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Global, regional, and national epidemiology of congenital birth defects in children from 1990 to 2021: a cross-sectional study

BMC Pregnancy and Childbirth volume 25, Article number: 484 (2025) Cite this article

Abstract

Background

This aim of this study was to investigate the prevalence, mortality, and disability-adjusted life year trends of congenital birth defects in children, including the causes of related burdens.

Methods

This cross-sectional study used the 2021 Global Burden of Disease data from 204 countries and regions and included children aged 0–14 (from 1990 to 2021) years with congenital birth defects. The prevalence, all-cause and specific-cause mortality, disability-adjusted life years, and corresponding estimated annual percentage changes (EAPCs) of congenital birth defect burden rates in children were measured. The identified trends were stratified by region, country, sex, and socio-demographic index.

Results

In 2021, approximately 31.64 million children aged 0–14 worldwide were affected by congenital birth defects, marking a 6.68% increase since 1990. While the global prevalence slightly decreased (from 1,705 cases per 100,000 in 1990 to 1,573 cases per 100,000 in 2021), the number of deaths declined significantly, from 902,741 to 475,816. Mortality rates decreased from 51.91 to 23.65 per 100,000. Low socio-demographic regions had the highest mortality rate (43.33 per 100,000). Oceania (EAPC, 0.27) and Central Asia (EAPC, 0.24) had a considerable increase in prevalence rates. In 2021, Brunei Darussalam had the highest prevalence rate (2444.81 per 100,000), while Cook Islands had the lowest (1071.20 per 100,000).

Conclusions

Congenital birth defects in children remain a global challenge, with the overall rates decreasing but increasing in some regions, particularly in those with low socio-demographic indices. A better understanding of the epidemiology of congenital birth defects in children may contribute to the optimization of health policies worldwide.

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Background

Congenital birth defects (CBDs) are a leading cause of childhood death and disability worldwide [1,2,3]. Severe CBDs, including congenital heart disease and neural tube defects (such as anencephaly), are majorly influenced by genetic and environmental factors, including chromosomal abnormalities, pregnancy infections, malnutrition, and exposure to harmful substances during pregnancy [4, 5]. Additionally, advanced maternal age [6] and delays in prenatal detection and management of CBDs owing to limited resources and healthcare provision, further increase this risk [7, 8].

Previous epidemiological studies have highlighted the high incidence of CBDs and their significant impact on public health, with a global incidence of congenital anencephaly of approximately 8–10 out of every 1000 newborns [4]. Congenital heart disease is the most common CBD [9], with an estimated birth prevalence of 9.41 per 1,000 live births as of 2017 [10]. The World Health Organization (WHO) reports that approximately 240,000 newborns worldwide die annually from CBDs within the first 28 days of life, as well as an additional 170,000 children aged ≤ 5 years. CBDs account for approximately 10% of causes of death in newborns and children under 5 years, particularly notable in contexts where other causes of death have been eliminated [11]. Data from 2016 indicate that CBDs are the leading cause of death among children in all countries except Honduras and Guatemala [12]. Improved prenatal healthcare, nutrition, and prenatal screening technologies can reduce CBD incidence and mortality [13]. However, owing to significant differences in health conditions and medical resources across regions, the epidemiological characteristics of CBDs vary widely worldwide [10].

Over the past few decades, substantial progress has been made globally in improving child survival rates, which has substantially reduced mortality rates from various causes [11, 14]. For instance, the under-five mortality rate in Central America decreased by 65% from 1990 to 2016 [12]. Despite these advances [15], a comprehensive understanding of the geographic trends in the disease burden of CBDs globally during the same period is lacking [16]. Currently, there are also no updated reports on the long-term global trends in the epidemiology of CBDs in children younger than 14 years. We utilized the most recent data from the Global Burden of Disease (GBD) database to analyse the trends in the prevalence, related mortality, and disability-adjusted life years (DALYs) of CBDs in children from 1990 to 2021. We also examined corresponding disease risk factors, particularly comparing those observed in 1990 and 2021.

Methods

Overview and data collection

The 2021 GBD study systematically gathers data from diverse sources, including hospital records, birth registries, vital registration systems, household surveys, and published literature. These data undergo rigorous standardization and are mapped to the GBD cause hierarchy using the International Classification of Diseases (ICD) codes. Advanced modelling tools, such as the Cause of Death Ensemble model (CODEm) and DisMod-MR 2.1, are then utilized to estimate the disease burden. Using the data query tool available at GBD Results Tool (https://vizhub.healthdata.org/gbd-results), we collected the most recent data for 2021 on standardized disease names, prevalence, mortality, and DALYs for children aged 0–14 years. The 2021 GBD study provided comprehensive data on the prevalence, mortality, and DALYs for 371 diseases and injuries across 204 countries and territories. This dataset al.so included detailed information on the number of cases, rates, and uncertainty intervals (UI), allowing for an in-depth analysis of the global burden of CBDs among children [17]. CBDs are categorized under Level 3 causes in the GBD hierarchy and encompass a range of structural or functional anomalies present at birth. These include, but are not limited to, congenital heart anomalies, digestive congenital anomalies, Down syndrome, Klinefelter syndrome, neural tube defects, orofacial clefts, Turner syndrome, urogenital congenital anomalies, congenital musculoskeletal, and limb anomalies. CBDs includes livebirths (i.e., excludes stillbirths and pregnancy terminations) with any condition resulting from abnormalities of embryonic development, excluding minor anomalies as defined by EUROCAT and defects arising from infections or substance abuse (https://www.healthdata.org/research-analysis/diseases-injuries-risks/factsheets-hierarchy#diseases ). Linear regression was used to calculate the estimated annual percentage change (EAPC). We also analysed the global disease factors contributing to the prevalence, mortality, and DALYs [18]. This cross-sectional study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines and was conducted in accordance with the principles of the Declaration of Helsinki. The need for ethical approval and informed consent were waived because the GBD is publicly available and no identifiable information was included in the analyses.

Socio-demographic index

The socio-demographic index (SDI) provides a standardized metric for studying global health inequalities, allowing for objective and accurate comparisons between countries and regions. The SDI includes three components: total fertility rate under age 25, average years of education in the population aged ≥ 15 years, and lag-distributed income per capita [19]. The SDI ranges from 0 to 1, with 1 representing the highest level of socio-demographic development [20]. In our analysis, countries and geographic regions were categorized into five SDI levels—low, low-middle, middle, high-middle, and high SDI regions—to explore the relationship between the burden of CBDs in children and socioeconomic development.

Statistical analysis

The main indicators used to describe the burden of CBDs in children were prevalence, mortality, DALYs, and their corresponding rates. Consistent with GBD study methodologies, prevalence was reported per 100,000 population along with a 95% UI [17]. Time trends in the disease burden were analysed by calculating the EAPC with the 95% confidence interval (CI), determined through linear modelling. Furthermore, an etiological proportion analysis of CBDs in children was conducted. All calculations were performed using R Studio version 4.3.2 (R Foundation for Statistical Computing, Vienna, Austria), and a two-sided p < 0.05 was considered statistically significant.

Results

Global and SDI regional trends

Prevalence

In 2021, the global prevalence of CBDs in children was 31.64 million (95% UI, 28.44–35.16), representing a 6.68% increase from 1990 (Table 1). Although the overall global prevalence of CBDs decreased from 1,705 per 100,000 population in 1990 to 1,573 per 100,000 population in 2021 (EAPC, -0.17), there was an upward trend between 2000 and 2010 (Fig. 1A). The prevalence was consistently higher in men than in women across all SDI groups (Table A1). In 2021, the prevalence of CBDs was highest in low SDI regions at 1693 per 100,000 population. Most cases were in low-middle SDI regions, with 9.50 million cases. Although the greatest reduction in prevalence occurred in low-middle and low SDI regions, the prevalence of cases was on the rise (Table 1).

Table 1 CBD-related prevalence from 1990 to 2021 by SDI and GBD2021 regions
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Fig. 1
figure 1

Epidemiologic trends in prevalence, death, and DALY rates of CBDs. Data are shown as of 2021 in five SDI regions and sex groups of childhood CBDs. DALY, disability-adjusted life year; CBDs, congenital birth defects; SDI, socio-demographic index

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Mortality

Over the past 31 years, global deaths related to CBDs in children decreased from 902,741 in 1990 to 475,816 in 2021. Similarly, the mortality rate decreased from 52 per 100,000 in 1990 to 24 per 100,000 in 2021 (EAPC, -2.05) (Table A2). However, only low SDI regions reported a 5.72% increase in deaths; the other SDI regions achieved a reduction in the burden of deaths. Moreover, regions with a relatively high SDI had lower mortality rates, and the mortality rate was consistently higher in men across all SDI groups (Table A3). All SDI regions experienced reduced mortality rates (Fig. 1B), with the high-middle SDI region showing the greatest decline (EAPC, -3.79). In 2021, the number of deaths related to CBDs was highest in low SDI regions at 199,408 and lowest in high SDI regions at 12,278. This was different from the situation in 1990, where middle SDI regions had the highest number of deaths at 275,706 (Table A2).

DALYs

Global DALYs for CBDs in children decreased from 83.45 million in 1990 to 45.70 million in 2021 (EAPC, -1.98) (Table A4). Although the DALY rate decreased globally across all SDI regions and in all sexes from 1990 to 2021 (Fig. 1C, Table A5), cases change in DALYs in low SDI regions increased by 7.69%. In 1990 and 2021, regions with relatively high SDIs had the lowest DALY rates. In 2021, low SDI regions had the highest DALY rate and the highest DALY number, while high SDI regions had the lowest. The high-middle SDI region showed the greatest DALY rate reduction (EAPC, -4.00; 95% CI, -4.24 to -3.77) (Table A4).

Geographic regional trends

Prevalence

Among the 21 geographic GBD regions, South Asia had the highest number of CBDs in children in 2021 (8.29 million), while Oceania had the fewest cases (0.07 million). The prevalence increased in 11 regions compared to that in 1990. High-income Asia Pacific had the highest prevalence in 1990 (2357 per 100,000 population) and 2021 (2233 per 100,000 population), contrasting with Oceania’s lowest prevalence in 1990 (1365 per 100,000 population). By 2021, East Asia had the lowest prevalence of CBDs in children (1221 per 100,000 population). From 1990 to 2021, Oceania experienced the largest increase (EAPC, 0.27), while Eastern Sub-Saharan Africa saw the greatest decrease in prevalence (EAPC, -0.40), despite a 74.32% increase in the number of cases (Table 1). Comparing 1990 and 2021 in the regional analysis showed that the prevalence of CBDs in Oceania, Central Asia, South Latin America, and the Caribbean did not decrease, with EAPCs of 0.27, 0.24, 0.16, and 0.03, respectively (Table 1).

Mortality

In 2021, Western Sub-Saharan Africa had the highest number of CBD-related deaths in children among the 21 GBD regions (106,284), while Australasia had the fewest (330). Oceania had the highest mortality rate (54 per 100,000 population), while the high-income Asia Pacific had the lowest (5 per 100,000 population). East Asia saw the largest reduction in mortality rate over three decades (EAPC, -5.29; 95% CI, -5.56 to -5.01). However, Central Asia had the smallest reduction in mortality rate (EAPC, 0.27; 95% CI, -0.07 to 0.61) (Table A2).

DALYs

South Asia had the highest DALYs related to CBDs in children in 1990 (17.56 million). By 2021, Western Sub-Saharan Africa had the highest DALYs (9.83 million). Australasia consistently had the lowest DALYs, dropping as low as 0.04 million in 2021. Oceania had the highest DALY rate in 2021 (4979 per 100,000 population), while Australasia had the lowest (679 per 100,000 population). From 1990 to 2021, Central Asia had the smallest decrease in DALY rate and possibly a slight increase (EAPC, 0.28; 95% CI, -0.04 to 0.60). East Asia had the largest decrease in DALY rate (EAPC, -4.93; 95% CI, -5.17 to -4.70) (Table A4).

National trends

Prevalence

In 2021, among the 204 countries and territories, India had the highest number of CBD cases in children, while Tokelau had the fewest cases. Brunei Darussalam had the highest prevalence, contrasting with that of the Cook Islands, which had the lowest (Table A6, Fig. 2A). Georgia had the largest increase in prevalence (EAPC, 0.83), while Serbia had the largest decrease (EAPC, -0.75) (Table A7, Fig. 2A).

Fig. 2
figure 2

Global burden of CBDs for both sexes in 204 countries and territories. (A) Prevalence in 2021; EAPC of prevalence rates between 1990 and 2021. (B) Death rate in 2021; EAPC of death rate attributable to CBDs between 1990 and 2021. (C) DALY rate in 2021; EAPC of DALY rate attributable to CBDs between 1990 and 2021. CBDs, congenital birth defects; EAPC, estimated annual percentage change; DALY, disability-adjusted life year

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Mortality

In 2021, India reported the highest number of CBD-related deaths in children, while San Marino had the lowest number of deaths. Afghanistan had the highest mortality rate, contrasting with San Marino’s lowest mortality (Table A8, Fig. 2B). Saudi Arabia had the largest decrease in mortality rate (EAPC, -6.49). Conversely, Turkmenistan (EAPC, 1.43) had the largest increase in mortality rate (Table A7, Fig. 2B).

DALYs

India had the highest DALYs related to CBDs in children in 2021, while the Republic of San Marino had the lowest number of DALYs. Afghanistan had the highest DALY rate, while San Marino had the lowest DALY rate (Table A9, Fig. 2C). Turkmenistan had the largest increase in DALY rate (EAPC, 2.24), while Saudi Arabia had the largest decrease (EAPC, -6.51) (Table A7, Fig. 2C).

Proportion of causes of CBDs in children

Globally, the proportion of these aetiologies did not change significantly from 1990 to 2021 (Fig. 3A). Specifically, in 2021, congenital musculoskeletal and limb anomalies, congenital heart anomalies, and urogenital congenital anomalies accounted for 27.8%, 22.8%, and 13.9% of CBDs in children, respectively. Among the 21 geographic regions, the proportion of congenital musculoskeletal and limb anomalies was highest in high-income Asia Pacific (49.1%) and lowest in South Asia (21.3%). The proportion of congenital heart anomalies was highest in Central Europe (31.7%) and lowest in Southern Latin America at 18.5% (Fig. 3A). Congenital heart anomalies were the primary cause of CBD-related deaths in children, accounting for 46.7% of global deaths in 2021, a slight decrease from 55.0% in 1990. Among the 21 geographic regions, Central Asia had the highest proportion of deaths due to congenital heart anomalies (64.4%), while high-income North America had the lowest (29.6%) (Fig. 3B).

Fig. 3
figure 3

Analysis of the CBD proportion of causes. (A) Comparison between 1990 and 2021 based on the analysis of the proportion of causes of prevalence divided by 21 GBD regions. (B) Comparison between 1990 and 2021 based on the analysis of the proportion of causes of death divided by 21 GBD regions. (C) Comparison between 1990 and 2021 based on the analysis of the proportion of causes of DALYs divided by 21 GBD regions. CBDs, congenital birth defects; GBD, Global Burden of Disease; DALY, disability-adjusted life year

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Moreover, congenital heart anomalies and other chromosomal abnormalities also contributed to 44.5% and 19.4% of global DALYs related to CBDs in children, respectively. Among the 21 geographic regions, Central Asia had the highest proportion of DALYs caused by congenital heart anomalies (60.6%), while high-income Asia Pacific had the lowest (26.5%) (Fig. 3C).

Association of CBD burden in children with SDI

In 2021, the prevalence (r=-0.812; p < 0.001), mortality rate (r=-0.177; p = 0.011), and DALY rate (r=-0.808; p < 0.001) of CBDs were negatively correlated with the SDI, with prevalence showing the strongest correlation (Fig. 4A–C). The EAPC in prevalence correlated positively with SDI (r = 0.281; p < 0.001), while the EAPC in mortality rate (r=-0.439; p < 0.001) and DALY rate (r=-0.233; p < 0.001) correlated negatively with SDI (Fig. 4D–F). When we further examined the non-linear association between the SDI and prevalence/death/DALY rates using Gaussian process regression, the CBD-related prevalence/death/DALY rates of children decreased with increasing SDI levels. The relationship between SDI and prevalence was similar to a U-shape. When SDI approached 0.5–0.70, the fitting curve reached its lowest value (Fig. 4G), while the relationship between SDI and mortality/DALY rate was similar to a downward-sloping line. As SDI increased, the CBD-related mortality/DALY rate decreased, and the fitting curve reached its lowest value (Fig. 4H and I). According to the GBD region, the death/DALY rates in North Africa and the Middle East were considerably higher than the average expected since 1990, and all regions showed an improvement trend in death/DALY rates with the increase in SDI.

Fig. 4
figure 4

Correlation analysis. (A) Correlation between the SDI and prevalence in 2021. (B) Correlation between the SDI and death rate in 2021. (C) Correlation between the SDI and DALY rate in 2021. (D) Correlation between the SDI and the EAPC of prevalence rates. (E) Correlation between the SDI and the EAPC of death rate. (F) Correlation between the SDI and the EAPC of the DALY rate. Relationship between the rates of CBD prevalence/death/DALYs and SDI (1990–2021) across 21 GBD regions. For each region, points from left to right depict estimates from each year from 1990 to 2021. Solid black line shows expected values across the spectrum of the SDI. (G) Prevalence. (H) Death rate. (I) DALY rate. CBDs, congenital birth defects; DALY, disability-adjusted life year; EAPC, estimated annual percentage change; GBD, Global Burden of Disease; SDI, socio-demographic index

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Discussion

Our study investigated the prevalence of CBDs, related mortality, and DALYs among children aged 0–14 years in all regions and countries covered by the GBD from 1990 to 2021 and the corresponding composition of disease aetiology. Our findings highlight the comparison between 1990 and 2021, indicating a global decrease in the burden of CBDs, although some regions and countries had increased prevalence, mortality, and DALY rates. A global assessment of the epidemiological patterns of CBDs in children may contribute to policy formulation and clinical funding management. Our findings also provide the latest insights into the burden of CBDs among children belonging to different income levels and countries over the past 30 years.

From 1990 to 2021, despite a 6.68% increase in the number of CBD cases, there was a decrease in the global mortality, DALY, and prevalence rates of CBDs in children. This rise in prevalence is likely due to decreased mortality rates, as medical advancements have improved early diagnosis and treatment, allowing more infants with congenital defects to survive [21]. Additionally, improved identification and recording of congenital defects contribute to these trends [22]. From 1990 to 2019 [23], the global EAPC of the prevalence rate of CBDs was − 0.18%, while the latest analysis found a prevalence of 1572.51 per 100,000 in 2021, with an updated EAPC of -0.17% (-0.19% for women, -0.15% for men) for the 31-year period of 1990–2021.

The SDI helps to identify and quantify health disparities in different regions, guiding health policymakers in resource allocation and intervention measures. By comparing disease burdens across SDI regions, we can better understand the role of socioeconomic factors in health disparities and develop more effective public health strategies [24]. We found a significant negative correlation between SDI and CBDs in terms of prevalence, mortality, and DALYs. Areas with high and medium-to-high SDI showed the greatest decreases in mortality and DALYs related to CBDs in childhood, likely due to high-quality medical services and advanced prenatal diagnosis in high SDI areas, which enables early diagnosis and treatment. In 2021, the DALY rate remained higher in low SDI regions than in high-to-medium SDI regions in 1990. Notably, the mortality rate in low SDI regions was twice that of high SDI regions in 1990.

CBDs are complex multifactorial diseases that includes but is not limited to genetic mutations, metabolic abnormalities, environmental pollution, pregnancy infections, nutritional status, and the lifestyle of pregnant women [25,26,27]. The exact role of each factor is not fully understood, and there may be complex interactions between them. Environmental and cultural differences across different geographical locations [28] and the availability of public health policies, prenatal care, and prenatal screening technology [28] may also contribute to the varying prevalence of CBDs. Industrialized regions may face higher environmental pollution risks [29, 30], while economically underdeveloped regions may experience increased CBD burdens due to malnutrition and inadequate medical resources [27, 31]. Furthermore, cultural practices, such as giving birth at an advanced maternal age and consanguineous marriages, also increase the risk of CBDs in some regions [32]. Public health policies, such as prenatal screening programs, healthcare access improvements, and maternal health interventions, have likely influenced trends in CBDs. However, in lower-resource settings, limited access to healthcare may hinder the effectiveness of these strategies. While our study provides a global overview, regional differences in public health policies likely contribute to the observed variations in CBD trends. Knowledge gained from the advanced experiences of other regions can be potentially applied to regions with heavy disease burdens to improve outcomes.

In 2021, congenital musculoskeletal and limb anomalies were the most common CBDs in children. Congenital heart anomalies remained the leading cause of death and DALYs; however, the proportion decreased compared to that in 1990.

This study had some limitations. First, the statistical analysis relies heavily on the accuracy of the GBD database, which can be affected by the availability or omission of national registration data and the lack of data on other risk factors related to CBDs in children. Potential confounding factors, such as differences in diagnostic capabilities, healthcare access, and variations in reporting practices across countries, may have influenced the observed prevalence rates, mortality, and DALYs in our study. Furthermore, the GBD methodology relies on modelled estimates, which despite being standardized, may still introduce biases due to data gaps or inconsistencies in underlying assumptions. Consideration of these limitations is essential when interpreting the global burden of CBDs as they may impact the accuracy of comparisons across regions. Despite the broad geographic coverage of the GBD 2021 study, data limitations may still exist in certain low-resource regions owing to insufficient health surveillance infrastructure. Nevertheless, recent improvements in the GBD database, including the inclusion of new clinical and claims data sources as well as enhanced mortality estimation methods, have substantially improved regional representativeness. Second, the lack of detailed classification and severity information for systemic diseases may affect assessment of the actual disease burden.

Conclusions

Over the past 30 years, with the improvement of prenatal diagnostic interventions and the development of diagnostic and treatment technologies, the global burden of CBDs in children has gradually decreased. However, the epidemic trends between regions are not completely consistent, and the disease burden in some countries and regions has actually increased. The findings of this cross-sectional study indicate that in areas with low SDI, the high rates of CBD-related mortality and DALYs in children remain at high levels. Therefore, more cost-effective and targeted strategies are urgently needed to reduce the mortality and DALY rates associated with CBDs in children. Additionally, future studies can build on our findings by exploring specific aetiologies and their interactions with environmental and genetic factors, thereby further elucidating CBDs in children.

Data availability

Data used in this study were obtained from the Global Health Data Exchange Global Burden of Disease Results Tool (https://ghdx.healthdata.org/gbd-results-tool), accessed on 12 October 2024.

Abbreviations

CBDs:

Congenital birth defects

CI:

Confidence interval

DALY:

Disability-adjusted life year

EAPC:

Estimated annual percentage change

GBD:

Global Burden of Disease

SDI:

Socio-demographic index

UI:

Uncertainty interval

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Acknowledgements

The authors thank all the members of the Institute for Health Metrics and Evaluation and all the collaborators involved in the 2021 Global Burden of Disease study.

Funding

This study was funded by the Scientific Research Fund of Liaoning Provincial Education Department, China (grant number JYTQN2023022 to XZ). The funding agency had no role in the study design; in the collection, analysis, and interpretation of the data; in the writing of the report; and in the decision to submit the article for publication.

Author information

Author notes

  1. Yinyan Li, Chuan He, Haijie Yu and Di Wu contributed equally to this work.

Authors and Affiliations

  1. Department of Ultrasonic Diagnosis, First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China

    Yinyan Li

  2. Department of Laboratory Medicine, First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China

    Chuan He

  3. Department of Cardiology, First Hospital of China Medical University, 155 Nanjing North Street, Heping District, Shenyang, 110001, China

    Haijie Yu, Di Wu & Xueyao Zhang

  4. Department of Gynecology and Obstetrics, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Road, Yuzhong District, Chongqing, 400000, China

    Li Liu

Authors
  1. Yinyan Li
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  2. Chuan He
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  3. Haijie Yu
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  4. Di Wu
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  5. Li Liu
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Contributions

XZ and YL provided the concept of research, literature retrieval, data analysis and interpretation, and drafting of the article. CH, HY and Di Wu provided data interpretation and revised the work critically for important intellectual content. LL contributed to the study design and revised the work critically for important intellectual content. All authors read and approved the final manuscript. All authors have participated sufficiently in the work and agreed to be accountable for all aspects of the work.

Corresponding authors

Correspondence to Li Liu or Xueyao Zhang.

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Ethics approval and consent to participate

This study was conducted in accordance with the principles of the Declaration of Helsinki. Ethical approval and informed consent were not required because the GBD is publicly available and no identifiable information was included in the analyses.

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Not applicable.

Competing interests

The authors declare no competing interests.

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Li, Y., He, C., Yu, H. et al. Global, regional, and national epidemiology of congenital birth defects in children from 1990 to 2021: a cross-sectional study. BMC Pregnancy Childbirth 25, 484 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12884-025-07612-1

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  • DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12884-025-07612-1

Keywords

BMC Pregnancy and Childbirth

ISSN: 1471-2393

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