Congenital Abnormalities and Preterm Birth Related to Maternal Illnesses During Pregnancy

The major objective of our studies in the last decade was a systematic analysis of maternal diseases during pregnancy to reveal their possible adverse effects on birth outcomes. This book provides the analysis of a uniquely large, population-based data set evaluating congenital anomalies as a consequence of maternal diseases. The possible adverse birth outcomes of babies born to mothers diagnosed with important diseases have not yet been evaluated in such a material by the same method. The greatest merit of these studies is that by analyzing their data the authors managed to identify some new previously unknown associations between maternal diseases and adverse birth outcomes. The first aim of the authors was to summarize 50 years of experiences in human teratology which may help younger experts to use them. The second objective was to show the methodological weaknesses of previous studies and to recommend the use of up-to-date methods when designing new studies. A surveillance database like the one used in these studies effectively helps to monitor the most important indicators of adverse birth outcomes such as congenital anomalies, preterm births, and low birth weight, to evaluate the efficacy of medical care of pregnant women, and to detect possible causes of adverse birth outcomes in order to help in their prevention. In addition, the analysis of cost-benefit of this database showed that the benefit is much higher than cost. This book may be useful in the daily practice for obstetricians, paediatricians, general practitioners and epidemiologists, moreover it could be used in the training programmes of medical students and residents as well. The major objective of our studies in the last decade was a systematic analysis of maternal diseases during pregnancy to reveal their possible adverse effects on birth outcomes. The two most important factors of infant mortality were parti- larly analyzed: structural birth defects, known as congenital abnormalities (CAs) and preterm birth (PB). In general the objectives of scienti c studies might be either to test a new hypothesis or to con rm or confront previously published results. However, less frequently the authors/scientists have personal motivations determined by their professional activities. The authors of this book are practicing physicians and genetic epidemiologist who are mainly interested in the following three practical questions: 1. The possible adverse effects of pharmaceutical products. The possible t- atogenic potential of about 170 drugs has been evaluated very thoroughly using the data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities (HCCSCA) in the last 50 years. These drugs were used to treat maternal diseases and the ndings of our population-based case-control studies will be cited in this book and are shown in the Appendix at the end of the book. However, our long experiences showed two problems in the drug teratology. In general the evaluation of clinical doses of these drugs is a particularly dif- cult challenge due to the modi cation effects of confounders. This problem motivated one of the authors to establish a new model of disaster epidemiology.

The major objective of our studies in the last decade was a systematic analysis of maternal diseases during pregnancy to reveal their possible adverse effects on birth outcomes. The two most important factors of infant mortality were parti- larly analyzed: structural birth defects, known as congenital abnormalities (CAs) and preterm birth (PB). In general the objectives of scienti c studies might be either to test a new hypothesis or to con rm or confront previously published results. However, less frequently the authors/scientists have personal motivations determined by their professional activities. The authors of this book are practicing physicians and genetic epidemiologist who are mainly interested in the following three practical questions: 1. The possible adverse effects of pharmaceutical products. The possible t- atogenic potential of about 170 drugs has been evaluated very thoroughly using the data set of the Hungarian Case-Control Surveillance of Congenital Abnormalities (HCCSCA) in the last 50 years. These drugs were used to treat maternal diseases and the ndings of our population-based case-control studies will be cited in this book and are shown in the Appendix at the end of the book. However, our long experiences showed two problems in the drug teratology. In general the evaluation of clinical doses of these drugs is a particularly dif- cult challenge due to the modi cation effects of confounders. This problem motivated one of the authors to establish a new model of disaster epidemiology.