Termination of pregnancy among very preterm births and its impact on very preterm mortality: results from ten European population‐based cohorts in the MOSAIC study

Abstract

Objective To study the impact of terminations of pregnancy (TOP) on very preterm mortality in Europe.Design European prospective population-based cohort study.Setting Ten regions from nine European countries participating in the MOSAIC (Models of OrganiSing Access to Intensive Care for very preterm babies) study. These regions had different policies on screening for congenital anomalies (CAs) and on pregnancy termination.Population or sample Births 22-31 weeks gestational age.Methods The analysis compares the proportion of TOP among very preterm births and assesses differences in mortality between the regions.Main outcome measures Pregnancy outcomes (termination, antepartum death, intrapartum death and live birth) and reasons for termination, presence of CAs and causes of death for stillbirths and live births in 2003.Results Pregnancy terminations constituted between 1 and 21.5% of all very preterm births and between 4 and 53% of stillbirths. Most terminations were for CAs, although some were for obstetric indications (severe pre-eclampsia, growth restriction, premature rupture of membranes). TOP contributed substantially to overall fetal mortality rates in the two regions with late second-trimester screening. There was no clear association between policies governing screening and pregnancy termination and the proportion of CAs among stillbirths and live births, except in Poland, where neonatal deaths associated with CAs were more frequent, reflecting restrictive pregnancy termination policies.Conclusion Proportions of TOP among very preterm births varied widely between European regions. Information on terminations should be reported when very preterm live births and stillbirths are compared internationally since national policies related to screening for CAs and the legality and timing of medical terminations differ.

Homocysteine remethylation pathway in neonates with congenital heart disease and neural tube defects

“…The percentage of the above-mentioned defects is higher in Poland than in most European countries, due to the fact that in Poland there are fewer cases of pregnancy terminations after the diagnosis of developmental anomalies during prenatal examinations. According to the Papiernik et al study, Poland is among the countries with the lowest frequency of abortions due to developmental defects [7]. Our report is the first study examining the relationships between concentrations involved in one-carbon metabolism (homocysteine, folate and vitamin B 12 ) in mothers and their offspring with congenital malformations (CHD and NTD).…”

“…It has been well documented that HHcy is associated with the occurrence of congenital defects, including neural tube closure failure and conotruncal septal anomalies in the heart [8,9,10,11]. HHcy is considered to be one of the independent etiological agents stimulating inborn, structural defects [7,10,11]. The impact of HHcy on embryonic precursor cells leads to defective fetal development, which results in impaired closure of the neural tube and abnormal development of the aorticopulmonary septum [6].…”

Neonatal Mortality: Incidence, Correlates and Improvement Strategies

“…These neonatal deaths, which usually occur in labour and delivery suites, may not be reported in unit-based studies (Evans & Levene, 2001). Similarly legal frameworks, clinical guidelines and practice of termination of pregnancies varies widely between countries and cultural groups, which affects overall perinatal and neonatal mortality (Papiernik et al, 2008). These variations in policy and practice generate variations between populations of very preterm births among countries.…”

“…In the MOSAIC Study cohort (Europe), pregnancy terminations constituted between 1 and 21.5percent of all very preterm births and between 4 and 53percent of stillbirths. Most terminations were due to congenital anomalies (Papiernik et al, 2008).…”

Neonatal mortality: the chance for improvement

“…12,13 This issue has also been studied in MOSAIC, which found large differences in the proportion of very preterm stillbirths resulting from terminations of pregnancy in European regions, and which found high rates of neonatal deaths due to congenital anomalies in Poland, a country with restrictive termination policies. 14 There also are discrepancies in how stillbirths and live births are classified despite the well-known and commonly accepted definitions of the World Health Organization. 15 Clinical practices differ as well, ranging from continuation or discontinuation of treatment up to extreme approaches such as the 'Groningen Regulation' allowing euthanasia on children whose condition does not promise proper development.…”