Judith Rankin

BACKGROUND: EUROCAT is a network of population‐based congenital anomaly registries providing standardized epidemiologic information on congenital anomalies in Europe. There are three types of EUROCAT membership: full, associate, or affiliate. Full member registries send individual records of all congenital anomalies covered by their region. Associate members transmit aggregate case counts for each EUROCAT anomaly subgroup by year and by type of birth. This article describes the organization and activities of each of the current 29 full member and 6 associate member registries of EUROCAT.METHODS: Each registry description provides information on the history and funding of the registry, population coverage including any changes in coverage over time, sources for ascertaining cases of congenital anomalies, and upper age limit for registering cases of congenital anomalies. It also details the legal requirements relating to termination of pregnancy for fetal anomalies, the definition of stillbirths and fetal deaths, and the prenatal screening policy within the registry. Information on availability of exposure information and denominators is provided. The registry description describes how each registry conforms to the laws and guidelines regarding ethics, consent, and confidentiality issues within their own jurisdiction. Finally, information on electronic and web‐based data capture, recent registry activities, and publications relating to congenital anomalies, along with the contact details of the registry leader, are provided.CONCLUSIONS: The registry description gives a detailed account of the organizational and operational aspects of each registry and is an invaluable resource that aids interpretation and evaluation of registry prevalence data. Birth Defects Research (Part A) , 2011.

Background: Obese and overweight women may benefit from increased physical activity (PA) during pregnancy. There is limited published data describing objectively measured PA in such women. Methods: A longitudinal observational study of PA intensity, type and duration using objective and subjective measurement methods. Fifty five pregnant women with booking body mass index (BMI) ≥ 25 kg/m² were recruited from a hospital ultrasound clinic in North East England. 26 (47%) were nulliparous and 22 (40%) were obese (BMI ≥ 30 kg/m²). PA was measured by accelerometry and self report questionnaire at 13 weeks, 26 weeks and/or 36 weeks gestation. Outcome measures were daily duration of light, moderate or vigorous activity assessed by accelerometry; calculated overall PA energy expenditure, (PAEE), and PAEE within four domains of activity based on self report. Results: At median 13 weeks gestation, women recorded a median 125 mins/day light activity and 35 mins/day moderate or vigorous activity (MVPA). 65% achieved the minimum recommended 30 mins/day MVPA. This proportion was maintained at 26 weeks (62%) and 36 weeks (71%). Women achieving more than 30 mins/day MVPA in the first trimester showed a significant reduction in duration of MVPA by the third trimester (11 mins/day, p = 0.003). Walking, swimming and floor exercises were the most commonly reported recreational activities but their contribution to estimated energy expenditure was small. Conclusion: Overweight and obese pregnant women can achieve and maintain recommended levels of PA throughout pregnancy. Interventions to promote PA should target changes in habitual activities at work and at home, and in particular walking.

Background: Whilst there has been increasing research interest in interventions which promote physical activity during pregnancy few studies have yielded detailed insights into the views and experiences of overweight and obese pregnant women themselves. The qualitative study described in this paper aimed to: (i) explore the views and experiences of overweight and obese pregnant women; and (ii) inform interventions which could promote the adoption of physical activity during pregnancy. Methods: The study was framed by a combined Subtle Realism and Theory of Planned Behaviour (TPB) approach. This enabled us to examine the hypothetical pathway between beliefs and physical activity intentions within the context of day to day life. The study sample for the qualitative study was chosen by stratified, purposive sampling from a previous study of physical activity measurements in pregnancy. Research participants for the current study were recruited on the basis of Body Mass Index (BMI) at booking and parity. Semi-structured, in-depth interviews were conducted with 14 overweight and obese pregnant women. Data analysis was undertaken using a Framework Approach and was informed by TPB. Results: Healthy eating was often viewed as being of greater importance for the health of mother and baby than participation in physical activity. A commonly cited motivator for maintaining physical activity during pregnancy is an aid to reducing pregnancy-related weight gain. However, participants often described how they would wait until the postnatal period to try and lose weight. A wide range of barriers to physical activity during pregnancy were highlighted including both internal (physical and psychological) and external (work, family, time and environmental). The study participants also lacked access to consistent information, advice and support on the benefits of physical activity during pregnancy. Conclusions: Interventions to encourage recommended levels of physical activity in pregnancy should be accompanied by accessible and consistent information about the positive effects for mother and baby. More research is required to examine how to overcome barriers to physical activity and to understand which interventions could be most effective for overweight/obese pregnant women. Midwives should be encouraged to do more to promote activity in pregnancy.

Objective: To investigate the association between maternal body mass index (BMI) and major, structural congenital anomalies. Design: Cohort study using prospectively collected data. Methods: Data on all singleton pregnancies booked at five maternity units in the north of England between 01 January 2003 and 31 December 2005 and data on congenital anomalies notified to the Northern Congenital Abnormality Survey were linked using key variables. Maternal pre-gestational diabetic status was derived from the Northern Diabetes in Pregnancy Survey. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated by maximum-likelihood logistic regression models, with missing values modelled as explicit categories. Results: There was a total of 41 013 singleton pregnancies during the study period, of which 682 were affected by a structural congenital anomaly, a total prevalence of 166 (95% CI: 154, 179) per 10 000 registered births. Overall, the risk of a congenital anomaly was significantly increased among the maternal underweight (BMI⩽18.5 kg m^–2; aOR=1.60, 95% CI: 1.09, 2.36; P=0.02) and maternal obese groups (BMI⩾30 kg m^–2; aOR=1.30, 95% CI: 1.03, 1.63; P=0.03), but not for maternal overweight (BMI=25–29.9 kg m^–2; aOR=0.85, 95% CI: 0.68, 1.06; P=0.15), compared with mothers of recommended BMI. Maternal obesity was associated with significantly increased risk of ventricular septal defect (aOR=1.56, 95% CI: 1.01, 2.40; P=0.04), cleft lip (aOR=3.71, 95% CI: 1.05, 13.10; P=0.04) and eye anomalies (aOR=11.36, 95% CI: 2.25, 57.28; P=0.003). Maternal underweight was associated with significantly increased risks of atrial septal defect (aOR=2.86, 95% CI: 1.18, 6.96; P=0.02), genital anomalies (aOR=6.30, 95% CI: 1.58, 25.08; P=0.009) and hypospadias (aOR=8.77, 95% CI: 1.42, 54.29; P=0.02). Conclusions: We found an overall increased risk of congenital anomalies in women who are obese and women who are underweight compared with women of recommended weight. Women should be made aware of these risks and supported to optimize their weight before pregnancy.

Aim Our aim was to determine the proportion of children with cerebral palsy (CP) who have a congenital anomaly (CA) in three regions (Isère Region, French Alps; Funen County, Denmark; Northern Region, England) where population‐based CP and CA registries exist, and to classify the children according to CA subtype.Method Data for children born between 1991 and 1999 were linked using electronic matching of cases. All potential matches were checked manually by each centre and verified as true matches.Results A total of 1104 children with CP were born during the study period (663 males, 441 females). Of these, 166 (15%; 95% Confidence Interval [CI] 13.0–17.3) children with CP had a CA: 8.8% had a cerebral anomaly, 4.8% had a non‐cerebral anomaly, and 1.4% had a non‐cerebral‐related syndrome or a chromosomal/genetic anomaly.Interpretation The prevalence of cerebral anomaly was highest in children with ataxic CP (41.7%) and lowest in those with dyskinetic CP (2.1%). Cerebral anomalies were found in 8.4% and 7% of children with bilateral and unilateral spastic CP respectively. The most frequent cerebral anomalies were primary microcephaly (26.5%) and congenital hydrocephalus (17.3%). The most common non‐cerebral anomalies recorded were cardiac (12.6% of children with CP and CA), urinary (5.4%), and musculoskeletal (5.4%). The prevalence of cerebral anomalies was higher among children born at term (13%) than among those born preterm (3.8%). Associated sensorineural or intellectual impairments occurred more often in children with CP and cerebral anomalies. We concluded that cerebral and non‐cerebral CA prevalence was higher among the CP population than in the general population of live births.

Many epidemiological studies assign exposure to an individual's residence at a single time point, such as birth or death. This approach makes no allowance for migration and may result in exposure error, leading to reduced study power and biased risk estimates. Pregnancy outcomes are less susceptible to this bias, however data from North American populations indicate that pregnant women are a highly mobile group. We assessed mobility in pregnant women in the north of England using data from the Northern Congenital Abnormality Survey (NorCAS).

Review from JAMA — Maternal Overweight and Obesity and the Risk of Congenital Anomalies — A Systematic Review and Meta-analysis

Objective: To describe the prevalence, associated anomalies, prenatal diagnosis and survival of cases of gastroschisis.Method: Data were extracted from the Northern Congenital Abnormality Survey (NorCAS) for cases delivered during 1997 to 2006.Results: A total of 143 cases of gastroschisis were notified from 310 410 registered births. Ten (7%) gastroschisis cases were associated with other structural anomalies. The male to female ratio among isolated gastroschisis cases was 1:1.1 and 4:1 among non‐isolated cases. The total prevalence for isolated cases was 4.28 per 10 000 births (95% CI 3.56–5.01), and the overall live birth prevalence was 4.21 per 10 000 live births (95% CI 3.49–4.93). There was an increase in total prevalence during the ten years, although this increase did not reach statistical significance (χ² test for trend = 0.996, p = 0.318). The maternal age‐specific prevalence was highest in the less than 20 years age group (18.6 per 10 000 births (95% CI 14.0–23.3)). 130 (97.7%) isolated cases resulted in a live birth; 122 (91.7%) infants were alive at age one year. The accuracy of prenatal diagnosis was high, with gastroschisis being detected in 130 (97.7%) isolated cases.Conclusion: This population‐based study demonstrates a continued increase in gastroschisis, especially in young mothers. The accuracy of prenatal diagnosis was very high. Just over 90% of children born with gastroschisis survived. Copyright © 2008 John Wiley & Sons, Ltd.

The link between maternal factors and birth outcomes is well established. Substantial changes in society and medical care over time have influenced women's reproductive choices and health, subsequently affecting birth outcomes. The objective of this study was to describe temporal changes in key maternal and fetal factors affecting birth outcomes in Newcastle upon Tyne over three decades, 1961–1992.