Characteristics of mothers who give birth to babies with structural congenital anomalies presenting at selected hospitals in Zambia

Abstract

Congenital anomalies (CA) is not only a leading cause of fetal loss, but also contributes significantly to preterm birth, childhood and adult morbidity along with impact on the mothers’ and their families’ psychosocial condition. From many studies, including those from Africa, it is apparent that maternal Socio-demographic status, nutritional status, educational level and overall healthcare have substantial impact on prevalence of certain congenital anomalies. Several congenital anomalies are avoidable by modest measures, and therefore there is need for data on structural anomalies and maternal characteristics related to congenital anomalies. In Zambia, the prevalence of congenital anomalies and characteristics of mothers who give birth to babies with congenital anomalies have not been examined in studies. Therefore, this study aimed to explore maternal characteristics in order to help develop targeted interventions, that may lead to a reduction of the incidence of congenital anomalies, as well as perinatal and neonatal mortality. This was a hospital based unmatched case control study comprising 112 mothers with babies with CA and 216 mothers with normal babies who were recruited from Neonatal Intensive Care Unit (NICU) and Labour Wards of the University Teaching Hospital (UTH), Levy Mwanawasa University Teaching Hospital (LMUTH), Ndola Teaching Hospital and Kitwe Teaching Hospital in Zambia from October, 2018 to February, 2019. Convenient sampling method was used for cases, controls were consecutively recruited. The commonest CA identified were neural tube defects (33%), while the least were genitourinary system anomalies (2.7%). It was also found women who had attained only up to primary education were 6 times more likely to give birth to a baby with CA (AOR 6.305; 95% CI 1.223-32.507). Those women who had consumed alcohol in the index pregnancy were 4 times more likely to give birth to a baby with CA (AOR 4.639; 95% CI 1.284-16.766). Maternal obesity was found to be predictor of CA (AOR 2.902; 95% CI 1.229-19.555). Further, mothers who started taking folic acid supplementation in first trimester were more than 90% less likely to give birth to a child with CA in the index pregnancy (OR 0.032; 95% CI 0.004-0.256). The magnitude and the burden of congenital anomalies among mothers in Zambia continuous to be high. The maternal risks for CA was found to be multifactorial. A lifestyle modification, like pre-pregnancy weight reduction, avoiding alcohol in pregnancy can lead to a reduction in CA. The role of folic acid supplementation in reduction of NTDs and other birth defects cannot be overemphasised.

Key Words: Congenital anomalies, fetal loss, preterm birth, childhood and adult morbidity