DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20182804

Maternal and neonatal characteristics of babies admitted with congenital CNS anomalies in a tertiary hospital in North Central Nigeria

Udochukwu Michael Diala, Bose Ozoiza Toma, Danaan Shilong, David Danjuma Shwe, Gyang Markus Bot, Akinyemi David Ofakunrin, Peter Binitie

Abstract


Background: CNS anomalies are an important group of largely preventable congenital anomalies. Knowledge of maternal and neonatal sociodemographic characteristics could identify a pattern of population at risk in order to target preventive interventions.

Methods: This was a 3-year retrospective review of health records of all neonates admitted with CNS anomalies in Jos University Teaching Hospital (JUTH), Jos, central-Nigeria.

Results: Out of a total of 27 neonates with congenital CNS anomalies reviewed, 25 had neural tube defects, 1 hydrocephalos and 1 anencephaly. The peak age group of mothers were 20-29years (44.4%) and 30-39 years (44.4%). Twenty-two (81.5%) mothers had antenatal care (ANC). No mother booked in the 1st month and only 7 (25.9%) booked in the first trimester. Twenty-four (88.9%) mothers took folic acid during pregnancy. No mother had peri-conceptional folic acid use. There were 11(40.7%) home births with 14(87.5%) of the 16 hospital births taking place in lower tier health facilities. Twenty-six (96.3%) mothers had vaginal delivery. An obstetric ultrasound scan was reported by one (3.7%) mother and did not detect the anomaly. Five (18.5%) of the mothers had HIV infection. Twenty-six were term with a male: female ratio of 1.1:1. The median age at presentation was 2 (interquartile range 1, 8) days.

Conclusions: Neonates with congenital CNS anomalies in JUTH frequently had mothers aged <35 years who did not receive preventive care before and during delivery. We therefore recommend interventions to improve the efficiency of health care delivery to cater for this gap.


Keywords


Central nervous system anomalies, Maternal sociodemographic

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References


Gillani S, Kazmi NH, Najeeb S, Hussain S, Raza A. Frequencies of congenital anomalies among newborns admitted in nursery of Ayub Teaching Hospital Abbottabad, Pakistan. J Ayub Med Coll Abbottabad. 2011;23(1):117-21.

Adeyemo AA, Okolo CM, Omotade OO. Major congenital malformations among paediatric admissions at University College Hospital, Ibadan, Nigeria. Ann Trop Paediatr. 1994;14(1):75-9.

Ambe JP, Madziga AG, Akpede GO, Mava Y. Pattern and outcome of congenital malformations in new born babies in a Nigerian teaching hospital. West Afr J Med. 2010;29(1):24-9.

Opitz JM, Wilson GN, Barness EG. Abnormalities of blastogenesis, organogenesis, and phenogenesis. Potter’s Pathology of the Fetus and Infant. St. Louis: Mosby. 1997:65-102.

Keeling JW, Boyd PA. Congenital abnormalities and the examination of the fetus following prenatal suspicion of congenital abnormality. In Fetal and Neonatal Pathology. 3rd edition. Springer. 2001:111-52.

Lemmens M, van Vugt JG, Willemsen M, van der Voorn P, van Bokhoven H, ten Donkelaar HJ. Causes of congenital malformations In: Donkelaar HJ, Lammens M, Hori A, eds. Clinical Neuroembryology. 2nd ed. Berlin Heidelberg: Springer;2014:105-64.

Kirke PN, Molloy AM, Daly LE, Burke H, Weir DG, Scott JM. Maternal plasma folate and vitamin B12 are independent risk factors for neural tube defects. Q J Med. 1993;86:703-8.

Rosa FW. Spina bifida in infants of women treated with carbamazepine during pregnancy. N Engl J Med. 1991;324(10):674-77.

Blaw ME, Woody RC. Valproic acid embryopathy? Neurology. 1983;33(2):255.

Wilson JG. Environment and Birth Defects. New York: Academic Press;1973.

The National Academics of Sciences Engineering Medicine. Dietary reference intakes for thiamin, riboflavin, niacin, vitamin B6, Folate, vitamin B12, pantothenic acid, biotin, and choline. In:Washington DC: National Academies Press;1998. Available at: http://www.nap.edu/catalog/6015.html.

Czeizel AE, Dudas I, Vereczkey A, Banhidy F. Folate deficiency and folic acid supplementation: the prevention of neural-tube defects and congenital heart defects. Nutrients. 2013;5(11):4760-75.

De Wals P, Tairou F, Van Allen MI, Uh SH, Lowry RB, Sibbald B, et al. Reduction in neural-tube defects after folic acid fortification in Canada. New Eng J Med. 2007 Jul 12;357(2):135-42.

Wilson RD, Genetics C, Motherisk. Pre-conceptional vitamin/folic acid supplementation 2007: the use of folic acid in combination with a multivitamin supplement for the prevention of neural tube defects and other congenital anomalies. J Obstet Gynaecol Can. 2007;29(12):1003-13.

Abdullahi H, Gasim IG, Saeed A, Imam AM, Adam I. Antenatal iron and folic acid supplementation use by pregnanat women in Khartoum, Sudan. BMC Research Notes. 2014;7:498.

Nilsen RM, Vollset SE, Gjessing HK, Magnus P, Meltzer HM, Haugen M, et al. Patterns and predictors of folic acid supplement use among pregnant women: the Norwegian Mother and Child Cohort Study. Am J clinical nutrition. 2006 Nov 1;84(5):1134-41.

World Health Organization. Chapter XVII Congenital malformations, deformations and chromosomal abnormalities (Q00-099). In. International Statistical Classification of Diseases and Related Health Problems 10th Revision. ICD-10 Version:2016: World Health Organization;2016.

Fontoura FC, Cardioso MVL. Association between congenital malformation and neonatal and maternal variables in neonatal units of a Northeast Brazilian city. Text Content Nursing. 2014;23(4):907-14.

Nnadi DC, Singh S. The prevalence of neural tube defects in north-west Nigeria. Suadi J Health Sci. 2016;5(1):6-10.

Adeleye AO, Olowookere KG. Central nervous system congenital anomalies: a prospective neurosurgical observational study from Nigeria. Congenit Anom (Kyoto). 2009;49(4):258-61.

Idowu OE, Olawehinmi OS. Surgical congenital central nervous system anomalies in a tropical teaching hospital. Br J Neurosurg. 2012;26(5):726-9.

Airede KI. Neural tube defects in the middle belt of Nigeria. J Trop Pediatr. 1992;38(1):27-30.

Goetzinger KR, Shanks AL, Odibo AO, Macones GA, Cahill AG. Advanced Maternal Age and the Risk of Major Congenital Anomalies. Am J Perinatol. 2017;34(3):217-22.

Baird PA, Sadovnick AD, Yee IM. Maternal age and birth defects: a population study. Lancet. 1991;337(8740):527-30.

Czeizel A. Maternal mortality, fetal death, congenital anomalies and infant mortality at an advanced maternal age. Maturitas. 1988;1:73-81.

Hollier LM, Levana KJ, Kelly MA, Mcintire DD, Cunningham AFG. Maternal age and malformations in singelton births. Obstetrics and Gynecology. 2000;96(1):701-6.

Hagen A, Entezami M, Gasiorek-Wiens A, Albig M, Becker R, Knoll U, et al. The impact of first trimester screening and early fetal anomaly scan on invasive testing rates in women with advanced maternal age. Ultraschall in der Medizin-Euro J Ultrasound. 2011 Jun;32(03):302-6.

Kim MJ, Kim J, Hwang EH, Song Y, Kim H, Hyun T. Awareness, knowledge, and use of folic acid among non-pregnant Korean women of childbearing age. Nutr Res Pract. 2018;12(1):78-84.

Dessie MA, Zeleke EG, Workie SB, Berihun AW. Folic acid usage and associated factors in the prevention of neural tube defects among pregnant women in Ethiopia: cross-sectional study. BMC Pregnancy Childbirth. 2017;17(1):313.

Persad VL, Van den Hof MC, Dube JM, Zimmer P. Incidence of open neural tube defects in Nova Scotia after folic acid fortification. CMAJ. 2002;167(3):241-5.

Hamner HC, Tinker SC. Fortification of corn masa flour with folic acid in the United States: an overview of the evidence. Ann N Y Acad Sci. 2014;1312:8-14.

Czeizel AE, Rockenbauer M, Sørensen HT, Olsen J. The teratogenic risk of trimethoprim-sulfonamides: a population based case-control study. Reproductive Toxicology. 2001;15(6):637-46.

Jungmann EM, Mercey D, DeRuiter A, Edwards S, Donoghue S, Booth T, et al. Is first trimester exposure to the combination of antiretroviral therapy and folate antagonists a risk factor for congenital abnormalities?. Sexually transmitted infections. 2001 Dec 1;77(6):441-3.

Meijer WM, de Walle HE, Kerstjens-Frederikse WS, de Jong-van den Berg LT. Folic acid sensitive birth defects in association with intrauterine exposure to folic acid antagonists. Reprod Toxicol. 2005;20(2):203-7.