity. Int J Cardiol. 2016 Sep;218:144–9.
99. Gijtenbeek M, Shirzada MR, Ten Harkel ADJ, Oepkes D, C. Haak M. Congenital Heart Defects in Monochorionic Twins: A Systematic Review and Meta-Analysis. J Clin Med. 2019 Jun 24;8(6):902.
100. Ahn D, Kim J, Kang J, Kim YH, Kim K. Congenital anomalies and maternal age: A systematic review and meta‐analysis of observational studies. Acta Obstet Gynecol Scand. 2022 May 14;101(5):484–98.
103. Chen X, Lou H, Chen L, Muhuza MPU, Chen D, Zhang X. Epidemiology of birth defects in teenage pregnancies: Based on provincial surveillance system in eastern China. Front Public Health. 2022 Dec 6;10.
Prabhcharan G, Lende M, van Hook JW. Twin Births [Internet]. 2022 [cited 2022 Aug 14]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493200/?report=classic
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spelling Beltran Avendaño, Mónica Andrea053bd7db-1f3d-40cf-86e3-b4cf7cdc846cHerrera Galindo, Víctor Mauricio82736c90-93c9-4f26-86c7-0c8ae52dea2fRubio Duarte, Andrés Felipe7dc5f2c3-96fb-4a91-a1c4-155026f20463Rubio Duarte, Andrés Felipe [0001774484]Herrera Galindo, Víctor Mauricio [0000068020]Beltrán Avendaño, Mónica Andrea [0000423319]Rubio Duarte, Andrés Felipe [WII30IAAAAJ&hl=es]Herrera Galindo, Víctor Mauricio [es&oi=ao]Rubio Duarte, Andrés Felipe [0000-0001-9091-5367]Beltrán Avendaño, Mónica Andrea [0000-0001-6973-9557]Rubio Duarte, Andrés Felipe [Felipe-Rubio-Duarte]Beltrán Avendaño, Mónica Andrea [Monica-Andrea-Beltran-Avendano-2194091127]Herrera Galindo, Víctor Mauricio [víctor-mauricio-herrera-galindo]Beltrán Avendaño, Mónica Andrea [mónica-andrea-beltrán-avendaño]ColombiaUNAB Campus Bucaramanga2023-06-28T16:48:54Z2023-06-28T16:48:54Z2023-05-15http://hdl.handle.net/20.500.12749/20350instname:Universidad Autónoma de Bucaramanga - UNABreponame:Repositorio Institucional UNABrepourl:https://repository.unab.edu.cohttps://doi.org/10.29375/tesis.20350Introducción: Los defectos congénitos son un problema de salud pública, anualmente se registran en Colombia alrededor de 3000 casos. Se estima que un 94% de los casos se presentan en países de bajos-medianos ingresos, como Colombia. Tienen una gran carga de morbimortalidad perinatal, causan 1 de cada 5 muertes en recién nacidos. El embarazo múltiple también tiene un impacto negativo en la salud de la gestante y el recién nacido, incrementando el riesgo de aborto, óbito fetal, parto prematuro, trastornos hipertensivos asociados al embarazo y muerte perinatal. La presencia de defectos congénitos en el embarazo múltiple puede aumentar la morbimortalidad materna y perinatal. Metodología: Estudio tipo casos-controles basado en datos secundarios anonimizados de registros de la ficha de notificación para defectos congénitos del Sistema Nacional de Vigilancia Epidemiológica (SIVIGILA) en el periodo 2016-2021. Los casos fueron todos los recién nacidos elegibles con diagnóstico de anomalía congénita utilizando la Clasificación Internacional de Enfermedades 10ª edición CIE- 10; los controles fueron los recién nacidos vivos registrados en el Departamento Nacional de Estadística (DANE), nacidos en el mismo año y municipio del caso, escogidos aleatoriamente en relación 1:1. Inicialmente fue realizado un análisis descriptivo. Se estimó la prevalencia para el periodo a nivel nacional y por departamentos de todas las anomalías congénitas y para los siguientes grupos: cardiovascular, neurológica, genitales, labio leporino y paladar hendido. El denominador para el cálculo corresponde a la totalidad de nacidos vivos, registrados en el DANE, a nivel nacional y por departamentos. Se graficaron en un mapa geográfico mediante el uso de GeoDa®. Posteriormente se realizó una descripción de los casos y controles en función de la multiplicidad del embarazo y grupo etario materno. Los casos fueron caracterizados de acuerdo al número de anomalías registradas y el grupo CIE-10 al cual pertenecen. Se construyó un modelo de regresión logística condicionada por municipio de residencia y año de registro, estimando el OR con un IC95% de la asociación entre el embarazo múltiple y las anomalías congénitas, estimando el efecto confusor de la edad materna, tratada como variable discreta. El análisis fue realizado en el programa estadístico R. Resultados: Para el periodo de estudio hubo un total de 3,213,606 nacidos vivos reportados ante el DANE y 34,108 casos de anomalías congénitas tipo malformación reportados en el SIVIGILA, con una prevalencia general de 106.1 (IC95%: 105-107.3) casos por cada 10,000 nacidos vivos (nv). Las anomalías cardiovasculares, del sistema urinario, neurológicas y el labio-paladar hendido tienen una mayor prevalencia en la región andina y el centro del país; los departamentos de Santander, Antioquia y Boyacá concentran la mayor prevalencia de este grupo de anomalías. Se parearon un 95.8% de los casos. La prevalencia de embarazo múltiple fue de 2.8%, siendo más frecuente en los recién nacidos con anomalía congénita (4.2%) que en los controles (1.4%) siendo esta una diferencia estadísticamente significativa (p<0.05). El resultado del modelo de regresión logística condicional estima una mayor probabilidad de cualquier anomalía congénita en el embarazo múltiple con respecto al embarazo único (OR=3.16, IC95%: 2.8-3.5), relación que se mantiene luego de incorporar el grupo etario materno en el modelo (OR=3.09, IC95%: 2.8-3.4), siendo la de mayor magnitud la observada para el grupo de anomalías no clasificadas (OR=10.9, IC95%: 4.9-24.3), sistema respiratorio (OR=3.88, IC95%: 1.8-8.6), cardiovascular (OR=3.69, IC95%: 2.9-4.6) y las anomalías genitales (OR=3.32, IC95%: 1.9-5.8). Conclusiones: El embarazo múltiple se asocia a una mayor probabilidad de anomalías congénitas en el recién nacido, independiente del grupo de anomalía y la edad materna. La probabilidad de anomalía congénita en embarazo múltiple aumenta proporcional a la edad materna. Los resultados son concordantes con estudios en población asiática y americana. La distribución de las anomalías congénitas en Colombia es heterogénea con una mayor tasa en la región Andina y centro para cardiopatías, anomalías del sistema nervioso, urinario, neurológico y labio-paladar hendido.MaestríaIntroduction: Congenital defects are a public health problem, with approximately 3,000 cases reported annually in Colombia. It is estimated that 94% of cases occur in low-to-middle-income countries like Colombia. They impose a significant burden of perinatal morbidity and mortality, accounting for 1 in 5 deaths among newborns. Multiple pregnancies also have a negative impact on the health of both the mother and the newborn, increasing the risk of abortion, fetal death, preterm birth, pregnancy-associated hypertensive disorders, and perinatal death. The presence of congenital defects in multiple pregnancies can further increase maternal and perinatal morbidity and mortality. Methodology: A case-control study was conducted based on anonymized secondary data from the Congenital Defect Notification Form of the National Epidemiological Surveillance System (SIVIGILA) for the period 2016-2021. Cases included all eligible newborns diagnosed with a congenital anomaly using the 10th edition of the International Classification of Diseases (ICD-10), while controls were live births registered in the National Department of Statistics (DANE), born in the same year and municipality as the cases, randomly selected in a 1:1 ratio. Initially, a descriptive analysis was performed. The prevalence for the entire period was estimated at the national level and by department for all congenital anomalies and the following groups: cardiovascular, neurological, genital, cleft lip, and cleft palate. The denominator for the calculation corresponded to the total number of live births registered in DANE, nationally and by department. GeoDa® software was used to graphically represent the data on a geographic map. Subsequently, cases and controls were described according to the multiplicity of pregnancy and maternal age group. The cases were characterized based on the number of registered anomalies and their corresponding ICD-10 group. A conditional logistic regression model was constructed by municipality of residence and year of registration, estimating the odds ratio (OR) with a 95% confidence interval (CI) for the association between multiple pregnancy and congenital anomalies, considering maternal age as a discrete variable. The analysis was conducted using the R statistical software. Results: During the study period, a total of 3,213,606 live births were reported to DANE, and 34,108 cases of congenital anomalies were reported in SIVIGILA, resulting in a general prevalence of 106.1 (95% CI: 105-107.3) cases per 10,000 live births. Cardiovascular, urinary system, neurological, and cleft lip/palate anomalies had a higher prevalence in the Andean region and central Colombia. The departments of Santander, Antioquia, and Boyacá had the highest prevalence of these anomaly groups. A total of 95.8% of the cases were matched with controls. The prevalence of multiple pregnancies was 2.8%, being more frequent in newborns with congenital anomalies (4.2%) than in controls (1.4%), with a statistically significant difference (p<0.05). The conditional logistic regression model estimated a higher probability of any congenital anomaly in multiple pregnancies compared to singleton pregnancies (OR=3.16, 95% CI: 2.8-3.5). This association remained significant after incorporating maternal age group into the model (OR=3.09, 95% CI: 2.8-3.4). The highest magnitude of association was observed for the group of unclassified anomalies (OR=10.9, 95% CI: 4.9-24.3), followed by respiratory system (OR=3.88, 95% CI: 1.8-8.6), cardiovascular (OR=3.69, 95% CI: 2.9-4.6), and genital anomalies (OR=3.32, 95% CI: 1.9-5.8). Conclusions: Multiple pregnancy is associated with a higher probability of congenital anomalies in newborns, regardless of the anomaly group or maternal age. The probability of congenital anomalies in multiple pregnancies increases proportionally with maternal age. The results are consistent with studies conducted in Asian and American populations. The distribution of congenital anomalies in Colombia is heterogeneous, with higher rates in the Andean and central regions for heart defects, nervous system abnormalities, urinary system anomalies, neurological anomalies, and cleft lip/palate.Modalidad Presencialapplication/pdfspahttp://creativecommons.org/licenses/by-nc-nd/2.5/co/Abierto (Texto Completo)Atribución-NoComercial-SinDerivadas 2.5 Colombiahttp://purl.org/coar/access_right/c_abf2Asociación entre la multiplicidad del embarazo y anomalías congénitas en el recién nacido: Estudio de casos-controles de base poblacionalAssociation between pregnancy multiplicity and congenital anomalies in newborns: a Population-Based case-control study.Thesisinfo:eu-repo/semantics/masterThesisTesisinfo:eu-repo/semantics/acceptedVersionhttp://purl.org/redcol/resource_type/TMMagíster en Métodos para la Producción y Aplicación de Conocimiento Científico en SaludUniversidad Autónoma de Bucaramanga UNABFacultad Ciencias de la SaludMaestría en Métodos para la Producción y Aplicación de Conocimiento Científico en SaludMultiple pregancyCongenital anomalyNewbornMedical sciencesHuman abnormalitiesAbnormalities in the fetusMultiple pregnancyPregnancy periodCiencias médicasAnormalidades humanasAnormalidades en el fetoEmbarazo múltiplePeriodo de embarazoEmbarazo múltipleAnomalía congénitaRecién nacidoWorld Health Orgnaization. Congenital anomalies [Internet]. Health topics: Congenital anomalies. 2022 [cited 2022 Jun 30]. Available from: https://www.who.int/health-topics/congenital-anomalies#tab=tab_12. Feldkamp ML, Carey JC, Byrne JLB, Krikov S, Botto LD. Etiology and clinical presentation of birth defects: population based study. BMJ. 2017 May 30;j2249.3. Sitkin NA, Ozgediz D, Donkor P, Farmer DL. Congenital anomalies in low- and middle-income countries: the unborn child of global surgery. World J Surg. 2015 Jan;39(1):36–40.4. Organización Panamericana de la Salud, Banco Mundial. Present and Future of Birth Defects Surveillance in the Americas. In: Present and Future of Birth Defects Surveillance in the Americas. 1st ed. Washington, D.C; 2020. p. 5–11.5. Cornel M. Wealth and health in relation to birth defects mortality. J Epidemiol Community Health (1978). 2000 Sep 1;54(9):644–644.6. Todros T, Capuzzo E, Gaglioti P. Prenatal diagnosis of congenital anomalies. Images Paediatr Cardiol. 2001 Apr;3(2):3–18.7. Tudorache DRES. Management of Pregnancy and Delivery in Prenatally Diagnosed Congenital Anomalies. In: Congenital Anomalies [Internet]. Rijeka: IntechOpen; 2017. p. Ch. 22. Available from: https://doi.org/10.5772/intechopen.718028. Collins J. Global epidemiology of multiple birth. Reprod Biomed Online [Internet]. 2007;15:45–52. Available from: https://www.sciencedirect.com/science/article/pii/S14726483106225119. Smith LK, Manktelow BN, Draper ES, Boyle EM, Johnson SJ, Field DJ. Trends in the incidence and mortality of multiple births by socioeconomic deprivation and maternal age in England: population-based cohort study. BMJ Open [Internet]. 2014 Apr 1;4(4):e004514. Available from: http://bmjopen.bmj.com/content/4/4/e004514.abstract10. Mackie F, Morris K, Kilby M. Multiple Gestation: biology and epidemiology. In: The Global Library of Women’s Medicine’s. 1st ed. London: David Bloomer ; 2016. p. 15–8.11. Black M, Bhattacharya S. Epidemiology of multiple pregnancy and the effect of assisted conception. Semin Fetal Neonatal Med. 2010 Dec;15(6):306–12.12. Russell RB, Petrini JR, Damus K, Mattison DR, Schwarz RH. The changing epidemiology of multiple births in the United States. Obstetrics and gynecology. 2003 Jan;101(1):129–35.13. Kalikkot Thekkeveedu R, Dankhara N, Desai J, Klar AL, Patel J. Outcomes of multiple gestation births compared to singleton: analysis of multicenter KID database. Matern Health Neonatol Perinatol. 2021 Dec 28;7(1):15.14. Dudenhausen JW, Maier RF. Perinatal Problems in Multiple Births. Dtsch Arztebl Int. 2010 Sep 24;15. Cheong-See F, Schuit E, Arroyo-Manzano D, Khalil A, Barrett J, Joseph KS, et al. Prospective risk of stillbirth and neonatal complications in twin pregnancies: systematic review and meta-analysis. BMJ. 2016 Sep 6;i4353.16. Boklage CE. Traces of embryogenesis are the same in monozygotic and dizygotic twins: not compatible with double ovulation. Human Reproduction. 2009 Jun 1;24(6):1255–66.17. Prabhcharan G, Lende M, van Hook JW. Twin Births [Internet]. 2022 [cited 2022 Aug 14]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK493200/?report=classic18. García Acero M, Plata S. Caracterización de las anomalías congénitas desde la inclusión en el sistema de vigilancia Sivigila en Colombia, 2010-2013. Universitas Médica. 2017 Apr 1;58(1).19. González González NO. Protocolo de Vigilancia en Salud Pública de Defectos Congénitos. Bogota DC; 2022 Jan.20. Khalil A, Rodgers M, Baschat A, Bhide A, Gratacos E, Hecher K, et al. ISUOG Practice Guidelines: role of ultrasound in twin pregnancy. Ultrasound in Obstetrics & Gynecology. 2016 Feb;47(2):247–63.21. D’Addario V, Rossi C. Diagnosis of chorionicity: The role of ultrasound. Diagnóstico Prenatal. 2014 Jul;25(2):58–64.22. Townsend R, Khalil A. Ultrasound surveillance in twin pregnancy: An update for practitioners. Ultrasound. 2018 Nov 22;26(4):193–205.23. Joint WHO-March of Dimes Meeting on Management of Birth Defects and Haemoglobin Disorders (2nd : 2006 : Geneva S, Organization WH, Dimes M of. Management of birth defects and haemoglobin disorders : report of a joint WHO-March of Dimes meeting, Geneva, Switzerland, 17-19 May 2006 [Internet]. Geneva: World Health Organization; 2006. Available from: https://apps.who.int/iris/handle/10665/4358724. World Health Organization, International Clearinghouse for Birth Defects Surveillance and Research, US Centers for Disease Control and Prevention. Birth defects surveillance: a manual for programme managers. 1st ed. Vol. 1. Geneva; 2014. 1–126 p.25. Cunningham FG, Williams JW. Williams obstetrics. 23rd ed. / [edite... Cunningham FG, Williams JW (John W, editors. New York: McGraw-Hill, Medical Pub. Division; 2010.26. Institute for Health Metrics and Evaluation (IHME). Global Burden of Disease Study 2019 (GBD 2019) Results [Internet]. 2019 [cited 2022 Jul 25]. Available from: https://vizhub.healthdata.org/gbd-results/.27. Oumer M, Demissie Kassahun A. Birth prevalence of encephalocele in Africa: a systematic review and meta-analysis. BMJ Paediatr Open. 2021 Dec 7;5(1):e001117.28. Wonkam A. The Burden of Birth Defects and Genetic Disease in Sub-Saharan Africa. In: Genomics and Health in the Developing World. Oxford University Press; 2012. p. 421–43.29. Cardoso-dos-Santos AC, Magalhães VS, Medeiros-de-Souza AC, Bremm JM, Alves RFS, Araujo VEM de, et al. Redes internacionais de colaboração para a vigilância das anomalias congênitas: uma revisão narrativa. Epidemiologia e Serviços de Saúde. 2020 Jul;29(4).30. Sié A, Hanefeld J, Chaponda M, Chico RM, LeDoare K, Mayaud P, et al. Congenital malformations in sub-Saharan Africa—warnings of a silent epidemic? Lancet Infect Dis. 2021 May;21(5):594–6.31. Avila Mellizo GA. Defectos Congénitos Colombia 2018. Bogota DC; 2018.32. United Nations Development Programme. The Sustainable Development Goals (SDGs) [Internet]. 2020 [cited 2022 Sep 14]. Available from: https://www.undp.org/sustainable-development-goals#:~:text=The%20Sustainable%20Development%20Goals%20(SDGs)%2C%20also%20known%20as%20the,people%20enjoy%20peace%20and%20prosperity.33. Organización Panamericana de la Salud. Objetivos de Desarrollo Sostenible - OPS/OMS Material científico técnico [Internet]. 2018 [cited 2022 Sep 3]. Available from: https://www.paho.org/es/temas/determinantes-ambientales-salud/objetivos-desarrollo-sostenible-opsoms-material-cientifico34. Organización Panamericana de la Salud. Agenda de Salud Sostenible para las Américas 2018-2030 [Internet]. 2019 [cited 2022 Aug 12]. Available from: https://www.paho.org/es/agenda-salud-sostenible-para-americas-2018-203035. Ministerio de Salud y Protección Social. Resolución número 1035 de 2022. 1035 Colombia; Jun 22, 2022 p. 51–70.36. Organización Mundial de la Salud. Comisión sobre Determinantes Sociales de la Salud . Geneva; 2008.37. Organización Panamericana de la Salud. Determinantes sociales de la salud [Internet]. 2010 [cited 2022 Aug 25]. Available from: https://www.paho.org/es/temas/determinantes-sociales-salud38. Littleton HL, Bye K, Buck K, Amacker A. Psychosocial stress during pregnancy and perinatal outcomes: a meta-analytic review. Journal of Psychosomatic Obstetrics & Gynecology. 2010 Nov 2;31(4):219–28.39. Class QA, Lichtenstein P, Långström N, D’Onofrio BM. Timing of Prenatal Maternal Exposure to Severe Life Events and Adverse Pregnancy Outcomes: A Population Study of 2.6 Million Pregnancies. Psychosom Med. 2011 Apr;73(3):234–41.40. Martini J, Knappe S, Beesdo-Baum K, Lieb R, Wittchen HU. Anxiety disorders before birth and self-perceived distress during pregnancy: Associations with maternal depression and obstetric, neonatal and early childhood outcomes. Early Hum Dev. 2010 May;86(5):305–10.41. Khashan AS, McNamee R, Abel KM, Mortensen PB, Kenny LC, Pedersen MG, et al. Rates of preterm birth following antenatal maternal exposure to severe life events: a population-based cohort study. Human Reproduction. 2009 Feb 1;24(2):429–37.42. Hedegaard M, Henriksen TB, Secher NJ, Hatch MC, Sabroe S. Do Stressful Life Events Affect Duration of Gestation and Risk of Preterm Delivery? Epidemiology. 1996 Jul;7(4):339–45.43. Christianson A, Howson C, Modell B. Global Report of Birth Defects. March of Dimes Birth Defects Foundation, editor. Vol. 1. New York; 2006. 14–34 p.44. Vrijheid M. Socioeconomic inequalities in risk of congenital anomaly. Arch Dis Child. 2000 May 1;82(5):349–52.45. Larson CP. Poverty during pregnancy: Its effects on child health outcomes. Paediatr Child Health. 2007 Oct;12(8):673–7.47. Kucik JE, Nembhard WN, Donohue P, Devine O, Wang Y, Minkovitz CS, et al. Community socioeconomic disadvantage and the survival of infants with congenital heart defects. Am J Public Health. 2014 Nov;104(11):e150-7.48. Xiang L, Su Z, Liu Y, Zhang X, Li S, Hu S, et al. Effect of family socioeconomic status on the prognosis of complex congenital heart disease in children: an observational cohort study from China. Lancet Child Adolesc Health. 2018 Jun;2(6):430–9.49. Pawluk MS, Campaña H, Gili JA, Comas B, Giménez LG, Villalba MI, et al. Adverse social determinants and risk for congenital anomalies. Arch Argent Pediatr. 2014;112(3):215–23.51. Bejarano J. Pobreza multidimensional en Colombia: las cifras de 2021 muestran una mejoría. 2021 [cited 2022 Sep 15]; Available from: https://www.elespectador.com/economia/macroeconomia/pobreza-multidimensional-en-colombia-las-cifras-de-2021-muestran-una-mejoria/51. Bejarano J. Pobreza multidimensional en Colombia: las cifras de 2021 muestran una mejoría. 2021 [cited 2022 Sep 15]; Available from: https://www.elespectador.com/economia/macroeconomia/pobreza-multidimensional-en-colombia-las-cifras-de-2021-muestran-una-mejoria/52. Departamento Administrativo Nacional de Estadística. Metodología: Índice de Pobreza Multidimensional (IPM) [Internet]. Bogota; 2014 [cited 2022 Sep 5]. Available from: http://microdatos.dane.gov.co/index.php/catalog/330/related_materials53. Callander EJ, Schofield DJ, Shrestha RN. Chronic health conditions and poverty: a cross-sectional study using a multidimensional poverty measure. BMJ Open. 2013 Nov;3(11):e003397.54. Peyvandi S, Baer RJ, Chambers CD, Norton ME, Rajagopal S, Ryckman KK, et al. Environmental and Socioeconomic Factors Influence the Live‐Born Incidence of Congenital Heart Disease: A Population‐Based Study in California. J Am Heart Assoc. 2020 Apr 21;9(8).55. Smith LK, Manktelow BN, Draper ES, Boyle EM, Johnson SJ, Field DJ. Trends in the incidence and mortality of multiple births by socioeconomic deprivation and maternal age in England: population-based cohort study. BMJ Open. 2014 Apr;4(4):e004514.56. Collins J. Global epidemiology of multiple birth. Reprod Biomed Online. 2007 Jan;15:45–52.57. Lee KS, Choi YJ, Cho J, Lee H, Lee H, Park SJ, et al. Environmental and Genetic Risk Factors of Congenital Anomalies: an Umbrella Review of Systematic Reviews and Meta-Analyses. J Korean Med Sci. 2021;36(28).58. Ekelund CK, Skibsted L, Søgaard K, Main KM, Dziegiel MH, Schwartz M, et al. Dizygotic monochorionic twin pregnancy conceived following intracytoplasmic sperm injection treatment and complicated by twin-twin transfusion syndrome and blood chimerism. Ultrasound in Obstetrics and Gynecology. 2008 Nov;32(6):832–4.59. Santana DS, Silveira C, Costa ML, Souza RT, Surita FG, Souza JP, et al. Perinatal outcomes in twin pregnancies complicated by maternal morbidity: evidence from the WHO Multicountry Survey on Maternal and Newborn Health. BMC Pregnancy Childbirth. 2018 Dec 20;18(1):449.46. American Heart Association News. Congenital heart disease linked to neighborhood pollution, poverty. 2019.60. Dudenhausen JW, Maier RF. Perinatal Problems in Multiple Births. Dtsch Arztebl Int. 2010 Sep 24;61. Wen SW, Demissie K, Yang Q, Walker MC. Maternal morbidity and obstetric complications in triplet pregnancies and quadruplet and higher-order multiple pregnancies. Am J Obstet Gynecol. 2004 Jul;191(1):254–8.62. Sairam S. Prospective risk of stillbirth in multiple-gestation pregnancies: a population-based analysis. Obstetrics & Gynecology. 2002 Oct;100(4):638–41.63. The National Institute for Health and Care Excellence. Draft quality standard for multiple pregnancy. 2013.64. Lemos E v., Zhang D, van Voorhis BJ, Hu XH. Healthcare expenses associated with multiple vs singleton pregnancies in the United States. Am J Obstet Gynecol. 2013 Dec;209(6):586.e1-586.e11.65. Vogel JP, Torloni MR, Seuc A, Betrán AP, Widmer M, Souza JP, et al. Maternal and Perinatal Outcomes of Twin Pregnancy in 23 Low- and Middle-Income Countries. PLoS One. 2013 Aug 1;8(8):e70549.66. Smits J, Monden C. Twinning across the Developing World. PLoS One. 2011 Sep 28;6(9):e25239.67. Jonsson H, Magnusdottir E, Eggertsson HP, Stefansson OA, Arnadottir GA, Eiriksson O, et al. Differences between germline genomes of monozygotic twins. Nat Genet. 2021 Jan 7;53(1):27–34.68. Lancaster PAL. Causes of birth defects: Lessons from history. Congenit Anom (Kyoto). 2011 Mar;51(1):2–5.69. Vargesson N. Thalidomide‐induced teratogenesis: History and mechanisms. Birth Defects Res C Embryo Today. 2015 Jun 4;105(2):140–56.70. Harris BS, Bishop KC, Kemeny HR, Walker JS, Rhee E, Kuller JA. Risk Factors for Birth Defects. Obstet Gynecol Surv. 2017 Feb;72(2):123–35.71. Centro Nacional de Defectos Congénitos y Discapacidades del Desarrollo. Guía para prevenir defectos de nacimiento [Internet]. 2020 [cited 2022 Aug 15]. Available from: https://www.cdc.gov/ncbddd/Spanish/birthdefects/prevention.html72. Kancherla V, Botto LD, Rowe LA, Shlobin NA, Caceres A, Arynchyna-Smith A, et al. Preventing birth defects, saving lives, and promoting health equity: an urgent call to action for universal mandatory food fortification with folic acid. Lancet Glob Health. 2022 Jul;10(7):e1053–7.73. Czeizel AE. Birth Defects Are Preventable. Int J Med Sci. 2005;91–2.74. Howley MM, Browne ML, van Zutphen AR, Richardson SD, Blossom SJ, Broussard CS, et al. Maternal autoimmune disease and birth defects in the National Birth Defects Prevention Study. Birth Defects Res A Clin Mol Teratol. 2016 Nov;106(11):950–62.75. Parimi M, Nitsch D. A Systematic Review and Meta-Analysis of Diabetes During Pregnancy and Congenital Genitourinary Abnormalities. Kidney Int Rep. 2020 May;5(5):678–93.76. Zhang TN, Huang XM, Zhao XY, Wang W, Wen R, Gao SY. Risks of specific congenital anomalies in offspring of women with diabetes: A systematic review and meta-analysis of population-based studies including over 80 million births. PLoS Med. 2022 Feb 1;19(2):e1003900.77. Rohde C, Thiele AG, Baerwald C, Ascherl RG, Lier D, Och U, et al. Preventing maternal phenylketonuria (PKU) syndrome: important factors to achieve good metabolic control throughout pregnancy. Orphanet J Rare Dis. 2021 Dec 18;16(1):477.78. Wen J, Jiang J, Ding C, Dai J, Liu Y, Xia Y, et al. Birth defects in children conceived by in vitro fertilization and intracytoplasmic sperm injection: a meta-analysis. Fertil Steril. 2012 Jun;97(6):1331-1337.e4.79. Zheng Z, Chen L, Yang T, Yu H, Wang H, Qin J. Multiple pregnancies achieved with IVF/ICSI and risk of specific congenital malformations: a meta-analysis of cohort studies. Reprod Biomed Online. 2018 Apr;36(4):472–82.80. Massaro PA, MacLellan DL, Anderson PA, Romao RLP. Does Intracytoplasmic Sperm Injection Pose an Increased Risk of Genitourinary Congenital Malformations in Offspring Compared to In Vitro Fertilization? A Systematic Review and Meta-Analysis. Journal of Urology. 2015 May;193(5S):1837–42.81. Lacamara C, Ortega C, Villa S, Pommer R, Schwarze JE. Are children born from singleton pregnancies conceived by ICSI at increased risk for congenital malformations when compared to children conceived naturally? A systematic review and meta-analysis. JBRA Assist Reprod. 2017;21(3).82. Yu D, Feng Y, Yang L, Da M, Fan C, Wang S, et al. Maternal Socioeconomic Status and the Risk of Congenital Heart Defects in Offspring: A Meta-Analysis of 33 Studies. PLoS One. 2014 Oct 27;9(10):e111056.83. Deguen S, Kihal W, Jeanjean M, Padilla C, Zmirou-Navier D. Neighborhood Deprivation and Risk of Congenital Heart Defects, Neural Tube Defects and Orofacial Clefts: A Systematic Review and Meta-Analysis. PLoS One. 2016 Oct 26;11(10):e0159039.84. Anyanwu LJC, Ade-Ajayi N, Rolle U. Major abdominal wall defects in the low- and middle-income setting: current status and priorities. Pediatr Surg Int. 2020 May 21;36(5):579–90.85. Vu GH, Warden C, Zimmerman CE, Kalmar CL, Humphries LS, McDonald-McGinn DM, et al. Poverty and Risk of Cleft Lip and Palate: An Analysis of United States Birth Data. Plast Reconstr Surg. 2022 Jan 21;149(1):169–82.86. Prescott KR, Wilkie AOM. Genetic aspects of birth defects: new understandings of old problems. Arch Dis Child Fetal Neonatal Ed. 2007 Jan 24;92(4):F308–14.87. Hobbs CA, Chowdhury S, Cleves MA, Erickson S, MacLeod SL, Shaw GM, et al. Genetic Epidemiology and Nonsyndromic Structural Birth Defects. JAMA Pediatr. 2014 Apr 1;168(4):371.88. Akhtar F, Bokhari S. Down Syndrome [Internet]. 1st ed. Vol. 1. 2021 [cited 2022 Sep 9]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK526016/89. Coppedè F. Risk factors for Down syndrome. Arch Toxicol. 2016 Dec 7;90(12):2917–29.90. World Health Organization. International Statistical Classification of Diseases and Related Health Problems [Internet]. 2nd ed. Vol. 2. 2004 [cited 2022 Sep 15]. Available from: https://apps.who.int/iris/bitstream/handle/10665/42980/9241546530_eng.pdf?sequence=1&isAllowed=y91. DANE. Geovisor de Consulta de Codificación de la Divipola [Internet]. 2022 [cited 2022 Sep 12]. Available from: https://geoportal.dane.gov.co/geovisores/territorio/consulta-divipola-division-politico-administrativa-de-colombia/92. Norwitz ER, Edusa V, Park JS. Maternal Physiology and Complications of Multiple Pregnancy. Semin Perinatol. 2005 Oct;29(5):338–48.93. Soma-Pillay P, Nelson-Piercy C, Tolppanen H, Mebazaa A. Physiological changes in pregnancy. Cardiovasc J Afr. 2016 May 18;27(2):89–94.94. Lee KS, Choi YJ, Cho J, Lee H, Lee H, Park SJ, et al. Environmental and Genetic Risk Factors of Congenital Anomalies: an Umbrella Review of Systematic Reviews and Meta-Analyses. J Korean Med Sci. 2021;36(28).95. Toufaily MH, Westgate MN, Lin AE, Holmes LB. Causes of Congenital Malformations. Birth Defects Res. 2018 Jan;110(2):87–91.96. Verma RP. Evaluation and Risk Assessment of Congenital Anomalies in Neonates. Children. 2021 Sep 28;8(10):862.97. Gijtenbeek M, Shirzada MR, Ten Harkel ADJ, Oepkes D, C. Haak M. Congenital Heart Defects in Monochorionic Twins: A Systematic Review and Meta-Analysis. J Clin Med. 2019 Jun 24;8(6):902.98. Panagiotopoulou O, Fouzas S, Sinopidis X, Mantagos SP, Dimitriou G, Karatza AA. Congenital heart disease in twins: The contribution of type of conception and chorionicity. Int J Cardiol. 2016 Sep;218:144–9.99. Gijtenbeek M, Shirzada MR, Ten Harkel ADJ, Oepkes D, C. Haak M. Congenital Heart Defects in Monochorionic Twins: A Systematic Review and Meta-Analysis. J Clin Med. 2019 Jun 24;8(6):902.100. Ahn D, Kim J, Kang J, Kim YH, Kim K. Congenital anomalies and maternal age: A systematic review and meta‐analysis of observational studies. Acta Obstet Gynecol Scand. 2022 May 14;101(5):484–98.103. Chen X, Lou H, Chen L, Muhuza MPU, Chen D, Zhang X. Epidemiology of birth defects in teenage pregnancies: Based on provincial surveillance system in eastern China. Front Public Health. 2022 Dec 6;10.Prabhcharan G, Lende M, van Hook JW. Twin Births [Internet]. 2022 [cited 2022 Aug 14]. 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