Original article
Demographic and environmental risk factors for gastroschisis and omphalocele in the National Birth Defects Prevention Study,☆☆

https://doi.org/10.1016/j.jpedsurg.2008.10.109Get rights and content

Abstract

Background

Primary prevention efforts for both gastroschisis and omphalocele are limited by the lack of known risk factors. Our objective was to investigate associations between potential maternal risk factors and gastroschisis and omphalocele within a large population-based sample of participants enrolled in the National Birth Defects Prevention Study (NBDPS).

Methods

Demographic, health-related, and environmental exposure data from the NBDPS were collected from women with expected delivery dates between October 1997 and December 2003. Data were collected on 485 cases of gastroschisis, 168 cases of omphalocele, and 4967 controls.

Results

Women who had offspring with gastroschisis were younger (adjusted odds ratio [AOR], 0.84; 95% confidence interval [CI], 0.81-0.86) and less likely to be black (AOR, 0.54; 95% CI, 0.34-0.85) than controls. They also were more likely to have smoked (AOR, 1.51; 95% CI, 1.12-2.03), taken ibuprofen (AOR, 1.61; 95% CI, 1.23-2.10), and consumed alcohol (AOR, 1.38; 95% CI, 1.06-1.79) than controls. Women who had offspring with omphaloceles were more likely to have consumed alcohol (AOR, 1.53; 95% CI, 1.04-2.25) and be heavy smokers (AOR, 4.26; 95% CI, 1.58-11.52) than controls.

Conclusions

Our results suggest a moderately increased risk of gastroschisis among women who used tobacco, alcohol, and ibuprofen during early pregnancy. A modestly elevated risk was observed for omphaloceles among women who used alcohol during the first trimester and among women who were heavy smokers.

Section snippets

Population

The population for this study included infants who were enrolled in the NBDPS with an expected date of delivery between October 1, 1997, and December 31, 2003. The NBPDS is an ongoing multisite case-control study incorporating data collected from 10 population-based state birth defects surveillance systems (Arkansas, California, Georgia, Iowa, Massachusetts, New York, New Jersey, North Carolina, Texas, and Vermont). Approximately 65% of eligible gastroschisis cases, 68% of eligible omphalocele

Results

A total of 485 cases of gastroschisis, 168 cases of omphalocele, and 4967 controls were included. Of those, 446 (92%) cases of gastroschisis and 105 (62.5%) cases of omphalocele had no other major structural birth defect. Table 1 presents demographic characteristics of cases and controls. More than 31% of women with pregnancies affected by gastroschisis were Hispanic, 8% were black, and 53% were white. Nearly 34% of mothers of infants with gastroschisis had household annual incomes of less than

Discussion

The current study investigated associations between maternal exposures and demographic factors in both gastroschisis and omphalocele within a large, population-based, case-control study, and found large differences in the demographic profiles of the 2 defects, while finding some similarities in their exposure profiles. This study increases our understanding of the epidemiological influences of gastroschisis and omphalocele by lending support to many previously reported risk factors while

Conclusion

Gastroschisis and omphalocele have an almost entirely discordant profile of demographic and exposure variables. Two strong vasoconstrictors, pseudoephedrine and cocaine, were not found to be significantly associated with gastroschisis despite previous reports of an association [2], [8], [9], [10], [12]. Neither did we find significant associations between gastroschisis and other often reported exposures including aspirin [6], [9], [10], acetaminophen [8], [10], and marijuana [5], [7], [26].

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    This work was supported by funds from the Centers for Disease Control and Prevention (CDC), grant no. 3U50DD613236. The contents are solely the responsibility of the authors and do not necessarily represent the official views of the CDC.

    ☆☆

    This study was approved by the Institutional Review Board of the University of Arkansas for Medical Sciences (Little Rock, Ark), protocol no. 04812.

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