Original StudyPrevalence, Mortality, and Spatial Distribution of Gastroschisis in Mexico
Introduction
Gastroschisis is a severe congenital anomaly characterized by evisceration of abdominal organs through a ventral abdominal wall defect, usually to the right of a normally inserted umbilicus without any protective membrane. After delivery, the child with gastroschisis requires neonatal surgical intervention, which is associated with significant health care costs, neonatal morbidity, and perinatal mortality.1, 2 Whereas the cause of gastroschisis is uncertain, well documented risk factors include young maternal age with a lower body mass index and maternal nativity; nevertheless, when stratified specifically according to maternal age, no other risk factor has consistently been associated with gastroschisis.3, 4, 5, 6, 7, 8, 9, 10 Besides the contribution of these risk factors, gastroschisis has been identified to occur in clusters as a clue in understanding its etiology.11, 12, 13, 14 Despite the recognition of the aforementioned findings, an extensive number of reports indicate an increasing prevalence of gastroschisis worldwide (10- to 20-fold over the past 50 years).3, 4, 5, 6, 7, 8, 9, 15, 16, 17, 18, 19 Furthermore, Mexico is recognized as a country with the highest prevalence of gastroschisis.15, 18, 19, 20, 21, 22 To date, Mexican studies on gastroschisis have been limited by the small case counts, which might have prevented recognition of social, demographic, and clinical factors. Moreover, no study has assessed the prevalence, mortality, and spatial distribution of gastroschisis in Mexico using large population-based data. Therefore, we draw on the General Directorate of Health Information of the Secretary of Health of Mexico to pool data from a large, population-based, and nationally representative sample of gastroschisis cases over the course of 15 years with a threefold purpose; to explore the prevalence, mortality, and spatial distribution of gastroschisis in Mexico from 2000-2014.
Section snippets
Materials and Methods
An analysis was performed in all infants with gastroschisis registered in the databases of hospital discharges of public institutions in the 32 states of Mexico from 2000-2014. These databases are produced at the General Directorate of Health Information of the Secretary of Health of Mexico.23 Continuous data from 2014 backward to whatever full calendar year was the earliest available and gastroschisis diagnoses confirmed by birth or death certificates (ICD-10 diagnosis code Q79.3,
Results
From 2000-2014, there were 25,635,416 live births (approximately 70% of total Mexican births over the course of the study period) and 10,287 gastroschisis cases among the 32 states of Mexico (birth prevalence rate, 4.01 per 10,000 live births). A consistent increase in the prevalence rate of gastroschisis was noted during the study period, from 2.09 per 10,000 in 2000 to 6.85 per 10,000 in 2014. There were 3305 deaths associated with gastroschisis (mortality rate, 1.28 per 10,000 live births).
Discussion
This is the first study to explore the prevalence, mortality, and spatial distribution of gastroschisis in Mexico using large population-based data. The present study shows a consistent increasing trend (at least threefold) in the birth prevalence of gastroschisis in Mexico during the period 2000-2014. Our findings agree with other reports around the world, indicating that the prevalence of gastroschisis has been increasing during the past two decades, particularly, among young maternal age
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Cited by (18)
Gastroschisis in monozygotic twins: A successful approach in a developing country
2022, Journal of Pediatric Surgery Case ReportsCitation Excerpt :An increasing global prevalence of gastroschisis has been reported (10–20-fold over the past 50 years), with 5.1 cases per 10,000 births in developing nations [1]. Despite the increased incidence [1,2], the causes still remain unknown. Genetic factors may contribute, such as in the cases occurring in twins, siblings (3.5–5.5%), or relatives (6.9%) [3,4].
Gastroschisis annual incidence, mortality, and trends in extreme Southern Brazil
2022, Jornal de PediatriaCitation Excerpt :North, Hill, and Valley MSs presented statistically significant changes. It is not possible to explain the causes of the trend variations seen in the observed periods, though similar gastroschisis rate trend variations were reported in several regions of the world by Herrera, Allman, and other authors, probably due to unclear environmental factors.6,7,24 A study on gastroschisis in São Paulo, Brazil, described the prevalence and seasonality changes by suggesting that pesticide exposure could have an influence on these changes.12
Sutureless Abdominal Closure in twin gastroschisis
2021, Journal of Pediatric Surgery Case ReportsCitation Excerpt :Gastroschisis is the most common congenital abdominal wall defect and is increasing in incidence worldwide [1–3].
Sex differences in surgically correctable congenital anomalies: A systematic review
2020, Journal of Pediatric SurgeryEvaluation of familial factors in a Mexican population-based setting with gastroschisis: Further evidence for an underlying genetic susceptibility
2018, Journal of Pediatric SurgeryCitation Excerpt :There may be several factors in play for these findings. For instance, the increasing prevalence in gastroschisis along with fertility in this Mexican population could possibly be associated with a higher familial recurrence risk [1–3]. On the other hand, it might be the result of a careful family and clinical investigation on gastroschisis, versus ascertainment bias that may have led to underreporting of familial recurrences of gastroschisis in other studies.
The authors indicate no conflicts of interest. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Secretary of Health of Mexico.