Metropolitan Atlanta Congenital Defects Program (MACDP)

The Metropolitan Atlanta Congenital Defects Program (MACDP) is a population-based tracking system for birth defects. MACDP was established in 1967 by the Centers for Disease Control and Prevention (CDC), Emory University, and the Georgia Mental Health Institute. It was the nation’s first population-based system for active collection of information about birth defects. Population-based means that the researchers look at all babies with birth defects who live in the study region to get a complete picture of what is happening within the population. Since 1967, the program has tracked birth defects among infants and children born to mothers living in metropolitan Atlanta using active case-finding methods and multiple sources of information.

MACDP’s purpose is to:

• Track the occurrence of birth defects.
• Maintain data for use in epidemiologic studies (studies that look at health effects within the population).
• Understand other health outcomes, such as mortality or death rates, associated with birth defects.
• Provide data for education and health policy decisions leading to prevention of birth defects.
• Serve as a model to help other programs develop and implement new tracking methods.
• Collaborate with state and international birth defects programs in tracking and prevention efforts.
• Provide a training ground for public health scientists in tracking and epidemiologic methods.

Reports and Resources

Metropolitan Atlanta Congenital Defects Program’s (MACDP) 40th Anniversary Edition Surveillance Report, 2007
This report describes the prevalence of birth defects in metropolitan Atlanta from 1968 through 2003. It also provides a detailed account of MACDP methods and ongoing activities. Errata, 2008

MACDP 6-Digit Code Defect List [PDF – 466K] (CDC BPA Code)
This list includes birth defects that are tracked by MACDP, as well as conditions that are never included and those that are included only under certain circumstances. The code is based on the International Classification of Diseases, 9th Revision, Clinical Modification and the British Pediatric Association (BPA) Classification of Diseases.

Methods

From 1968–2011, the MACDP tracking system covered five central counties of the metropolitan Atlanta area: Clayton, Cobb, DeKalb, Fulton, and Gwinnett. In 2012, due to resource limitations, the number of counties was reduced to three: DeKalb, Fulton, and Gwinnett. Now, the MACDP tracking system has approximately 35,000 births per year. The population has changed with the growth of Atlanta since the beginning of the study. Atlanta has become more urban and the racial and ethnic make-up has changed over time. Since MACDP began tracking birth defects in Atlanta, the percentage of births to non-White mothers has risen from 27% to 66%.

The key to the success of MACDP has been the many sources it uses to find infants with birth defects and the clinical review of abstracted records. The specially trained MACDP staff visits hospitals and clinics throughout the metropolitan Atlanta area to try to make certain that all infants and pregnancies affected by a birth defect are included. This is called active tracking. Then, CDC clinicians review the information to make sure that it is complete and the defect meets the case definitions used by MACDP. MACDP also links its data with that of other databases, such as information from birth and death certificates and genetics laboratories. Data linkage among the various databases broadens the scope of information, improves the ability to find infants with birth defects, helps prevent counting the same baby twice, and improves the overall quality of the data.

Birth defects are notifiable conditions in the state of Georgia (Chapter 12 of the Official Code of Georgia). Notifiable conditions are illnesses or diseases that are required by law to be reported to public health authorities. The Georgia Department of Public Health (DPH) has requested the staff of MACDP to act with DPH in the collection of public health surveillance data related to birth defects. MACDP data are protected by the Privacy Act of 1974 and by an Assurance of Confidentiality granted by the Director of CDC. Approval for MACDP has been granted by CDC’s Institutional Review Board.

Case Definition

For an infant with a birth defect to be included in the MACDP tracking system, the following criteria must be met:

• The mother must live in one of the designated counties of metropolitan Atlanta area at the time of delivery.
• The infant or fetus must have a birth defect on the MACDP 6-Digit Code Defect List [PDF – 466K] .
• Liveborn or stillborn infants with defects must have a gestational age of at least 20 weeks; electively terminated pregnancies with defects can be of any gestational age.
• For any liveborn infant, a birth defect must be identified by the child’s sixth birthday.

MACDP Articles

Boulet SL, Shin M, Kirby RS, Goodman D, Correa A. (2011).Sensitivity of birth certificate reports of birth defects in Atlanta, 1995–2005: effects of maternal, infant, and hospital characteristics. Public Health Reports. 126 (2):186-194.

Centers for Disease Control and Prevention. Update on overall prevalence of major birth defects – Atlanta, Georgia, 1978-2005. Morbid Mortal Wkly Rep MMWR. 2008;57;1–5.

Cragan JD, Gilboa SM. Including prenatal diagnoses in birth defects monitoring: experience of the metropolitan atlanta congenital defects program. Birth Defects Res Part A Clin Mol Teratol. 2009;85:20–9.

Duke W, Gilboa SM. Using an existing birth defects surveillance program to enhance surveillance data on stillbirths. Journal of Registry Management. 2014; 41(1):13-18.

Hartman RJ, Rasmussen SA, Botto LD, Riehle-Colarusso T, Martin CL, Cragan JD, Shin M, Correa A. (2011). The contribution of chromosomal abnormalities to congenital heart defects: a population-based study. Pediatr Cardiol. 32:1147–1157.

Jackson JM, Crider KS, Rasmussen SA, Cragan JD, Olney RS. (2012). Trends in cytogenetic testing and identification of chromosomal abnormalities among pregnancies and children with birth defects, metropolitan Atlanta, 1968-2005. Am J Med Genet A. 158A:116–123.

Kucik JE, Alverson CJ, Gilboa SM, Correa A. (2012). Racial/ethnic variations in the prevalence of selected major birth defects, Metropolitan Atlanta, 1994–2005. Public Health Report. 127(1):52-61.

Miller A, Riehle-Colarusso T, Siffel C, Frías JL, Correa A. (2011). Maternal age and prevalence of isolated congenital heart defects in an urban area of the United States. Am J Med Genet A. 155(9):2137-45

Miller A, Siffel C, Lu C, Riehle-Colarusso T, Frías JL, Correa A. Long-term survival of infants with atrioventricular septal defects. J Pediatr. 2010;156:994–1000.

Oster ME, Lee KA, Honein MA, Riehle-Colarusso T, Shin M, Correa A. Temporal trends in survival among infants with critical congenital heart defects. Pediatr. 2013;131(5):e1502-8.

Oster ME, Kim CH, Kusano AS, Cragan JD, Dressler P, Hales AR, Mahle WT, Correa A. A population-based study of the association of prenatal diagnosis with survival rate for infants with congenital heart defects. Am J Cardiol. 2014;113(6):1036-40.

Rasmussen SA, Wong LY, Correa A, Gambrell D, Friedman JM. Survival in infants with Down syndrome, Metropolitan Atlanta, 1979-1998. J Pediatr. 2006;148:806–12.

Reller MD, Strickland MJ, Riehle-Colarusso T, Mahle WT, Correa A. Prevalence of congenital heart defects in metropolitan Atlanta, 1998-2005. Pediatrics. 2008;153:807–13.

Riehle-Colarusso TJ, Autry A, Razzaghi H, Bolye CA, Mahle Wt, et al. Congenital heart defects and receipt of special education services. Pediatrics. 2015. [epub ahead of print]

Shin M, Besser LM, Correa A. Prevalence of spina bifida among children and adolescents in metropolitan Atlanta. Birth Defects Res Part A Clin Mol Teratol. 2008;82:748–54.

Strickland MJ, Klein M, Correa A, Reller MD, Mahle WT, Riehle-Colarusso TJ, et al. Ambient air pollution and cardiovascular malformations in Atlanta, Georgia, 1986–2003. Am J Epidemiol. 2009;169:1004–14.

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