Introduction
In Oman, LBW was 10.2% out of a total live birth of over 66,000 live
birth during 2013. The worldwide prevalence of low birth weight (LBW) is
15.5%, which amounts to about 20 million LBW infants born each year,
96.5% of them in the developing countries (1). For example, in Oman,
the prevalence of LBW was 4.2% in 1980, which doubled (8.1%) in 2000
and has shown a slow but steady increase reaching 10.2% in 2013. This
also causes an increase in the rate of LBW infants, and subsequently an
increased rate of long-term medical sequalae.
LBW has been increasing globally and regionally with various advancement
in medical care; including that of obstetric and neonatal care and
technological development with restricted growth, and pregnancy
complications are taking place as live births.
Recently, over the last few decades, devotion has been steered toward
the contribution of the intrauterine environment to the development of
chronic and noncommunicable diseases (NCD). Epidemiological studies have
demonstrated that a poor intrauterine environment is associated with an
increased risk of various non-communicable diseases such as chronic
kidney disease, and diabetes (1-5). Many of these diseases may be
associated with birth anomalies. Birth defects are an important cause of
infant mortality and disproportionately occur among LBW infants.
Congenital anomalies, also commonly referred to as birth defects, are
conditions of prenatal origin that are present at birth. Congenital
anomalies have a lifelong impact on children’s health and survival (6).
It is estimated that 1 in 33 newborns have birth defects and it leads to
300 000 yearly deaths of neonates (1) and linked to 3.2 million birth
related disabilities (7). Congenital anomalies encompass a wide array of
structural and functional abnormalities that can occur in isolation
(i.e., single defect) or as a group of defects (i.e., multiple defects).
Multiple defects may occur as part of well-described associations, such
as the non-random co-occurrence of vertebral anomalies, anal atresia,
cardiac defects, trachea-esophageal fistula, and/or esophageal atresia,
renal and radial anomalies, and limb defects (VACTERL) (8, 9). Such
disabilities can impose social stigma and economic burden on poor
families, society and health care organizations (6). Cardiac system,
neural tube defects and Down syndrome are most common type of anomalies
seen (6).
In 2013 the Global Burden of Disease reported that congenital anomalies
are one of the top ten causes of mortality in children under five years
old (10). Globally, the trend of childhood mortality due to infection
and malnutrition is decreasing. This is likely due to the wide
availability of vaccination, infection control and improvement in
nutrition supply (11). Besides, the availability of standard pediatric
and maternal health services, the contribution of congenital anomalies
upon mortality and morbidity of neonates is on the rise (12). Early
diagnosis of congenital anomalies in antenatal period is important for
effective counseling, fetal or neonatal timely intervention and
termination of pregnancy if needed, planning delivery and future
prevention (13, 14). The world health Assembly has highlighted the
importance of taking actions in prevention diagnosis and timely
intervention (15, 16).
To deal with the problem efficiently, accurate data is crucial to
establish the appropriate methods of surveillance of congenital
anomalies (17-20). Accurate estimate on the prevalence and mortality
linked to birth defects are limited in low- and middle-income countries
in contrast with high-income countries. For instance, in UK, the
prevalence of congenital anomalies estimated to be 2-3 % and the
20-year survival rate is about 85.55% (21). In United State it is
estimated to be 2-3% (17), 1.07% in Japan (22), in India 2.5 % (17)
and in KSA 52.17 per 1000 pregnancies (7, 23). However, government
actions and efforts on improving risk factors and primary prevention is
more effective when based on accurate data and information gathered
about the causes, patterns and outcomes of congenital anomalies (7, 23).
In this study, we gathered data from the only tertiary hospital for
obstetric cases that seen in the Obstetric Ultrasound and Fetal Medicine
units, of fetuses with major congenital anomalies, for a duration of 10
years. Main aim was to identify the prevalence, patterns, maternal
characteristics and perinatal outcomes.