Congenital anomalies in an area at high risk of environmental crisis. The case of Brindisi

Introduction Congenital anomalies (CAs) and their primary prevention are a public health issue and both genetic and environmental factors can contribute to their causation. Brindisi is an area "at high risk of environmental crisis". This work aimed at estimating the prevalence of CAs and at evaluating possible association with air pollution. Materials and methods Newborns up to 28 days of age, born between 2001 and 2010 to mothers resident in Brindisi and discharged with a diagnosis of CA have been considered. We classified cases according to the coding system adopted by the European Network for the Surveillance of Congenital Anomalies (EUROCAT). We classified cases in the following categories: total CAs, congenital heart disease (CHDs) and other CAs according to the coding system adopted by EUROCAT. We classified CHDs in three classes according to their severity. Prevalence rates of CAs in Brindisi were compared with those reported by EUROCAT. Logistic regression models were adapted to evaluate the association between CAs and municipality of residence of the mother during pregnancy. Total suspended particles, nitrogen and sulfur dioxides were routinely monitored over the ten years. Exposition was then estimated from air quality monitors data as averages and percentiles over pregnancy 3rd-8th weeks. Results and discussion Out of 8,503 newborns we recorded 194 subjects with CAs (228.2/10,000 total births), 1.2 times higher than the one reported by the EUROCAT pool of registries. We observed 83 subjects with congenital heart diseases (CHDs) with an excess of 49.1%. Odds Ratios for CHDs significantly increased for newborns to mothers resident in Brindisi. Out of 83 cases with CHD, we observed 9 cases (10.8%) with medium probability of perinatal mortality (Severity II) and 69 cases (83.1%) with low probability of perinatal mortality (Severity III). No case with high probability of perinatal mortality was registered. Five cases (6%) were not classified because of a poorly specified code. Two cases of CHDs (2.4%) were associated with a chromosomal anomaly. Among 109 cases with CAs observed from 2001 to 2005, 59.6% presented further hospital admissions; of these 38.5% reported the same diagnosis of CAs observed in the first 28 days of life. Our findings indicated an increased prevalence of CAs (especially CHDs) in the city of Brindisi. Averaged exposition for CA cases showed slightly higher values than that for newborns without CA. A case-control analysis might give more detailed results. More research in terms of etiological studies is needed, in order to analyze the role of different risk factors in the possible causation of CAs and to identify the best strategies for primary prevention.