Are more babies with Down syndrome born to younger mothers?

Although the chance of giving birth to a baby with Down syndrome begins to rise quite quickly for mothers aged over 30 years, in most countries it has traditionally been the case that more babies are born to younger than to older women. This was because, in general, many more babies were born to younger women than to older women. But, is this still the case?

This question arose a few weeks ago when reviewing a draft of an updated information booklet on Down syndrome published by Early Support: are more babies with Down syndrome born to mothers aged under 35 years than to mothers aged 35 years or over?

It is well established that the chance of giving birth to a baby with Down syndrome is higher among older women than it is among younger women. Since 1989, a national registry has recorded all diagnosed cases of Down syndrome (prenatal and postnatal) in England and Wales. This large dataset offers probably the best estimation of the chances of giving birth to a baby with Down syndrome for mothers of different ages. From around 30 years of age (at the time of birth) the chance increases markedly, rising from 1 in 1,339 at 25 years to 1 in 352 at 35 years and 1 in 35 at 45 years. This graph shows how many babies would be born with Down syndrome in the absence of prenatal screening and selective terminations to mothers of different ages (per 1,000 livebirths):

Estimated prevalence of babies with Down syndrome by age of mother at birth (per 1,000 livebirths)

Estimated prevalence of babies with Down syndrome by age of mother at birth (per 1,000 livebirths). Source: http://dx.doi.org/10.1136/jms.9.1.2

Clearly, of babies born to mothers aged 35 years or older, more will have Down syndrome than among babies born to mothers aged under 35 years. We might suppose, therefore, that more babies with Down syndrome are born to older mothers. In the past, this has not been true, because many more babies were born to younger mothers than to older mothers. However, the relative difference has narrowed over the past 20 years. As a paper published in Down Syndrome Research and Practice a few years ago pointed out, the percentage of all births in England and Wales to mothers aged 35 and over increased from 9% in 1989 to 19% in 2003. During this time, the proportion of children with Down syndrome born to mothers aged 35 and over rose from 24.2% to 50.9%.

So, what has happened since 2003? Here is the latest data -

Year Mothers aged <35 years Mothers aged ≥35 years Mothers age unknown
Live born Outcome
unknown
Live born Outcome
unknown
Live born Outcome
unknown
1989 536 0 172 8 22 0
1990 521 1 197 11 8 0
1991 505 2 205 7 15 0
1992 448 5 183 13 24 0
1993 430 1 159 7 23 0
1994 399 9 183 15 43 1
1995 348 5 192 18 28 2
1996 370 4 192 9 33 0
1997 382 5 233 14 38 0
1998 352 6 226 20 42 0
1999 318 10 221 17 52 2
2000 315 23 228 38 35 0
2001 254 17 214 62 94 2
2002 271 31 199 72 111 0
2003 258 18 268 48 85 4
2004 286 17 281 63 90 1
2005 298 36 308 98 127 6
2006 281 43 316 86 152 11
2007 288 38 336 72 79 5
2008 300 27 324 56 110 3
2009 292 28 352 43 126 1
2010 271 26 326 70 122 1

Assuming that the outcomes of pregnancies for which outcomes are unknown and for those for which maternal ages are unknown were similar to the known outcomes, then we can conclude that in 2009 and 2010 55% of babies with Down syndrome were born to ‘older’ mothers:

Proportion of babies born with Down syndrome in England and Wales born to mothers aged younger than 35 years and mothers aged 35 years or older, 1989-2010

Proportion of babies born with Down syndrome in England and Wales born to mothers aged <35 years and mothers aged ≥35 years, 1989-2010.  Source: National Down Syndrome Cytogenetic Register (NDSCR).

The trends are likely to be quite similar in other developed countries.

Minister responds to UK education guidelines

Last week, the All Party Parliamentary Group on Down Syndrome (APPGDS) presented a new report on good practice in education to Edward Timpson MP, Parliamentary Under Secretary of State (Children and Families) who is responsible for special educational needs and disability at the Department for Education.

The report summarises information about the specific learning needs of children with Down syndrome, sets out principles for effective education practice, and calls on government to:

  1. Recognise the specific developmental and educational needs of children and young people with Down syndrome as a unique group
  2. Ensure effective planning and monitoring for this population of children/ young people
  3. Develop the inspection framework so that the inspection process is informed by and checks against identified good practice with pupils with SEN, and specifically Down syndrome
  4. Promote and support syndrome-specific approaches tailored to the learning profile of children and young people with Down syndrome, and endorse the principles set out in this document
  5. Develop government led, centrally produced, evidence based guidance for practitioners on Down syndrome
  6. Protect the provision of specialist Down syndrome support services
  7. Recognise and meet the need for provision of additional resourcing

You can watch the Minister’s reply here and download the report here (PDF, 1.2MB).

Latest data on births in England and Wales

The latest Annual Report from the National Down Syndrome Cytogenetic Register (NDSCR) has been published. NDSCR collects data on babies diagnosed with Down syndrome throughout England and Wales. The Annual Report provides updated data for 1998 through to 2011, though the 2011 numbers remain provisional.

In the five years from 2006 to 2010, an average of 741 babies were born with Down syndrome each year in England and Wales. Extrapolating on the basis of population, we can estimate that an average of 836 babies were born with Down syndrome each year from 2006 to 2010 in the United Kingdom. There were 16% more babies born during this period than the previous five years (2001-2005) and 19% more than in the five years prior to that (1996-2000). In other words, there are around 19% more babies being born in England and Wales than 10 years ago.

Of course, some of this increase is due to an increase in births in general. In the five years from 2006 to 2010, the live birth prevalence of Down syndrome in England and Wales averaged 10.6 per 10,000 (1 in 944 babies). Live birth prevalence was during this period was 3% higher than in the previous five years (2001-2005: 10.3 per 10,000) and 8% higher than in the period prior to that (1996-2000: 9.8 per 10,000). In other words, the live birth rate in England and Wales is 8% higher than 10 years ago.

The recent increases in live births and live birth prevalence (babies born with Down syndrome as a proportion of all babies born) seem to have peaked in 2009 with 774 births in England and Wales (1.1 per 1,000 or 1 in 912 live births) and fallen to around 725 annual births (1.0 per 1,000) in 2010/11.

There seems to be a slight trend towards fewer terminations being chosen after a prenatal diagnosis – from around 92% in the late 1990s to around 90.5% in recent years. Note that this is the proportion of babies prenatally diagnosed with Down syndrome that were terminated – not the proportion of all babies with Down syndrome.

Babies with Down syndrome (and other trisomies) are substantially more likely to be lost during pregnancy than other babies. Therefore, the number of terminations recorded does not tell us how many babies were not born that would have been born in the absence of genetic screening and selective terminations. This is because many of the babies terminated would not have survived to term in the absence of intervention.

In 2010, there were 1,111 terminations recorded. We can estimate (from the ages at which mothers gave birth in that year) that 1,613 babies would be expected to be born with Down syndrome. Therefore, 888 (55%) fewer babies with Down syndrome were born in 2010 than would have been born in the absence of genetic screening and selective terminations.

Given recent trends in births, we can estimate that there are approximately 37,000 people with Down syndrome living in the United Kingdom today.

CBBC programme about young people with Down syndrome

A great programme from the BBC about three young people with Down syndrome:

Ruben, Harley and Nicole are three very different 12-year-olds, with one very big thing in common. They all have a dream and they won’t let anything stand in the way of it – especially something as unimportant as having Down’s Syndrome. Having been wrapped up in cotton wool by their parents since they were born, we follow these three extraordinary children over the summer that will change their lives.

bbc-my-life-still

Watch here (may not be available in all countries): http://dsuri.net/YIjfu5

Volunteer Trustees and Directors

We are seeking additional Trustees and Directors to help lead our work improving education for children with Down syndrome. If you may be interested, please get in touch and consider coming along to a briefing in London on 26 February 2013.

There are an estimated 13,000 children (under the age of 18) with Down syndrome in the United Kingdom, 83,000 in the United States, 8,000 in Canada, 7,000 in Australia, 145,000 across Europe and (perhaps) 1.6 million worldwide. Almost all should (and could) be receiving more effective early intervention, speech therapy and education than they do – helping them to lead more independent, productive and fulfilling adult lives. Improving outcomes for all of these children is what DSE exists to do.

Down Syndrome Education International is a unique charity with a successful 25-year track record. We focus on improving education for children with Down syndrome through research, services and resources supporting families and educators worldwide.

The charity is widely regarded as a world leader in its field. Over three decades, we have advanced understanding of the children’s learning needs, investigating early language development, reading and literacy, memory, number skills, behaviour, inclusion and more. We work closely with colleagues at Universities around the UK and around the world.

Our current research interests include early language development, early cognition and problem-solving, attention and executive function, working and short term memory, speech clarity, reading instruction, reading comprehension, numeracy and social development and behaviour. In several of these research areas, we have practical candidate interventions ready for evaluation that we believe stand a good chance of being shown to be effective at improving critical educational outcomes for children with Down syndrome. With the necessary funding in place, each of these trials could deliver results within 18 to 36 months and (if successful) then immediately start to transform speech therapy, early intervention and teaching practice for children with Down syndrome.

Our books, teaching materials, films and web sites help over 150,000 people in over 170 countries worldwide annually. We are actively developing our See and Learn early teaching materials to help families, teachers and therapists to support language and reading, memory, speech and number skills development during the important early years. We have recently published a new, evidence-based primary school reading and language intervention – the direct result of a major research project and the first rigorously evaluated intervention designed for children with Down syndrome.

We also present web seminars, workshops and conferences to audiences around the UK and around the world. We are regularly invited to speak at major conferences, and in recent years have hosted education conferences in the UK, the US and Ireland.

Changing times

Down Syndrome Education International has been changing over the past 5 years to do more to meet the needs of families and children throughout the world.

In 2007, we began to focus more of our attention towards research. For several years prior to this, our research activities had slowed while we expanded our publishing, training and consulting activities. In 2008, we secured a major grant from the Big Lottery Fund to evaluate a reading and language intervention (that we are now publishing). Also in 2008, we established Down Syndrome Education USA to develop services and activities to support families and children with Down syndrome in North America, and to further develop research activities in the US.

Since late 2008, we have had to adapt to the new economic realities, which in the UK have included greater competition for charitable funding from trusts and foundations, and reduced funding from corporations and government. Local government cutbacks in the UK following the 2010 Spending Review (in part) led to the closure of local support services for families and schools in southern England in 2011.

Over the past few years, we have grown our income (figure, right) – in part by growing revenues from social enterprise activities. Many of the resources and services that we supply can only be provided by charging for them. With some sources of charitable income on the decline, we are increasingly having to rely on these revenues to not only cover the costs of the services, but also to contribute to future research.

During the past year, we have restructured our UK operations, moving to smaller offices in the north of England and outsourced much of what we used to do in-house. We are increasingly funding researchers in Universities rather than employing permanent researchers ourselves. We are also shifting our focus to training professionals working for other charitable and public sector organisations, rather than being a ‘frontline’ training provider. These changes are not only improving efficiency, but also increasing the impact that we have on the education of thousands of young people with Down syndrome.

Seeking new Trustees and Directors

With these strategic shifts in mind, we are now seeking to expand both the Board of Trustees of Down Syndrome Education International (DSEI) and the Board of Directors of its subsidiary social enterprise company, Down Syndrome Education Enterprises CIC (DSEE). DSEI is a UK-registered charitable company through which we operate our UK and international research activities and charitable services. DSEE is a UK-registered community interest company that is wholly owned by DSEI and through which we operate publishing, training and consulting services. Both DSEI and DSEE work in a close strategic partnership with Down Syndrome Education USA – our associated US nonprofit through which we operate publishing, training and consulting services in North America.

We are seeking volunteers who wish to serve on either one of these Boards and help us do more to improve education for children with Down syndrome everywhere. We are interested in recruiting parents, education professionals and researchers with relevant experience and expertise. In addition to educational and research expertise, we are seeking volunteers with experience in accounting and finance, sales and marketing, publishing and distribution, and general business management. We also expect all our Trustees to assist with fundraising in any ways they can.

Both Boards meet three times each year in London, in between which we communicate regularly by email and occasional teleconference.

Trustees of DSEI are responsible for setting research priorities, fundraising and charitable services. Directors of DSEE are responsible for developing and operating effective support services and publications that help improve outcomes for children with Down syndrome. Clearly, the two Boards work closely together and there is some dual representation.

Members of both Boards serve as company directors (DSEI is a limited company as well as being a charity). Members of the DSEI Board also serve as charity Trustees. Further information about the role of charity Trustees is available in the Charity Commission’s publication The Essential Trustee: what you need to know (PDF).

We do not remunerate DSEI Trustees or DSEE Directors. However, we can cover out-of-pocket expenses.

London briefing event, 26 February 2013

If you are interested in helping us continue to improve education for children with Down syndrome, we invite you to get in touch.

We are holding a meeting on 26 February 2013 in London to provide information to anyone interested in becoming a Trustee or Director and to give you an opportunity to meet staff and existing members of the boards.

The briefing will be held at 11:00 in central London and followed by a sandwich lunch at 12:30.

Further information

If you would like to attend the briefing or if you would like further information, please contact me at frank@dseinternational.org