BIBLIOGRAPHIC INPUT SHEET TEMPORARY Patterns of mortality ...

ChapterX. CongenitalAnomalies
105
TABLH 105. Deaths of Infants with Congenital Anomalies of Nervous System in Urban and Rural
Areas of El Salvador Project.
Area
Infants with
ranomales
anornlles"nervous
Aneneephalus Spina hifida Other systemo of
(740) (741) (742, 743)
No.
Rate
No. nate No. Itate No. Itate
San Salvador .................... 40 156.1
Rural municipios................. 18 333.3
6 23.4 2) 113.2 8 31.2
2 37.0 11 203.7 6 111.1
IRates per 100 000 live births.
bFour infants had two anomalies.
small, this is a valuable clue for research
into the causation of these serious anonmlies.
It may be, for example, that there is
something lacking in the diet in the rural
municipios and that the deficiency of that
element is greater than in the city. The Investigation
was very well conducted in El
Salvador even though the diagnostic facilities
were limited in the rural municipios.
Therefore, this may represent the most coinplete
data collected in an area known to
have an unusually high frequency of serious
nutritional deficiency. It has been known
for some time that certain antimetabolites
produce teratogenic effects through nutritional
or toxic mechanisins. Such is the ease
of Aminopterin I4-,iiiino-l)teroylglutamic
acid), an antimetaolite of folic acid used in
the treatment of leukemia, which has been
known to produce cleft lip and cleft palate,
hydroceplhalus, anenceplhalus, and enceplalocele
as observed in embryos and fetuses
of women who have used that drug as an
abortive (Thiersch, 1956; Warkany et al.,
1959). The question remains whether there
is a possibility that chronic deficiency of nutrients
such as folic acid, operating perhaps
through various generations, could be responsible
for increased frequency of these
serious anomalies. If the health status of the
mother was altered by nutritional deficiency,
such damage might be transmitted to her
children. Excessive death rates for protein
malnutrition in deceased children were
found in the El Salvador project, as was
shown in Chapter IX (Nutritional Deficiency).
The data surely indicate the need for
further research in this field.
Because of the prol)able importance of
age of the mother at birth of child as a deterinining
factor, (lata on maternal age are
presented for infant deaths from congenital
anonlries of the nervous system (Table
106).
For seven projects the distributions of live
births were available for use in calculation
of death rates by age of mother (Table 107).
Fortunately, three of these projects aire the
ones with unusual frequencies of anomalies
of the nervous system.
The death rates for these anomalies in
Shterbrooke were high in infants of young
mothers and declined in the older mothers.
In El Salvador the rate was high for young
mothers but eveen higher for mothers agedh
35 years and over (Figure 991. Thus the
l)atterns of mortality in these two projects
appear to differ. In the El Salvador project
the rate was high due to spina bifida,
while in Sherbrooke the rate was high for
that condition as well as for anencel)halus.
It is possible that the causative agents of
anencephalus and spina hifida differ also.
The pattern in Monterrey is similar to that