The effect of some factors (age group of mother, new borne gender year months) on the congenital malformation percent of new borns in Al-Zahra Hospital for obstatric and pediatric /

The study was conducted on specimen (402) of new born congital malformations during years (2009,2010,2011) in al-Zahra hospital of obstatric / Al-Najaf , for determine the relation-ship among (age group of mother ,new borne gender, and year months ) with malformation percent.

The study was conducted on specimen (402) of new born congital malformations during years (2009,2010,2011) in al-Zahra hospital of obstatric / Al-Najaf , for determine the relation-ship among (age group of mother ,new borne gender, and year months ) with malformation percent.

Introduction
According to the World Health Organization the term congenital anomaly includes any morphological, functional, biochemical or molecular defects that may develop in the embryo and fetus from conception until birth, present at birth, whether detected at that time or not(1). In recent years, a number of studies have shown that prenatal exposures of the parents are associated with an increased risk for having malformed child (2,3). There may be regional variations in the rate and pattern of congenital malformations or these could vary over time (4).
Epidemiological surveys of congenital malformations in various part of the world and among different ethnic groups with widely varying marital habits, socioeconomic status and environment not only help in understanding the frequency of malformations in specific areas but also contribute to the general knowledge about the predisposing factors and different patterns of congenital malformations (5).
Based on World Health Organization report, about 3 million fetuses and infants are born each year with major malformations. Several large population based studies place the incidence of major malformations at about 2-3% of all live births (1). About 20% of all major congenital malformations are genetically transmitted by a monogenic abnormality, 5-10% are due to chromosomal anomalies, and 2-10% are due to viral infections. In about 60%, the cause is unknown and presumed to be multifactorial (6).
The aim of study was undertaken to determine the relationship among congenital malformation, age of pregnant women, neonate ' s sex and seasonal period during three years(2009,2010and 2011).

Material and Methods
The present study was involved (402) cases of delivery pregnant woman posses neonates with congenital malformations in Al-Zahra hospital for obstetric and pediatric in Al-Najaf government. The continuous visits was done to diagnosed the congenital malformations for the years (2009, 2010, 2011). The age of mother range from 12 to 47 years.
Chi-square test and analysis of variance were used for statistical analysis of data (Snedecor and Cochran, 1974), has been used to determine the relationship between: 1-age of mother and malformations percent 2-gender and malformations during period distribution of malformations according to years. 3-months in the period and malformations.

Results
The present study revealed that the total collect cases of congenital anomalies of years (2009, 2010 and 2011) was 402 cases of the total (56043) live births, the on basis on the distribution of cases depending on years of study was the year 2011 more frequent and the last of the past years 2009 (Table 1). , the causation of the anomalies is for the most part unknown. These anomalies may be due to a variety of factors, including maternal health, heredity, environmental factors (7), the maternal overweight and obesity (8), diabetes, epilepsy and those taking other specific drugs with teratogenic effects (7).
In this present study was recorded the type of congenital malformations and their numbers for each month during period of the study. The high malformations percent (10.2%, 13.8%) were appeared in the March and April in year 2010 and 2011. While the high percent of malformations (14.2%) was in year 2009 during period in December, these information were presented in the tables (2,3,4). In contrast (9,10,11) whose found that hot season recorded high percent of anomalies during summer months. The effect of Monthly variation in the incidence of congenital malformations may be secondary to the effect of yet to be identified teratogens acting on the population at large, or, more likely, to changes in activity and dietary patterns of the population (12).
The present study revealed that the relationship between the mother age and congenital malformations during the period 2009, 2010 and 2011 years, the results revealed that the age group  (Table  5,6,7). The increase of percentage of anomalies according to maternal age (22-26)in all years of study may be due to hormonal imbalance especially steroid hormones (progesterone, estrogen or androgen) and gonadotrophic hormones as well (FSH,LH)as other causes of congenital malformations involved the malnutrion, chemical pollutions and microbial agents, these suggestions which accordance with previous studies (13,14) .from another hand, the drug intake during pregnancy include oral contraceptive pills, progesterone analogues to confirm pregnancy medications for medical dilments and sex selection drug to bear male off spring. The present study revealed that the high percent (19%) of malformations appeared during year 2009 was congenital hydrocephalus, in the period year 2010, the high percent of malformations (27%) was microcephalus. While the cardiovascular malformations were high percent in year 2011, that reached to (40.5%) ( Table 8). This finding is agree with the result of (15) how found that congenital heart disease was the commonest associated anomaly (47%) identified and this results may be attributed to multiple factors, spontaneous abortions, involuntary childlessness, maternal disease, body mass index, medical drug use, alcohol use parental employment and paternal age (15 ). The only single putative risk factor that could have directly contributed to the increased risk for cardiac defects was maternal residency in a rural district (16).
The present findings show that the malformations in the male (59.5%) neonates higher than female neonates (40.5%) and represent the significant differences at (p 0.05) during the year 2011 (Table 9). While in year 2010 the results showed that the malformations in the female neonates (57.5%) higher than male neonates (42.4%) and represent the significant differences at (p 0.05) (Table 10), and in year 2009 the result reveal that the gender of neonates have no effect on the percent of malformations these results was revealed biostatical non-significant (Table 11), our findings agreement and contrast in some way with ( 9) who found that the percent of malformations in female is higher than male especially in years 2005 and 2006. This variation in all these result may be indicate that the gender of neonates doesn't the only factor that contribute to the occurrence of malformations.           Recommendations 1-On a population level include childhood rubella immunization, screening and treatment for syphilis during pregnancy, periconceptional folic acid supplementation and/or folate food fortification for the prevention of neural tube defects. 2-On an individual level, optimizing the management of women at higher risk, for example, for women who are diabetic or epileptic, is the ideal approach to minimizing the risks of anomalies.