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Neo DT, Desrosiers TA, Martin CL, Carmichael SL, Gucsavas-Calikoglu M, Conway KM, Evans SP, Feldkamp ML, Gilboa SM, Insaf TZ, Musfee FI, Shaw GM, Shumate CJ, Werler MM, Olshan AF. Neighborhood-level Socioeconomic Position During Early Pregnancy and Risk of Gastroschisis. Epidemiology 2023; 34:576-588. [PMID: 36976718 PMCID: PMC10291502 DOI: 10.1097/ede.0000000000001621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
BACKGROUND Neighborhood-level socioeconomic position has been shown to influence birth outcomes, including selected birth defects. This study examines the un derstudied association between neighborhood-level socioeconomic position during early pregnancy and the risk of gastroschisis, an abdominal birth defect of increasing prevalence. METHODS We conducted a case-control study of 1,269 gastroschisis cases and 10,217 controls using data from the National Birth Defects Prevention Study (1997-2011). To characterize neighborhood-level socioeconomic position, we conducted a principal component analysis to construct two indices-Neighborhood Deprivation Index (NDI) and Neighborhood Socioeconomic Position Index (nSEPI). We created neighborhood-level indices using census socioeconomic indicators corresponding to census tracts associated with addresses where mothers lived the longest during the periconceptional period. We used generalized estimating equations to estimate odds ratios (ORs) and 95% confidence intervals (CIs), with multiple imputations for missing data and adjustment for maternal race-ethnicity, household income, education, birth year, and duration of residence. RESULTS Mothers residing in moderate (NDI Tertile 2 aOR = 1.23; 95% CI = 1.03, 1.48 and nSEPI Tertile 2 aOR = 1.24; 95% CI = 1.04, 1.49) or low socioeconomic neighborhoods (NDI Tertile 3 aOR = 1.28; 95% CI = 1.05, 1.55 and nSEPI Tertile 3 aOR = 1.32, 95% CI = 1.09, 1.61) were more likely to deliver an infant with gastroschisis compared with mothers residing in high socioeconomic neighborhoods. CONCLUSIONS Our findings suggest that lower neighborhood-level socioeconomic position during early pregnancy is associated with elevated odds of gastroschisis. Additional epidemiologic studies may aid in confirming this finding and evaluating potential mechanisms linking neighborhood-level socioeconomic factors and gastroschisis.
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Affiliation(s)
- Dayna T. Neo
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Tania A. Desrosiers
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Chantel L. Martin
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Suzan L. Carmichael
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
- Department of Obstetrics and Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Muge Gucsavas-Calikoglu
- Department of Pediatrics, Division of Genetics and Metabolism, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kristin M. Conway
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA
| | - Shannon Pruitt Evans
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
- Eagle Global Scientific LLC, San Antonio, TX, USA
| | - Marcia L. Feldkamp
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Suzanne M. Gilboa
- Division of Birth Defects and Infant Disorders, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA
| | - Tabassum Z. Insaf
- Bureau of Environmental and Occupational Epidemiology, Center for Environmental Health, New York State Department of Health, Albany, NY
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, NY
| | - Fadi I. Musfee
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR
- Arkansas Center for Birth Defects Research and Prevention, Fay W. Boozman College of Public Helath, University of Arkansas for Medical Sciences, Little Risk, AR
| | - Gary M. Shaw
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Charles J. Shumate
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, TX
| | - Martha M. Werler
- Department of Epidemiology, Boston University School of Public Health, Boston, MA
| | - Andrew F. Olshan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
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2
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Baldacci S, Santoro M, Coi A, Mezzasalma L, Bianchi F, Pierini A. Lifestyle and sociodemographic risk factors for gastroschisis: a systematic review and meta-analysis. Arch Dis Child 2020; 105:756-764. [PMID: 32051127 DOI: 10.1136/archdischild-2019-318412] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/24/2020] [Accepted: 01/24/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Gastroschisis is strongly associated with young maternal age. This association suggests the need for further investigations on non-genetic risk factors. Identifying these risk factors is a public health priority in order to develop prevention strategies aimed at reducing the prevalence and health consequences in offspring. OBJECTIVE To systematically assess and quantitatively synthesise the available epidemiological studies to evaluate the association between non-genetic risk factors and gastroschisis. METHODS Literature from PubMed, EMBASE and Scopus was searched for the period 1990-2018. Epidemiological studies reporting risk estimates between lifestyle and sociodemographic risk factors and gastroschisis were included. Two pairs of reviewers independently extracted information on study characteristics following Preferred Reporting Items for Systematic Reviews and Meta-Analyses and MOOSE (Meta-analysis Of Oservational Studies in Epidemiology) guidelines. Relative risk (RR) estimates were calculated across the studies and meta-analysis was performed using random-effects model. RESULTS We identified 58 studies. Meta-analyses were conducted on 29 studies. Maternal smoking (RR 1.56, 95% CI 1.40 to 1.74), illicit drug use (RR 2.14, 95% CI 1.48 to 3.07) and alcohol consumption (RR 1.40, 95% CI 1.13 to 1.70) were associated with an increased risk of gastroschisis. A decreased risk among black mothers compared with non-Hispanic white mothers (RR 0.49, 95% CI 0.38 to 0.63) was found. For Hispanic mothers no association was observed. CONCLUSIONS Exposure to smoking, illicit drugs and alcohol during pregnancy is associated with an increased risk of gastroschisis. A significantly decreased risk for black mothers was observed. Further epidemiological studies to assess the potential role of other environmental factors are strongly recommended. PROSPERO REGISTRATION NUMBER CRD42018104284.
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Affiliation(s)
- Silvia Baldacci
- Institute of Clinical Physiology National Research Council, Pisa, Italy
| | - Michele Santoro
- Institute of Clinical Physiology National Research Council, Pisa, Italy
| | - Alessio Coi
- Institute of Clinical Physiology National Research Council, Pisa, Italy
| | - Lorena Mezzasalma
- Institute of Clinical Physiology National Research Council, Pisa, Italy
| | - Fabrizio Bianchi
- Institute of Clinical Physiology National Research Council, Pisa, Italy.,Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Anna Pierini
- Institute of Clinical Physiology National Research Council, Pisa, Italy.,Fondazione Toscana Gabriele Monasterio, Pisa, Italy
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3
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Michikawa T, Yamazaki S, Suda E, Kuroda T, Nakayama SF, Isobe T, Kobayashi Y, Iwai-Shimada M, Sekiyama M, Kawamoto T, Nitta H. Does overweight before pregnancy reduce the occurrence of gastroschisis?: the Japan Environment and Children's Study. BMC Res Notes 2020; 13:47. [PMID: 32000843 PMCID: PMC6990474 DOI: 10.1186/s13104-020-4915-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 01/22/2020] [Indexed: 11/10/2022] Open
Abstract
Objective For several observational studies that have reported the factors related to gastroschisis, the target population in these studies was mainly residents of Europe or the US, and there is little data on the Asian population. In this study, we summarised characteristics of Japanese women who delivered infants with gastroschisis, particularly focusing on the pre-pregnancy body mass index (BMI), which was found to be inversely associated with gastroschisis in past studies, because the distribution of BMI is clearly different in Asia and the West. Results We used data from a nationwide birth cohort study which recruited pregnant women between 2011 and 2014. Among 92,796 women who delivered singleton live births, the frequency of underweight (pre-pregnancy BMI < 18.5 kg/m2) was 16.2%, reference weight (18.5–24.9 kg/m2) 73.1%, and overweight (≥ 25.0 kg/m2) 10.6%. We identified only 9 infants with gastroschisis, 2 of whose women were underweight (frequency of gastroschisis = 0.01%), 5 were in the reference group (0.01%), and 2 were overweight (0.02%). Of these 9 women, none were aged < 20 years, 2 were aged 20–29 years (frequency = 0.01%), and 7 were aged 30–39 years (0.01%). No reduction in the occurrence of gastroschisis was apparent among Japanese women who were overweight before pregnancy.
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Affiliation(s)
- Takehiro Michikawa
- Department of Environmental and Occupational Health, School of Medicine, Toho University, 5-21-16 Omori-nishi, Ota-ku, Tokyo, 143-8540, Japan. .,Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki, 305-8506, Japan.
| | - Shin Yamazaki
- Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki, 305-8506, Japan
| | - Eiko Suda
- Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki, 305-8506, Japan
| | - Tatsuo Kuroda
- Department of Paediatric Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shoji F Nakayama
- Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki, 305-8506, Japan
| | - Tomohiko Isobe
- Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki, 305-8506, Japan
| | - Yayoi Kobayashi
- Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki, 305-8506, Japan
| | - Miyuki Iwai-Shimada
- Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki, 305-8506, Japan
| | - Makiko Sekiyama
- Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki, 305-8506, Japan
| | - Toshihiro Kawamoto
- Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki, 305-8506, Japan
| | - Hiroshi Nitta
- Centre for Health and Environmental Risk Research, National Institute for Environmental Studies, 16-2 Onogawa, Tsukuba, Ibaraki, 305-8506, Japan
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4
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Centofanti SF, Francisco RPV, Phillippi ST, Galletta MAK, Sousa AMS, Rodrigues AS, Curi R, Brizot ML. Maternal nutrient intake and fetal gastroschisis: A case-control study. Am J Med Genet A 2019; 179:1535-1542. [PMID: 31215128 DOI: 10.1002/ajmg.a.61265] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 04/01/2019] [Accepted: 06/01/2019] [Indexed: 11/08/2022]
Abstract
Fetal gastroschisis is a paraumbilical abdominal wall defect with herniation of the abdominal organs. This multifactorial malformation occurs in young pregnant women, and the underlying cause of the disease remains unknown; however, nutritional factors may play a role in its development. This case-control study explored the association of maternal nutrient intake with the occurrence of gastroschisis. The gastroschisis group (GG) comprised 57 pregnant women with fetuses with gastroschisis, and the control group (CG) comprised 114 pregnant women with normal fetuses matched for maternal age, gestational age, and preconception body mass index classification. Nutritional assessments related to the preconception period were obtained using the food consumption frequency questionnaire, and nutrient intakes were calculated using nutrition programs. The median daily calorie intake was higher (2,382.43 vs. 2,198.81; p = .041) in the GG than in the CG. The median intake of methionine (763.89 vs. 906.34; p = .036) and threonine (1,248.34 vs. 1,437.01; p = .018) was lower in the GG than in the CG. Pregnant women with fetuses with gastroschisis have a diet characterized by higher calorie intake and lower levels of essential amino acids (methionine and threonine) during the preconception period than pregnant women with normal fetuses.
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Affiliation(s)
- Sandra F Centofanti
- Department of Obstetrics and Gynecology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Rossana P V Francisco
- Department of Obstetrics and Gynecology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Sonia T Phillippi
- Department of Nutrition, Faculty of Public Health, São Paulo University, Sao Paulo, Brazil
| | - Marco A K Galletta
- Department of Obstetrics and Gynecology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ana M S Sousa
- Department of Obstetrics and Gynecology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Agatha S Rodrigues
- Department of Obstetrics and Gynecology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil.,Department of Statistics, Institute of Mathematics and Statistics, Sao Paulo University, Sao Paulo, Brazil
| | - Rui Curi
- Post Graduate program on Health Sciences, Cruzeiro do Sul University, Sao Paulo, Brazil
| | - Maria L Brizot
- Department of Obstetrics and Gynecology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
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6
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Centofanti SF, Francisco RPV, Phillippi ST, Castro IA, Hoshida MS, Curi R, Brizot ML. Low serum fatty acid levels in pregnancies with fetal gastroschisis: A prospective study. Am J Med Genet A 2018; 176:915-924. [DOI: 10.1002/ajmg.a.38638] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Revised: 01/15/2018] [Accepted: 01/21/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Sandra F. Centofanti
- Department of Obstetrics and Gynecology, Faculty of Medicine, FMUSP; University of São Paulo; Sao Paulo SP Brazil
| | - Rossana P. V. Francisco
- Department of Obstetrics and Gynecology, Faculty of Medicine, FMUSP; University of São Paulo; Sao Paulo SP Brazil
| | - Sonia T. Phillippi
- Department of Nutrition, Faculty of Public Health; University of São Paulo; Sao Paulo SP Brazil
| | - Inar A. Castro
- Department of Food and Experimental Nutrition, Faculty of Pharmaceutical Sciences; University of São Paulo, São Paulo; Sao Paulo SP Brazil
| | - Mara S. Hoshida
- Department of Obstetrics and Gynecology, Faculty of Medicine, FMUSP; University of São Paulo; Sao Paulo SP Brazil
| | - Rui Curi
- Cruzeiro do Sul University; Sao Paulo SP Brazil
| | - Maria L. Brizot
- Department of Obstetrics and Gynecology, Faculty of Medicine, FMUSP; University of São Paulo; Sao Paulo SP Brazil
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7
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Wadhwa EL, Ma C, Shaw GM, Carmichael SL. Gastroschisis and maternal intake of phytoestrogens. Am J Med Genet A 2016; 170:2078-82. [PMID: 27232448 DOI: 10.1002/ajmg.a.37659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 03/27/2016] [Indexed: 11/06/2022]
Abstract
The prevalence of gastroschisis has increased significantly in the past few decades. The strongest risks have been observed for women <25 years old or of low body mass index, and maternal diet also been proposed to be associated with risk. The objective of this study was to evaluate whether the risk of gastroschisis is associated with maternal dietary intake of phytoestrogens. The analysis includes data on mothers of 409 gastroschisis cases and 3,007 controls who delivered their infants from 2005 to 2010 and participated in the National Birth Defects Prevention Study, a multistate, population-based, case-control study. Detailed information was obtained from maternal telephone interviews that included a validated food frequency questionnaire. We conducted logistic regression analyses that included each phytoestrogen in its continuous form (to test for linearity) and quadratic form (to test for non-linearity), adjusted for maternal energy intake, age, BMI, race-ethnicity, and smoking in 1st trimester. Logistic regression analysis indicated that biochanin A, formonoetin, and coumestrol had a significant non-linear association with gastroschisis (P-value <0.05 for quadratic term). Lower intakes were associated with increased risk, with somewhat stronger but relatively modest associations at the lower end of the distribution; for example, the ORs for the 10th versus 50th percentiles ranged from 1.1 to 1.2. Associations were not significant for the other phytoestrogens. This study provides some evidence for association with certain phytoestrogens, after adjusting for covariates. The implications of our findings for clinical practice are uncertain pending other studies examining this association. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Elizabeth L Wadhwa
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, California
| | - Chen Ma
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, California
| | - Gary M Shaw
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, California
| | - Suzan L Carmichael
- Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University, Stanford, California
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Vo LUT, Langlois PH. Time trends in prevalence of gastroschisis in Texas, 1999 to 2011: Subgroup analyses by maternal and infant characteristics. ACTA ACUST UNITED AC 2015; 103:928-40. [PMID: 26408207 DOI: 10.1002/bdra.23438] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 08/03/2015] [Accepted: 08/04/2015] [Indexed: 11/11/2022]
Abstract
BACKGROUND The prevalence of gastroschisis, a birth defect of the abdominal wall, has been increasing in several areas around the world. Suggested risk factors for gastroschisis include maternal age, race/ethnicity, nativity, body mass index, and socioeconomic status. METHODS Data for cases of gastroschisis and live births were taken from the Texas Birth Defects Registry and Texas vital records for deliveries between 1999 and 2011. Prevalence by subgroups over time was calculated for: infant sex, maternal age, race/ethnicity, nativity, education, parity, plurality, body mass index, and payer type. Stratified, adjusted, and interaction analyses of the trends were conducted using Poisson regression. A joinpoint trend analysis was also conducted for each subgroup. RESULTS A total of 2,549 gastroschisis cases and 4,970,979 live births were delivered in 1999 to 2011, for an overall prevalence of 5.13 cases per 10,000 live births (95% confidence interval = 4.93-5.33). On average, the prevalence increased 4.8% each year; this overall time trend was statistically significant (p-value < 0.0001). The time trend remained significant after adjusting for all variables, except payer type. The stratified analysis showed the increasing time trend was significant in many of the subgroups. However, there were no significant differences in the magnitude of the time trends between subgroups according to the interaction analysis. CONCLUSION This study confirms the increasing prevalence of gastroschisis over the time period 1999 to 2011 in Texas. The results suggest that no population subgroups are experiencing a significantly different increase in gastroschisis prevalence over time than others.
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Affiliation(s)
- Loc-Uyen T Vo
- Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, Texas.,University Health Science Center Houston School of Public Health, Austin Regional Campus, Austin, Texas
| | - Peter H Langlois
- University Health Science Center Houston School of Public Health, Austin Regional Campus, Austin, Texas
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9
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Krikov S, Botto LD, Shaw GM, Carmichael SL. Better diet quality before pregnancy is associated with reduced risk of gastroschisis in Hispanic women. J Nutr 2014; 144:1781-6. [PMID: 25332477 PMCID: PMC6498459 DOI: 10.3945/jn.114.201376] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Gastroschisis is unique because of its substantial risk in pregnancies of adolescent women. Adolescents may have poor diet quality, which places them at higher risk of gastroschisis. OBJECTIVE We investigated whether better maternal diet quality, measured by 2 different indices, reduced the risk of gastroschisis. METHODS We used case-control data from the National Birth Defects Prevention Study to investigate maternal diet quality among 1125 gastroschisis cases and 9483 controls (estimated delivery dates between 1997 and 2009). Cases were ascertained from 10 U.S. birth defect surveillance systems. Control subjects were randomly selected from birth certificates or hospital records. Using a 58-item food-frequency questionnaire, interviewers queried mothers about their average food and cereal intake during the year before conception. Diet quality scores [Diet Quality Index (DQI) and Mediterranean diet score (MDS)] were calculated using specific components. Women were excluded if they consumed <500 or >5000 kcal/d, reported pregestational diabetes, or had >1 missing food item. Quartile-specific adjusted ORs (aORs) were calculated, using as reference the lowest quartile. RESULTS Overall, we observed a statistically significant decrease with increasing diet quality for both the DQI and MDS. When stratified by maternal race/ethnicity, this finding was confined to Hispanic women. Among Hispanic women, the risk of gastroschisis decreased significantly with increasing DQI quartiles: quartile 2, aOR = 0.58 (95% CI: 0.40, 0.86); quartile 3, aOR = 0.52 (95% CI: 0.36, 0.79); and quartile 4, aOR = 0.48 (95% CI: 0.32, 0.76). Increasing diet quality, as measured by the MDS, showed reduced risk of gastroschisis among women, mostly Hispanic, who were born outside the United States: quartile 2, aOR = 0.62 (95% CI: 0.33, 1.16); quartile 3, aOR = 0.51 (95% CI: 0.28, 0.94); and quartile 4, aOR = 0.50 (95% CI: 0.28, 0.90). CONCLUSIONS Increasing diet quality was associated with a reduced risk of gastroschisis only among Hispanic and foreign-born women, but these findings require replication.
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Affiliation(s)
| | - Sergey Krikov
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT; and
| | - Lorenzo D Botto
- Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT; and
| | - Gary M Shaw
- Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
| | - Suzan L Carmichael
- Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
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Jones KL, Weiss LA, Hagey LR, Gonzalez V, Benirschke K, Chambers CD. Altered lipid metabolism in gastroschisis: A novel hypothesis. Am J Med Genet A 2013; 161A:1860-5. [DOI: 10.1002/ajmg.a.36002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 03/28/2013] [Indexed: 12/13/2022]
Affiliation(s)
- Kenneth Lyons Jones
- Division of Dysmorphology and Teratology, Department of Pediatrics; University of California, San Diego; La Jolla; California
| | - Lauren A. Weiss
- Division of Dysmorphology and Teratology, Department of Pediatrics; University of California, San Diego; La Jolla; California
| | - Lee R. Hagey
- Department of Medicine; University of California, San Diego; La Jolla; California
| | - Vanessa Gonzalez
- Division of Dysmorphology and Teratology, Department of Pediatrics; University of California, San Diego; La Jolla; California
| | - Kurt Benirschke
- Department of Pathology; University of California, San Diego; La Jolla; California
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11
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Khodr ZG, Lupo PJ, Canfield MA, Chan W, Cai Y, Mitchell LE. Hispanic ethnicity and acculturation, maternal age and the risk of gastroschisis in the national birth defects prevention study. ACTA ACUST UNITED AC 2013; 97:538-45. [DOI: 10.1002/bdra.23140] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 03/20/2013] [Accepted: 03/22/2013] [Indexed: 11/05/2022]
Affiliation(s)
- Zeina G. Khodr
- Division of Epidemiology; Human Genetics and Environmental Sciences, University of Texas School of Public Health; Houston; Texas
| | | | - Mark A. Canfield
- Birth Defects Epidemiology and Surveillance Branch; Texas Department of State Health Services; Austin; Texas
| | - Wenyaw Chan
- Division of Biostatistics; University of Texas school of Public Health; Houston; Texas
| | - Yi Cai
- Division of Biostatistics; University of Texas school of Public Health; Houston; Texas
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12
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Weiss LA, Chambers CD, Gonzalez V, Hagey LR, Jones KL. The omega-6 fatty acid linoleic acid is associated with risk of gastroschisis: a novel dietary risk factor. Am J Med Genet A 2012; 158A:803-7. [PMID: 22315197 DOI: 10.1002/ajmg.a.35204] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 11/23/2011] [Indexed: 11/09/2022]
Abstract
Gastroschisis is a congenital abdominal wall defect, thought by many to represent a disruption in intrauterine blood flow, where there is herniation of abdominal organs. Dietary intake is an important environmental factor that has been implicated in the development of many diseases. Omega-6 polyunsaturated fatty acids (PUFAs) are nutrients that are substrates for eicosanoid and cytokine synthesis and prone to oxidation, and play a role in modulating inflammation, immune function, and vascular system development. This pilot case-control study explored the association of dietary intake of the omega-6 PUFA linoleic acid with risk of gastroschisis. Between 2008 and 2011, we recruited 13 pregnant women in mid-gestation who were referred to the UCSD Prenatal Center for evaluation of an abnormal alpha-fetoprotein (AFP) test and subsequently identified as carrying a baby with gastroschisis. Nine controls were selected from a false positive AFP or from the UCSD prenatal clinic. Maternal dietary intake was collected via repeated food record during the last 20 weeks of gestation. Logistic regression was used to test the association between dietary intake of linoleic acid and odds of gastroschisis. Dietary intake of linoleic acid was associated with increased odds of gastroschisis (OR = 1.72; 95% CI: 1.08, 2.74; P = 0.02). A higher maternal intake of omega-6 PUFAs may increase the risk of having a baby with gastroschisis. The mechanism by which this occurs may be via inflammatory processes and oxidative stress leading to a vascular disruption. More research is needed including studies investigating integrated markers of PUFA status or inflammatory markers.
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Affiliation(s)
- Lauren A Weiss
- Division of Dysmorphology and Teratology, Department of Pediatrics, University of California, San Diego, La Jolla, California 92093-0828, USA.
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Feldkamp ML, Carmichael SL, Shaw GM, Panichello JD, Moore CA, Botto LD. Maternal nutrition and gastroschisis: findings from the National Birth Defects Prevention Study. Am J Obstet Gynecol 2011; 204:404.e1-404.e10. [PMID: 21396620 DOI: 10.1016/j.ajog.2010.12.053] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 12/07/2010] [Accepted: 12/27/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Gastroschisis is increasing in many countries, especially among young women. Because young women may have inadequate nutrition, we assessed the relationship between individual nutrients and the risk for gastroschisis. STUDY DESIGN We analyzed data from the National Birth Defects Prevention Study, a population-based case-control study. Cases were ascertained from 10 birth defect surveillance systems. Controls were randomly selected from birth certificates or hospital records. Nutrient intake was estimated for the year prior to conception from maternal interviews based on a 58-item food frequency questionnaire and cereal consumption reported. A total of 694 cases and 6157 controls were available for analysis. RESULTS Reported intake of individual nutrients did not substantially affect the risk for gastroschisis. Stratification by maternal age, preconception body mass index, folic acid-containing supplements, or energy intake (kilocalories) did not alter risk estimates. CONCLUSION This study does not support an increased risk for gastroschisis with decreasing tertiles of individual nutrients.
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Affiliation(s)
- Marcia L Feldkamp
- Division of Medical Genetics, Department of Pediatrics, University of Utah, Salt Lake City, USA.
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Frolov P, Alali J, Klein MD. Clinical risk factors for gastroschisis and omphalocele in humans: a review of the literature. Pediatr Surg Int 2010; 26:1135-48. [PMID: 20809116 DOI: 10.1007/s00383-010-2701-7] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2010] [Indexed: 10/19/2022]
Abstract
Gastroschisis and omphalocele are usually considered together since they are both congenital abdominal wall defects, and yet their anatomy, embryogenesis, and clinical presentation and problems are quite different. In addition, it appears that the risk factors for their occurrence differ. Etiologic factors contributing to the development of these defects are unknown. To investigate this we have reviewed reports of risk factors for each anomaly and report them here. We conducted a literature search using PubMed (http://www.ncbi.nlm.nih.gov/pubmed/) for risk factors implicated in the development of gastroschisis and omphalocele. The data reviewed here from clinical studies in the literature, closely parallels the data in animal studies which we reported earlier. There is little evidence for a genetic cause in the development of gastroschisis and much evidence supporting the possibility that environmental teratogens are important contributors to the development of this defect. On the other hand, in the case of omphalocele, there was little evidence for environmental factors and substantial data indicating that genetic or familial factors may play an important role.
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Affiliation(s)
- Polina Frolov
- Department of Surgery, Children's Hospital of Michigan, Wayne State University, 3901 Beaubien Street, Detroit, MI 48201-2119, USA
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Abstract
Gastroschisis (GS) continues to increase in frequency, with several studies now reported an incidence of between 4 and 5 per 10,000 live births. The main risk factor would seem to be young maternal age, and it is in this group that the greatest increase has occurred. Whilst various geographical regions confer a higher risk, the impact of several other putative risk factors, including smoking and illicit drug use, may be less important than when first identified in early epidemiological studies. Over 90% of cases of GS will now be diagnosed on antenatal ultrasound, but its value in determining the need for early delivery remains unclear. There would appear no clear evidence for either routine early delivery or elective caesarean section for infants with antenatally diagnosed GS. Delivery at a centre with paediatric surgical facilities reduces the risk of subsequent morbidity and should represent the standard of care. The relative roles of primary closure, staged closure and ward reduction, with or without general anaesthesia, appear less clear with considerable variation between centres in both the use of these techniques and subsequent surgical outcomes. Survival rates continue to improve, with rates well in excess of 90% now routine. The limited long-term developmental data available would suggest that normal or near-normal outcomes may be expected although there remains a need for further studies.
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Mac Bird T, Robbins JM, Druschel C, Cleves MA, Yang S, Hobbs CA. Demographic and environmental risk factors for gastroschisis and omphalocele in the National Birth Defects Prevention Study. J Pediatr Surg 2009; 44:1546-51. [PMID: 19635303 DOI: 10.1016/j.jpedsurg.2008.10.109] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Revised: 10/24/2008] [Accepted: 10/24/2008] [Indexed: 10/20/2022]
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.
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Affiliation(s)
- T Mac Bird
- Department of Pediatrics, Center for Applied Research and Evaluation, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72202-3591, USA
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Siega-Riz AM, Herring AH, Olshan AF, Smith J, Moore C. The joint effects of maternal prepregnancy body mass index and age on the risk of gastroschisis. Paediatr Perinat Epidemiol 2009; 23:51-7. [PMID: 19228314 DOI: 10.1111/j.1365-3016.2008.00990.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Young maternal age has been associated with an increased risk of gastroschisis, while high maternal weight status has been associated with a decreased risk. We were interested in investigating the joint effect of these two risk factors to identify thresholds in risk associated with body mass index (BMI) for a given age. Data from the National Birth Defects Prevention Study included 464 case infants with gastroschisis and 4842 healthy controls. A generalised additive model with a bivariate spline for continuous maternal age and prepregnancy BMI was used to model the probability of gastroschisis. The bivariate spline in BMI and maternal age was significantly associated with gastroschisis (P = 0.0001) after adjustment for study centre, maternal race/ethnicity, education, income and number of persons supported by income, smoking, alcohol use, vitamin use, vasoconstrictor medication use and gestational diabetes. The data indicate that women who are younger and who have lower BMI are at the greatest risk; a woman with a BMI of 17 who gives birth at age 15 has 7 times the odds (adjusted odds ratio = 7.0 [95% CI 4.2, 11.5]) of having an offspring with gastroschisis compared with a woman of age 24 with a BMI of 23. Furthermore, there was an interaction between maternal age and BMI for this risk. The increased risk of low maternal age and prepregnancy BMI associated with gastroschisis appears to suggest an aetiological role related to biological immaturity for this particular birth defect.
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Affiliation(s)
- Anna Maria Siega-Riz
- Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27516-3997, USA.
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Rasmussen SA, Frías JL. Non-genetic risk factors for gastroschisis. AMERICAN JOURNAL OF MEDICAL GENETICS PART C-SEMINARS IN MEDICAL GENETICS 2008; 148C:199-212. [DOI: 10.1002/ajmg.c.30175] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Vu LT, Nobuhara KK, Laurent C, Shaw GM. Increasing prevalence of gastroschisis: population-based study in California. J Pediatr 2008; 152:807-11. [PMID: 18492521 DOI: 10.1016/j.jpeds.2007.11.037] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2007] [Revised: 10/23/2007] [Accepted: 11/29/2007] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate time trend of gastroschisis and examine the epidemiological risk factors for gastroschisis. STUDY DESIGN This population-based study analyzed the active surveillance data from the California Birth Defects Monitoring Program from 1987 to 2003. RESULTS The overall birth prevalence of gastroschisis was 2.6 cases per 10,000 births (908 cases in >3.5 million births). In the adjusted analysis, by using the age of 25 to 29 years as the reference, mothers aged 12 to 15 years had a 4.2-times greater birth prevalence (95% CI, 2.5-7.0), and fathers aged 16 to 19 years and 20 to 24 years had 1.6- and 1.5-times greater birth prevalence (95% CI, 1.1-2.1 and 1.2-1.8), respectively. Compared with non-Hispanic whites and US-born Hispanic, both foreign-born Hispanics and blacks had adjusted prevalence ratio of 0.6 (95% CI, 0.5-0.7 and 0.4-0.9, respectively). In addition, nulliparity was also associated with gastroschisis. Independent of maternal age, paternal age, and maternal ethnicity, the birth prevalence increased 3.2-fold (95% CI, 2.3-4.3) during the 17-year study period. CONCLUSIONS The birth prevalence of gastroschisis continues to increase in California, and young, nulliparous women are at the greatest risk of having a child with gastroschisis.
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Affiliation(s)
- Lan T Vu
- Division of Pediatric Surgery, Department of Surgery, University of California, San Francisco, CA 94143-0570, USA.
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Chambers CD, Chen BH, Kalla K, Jernigan L, Jones KL. Novel risk factor in gastroschisis: Change of paternity. Am J Med Genet A 2007; 143A:653-9. [PMID: 17163540 DOI: 10.1002/ajmg.a.31577] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In recent years, an increase in the rate of gastroschisis has been documented in several countries throughout the world. Based on accumulating evidence that a maternal immunologic response to a novel set of paternal antigens may be involved in risk for several adverse pregnancy outcomes, including preeclampsia, reduced birth weight, and preterm delivery, we tested the hypothesis that a pregnancy following a change in fathers (change in paternity) may be a risk factor for gastroschisis. Using a case-control design, we compared the prevalence of change in paternity with the index pregnancy in 102 mothers of isolated gastroschisis cases to the prevalence of change in paternity in 117 mothers of non-malformed infants and 78 mothers of infants with neural tube defects or oral clefts. In a multivariate analysis, the adjusted odds of change in paternity in multigravid case mothers were 7.81 times higher (95% Confidence interval 2.80-21.88) relative to multigravid mothers of malformed and non-malformed controls combined, after adjustment for maternal age. These data suggest that maternal immune factors may play a role in the cause of gastroschisis. Further research is needed to corroborate these findings and to elucidate possible immunologic mechanisms involved in the pathogenesis of gastroschisis.
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Affiliation(s)
- Christina D Chambers
- Division of Dysmorphology and Teratology, Department of Pediatrics, University of California San Diego, La Jolla, CA 92103, USA.
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