Congenital Anomalies (CA) constitute one of the principal causes of infant mortality, morbidity, and disability in industrialized countries. Their etiology remains for the most part unknown, which constitutes an important barrier for their prevention. Nevertheless, periconceptional supplementation with folic acid represents an important possibility for primary prevention of neutral tube defects. In addition, primary prevention of CA can be achieved with: i) the elimination or avoidance of known teratogenic substances, ii) optimal management of certain chronic or pregnancy-associated diseases (notably, diabetes).
Important progress has taken place in prenatal screening for CA, in particular for chromosomal anomalies including Down syndrome, as well as, structural birth defects such as gastrointestinal and congenital heart defects. There have also been notable improvements in the postnatal clinical management and thus the outcomes of certain CA, especially congenital heart defects. Optimal management of many anomalies requires their prenatal detection, which can guide postnatal management, including a transfer in-utero or the newborn’s rapid transfer to a specialized clinical service.
The objectives are to study, using population-based data:
- the associations between different categories of CA and their potential risk factors (in particular, assisted reproduction technologies and, in the context of long-standing European collaborations, certain groups of medications)
- practice patterns and performance of prenatal screening and postnatal management of children with CA
- the outcomes, particularly long-term outcomes of children with CA, and iv) evaluation of the effectiveness of policies for prevention of CA.
Given the great heterogeneities that exist in the domain of CA, we have chosen to study three distinct anomalies:
- Congenital heart defects, which are the principal focus of our current and future projects. They comprise a large and very heterogeneous group of anomalies, many of which are curable but only if optima medical and/or surgical treatment begins soon after birth; prenatal screening for congenital heart defects is recommended and increasingly often performed to enable optimal postnatal medical management.
- Down syndrome, an anomaly for which several prenatal screening techniques are available, including the recently introduced non-invasive prenatal testing (NIPT) based on analysis of fetal DNA.
- Neural tube defects, which represent the most important and clearest example of the possibility of primary prevention for a group of CA.
Main data sources:
- REMAPAR : Paris Registry of Congenital Malformations (established in 1981)
- EPICARD (EPIdémiologie des enfants ou fœtus porteurs de CARDiopathies congénitales), Population-based, prospective cohort study of newborns with congenital heart defects with a follow-up of 8 years.
Selected Publications (2012-2017):
- Khoshnood B, Lelong N, Houyel L, Bonnet D, Ballon M, Jouannic JM, Goffinet F; EPICARD Study group.
Impact of prenatal diagnosis on survival of newborns with four congenital heart defects: a prospective, population-based cohort study in France (the EPICARD Study).
BMJ Open. 2017 Nov 8;7(11).
- Calderon J, Willaime M, Lelong N, Bonnet D, Houyel L, Ballon M, Goffinet F, Khoshnood B; EPICARD study group.
Population-based study of cognitive outcomes in congenital heart defects.
Arch Dis Child. 2017 Aug 5. pii: archdischild-2016-310830.
- Laas E, Lelong N, Ancel PY, Bonnet D, Houyel L, Magny JF, Andrieu T, Goffinet F, Khoshnood B; EPICARD study group.
Impact of preterm birth on infant mortality for newborns with congenital heart defects: The EPICARD population-based cohort study.
BMC Pediatr. 2017 May 15;17(1):124.
- Khoshnood B, Lelong N, Andrieu T, Houyel L, Bonnet D, Jouannic JM, Goffinet F on behalf of the EPICARD Study Group.
Assessing sociodemographic differences (or lack thereof) in prenatal diagnosis of congenital heart defects: A population-based study.
BMJ Open 2016 Mar 23;6(3):e009353
- Khoshnood B, Loane M, de Walle H, Arriola L, Addor MC, Barisic I, Beres J, Bianchi F, Dias C, Draper E, Garne E, Gatt M, Haeusler M, Klungsoyr K, Latos-Bielenska A, Lynch C, McDonnell B, Nelen V, Neville AJ, O’Mahony MT, Queisser-Luft A, Rankin J, Rissmann A, Ritvanen A, Rounding C, Sipek A, Tucker D, Verellen-Dumoulin C, Wellesley D, Dolk H.
Long term trends in prevalence of neural tube defects in Europe: population based study.
BMJ. 2015 Nov 24;351:h5949
- Tararbit K, Lelong N, Jouannic JM, Goffinet F, Khoshnood B; EPICARD Study Group.
Is the probability of prenatal diagnosis or termination of pregnancy different for fetuses with congenital anomalies conceived following assisted reproductive techniques? A population-based evaluation of fetuses with congenital heart defects.
BJOG. 2015 Jun;122(7):924-31.
- Tararbit K, Lelong N, Houyel L, Bonnet D, Goffinet F, Khoshnood B; EPICARD Study Group.
Assessing the role of multiple pregnancies in the association between tetralogy of Fallot and assisted reproductive techniques: a path-analysis approach.
Orphanet J Rare Dis. 2014 Feb 20;9:27.
- Tararbit K, Bui TT, Lelong N, Thieulin AC, Goffinet F, Khoshnood B.
Clinical and socioeconomic predictors of pregnancy termination for fetuses with congenital heart defects: a population-based evaluation.
Prenat Diagn. 2013 Feb;33(2):179-86.
- Tararbit K, Lelong N, Thieulin AC, Houyel L, Bonnet D, Goffinet F, Khoshnood B; EPICARD Study Group.
The risk for four specific congenital heart defects associated with assisted reproductive techniques: a population-based evaluation.
Hum Reprod. 2013 Feb;28(2):367-74.
- Khoshnood B, Loane M, Garne E, Addor MC, Arriola L, Bakker M, Barisic I, Bianca S, Boyd P, Calzolari E, Doray B, Draper E, Gatt M, Haeusler M, Melve KK, Latos-Bielenska A, McDonnell B, Mullaney C, Nelen V, O’Mahony M, Pierini A, Queisser-Luft A, Randrianaivo H, Rankin J, Rissmann A, Salvador J, Tucker D, Verellen-Dumoulin C, Wellesley D, Zymak-Zakutnya N, Dolk H.
Recent decrease in the prevalence of congenital heart defects in Europe.
J Pediatr. 2013 Jan;162(1):108-13.e2.
- Khoshnood B, Lelong N, Houyel L, Thieulin AC, Jouannic JM MD, PhD, Magnier S, Delezoide AL, Magny JF, Rambaud C, Bonnet D, Goffinet F, on behalf of the EPICARD Study Group.
Prevalence, pre- and post-natal diagnosis, and infant mortality of newborns with congenital heart defects: A population-based study using the International Paediatric and Congenital Cardiac Code (IPCCC).
Heart. 2012 Nov;98(22):1667-73.
- Laas E, Lelong N, Thieulin AC, Houyel L, Bonnet D, Ancel PY, Kayem G, Goffinet F, Khoshnood B, on behalf of the EPICARD Study Group.
Preterm birth and Congenital Heart Defects: A population-based study .
Pediatrics. 2012 Oct;130(4):e829-37.
Team members for the theme of congenital anomalies
Babak Khoshnood (Epidémiologiste, Inserm), François Goffinet (Obstétricien-Epidémiologiste Université Paris Descartes), Nathalie Lelong (Statisticienne, responsable d’étude, Inserm), Nathalie Bertille (Statisticienne), Alexandra Lecourbe (Coordinatrice d’étude), Cécile Leclerc (Coordinatrice d’étude).
- Establishment of a Federation of French Registries of congenital malformations (Registre des Antilles dirigé par Bruno Schaub, registre CEMC-Auvergne dirigé par Isabelle Perthus, registre de Bretagne dirigé par Florence Rouget, registre de la Réunion dirigé par Hanitra Randrianaivo, registre REMERA-Rhône Alpes dirigé par Emmanuelle Amar) in relation with the Public Health France (Anne Gallay, Nolwenn Regnault, Eugénia Gomes) and Inserm Charles Persoz, Corinne Alberti)
- Damien Bonnet (Hôpital Necker Enfants Malades, AP-HP, Centre de référence M3C, Université Paris Descartes, Paris)
- Christophe Delacourt (Hôpital Necker Enfants Malades, AP-HP, Service de pneumologie pédiatrique, Université Paris Descartes, Paris)
- Lucile Houyel (Hôpital Marie Lannelongue, Service de chirurgie des cardiopathies congénitales, Le Plessis-Robinson)
- Jean-Marie Jouannic (Hôpital Trousseau, AP-HP, Centre pluridisciplinaire de diagnostic prénatal, UPMC, Paris)
- European surveillance of congenital anomalies (JRC-EUROCAT)
- Safety of medication use in pregnancy (Euromedicat)
- Establishing a linked European Cohort of Chilldren with Congenital Anomalies (Eurolinkcat)
- International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR)
- Johanna Calderon, neuropsychologist, research associate, Harvard University, Boston
- Babak Choodari-Oskooei, biostatistician, MRC unit, University College, London
- Mithat Gönen, senior statistician, Sloan Cancer Center, New York