Prevalence of congenital anomalies and prenatal diagnosis by birth institution (public vs. non-public): indicators of inequality in access to elective termination of pregnancy for fetal anomalies.
Paloma Brun, Boris Groisman, María Paz Bidondo, Pablo Barbero, Marianela Trotta, Rosa Liascovich
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引用次数: 0
Abstract
Congenital anomalies (CA) encompass all morphological or functional alterations originating prenatally and present at birth. The prenatal diagnosis of these anomalies can significantly impact the overall health of the pregnant individual and may influence her decision regarding the continuation of the pregnancy. In contexts where safe pregnancy termination is not guaranteed by the state, it can lead to unsafe procedures with severe consequences. In our research, we analyzed epidemiological information on CA to develop potential indicators of inequity in access to safe abortion prior to the legalization of legal termination of pregnancy in Argentina. We included cases from 13 public hospitals and 9 non-public subsector hospitals, from the period 2013-2020. Two groups of specific CA were selected: 1) CA capable of being prenatally diagnosed, and 2) CA related to vascular disruptive events. 10/18 of the selected CA capable of being prenatally diagnosed had a significantly higher prevalence in public hospitals (anencephaly, encephalocele, spina bifida, microcephaly, hydrocephalus, holoprosencephaly, hydranencephaly, diaphragmatic hernia, gastroschisis, bilateral renal agenesis). Non public hospitals had higher prenatal detection. Birth prevalence of CA related with vascular disruptive events (limb reduction, Moebius syndrome, amniotic band sequence) were significantly higher in public hospitals. These results suggest disparities in access to prenatal diagnosis and safe abortion based on socioeconomic status. There was a significant gap in access to prenatal diagnosis for CA and possibly to safe elective abortion depending on the type of institution (public vs. non-public).
先天性畸形(Congenital anomalies,CA)包括所有源自产前并在出生时出现的形态或功能改变。这些异常的产前诊断会对孕妇的整体健康产生重大影响,并可能影响其是否继续妊娠的决定。在安全终止妊娠得不到国家保障的情况下,可能会导致不安全的手术,造成严重后果。在我们的研究中,我们分析了有关 CA 的流行病学信息,以制定在阿根廷合法终止妊娠合法化之前安全堕胎机会不平等的潜在指标。我们纳入了 2013-2020 年间 13 家公立医院和 9 家非公立分部门医院的病例。我们选取了两组特定的CA:1)可在产前确诊的CA;2)与血管破坏事件相关的CA。在所选的可进行产前诊断的 CA 中,10/18 在公立医院的发病率明显更高(无脑畸形、头畸形、脊柱裂、小头畸形、脑积水、全脑畸形、肾积水、膈疝、胃畸形、双侧肾发育不全)。非公立医院的产前检测率较高。与血管破坏事件(肢体缩窄、莫比乌斯综合征、羊膜带序列)相关的 CA 出生率在公立医院明显较高。这些结果表明,在获得产前诊断和安全堕胎方面,社会经济地位存在差异。不同类型的机构(公立与非公立)在获得 CA 产前诊断和安全选择性人工流产方面存在明显差距。
期刊介绍:
The Journal of Community Genetics is an international forum for research in the ever-expanding field of community genetics, the art and science of applying medical genetics to human communities for the benefit of their individuals.
Community genetics comprises all activities which identify persons at increased genetic risk and has an interest in assessing this risk, in order to enable those at risk to make informed decisions. Community genetics services thus encompass such activities as genetic screening, registration of genetic conditions in the population, routine preconceptional and prenatal genetic consultations, public education on genetic issues, and public debate on related ethical issues.
The Journal of Community Genetics has a multidisciplinary scope. It covers medical genetics, epidemiology, genetics in primary care, public health aspects of genetics, and ethical, legal, social and economic issues. Its intention is to serve as a forum for community genetics worldwide, with a focus on low- and middle-income countries.
The journal features original research papers, reviews, short communications, program reports, news, and correspondence. Program reports describe illustrative projects in the field of community genetics, e.g., design and progress of an educational program or the protocol and achievement of a gene bank. Case reports describing individual patients are not accepted.