https://doi.org/10.15218/ejnm.2023.19 Erbil j. nurs. midwifery, Vol. 6, No. (2), Nov 2023 Original Article Risk Factors Associated with Congenital Anomalies among Children Admitting Surgical Unit in Rapareen Pediatric Teaching Hospital in Erbil City ABSTRACT Backgrounds and objectives: Congenital anomalies, which can affect how the body oper- ates, are anatomical, functional, or metabolic abnormalities that develop during intrau- terine life. The study aimed to identify risk factors associated with congenital anomalies among children who are admitting to the surgical unit at Rapareen Pediatric Teaching Hospital in Erbil city. Methods: descriptive, case-control design was used to conduct this study. This study was conducted in Rapreen Pediatric Teaching Hospital in Erbil from 1st of July to 1st of Octo- ber 2022. Non- probability purposive sample of 100 mothers with congenital anomalies children and admitted to the Surgical Unit and 100 mothers with other health condition children (control group) at Rapareen Pediatric Teaching Hospital were asked respectfully to participate in the study. Descriptive and frequency, Regression analytics was used for exploring the factors associated with congenital anomalies, Chi-square was used to find out the association between dependent and independent variables, and t-tests were used to identify the differences between case and control groups. Results: the results show that that anemia in pregnancy, previous history of congenital anomalies, family history of congenital anomalies, Pesticide use, living near of mobile sta- tion, passive smoke, stress during pregnancy, didn't use folic acid, and drink of coffee dur- ing pregnancy had a very high statistical difference between case and control P-value <0.001, while Radiation exposure had a difference between case and control P-value of 0.045. That age of mothers and weight were factors which highly statistical associated with congenital anomalies among children P-value 0.001 and <0.001 respectively, moreo- ver age of father and history of previous abortion were factors behind the congenital anomalies P-value 0.033 and 0.017 respectively. Conclusions: the study concluded that age of mothers and father, weight, and history of previous abortion were factors behind the congenital anomalies. Primary prevention is most important to reduce the incidence of congenital anomalies and the morbidity asso- ciated with it. Keywords: Congenital; Risk factor; Rapareen; Erbil. Chawarwan Saleem Abdullah; Department of Nursing, College of Nursing, Hawler Medical University, Kurdistan Region- Iraq. (Correspondence: chawarwan.abdullah@hmu.edu.krd) Shukir Saleem Hasan; Department of Nursing, College of Nursing, Hawler Medical University and Faculty of Nursing, Tishk International University, Kurdistan Region- Iraq. 182 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Received: 13/02/2023 Accepted: 30/04/2023 Published: 30/05/2024 mailto:chawarwan.abdullah@hmu.edu.krd https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.19 Erbil j. nurs. midwifery, Vol. 6, No. (2), Nov 2023 Original Article Congenital anomalies also known as con- genital malformations have been defined as a " structural or functional anomalies that occur during intrauterine life and can be identified prenatally, at birth, or some- times may only be detected later in infan- cy". Congenital anomalies increase the risk of long term disability, an estimated 240 000 newborns die worldwide within 28 days of birth every year, and congenital anomalies also are the main causes of fur- ther 170 000 deaths of children between the ages of 1 month and 5 years [1]. Nearly 95% of the babies who died from congeni- tal malformation were lived in middle- and low-income countries [2].The prevalence rates of conginatal anomalies are different from country to other country, the preva- lence of congenital anomalies in Japan is low which 1.07% and as high as in Taiwan which is 4.3%, in US was 2-3%, in England has been reported is 2%, and in Lebanon has been estimated as 1.64% [3]. In Turkey, depend to the Turkish Statistical Institute congenital malformations and chromoso- mal anomalies were responsible for 1.23% of all causes of death in 2018[4]. In Iran the prevalence rate among children was esti- mated to be 2.3%, the total prevalence rates, in terms of gender, were more in boys (3%) than girls (2%) [5]. In 2007 high rate of congenital anomalies was reported from Bagdad city in Iraq which is estimated in 12.36 per 1000, in Al-Anabr was 8.5 per 1000 birth, however, a study from Erbil, Iraq on live births between 1990 and 1999 revealed an unexpected high rate of 23.9 congenital anomalies per 1000 live births [6]. Other study revealed that in Erbil city\ Iraq for about 35,803 recorded births, 130 mothers delivered newborns with congeni- tal anomalies in Maternity teaching hospi- tal from the time period of April 2015 to the March of 2016 [7].Babies are born Babies are born with congenital anomalies because of many causes and risk factors. For about 50% of congenital anomalies, causes are undefined yet, but the studies showed that 30-40% may due to genetic, 5 to 10% related to environment, chromosomal abnormality constitutes 6%, and multifactorial 20- 30% [3]. Reported that every year in 8 million births, 6% of total births are born with serious congenital anomalies of genetic or partially genetic origin. Additionally more than 100 \1000 are born with serious birth defects of post conception origin related to maternal exposure to environmental agents [8]. The study was conducted in Mardan (Pakistan) suggested that consanguineous marriages and lack of folic acid are the topmost risk factors that had the role to increasing rate of congenital anomalies [9]. Ameen and her colleagues in Erbil\Iraq (2018) showed that mothers with history of previous congenital anomalies, parental consanguinity, and mothers with medical disorder during pregnancy were risk factors for delivered babies with congenital anomalies [7]. A number of congenital anomalies can be prevented through many ways like vaccination, adequate intake of folic acid or iodine through fortification of staple foods or supplementation, and adequate care before and during a pregnancy are examples of prevention methods [1]. Knowing information about the risk factors of congenital anomalies is beneficial to obtain baseline rates of risk factors, documenting changes over time, and identifying clues to the etiology of conditions. This information is also helpful to plan and assess antenatal screening for congenital anomalies, especially for high- risk populations. The study aimed to identify factors associated with children with congenital anomalies who are admitted to the surgical unit at Rapareen 183 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. INTRODUCTION https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.19 Erbil j. nurs. midwifery, Vol. 6, No. (2), Nov 2023 Original Article After constructing the questionnaire, it will send to the number of experts in the fields of medicine, nursing, and biostatistics. The comments of experts were taken into con- sideration regarding clarity, relevancy, and adequacy to achieve the objectives. The reliability of the questionnaire was tested by the pilot test of 10 children with con- genital anomalies, and who admitted to surgical unit at Raparin Teaching Hospital for children.Before data collection, formal permission was obtained from Hawler Medical University\ College of Nursing and Rapareen Pediatric Teaching Hospital for conducting the study (12)19-June-2022. A primary approval was obtained from the research ethics committee, Hawler Medi- cal University/Nursing. Oral Informed con- sent was obtained from mothers before data collection, after the explanation of the purpose of the study, benefits, rights to privacy, and rights to withdraw at any time. The investigator promised to keep the information for confidential and ano- nymity. A pilot study was conducted on 10 % of the total sample of congenital anoma- ly babies to test the content validity and feasibility of designed tools and estimate the time required for filling the tool modifi- cations will do accordingly. The data was analyzed by the statistical Package for the Social Sciences version 23 (SPSS). Frequen- cy and Linear regression analytics for ex- ploring the factors associated with congen- ital anomalies, Chi-square to find out the association between dependent and inde- pendent variables, and T-test test to iden- tify the differences between case and con- trol The current results show that less than half of participants in case and control group were between the ages of 21-25 (46% and 48% respectively). Concerning the occupa- tion of mothers 71% in case and 78% in Pediatric Teaching Hospital in Erbil city. Quantitative design, descriptive- retro- spective, case and control study were used to conduct this study. The study was carried out at Rapareen Pediatric Teaching Hospital (RPTH) in Erbil city. This study was conducted in Rapreen Pediatric Teaching Hospital in Erbil and the time in- terval was from 1st of July to 1st of Octo- ber 2022. Non- probability purposive sam- ple of 100 mothers, who born children with congenital anomalies and were ad- mitted to the Surgical Unit at RPTH, and 100 mothers had children with other health conditions at RPTH were asked re- spectfully to participate in the study. Mothers who are willing to participate in the study, Child diagnosed by the related consultant surgeon and admitted to surgi- cal department, and Child admitted to the surgery department and complained of congenital anomalies were included in the study. While, the congenital anomalies children are admitted to others sectors (Private hospitals), Orphan children (mother's die), and Mothers with psycho- logical problems were excluded from the study. Data was collected by using a ques- tionnaire format and was distributed by the investigator and thought direct (face to face) interview method with mothers have children with congenital anomalies , who kindly accept to participate in the study. The cases that fulfill the inclusion criteria were selected. The interviews were conducted at surgical unit of Rapa- reen Pediatric Teaching Hospital. To avoid extra crowded, the researcher attended the hospital during evening shift from 2 PM to 6 PM every other day, and each in- terview session took approximately (15- 30) minutes. The questionnaire format was prepared by the investigator. The questionnaire includes the following parts. 184 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. RESULTS METHODS https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.19 Erbil j. nurs. midwifery, Vol. 6, No. (2), Nov 2023 Original Article control were housewives, while more than half of participants in case and control groups were illiterate(54% and 63% respec- tively). More than half (53%) of mothers in case group lived in urban area while, the majority (72%) of mothers in control group lived in urban area. As for the economic status of participants, results showed that The result of current study in Table 2 shows that 58% of children in case and 67% of children in control were ages between 1days -1 years old, while more than half (56%) of children in case and 43% of chil- dren in control group were male. Concern- ing the gestational age 40% in case and the highest parentage in case and control groups had satisfied with economic status for daily needs (66% and 80% respective- ly). The result showed that 40% of fathers in case group were between the ages of 26 -35 but, 37% of fathers in control group were between the ages of 21-25 years old Table 1. 47% in control were preterm. The weight of children accounted as 62% in case group and 68% in control were be- tween (1-10kg). The majority of mothers in case and control groups hadn't history of abortion (85% and 80% respectively). 185 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 1: Assessment of Socio- demographic Characteristics of Mothers in Case and Control Group. (N0. 100: case and control) Socio-demographics Case Group Control Group No. % No. (%) Mother Age (years) ≤ 20 13 (13) 11 (11) 21-25 46 (46) 48 (48) 26-35 27 (27) 36 (36) ≥ 36 14 (14) 5 (5) Occupation Housewife 71 (71) 78 (78) Governmental employee 14 (14) 8 (8) Private employee 11 (11) 8 (8) Student 4 (4) 6 (6) Level of Education Illiterate 54 (54) 63 (63) Able to read and write 16 (16) 11 (11) Primary school 8 (8) 1 (1) Secondary school 8 (8) 1 (1) Institute graduate 8 (8) 13 (13) College graduated 6 (6) 11 (11) Post graduated 0 (0) 0 (0) Residency Areas Rural 33 (33) 16 (16) Urban 53 (53) 72 (72) Suburban 14 (14) 12 (12) Economic sufficient for daily need 66 (66) 80 (80) Insufficient 24 (24) 16 (16) exceeds needs 10 (10) 2 (2) Father Age (years) ≤ 20 5 (5) 5 (5) 21-25 31 (31) 37 (37) 26-35 40 (40) 27 (27) ≥ 36 24 (24) 31 (31) https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.19 Erbil j. nurs. midwifery, Vol. 6, No. (2), Nov 2023 Original Article 186 Table 3 show comparison between case and control regarding risk factors associat- ed with congenital anomalies, concerning consanguinity, medical disease, andoligo- hydramina , there was a highly statistical difference shown between case and con- trol with P. Value (<0.001, <0.001, and 0.001 respectively), while there was no statistical difference happen between case and control regarding polyhydramine with P.value= 0.150. The result of study indicated that anemia in pregnancy, previ- ous history of congenital anomalies, fami- ly history of congenital anomalies, Pesti- cide use, living near of mobile station, passive smoking, stress during pregnancy, didn't using folic acid, and drink of coffee during pregnancy had a very high statisti- cal difference between case and control P. Value <0.001, while Radiation exposure had a difference between case and con- trol P. Value=0.045. At the same time there was no statistical difference happen between case and control regarding using of unprescribed medication ,Chemical substance use, living near electrical tower,active smoker during pregnancy, infection during pregnancy, and having corona virus which ( P. Value = 0.098, 1.00, 0.857, 1.000, 0.723, and 0.055) re- spectively. Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Com- mons Attribution-NonCommercial-ShareAlike 4.0 International Concerning the types of congenital anoma- lies (Fig.1) the result of chart shows that 41% of case groups had genitourinary anomalies, 33% had digestive anomalies, 10% hand musculoskeletal anomalies, 7% of case had respiratory anomalies, 6% had circulatory anomalies, and 8% had other anomalies. Table 2: Assessment of demographic characteristics of children. Children characteristics Case Group Control Group No. (%) No. (%) Child age 1days- 1years 58 (58) 67 (67) 1years- 3years 26 (26) 20 (20) 3years- 6years 14 (14) 8 (8) ≥ 7 years 2 (2) 5 (5) Gender Male 56 (56) 43 (43) Female 44 (44) 57 (57) Gesta- tional age Preterm 40 (40) 47 (47) Term 45 (45) 45 (45) post term 15 (15) 8 (8) Weight (kg) 1-10 62 (62) 68 (68) 11-20 20 (20) 19 (19) 21-30 16 (16) 9 (9) ≥ 31 2 (2) 4 (4) Abor- tion None 85 (85) 80 (80) 1-3 4-6 14 1 (14) (1) 12 8 (12) (8) ≥ 7 0 (0) 0 (0) Figure 1: Types of congenital anomalies https://creativecommons.org/licenses/by-nc-sa/4.0/ https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.19 Erbil j. nurs. midwifery, Vol. 6, No. (2), Nov 2023 Original Article 187 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. Table 3: Compare between case and control regarding risk factors associated congenital anomalies. (n. 100 case and control). Risk factors associated with congenital anomalies Group N Mean SD F P-value T 95% confidence interval the difference Lower Upper Consanguinity Case 100 0.68 0.4688 35.45 0.001 -2.87 -0.2864 -0.05357 Control 100 0.850 0.3588 -2.87 -0.2864 -0.05352 Medical Dis- ease Case 100 0.780 0.4163 44.05 0.001 -3.06 -0.2464 -0.05357 Control 100 0.930 0.2564 -3.06 -0.2465 -0.05345 Oligohydrami- nas Case 100 0.900 0.3015 11.70 0.001 -1.66 -0.1310 0.01102 Control 100 0.960 0.1969 -1.66 -0.1310 0.01109 Polyhydrami- nous Case 100 0.950 0.2190 2.089 0.150 -0.719 -0.0748 0.03485 Control 100 0.970 0.1714 -0.719 -0.0748 0.03487 Anaemia Case 100 0.800 0.4020 21.43 0.001 -2.22 -0.2074 -0.01252 Control 100 0.910 0.2876 -2.22 -0.2075 -0.01246 Previous congeni- tal anomalies Case 100 0.830 0.3775 27.02 0.001 -2.46 -0.1980 -0.02192 Control 100 0.940 0.2386 -2.46 -0.1981 -0.02182 Family history Case 100 0.780 0.4163 66.08 0.001 -3.61 -0.2627 -0.07723 Control 100 0.950 0.2190 -3.61 -0.2629 -0.07705 Unprescribed medication use Case 100 0.980 0.1407 2.768 0.098 0.826 -0.0277 0.06773 Control 100 0.960 0.1969 0.826 -0.0277 0.06776 Radiation Case 100 0.990 0.1000 4.082 0.045 -1.00 -0.0297 0.00972 Control 100 1.00 0.0010 -1.00 -0.0298 0.00984 Chemical substance use Case 100 0.960 0.1969 0.001 1.00 0.001 -0.0549 0.05493 Control 100 0.960 0.1969 0.001 -0.0549 0.05493 Pesticide use Case 100 0.770 0.4229 73.80 0.001 -3.77 -0.2739 -0.08607 Control 100 0.950 0.2190 -3.77 -0.2741 -0.08588 Mobile station Case 100 0.830 0.3775 73.50 0.001 -3.72 -0.2294 -0.07055 Control 100 0.980 0.1407 -3.72 -0.2297 -0.07027 Electrical tower Case 100 0.900 0.3015 0.032 0.857 -1.70 -0.3882 0.02821 Control 100 1.08 1.011 -1.70 -0.3891 0.02911 Active smoker Case 100 0.940 0.2386 0.001 1.00 0.001 -0.0665 0.06657 Control 100 0.940 0.2386 0.001 -0.0665 0.06657 Passive smoker Case 100 0.710 0.4560 20.56 0.001 -2.21 -0.2456 -0.01438 Control 100 0.840 0.3684 -2.21 -0.2456 -0.01435 Stress Case 100 0.820 0.3861 19.29 0.001 -2.11 -0.1932 -0.00679 Control 100 0.920 0.2726 -2.11 -0.1932 -0.00672 Didn’t use Folic acid Case 100 0.920 0.2726 41.30 0.001 -2.93 -0.1337 -0.02623 Control 100 1.00 0.0001 -2.93 -0.1341 -0.02590 Coffee drink Case 100 0.890 0.3144 15.22 0.001 -1.88 -0.1431 0.00317 Control 100 0.960 0.1969 -1.88 -0.1432 0.00326 Infection Case 100 0.810 0.3942 0.126 0.723 0.178 -0.1010 0.12104 Control 100 0.800 0.4020 0.178 -0.1010 0.12104 Corona virus Case 100 0.870 1.106 3.718 0.055 -0.174 -0.2469 0.20693 Control 100 0.890 0.3144 -0.2479 0.20795 https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.19 Erbil j. nurs. midwifery, Vol. 6, No. (2), Nov 2023 Original Article 188 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. the same time age of father and history of previous abortion were factors behind the congenital anomalies p.value (0.033 and 0.017 respectively). years in the control group [10, 11]. Con- cerning the occupation of mothers nearly three quarter of case and two-thirds in control were housewives, This result matches with a case-control study report- ed in Ethiopia (2021) which mentioned that number of participants in case and control were housewife [10], and also same with the case-control study done in Erbil city which indicated that the most of mothers in both groups were housewives [7]. Regarding the level of education of participants, more than half in case and control groups were illiterate, this finding disagreed with the study which was car- ried out in Saudi Arabia which stated that DISCUSSION Table 4 shows that age of mothers and weight were factors which highly statistical associated with congenital anomalies P.value (0.001 and <0.001 respectively), at The majority of children are born with con- genital anomalies and they are impacted physically, mentally or socially, or it may be have a chance to boosting the risk of mor- bidity related to many health problems. Based on the analysis presented in the re- sults, less than half, respectively, of partici- pants in the case and control groups were aged between (21-25) years, This result is similar to a case-control study carried out in Ethiopia, which revealed that less than half of samples in the case and control groups were between 21 and 25 years old, and disagrees with the study done in Iran, which reported that the mean mothers age was 29.48 years in the case group and 27.9 Table 4: Factors associated with congenital anomalies Selected factors Unstandardized Coefficients Standardized Coefficients t P- val- ue 95% Confidence Interval for B B Std. Error Beta Lower Bound Upper Bound (Constant) -0.390 0.156 -2.495 0.015 -0.701 -0.079 Age mother 0.137 0.041 0.152 3.360 0.001 0.056 0.219 Occupation -0.004 0.049 -0.004 -0.078 0.938 -0.101 0.094 Level education 0.025 0.026 0.050 0.943 0.349 -0.028 0.078 Residency -0.008 0.055 -0.006 -0.138 0.891 -0.117 0.101 Economic -0.040 0.060 -0.034 -0.676 0.501 -0.159 0.078 Father age 0.102 0.047 0.109 2.165 0.033 0.008 0.196 Abortion -1.125 0.462 -0.140 -2.436 0.017 -2.045 -0.206 Gender -0.056 0.073 -0.035 -0.760 0.449 -0.202 0.090 Gestational age 0.018 0.051 0.016 0.357 0.722 -0.083 0.119 Weight 0.974 0.230 1.006 4.234 0.001 0.516 1.432 https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.19 Erbil j. nurs. midwifery, Vol. 6, No. (2), Nov 2023 Original Article 189 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. more than half in case and control were schooling up to high school [12]. More than half in case group lived in urban area while, the majority of mothers in control group lived in urban area. The study done in Ethiopia which stated that less than half of mothers in case group lived in urban ar- ea, at the same time, the majority of moth- ers in control group lived in urban area [13].the area of living is effect on mother's knowledge and awareness regarding con- genital anomalies and safe pregnancy, newborn care and antenatal care during pregnancy. The majority in case and con- trol groups had satisfied with economic status for daily needs. The study carried out in Riyadh, Saudi Arabia mentioned that less than half of participant in case and control hand satisfied family monthly in- come [12]. The study done Ethiopia in 2018 reported that totally 47.8% of sam- ples in both groups had middle economic status [13]. The result showed that less than half of fathers in case group was be- tween the ages of (26-35) meanwhile, one- third of fathers in control group were be- tween the ages of (21-25). This result near- ly agreed with the study which is done in Ethiopia which revealed that 40% in case was their ages ranged between 26-34 but, 29.7% samples in control group aged was <=25 [10].More than half of children in case and 43% of children in control group were male. This finding is agreed with the study which carried out in Egypt which re- ported that more than half of children in case and less than half of children in con- trol were male, but, disagreed with the study done in Nepal which mentioned that more than half of children in case and less than half of children control was girl [2,14]. Concerning the gestational age 40% in case and 47% in control were preterm. This out- come unsupported with the case-control study which carried out in Egypt which an- nounced that the majority of children in both group were full term [2]. The weight of children accounted as more than half in case and control group were between (1-10kg). The study carried out in Brazil which stated that most of the children in case and control were normal weight [15]. The majority of mothers in case and control groups hadn't history of abortion. This result supported with the case- control study which was carried out in Erbil city in Iraq which announced that majority of mothers in case and control hadn’t history of abortion [7]. As in my experience during my duty I detected mothers with multiple abortions are risk of having infants with congenital anoma- lies in comparison with others mothers. Regarding the assessment the types of congenital anomalies in current study, the results show in Fig.1 that the most of congenital anomalies are shown in geni- tourinary system, this finding is matches with prospective study which is done in Punjab (India) which indicated that major defects were present in 68.11%. CNS and urogenital systems were most commonly involved [16], and disagreed with the study of done in Erbil city in Iraq which mentioned that the most common area for anomalies was the central nervous system (37.7%) followed by the musculo- skeletal (23.1%) and gastrointestinal sys- tems (20.8%) [7]. Table 3 explains the Compare between case and control re- garding risk factors associated with con- genital anomalies. Concerning consan- guinity, medical disease, oligohydramina, anaemia in pregnancy, previous history of congenital anomalies, family history of congenital anomalies, Pesticide use, living near of mobile station, passive smoking, stress during pregnancy, not using folic acid, and drink of coffee during pregnan- cy, there was a highly statistical differ- ence shown between case and control. Iraq in which mentioned that there were https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.19 Erbil j. nurs. midwifery, Vol. 6, No. (2), Nov 2023 Original Article 190 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. high statistical differences shown between case and control regarding consanguinity, medical disease, and oligohydramina [7]. The prospective analytic cross section- al study carried out in Neonatal Intensive Care Unit in Egypt announced that consan- guinity and family history of congenital anomalies were a high statistical difference shown between case and control but, men- tioned that there were no statistical differ- ences shown between case and control regarding having medical diseases and drug use during pregnancy [17]. Other study done in India indicated that there were no statistical difference shown be- tween case and control regarding having medical diseases and history of anemia during pregnancy [18]. The study which was done in India mentioned that there was a statistical difference happen be- tween case and control regarding consan- guinity, previous child with congenital anomalies, and no intake of Iron/Folic ac- id. Still, there were no statistical difference happen between case and control regard- ing medical disease and anemia during pregnancy [19]. The result of the current study shows that radiation exposure had a difference between case and control, this finding is unequal with the study done in Hamadan which mentioned that there was no statistical difference happens between case and control regarding radiography during pregnancy, stressful pregnancy, medical disease, oligohydramina, exposure to chemicals and family medical history of congenital anomalies [20]. Another study in China mentioned that there were a high- ly statistical difference shown between case and control regarding family history of congenital anomalies, stressful life events, taking folic acid, and smoking, while there was no statistical difference shown be- tween case and control regarding medical disease during pregnancy [21]. The study which carried out the study in Ethiopia mentioned that there was a high statisti- cal difference occurred between case and control regarding passive smoking, folic acid use during pregnancy, and exposure to pesticides. Still, announced that there was no statistical difference between case and control regarding drinking coffee during pregnancy [10]. Other studies in India mentioned that there were statisti- cal differences occurred between case and control regarding living near mobile station and passive smoking [8]. Table 4 showed that weight was factor which highly statistically associated with occur- rence of congenital anomalies and a his- tory of previous abortion was a factor be- hind the congenital anomalies. The case- control study done in Erbil city showed that the weight of children was a factor which highly statistically associated with the occurrence of congenital anomalies, and the history of previous abortion was the factor behind the congenital anoma- lies [7]. The result of the current study indicated that the age of mothers factors which highly statistical associated with occurrence of congenital anomalies. This result is agreed with the study done in Nepal which reported that the age of mothers was a factors that highly statisti- cal associated with congenital anomalies, but mentioned that the weight of chil- dren wasn't a factors that statistical asso- ciated with congenital anomalies [14]. Another study in India showed that the weight of the mother and history of abor- tion were a factors that statistical signifi- cant with congenital anomalies [8]. The research carried out in Egypt found that the age of mother and the history of pre- vious abortion didn't factors that causes for congenital anomalies [17]. The result of study indicated that father age is a fac- tor that statistically significant with con- genital anomalies. This outcome is sup- ported by the study done in Mexico https://creativecommons.org/licenses/by-nc-sa/4.0/ https://doi.org/10.15218/ejnm.2023.19 Erbil j. nurs. midwifery, Vol. 6, No. (2), Nov 2023 Original Article 191 Copyright ©2022 The Author(s). This is an Open Access article which licensed under the terms and conditions of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. It permits no additional restrictions on use, distribution, and reproduction in any medium provided the original work is properly cited. which mentioned that father age and birth weight are factors that highly statistically significant with congenital anomalies [22] also, equal to the study which was done in Iran which stated that father age is a factor that statistical significant with congenital anomalies [11]. Early marriage and early and late pregnancy are increase the risk of having children with congenital anomalies because of the anatomical and functional maturation of reproductive organs. The finding reported that consanguinity, medical disease, oligohydramina, anaemia in pregnancy, previous history of congeni- tal anomalies, family history of congenital anomalies, Pesticide use, living near of mo- bile station, passive smoking, stress during pregnancy, not using folic acid, radiation exposure and drink of coffee during preg- nancy, there was a highly statistical differ- ence shown between case and control. The results were indicated that that age of mothers and weight were factors which highly statistically associated with congeni- tal anomalies, and at the same time age of father and history of previous abortion were factors behind the congenital anoma- lies [1] World Health Organization.Birth Defects. WHO Headquarters in Geneva.2022. Availa- ble from: https://www.who.int/news-room/ fact-sheets/detail/birth-defects [2] Abdoul SM, Sherif AA, Wahdan IM, Ashour KS. Pattern and risk factors of congenital anomalies in a pediatric university hospital, Alexandria, Egypt. Journal of the Egyptian Public Health Association. 2019.94(3). https://doi.org/10.1186/s42506-018-0004-3 [3] Francine R, Pascale S, Aline H. Congenital Anomalies: Prevalence and Risk Factors. Uni- versal Journal of Public Health. 2014. 2(2): 58 -63.https://www.researchgate.net/ publica- tion/259526843_Congenital_Anomalies_Pre valence_and_Risk_Factors [4] Turkbay D, Canpolat FE, Derme T, Altug N, Yilmaz Y. The birth prevalence of selected major congenital anomalies: Six-year’s ex- perience in a tertiary care maternity hospi- tal. Turk Pediatri Ars 2020; 55(4): 393–400. https://www.ncbi.nlm.nih.gov/pmc/ articles/PMC7750351/pdf/TPA-55-393.pdf [5] VATANKHAH S, JALILVAND M, SARKHOSH S, AZARMI M, MOHSENI M. Prevalence of Congenital Anomalies in Iran: A Review Article. Iran J Public Health. 2017; 46 (6).733-743.https://www.ncbi.nlm.nih.gov/ pmc/articles/PMC5558066/pdf/IJPH-46- 733.pdf [6] Al-Hadithi, Al-Diwan JK, Saleh AM, Shabila NP. 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