Abstract
Birth defects are a global problem, but their impact is particularly severe in low and middle income countries, where the conditions for prevention, treatment, and rehabilitation are more critical. The epidemiological transition in the infant mortality causes, and the concern of the community and the mass media about the teratogenic risk of environmental pollutants, has made health authorities aware of the importance of birth defects in Argentina. The objective of this paper is to outline those actions specifically taken in Argentina aimed at the prevention of birth defects at a national level. Firstly, we focus on birth defects in Argentina on a general basis, and then we present different laws and actions taken in terms of surveillance and public health programs, primary, secondary, and tertiary prevention. Finally, we present the Teratology Information Service “Fetal Health Line”, and the genetic services organization and health professionals training by the National Center of Medical Genetics and the National Program of Genetics Network. In conclusion, in the country, several programs focus on different approaches to the problem, and the challenge is to coordinate the teamwork between them. Finally, we list tips to address birth defects from the public health perspective.
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Alba A, Barbero P, Barreiro C, Chertkoff L, Dain L, Ferreiro V, Francipane L, Frechtel G, Gallego M, Liascovich R, Meroni ME, Rozental S (2007). Diseño y organización de una Red Nacional de Genética Médica (Design and organization of a national network of medical genetics.) Spanish. Unpublished, available from the author
Barbero P, Liascovich R, Rozental S, Botto R, Gramajo S, Haefliger C (2003) Conocimientos de tocoginecólogos y pediatras acerca de la etiología y los factores de riesgo de los defectos congénitos (Gynecologists and pediatricians knowledge about the etiology and risk factors of birth defects). Arch Argent Pediatr 101(3):184–192
Barbero P, Valdez R, Rodríguez H, Tiscornia C, Mansilla E, Allons A, Coll S, Liascovich R (2008) Choanal atresia associated with maternal hyperthyroidism treated with methimazole: a case-control study. Am J Med Genet A 146A:2390–2395. doi:10.1002/ajmg.a.32497
Barbero P, Liascovich R, Valdez R, Moresco A (2011) Efecto teratogénico del misoprostol: un estudio prospectivo en Argentina (Misoprostol teratogenicity: a prospective study in Argentina). Arch Argent Pediatr 109(3):226–231. doi:10.1590/S0325-00752011000300007
Barreiro CZ, Bidondo MP, Garrido JA, Deurloo J, Acevedo E, Luna A, Gutiérrez E, Dellamea CA, Picón C, Torres K, De Castro MF, Torrado MV, Teiber ML, Kassab S, Elmeaudy P, Rodriguez J (2013) CHACO outreach project: the development of a primary health care-based medical genetic service in an Argentinean province. J Commun Genet 4(3):321–334
Borruel M, Mas P, Borruel G (2010) Estudio de carga de enfermedad (burden of diseases study). National Ministry of Health Website www.msal.gov.ar/fesp/descargas_home/Estudio_de_carga_FESP_Imprenta.pdf. Accessed 24 Feb 2014
Botto LD, Mastroiacovo P (2000) Surveillance for birth defects and genetic diseases in “Genetics and public health in the 21st century”. Oxford University Press, Oxford, UK
Bronberg R, Alfaro E, Chaves E, Dipierri J (2009) Mortalidad infantil por malformaciones congénitas en Argentina: análisis del quinquenio 2002–2006 (Analysis of infant mortality from congenital malformations in Argentina during the 2002–2006 period). Arch Argent Pediatr 107(3):203–211
Castilla EE, Orioli IM (2004) ECLAMC. The Latin-American collaborative study of congenital malformations. Commun Genet 7 pp 76:94
Christianson A, Howson CP (2006) Modell B. Global report on birth defects. The hidden toll of dying and disabled children. March of Dimes Birth Defects Foundation, White Plains
Consulting group on NTDs (2013) National Ministry of Health, Recomendaciones para los Servicios de Neonatología ante el diagnóstico de Mielomeningocele (Recommendations for neonatologists on management of myelomeningocele). Available from the corresponding author
DEIS (Department of Health Statistics and Research) National Ministry of Health (2013) Vital Statistics. www.deis.gov.ar/Publicaciones/Archivos/Serie5Nro56.pdf. Accessed 24 Feb 2014
DEIS (Department of Health Statistics and Research) & Department of Maternal and Child Health, National Ministry of Health (2012) Mortalidad Infantil según criterios de reducibilidad. Sistema Estadístico de Salud. 2011. Serie 3, Número 56. Tercera Revisión, Edición
Department of Maternal and Child Health, National Ministry of Health (2013) Recomendaciones para la Práctica del control preconcepcional, prenatal y puerperal (Recommendations for practices on preconception, prenatal and postnatal care). http://www.msal.gov.ar/images/stories/bes/graficos/0000000158cnt-g02.control-prenatal.pdf Accessed 24 Feb 2014
Epidemiological Bulletin, National Ministry of Health (2013) Available at http://www.msal.gov.ar/images/stories/boletines/Boletin%20Integrado%20De%20Vigilancia%20N200-SE52.pdf Accessed 24 Feb 2014
Garcia-Jimenez S (2011) Progresos en la eliminación del sarampión, la rubéola y el Síndrome de Rubéola Congénita en la región de las Américas (Progress towards elimination of measles, rubella and Congenital Rubella Syndrome in the Americas), Available at http://www.deafblindinternational.org/DOCS/PAHO%20paper%20-%20Spanish.ppt. Accessed 24 Feb 2014
Gregg NM (1991) Congenital cataract following German measles in the mother. 1941. Epidemiol Infect 107(1):iii–xiv
Groisman B, Bidondo MP, Barbero P, Gili JA, Liascovich R (2013a) RENAC Task Force. RENAC: National Registry of Congenital Anomalies of Argentina. Arch Argent Pediatr 111(6):484–494
Groisman B, Bidondo MP, Gili JA, Barbero P, Liascovich R (2013b) Strategies to achieve sustainability and quality in birth defects registries: the experience of the National Registry of Congenital Anomalies of Argentina. J Registry Manag 40(1):29–31
Groisman B, Liascovich R, Barbero P, Alberg C, Moorthie S, Nacul L, Sagoo GS (2013c) The use of a Toolkit for health needs assessment on neural tube defects in Argentina. J Commun Genet 4(1):77–86
Incluir Salud (2014) Available at http://www.msal.gov.ar/index.php/programas-y-planes/295-incluir-salud Accessed 24 Feb 2014
INDEC (2003) National Institute for Statistics and Census, National survey on disabled people. www.indec.mecon.ar/principal.asp?id_tema=166. Accessed 24 Feb 2014
INDEC (2010) National Institute for Statistics and Census. www.indec.gov.ar. Accessed 24 Feb 2014
Law 1.101 (1985) Creación de la Comisión Nacional Asesora para la Integración de Personas Discapacitadas (Creation of the National Advisory Committee for the Integration of Disabled People), Available at http://www.infoleg.gov.ar/infolegInternet/anexos/180000-184999/183546/texact.htm Accessed 24 Feb 2014
Liascovich R, Rozental S, Barbero P, Alba L, Ortiz Z (2006) Censo de servicios de genética médica en Argentina (A census of medical genetics services in Argentina). Rev Panam Salud Púb 19(2):104–111
Liascovich R, Gili JA, Valdez R, Somaruga L, Goldshmidt E, Bronberg R, Ricagni C, Mussi M, Medina A, Deguer C, Menzio M, Guevel C, Fernández MM, Marconi E, López Camelo JS (2011) Desarrollo de un registro nacional de anomalías congénitas: estudio piloto de factibilidad (Development of a national registry of congenital anomalies: a feasibility pilot study). Rev Argent Salud Pública 2(6):6–11
López-Camelo JS, Castilla EE, Orioli IM (2010) Folic acid flour fortification: impact on the frequencies of 52 congenital anomaly types in three South American countries. Am J Med Genet A 52A(10):2444–2458
Luquetti DV, Koifman RJ (2011) Surveillance of birth defects: Brazil and the US. Cien Saude Colet 16(1):777–785
Mario S, Pantelides EA (2009) Estimación de la magnitud del aborto inducido en la Argentina (Estimation of the magnitude of induced abortion in Argentina). Notas de Población 87:95–120. Available at www.eclac.cl/publicaciones/xml/1/36501/lcg2405-P_4.pdf Accessed 24 February 2014
Martín MC, Barbero P, Groisman B, Aguirre MA, Koren G (2014) Methotrexate embryopathy after exposure to low weekly doses in early pregnancy. Reprod Toxicol 43:26–29
Nacul LC, Stewart A, Alberg C, Chowdhury S, Darlison MW, Grollman C, Hall A, Modell B, Moorthie S, Sagoo GS, Burton H (2014) A Toolkit to assess health needs for congenital disorders in low- and middle-income countries: an instrument for public health action. J Public Health 36(2):243–250
National Law 22,431 (1981) Available at http://www.infoleg.gob.ar/infolegInternet/anexos/20000-24999/20620/texact.htm Accessed 24 Feb 2014
National Law 23413 (1986) Available at http://www.infoleg.gov.ar/infolegInternet/verNorma.do?id=22294 Accessed 24 Feb 2014
National Law 23874 (1990) Available at http://www.infoleg.gov.ar/infolegInternet/verNorma.do?id=274 Accessed 24 Feb 2014
National Law 24438 (1994) Available at http://www.infoleg.gob.ar/infolegInternet/verNorma.do;jsessionid=F6E7FCBD46D2EAE91992A8584712E32B?id=811 Accessed 24 Feb 2014
National Law 24,901 (1997) Available at http://infoleg.mecon.gov.ar/infolegInternet/anexos/100000-104999/100218/norma.htm Accessed 24 Feb 2014
National Law 25,504 (2001) Available at http://infoleg.mecon.gov.ar/infolegInternet/verNorma.do?num=70726&INFOLEG_OLD_QUERY=true Accessed 24 Feb 2014
National Law 25.630 (2002) Available at http://infoleg.mecon.gov.ar/infolegInternet/anexos/75000-79999/77088/norma.htm Accessed 24 Feb 2014
National Law 26279 (2007) Available at http://infoleg.mecon.gov.ar/infolegInternet/anexos/130000-134999/131902/norma.htm Accessed 24 Feb 2014
National Law 26.689 (2011) Available at http://infoleg.gob.ar/infolegInternet/anexos/185000-189999/185077/norma.htm Accessed 24 Feb 2014
National Ministry of Health (2011) Procedures manual for endocrine and metabolic screening, Available at http://www.msal.gov.ar/images/stories/bes/graficos/0000000068cnt-p01-manual-de-procedimiento.pdf. Accessed 2 Feb 2014
National Program for Early Detection and Treatment of Hearing Loss (2012) NMoH. Situación actual del Programa Nacional de Detección Temprana y Atención de la Hipoacusia (Current situation of the National Program for Early Detection and Treatment of Hearing Loss). Available at http://www.msal.gov.ar/images/stories/cofesa/2012/acta-03-12/2-hipoacusia-03-12.ppt Accessed 24 Feb 2014
PAHO (2009) Plan de Acción para la documentación y verificación de la eliminación de sarampión, rubéola y síndrome de rubéola congénita en la Región de las Américas (Action plan for the documentation and verification of the elimination of measles, rubella and congenital rubella syndrome in the Americas). Available at http://www.bvsde.paho.org/texcom/sct/048018.pdf Accessed 24 Feb 2014
PAHO (2011) Aportes para el desarrollo humano en Argentina (Contributions for human development in Argentina). Available at http://www.undp.org.ar/desarrollohumano/El%20sistema%20de%20salud%20argentino%20-%20%20pnud%20ops%20cepal%20version%20final.pdf Accessed 24 Feb 2014
Palena C, Bahamondes MV, Schenk V, Bahamondes L, Fernandez-Funes J (2009) High rate of unintended pregnancy among pregnant women in a maternity hospital in Córdoba, Argentina: a pilot study. Reprod Health 6:11
Pardon F, Vilariño M, Barbero P, Garcia G, Outon E, Gil C, Vera A, Rossi S, Distefano A (2011) Rubella vaccination of unknowingly pregnant women during 2006 mass campaign in Argentina. J Infect Dis 204(Suppl 2):S745-S747
Penchaszadeh VB (2013) Genetic testing and services in Argentina. J Commun Genet 4(3):343–354
Plan SUMAR (2013) National Ministry of Health, Annual report, Available at http://www.msal.gov.ar/sumar/images/stories/pdf/memoria-anual-sumar-2013.pdf. Accessed 24 Feb 2014
Plan SUMAR nomenclator (2013) National Ministry of Health. Available at http://www.msal.gov.ar/sumar/images/stories/pdf/nomenclador.pdf
Press department, National Ministry of Health (2014) Press release on the National Program for congenital heart disease, Available at http://www.msal.gov.ar/prensa/index.php?option=com_content&view=article&id=1817:en-tres-anos-operaron-gratuitamente-del-corazon-a-casi-6000-chicos-de-todo-el-pais&catid=6:destacados-slide1817. Accessed 24 Feb 2014
ProNaCEI (2014) Available at http://www.msal.gov.ar/images/stories/epidemiologia/inmunizaciones/Alerta-caso-confirmado-rubola-13-6-2014.pdf
RENAC (2014) Annual Report, National Center of Medical Genetics, National Ministry of Health (available from the corresponding author)
Resolution 1227 (2008) National Ministry of Health. Available at http://www.infoleg.gov.ar/infolegInternet/anexos/145000-149999/146485/norma.htm. Accessed 24 Feb 2014
Salud Fetal (2014) National Center of Medical Genetics. Available at http://www.anlis.gov.ar/inst/CeNaGeM/saludfetal/todo.htm. Accessed 24 Feb 2014
Speranza AM, Kurlat I (2001) Regionalización del cuidado peri-natal: una estrategia para disminuir la mortalidad infantil y la mortalidad materna. Rev Argent Salud Pública 2(7):40–42
Stevenson RE, Hall JH, Goodman RM (1993) Human malformation and related Anomalies. Oxford monographs on medical genetics N. 27. Oxford University Press, New York
Valdez RM, Barbero PM, Liascovich RC, De Rosa LF, Aguirre MA, Alba LG (2007) Methimazole embryopathy: a contribution to defining the phenotype. Reprod Toxicol 23(2):253–255
Williams R, Wright J (1998) Epidemiological issues in health needs assessment. BMJ 316(7141):1379–1382. doi:10.1136/bmj.316.7141.1379
World Health Assembly (2010) Sixty-third world health assembly: birth defects. WHO website http://apps.who.int/gb/ebwha/pdf_files/WHA63/A63_R17-en.pdf. Accessed 24 Feb 2014
Wright J, Williams R, Wilkinson JR (1998) Development and importance of health needs assessment. BMJ 316(7140):1310–1313. doi:10.1136/bmj.316.7140.1310
Zabala R, Waisman I, Corelli M, Tobler B (2008) Ácido fólico para prevenir defectos del tubo neural: consumo e información en mujeres en edad fértil de la Región Centro Cuyo (Folic acid for neural tube defects prevention: consumption and information in fertile-age women in Centro Cuyo Region). Arch Argent Pediatr 106(4):295–301
Acknowledgments
This work was supported by grants from the Agencia Nacional de Promoción Científica y Técnológica, Buenos Aires, Argentina (PICTO 2011-0147), and the National Ministry of Health (Becas Salud Investiga 2011-2012-2013).
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The authors declare that the experiments comply with the current laws of the country in which they were performed (Argentina).
Conflict of interest
María Paz Bidondo, Boris Groisman, Pablo Barbero, and Rosa Liascovich declare that they have no conflict of interest.
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Bidondo, M., Groisman, B., Barbero, P. et al. Public health approach to birth defects: the Argentine experience. J Community Genet 6, 147–156 (2015). https://doi.org/10.1007/s12687-014-0209-x
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DOI: https://doi.org/10.1007/s12687-014-0209-x