Risk factors for congenital anomalies in high risk pregnant women: A large study from South India

Abstract

Background: High Risk Pregnancy (HRP) is a condition where mother or developing fetus or both are at increased risk of complications during or after pregnancy and birth. There are no studies so far which have characterized congenital anomalies (CAs) in HRP women with different previous obstetric histories.

Aim: The present study was aimed to determine the prevalence, types and distribution of various CAs and also to find out the exact risk factors for different obstetric histories.

Subjects and methods: A total of 3301 HRP women (2011–2014) were enrolled. Diagnosis was made using 3D/4D ultrasound. Serum was analyzed for IgG & IgM against TORCH (Toxoplasma, Rubella, CMV and HSV) agents by ELISA. Eleven percent were pregnant women carrying fetuses with CAs in the present pregnancy, while remaining 89% were with bad obstetric history (BOH) and other medical and obstetric complications.

Results: Eleven percent pregnant women were carrying fetuses with CAs in the present pregnancy. The major CAs observed were Central Nervous System (CNS) followed by renal anomalies. Maternal age (≤25 years, OR =1.42, p= 0.002), paternal age (<30 years, OR =1.51, p< 0.001), consanguinity (OR =1.39, p= 0.012) and primi gravida (OR= 3.40, p<0.001) were identified as risk factors for HRP women with fetal CAs in present pregnancy. Maternal age 625 years and paternal age <30 years conferred around 2-fold risk toward CAs in primi gravida
women (p< 0.001) whereas consanguinity was associated with CAs in HRP women with BOH (OR= 1.95, p<0.018). Toxoplasmosis played a significant role in pregnant women with CAs in present pregnancy with previous normal pregnancies (OR = 4.45, p= 0.009).

Conclusion: High prevalence of CAs was found in HRP women compared to general population. Low parental age contributed toward CAs in primi gravida women while consanguinity was found to be a predisposing factor for CAs in HRP with previous BOH. Toxoplasmosis conferred risk for CAs in HRP women with previous normal pregnancies.

Keywords: High Risk Pregnancy; Congenital anomalies; Bad obstetric history; Ultrasound; Toxoplasma; Rubella; CMV and HSV