Decrease of perinatal mortality associated with congenital anomalies after prenatal screening was introduced in the Netherlands

OBJECTIVES: There has been much discussion about the relatively high perinatal mortality seen in the Netherlands (Buitendijk 2004, Europeristat 2009), for which congenital anomalies (CA) are known to be one of the four main risk factors. There was no nationwide routine prenatal screening for CA in the Netherlands until 2007. We have analysed data for a 14-year period from the EUROCAT registries to investigate the effect of the introduction of screening for CA on the perinatal mortality rate in the Netherlands and compared the results with those from other European registries. METHODS: We used data from the European Surveillance of Congenital Anomalies (EUROCAT) database covering the period 1998 to 2011. We included registries that had correctly coded the date of death for more than 80% of their cases. Perinatal mortality was defined as: deaths in the first week after birth plus late foetal deaths and stillbirths from 20 weeks' gestation onwards, excluding terminations of pregnancy for foetal anomalies (TOPFA). RESULTS: A total of 84.832 cases of CA were included from 13 European registries covering a total of 3.1million births. In Europe the perinatalmortality associated with CA decreased from an average of 1.35 per 1000 births in the period 1998-2006 to 1.15 per 1000 births in the period 2007-2011. In the northern Netherlands, it dropped from 1.73 per 1000 births in the period 1998-2006 to 1.00 per 1000 births in the period 2007- 2011. In 2011, the perinatal mortality associated with CA in the northern Netherlands was on the same level as the rest of Europe. Our data also showed that, since the introduction of prenatal screening, more parents have chosen to terminate a pregnancy if congenital anomalies are discovered. CONCLUSIONS: Perinatal mortality associated with congenital anomaly (CA) has decreased in the northern Netherlands since 2005. The introduction of prenatal screening in 2007 markedly contributed to this trend: pregnancies involving CA were terminated more often, leading to a decrease in the perinatal mortality rate. By 2011, the perinatal mortality rate associated with CA in the northern Netherlands was equal to that for the rest of Europe.