Despite intense study during the 20th century, at its end the causes of the great
majority of congenital malformations were still unknown. Several means had been
used to try to remedy this unsatisfactory situation, a major one being the epidemiological
approach, that is, by analyzing patterns of occurrence and association.
Epidemiology is defined as the study of “the distribution and determinants of healthrelated
states and events in defined populations” (Last 1988); which in the context of
malformations refers to examining whether and how such abnormalities, especially
particular types, may be related to time, place, circumstance, and condition; for the
purpose of clarifying etiology and, implicitly, preventing them. Studies of these
relations have grown in number and variety, and it is an object of this writing to
describe the most significant of them, and to consider efforts to achieve this end.
This is a worthy and far-seeing objective, but a purpose of the writing as well,
of more immediacy, is to bring into focus the connection of death and congenital
malformation, so as to acknowledge and assess the advancement time has brought
in dealing with the problems of infant mortality.