Surveillance of Multiple Congenital Anomalies in Italian Contaminated Sites

Introduction. Multiple Congenital Anomalies (MCAs) are events characterized by major defects of more organ systems not recognized as a sequence or as a consequence of a syndrome. MCAs are considered sensitive reproductive outcomes for detecting new teratogenic agents, including environmental factors. The aim of this study is to investigate the risk of MCAs in the newborns residing in the Italian National Priority Contaminated Sites (NPCSs). Methods. A total of 14 NPCSs covered by regional registries of congenital anomalies were analyzed. Specific algorithms for the detection of cases of congenital anomalies from healthcare databases were used for the NPCSs partially covered by registry. Cases of MCA were extracted applying a specific computer algorithm developed by EUROCAT. For each NPCS, Prevalence Ratio (PR) with 90% Confidence Interval (CI) were calculated using the corresponding regional area as reference. Results. 781 cases with MCA were observed among 290,000 births in the NPCSs between 1992 and 2011. The prevalence in the NCPSs was 26.9 per 10,000 newborns, higher than the prevalence observed in the total area covered by registries (21.6/10,000) and in the EUROCAT registries (15.8/10,000). Excesses of MCAs were detected in the NPCSs of Manfredonia-Apulia region (PR=1.56; 90%CI: 1.13-2.11), Mantua-Lombardy region (PR=1.37; 90%CI: 0.94-1.92) and Leghorn-Tuscany region (PR=1.20; 90%CI: 0.95-1.52). Conclusions. We observed a high prevalence of MCAs in some contaminated areas where a critical reproductive health status of the residing population emerged from a recent national study. Even though MCAs are quite rare events, they represent a useful outcome to detect a possible role of environmental factors in the occurrence of congenital anomalies. This feature is especially considerable in the surveillance of population residing in contaminated areas. The results contribute to highlighting the need to strengthen research and health surveillance activities in NPCSs.