Population-based surveillance of congenital anomalies over 40 years (1981-2020): results from the Paris Registry of Congenital Malformations (remaPAR).

INTRODUCTION:Registries of congenital anomalies (CAs) play a key role in the epidemiological surveillance of CAs. The objective was to estimate the prevalence of CAs and proportions of prenatal diagnosis, terminations of pregnancy for fetal anomaly (TOPFA) and infant mortality in the Paris Registry of Congenital Malformations (remaPAR) over 40 years, from 1981 to 2020. MATERIAL AND METHODS:remaPAR records all births (live births, stillbirths ≥22 weeks of gestation and TOPFA at any gestational age) with CAs detected prenatally until the early neonatal period. We estimated the prevalence of CAs and proportions of prenatal diagnosis, TOPFA and infant mortality, overall and for a selected group of CAs in 3-year intervals. RESULTS:The prevalence of CAs remained stable during the study period: 2.9% of total births and 2.1% of live births. Genetic anomalies were the most frequent subgroup (about 23%), followed by congenital heart defects (about 22%) and limb defects (about 20%). Among non-genetic anomalies, the prevalence per 10,000 births was the highest for hypospadias (about 18%) and the lowest for bilateral renal agenesis (about 1%). Prenatal diagnoses increased from about 17% in the 1980s to approximately 70% in the most recent period (2018-2020), whereas the proportion of early TOPFA <16 weeks of gestation increased from 0.4% to 14%. Infant mortality ranged from 0% for transverse limb reduction defects to 86% for hypoplastic left heart syndrome. CONCLUSION:The overall prevalence of CAs was fairly stable in Paris from 1981 to 2020. Prenatal diagnoses substantially increased, accompanied by much smaller increases in TOPFA.