1
|
Tadesse AW, Ayano G, Dachew BA, Tusa BS, Damtie Y, Betts K, Alati R. The association between prenatal cannabis use and congenital birth defects in offspring: A cumulative meta-analysis. Neurotoxicol Teratol 2024; 102:107340. [PMID: 38460861 DOI: 10.1016/j.ntt.2024.107340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 03/11/2024]
Abstract
OBJECTIVE To examine the association between prenatal cannabis use and structural birth defects in exposed offspring. METHODS In line with the preregistered protocol (PROSPERO: CRD42022368623), we systematically searched PubMed/Medline, CINHAL, EMBASE, Web of Science, ProQuest, Psych-Info, and Google Scholar for published articles until 25 January 2024. The methodological quality of the included studies was appraised by the Newcastle-Ottawa Quality Assessment Scale (NOS). A meta-analysis was carried out to report the pooled effect estimates from the included studies. We further performed subgroup, leave-one-out sensitivity, and meta-regression analyses, which increased the robustness of our findings. RESULTS In this cumulative meta-analysis, thirty-six observational studies, consisting of 18 case-control and 18 cohort studies, with 230, 816 cases of birth defects and 18,049,013 controls (healthy babies) were included in the final analysis. We found that offspring exposed to maternal prenatal cannabis are at greater risks of a wide range of structural birth defects: cardiovascular/heart [OR = 2.35: 95 % CI 1.63 - 3.39], gastrointestinal [OR = 2.42: 95 % CI 1.61 - 3.64], central nervous system [OR = 2.87: 95 % CI 1.51 - 5.46], genitourinary [OR = 2.39: 95 % CI 1.11 - 5.17], and any (unclassified) birth defects [OR = 1.25: 95 % CI 1.12 - 1.41]. CONCLUSION The findings from the current study suggest that maternal prenatal cannabis exposure is associated with a higher risk of different forms of structural birth defects in offspring. The findings underscore the significance of implementing preventive strategies, including enhanced preconception counselling, to address cannabis use during pregnancy and mitigate the risk of birth defects in offspring.
Collapse
Affiliation(s)
- Abay Woday Tadesse
- School of Population Health, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, WA 6102, Australia; Samara University, College of Medicine and Health Sciences, Department of Public Health, 132, Semera, Ethiopia; Dream Science and Technology College, 1466 Dessie, Ethiopia.
| | - Getinet Ayano
- School of Population Health, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, WA 6102, Australia
| | - Berihun Assefa Dachew
- School of Population Health, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, WA 6102, Australia
| | - Biruk Shalmeno Tusa
- School of Population Health, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, WA 6102, Australia
| | - Yitayish Damtie
- School of Population Health, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, WA 6102, Australia
| | - Kim Betts
- School of Population Health, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, WA 6102, Australia
| | - Rosa Alati
- School of Population Health, Faculty of Health Sciences, Curtin University, Kent Street, Bentley, WA 6102, Australia; Institute for Social Sciences Research, The University of Queensland, 80 Meier's Rd, Indooroopilly, QLD 4068, Australia
| |
Collapse
|
2
|
Sujan AC, Pal A, Avalos LA, Young-Wolff KC. A systematic review of in utero cannabis exposure and risk for structural birth defects. Front Pediatr 2023; 11:1149401. [PMID: 37303758 PMCID: PMC10248236 DOI: 10.3389/fped.2023.1149401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Introduction Cannabis use among pregnant women has increased over time. Therefore, there is a great public health need to understand the consequences of in utero cannabis exposure. While several meta-analyses and reviews have summarized the evidence of in utero cannabis exposure on adverse obstetric outcomes (e.g., low birth weight and preterm birth) and long-term offspring development, there has not been a focus on in utero cannabis exposure and risk for structural birth defects. Methods We conducted a systematic review using PRISMA guidelines to evaluate the association between in utero cannabis exposure and structural birth defects. Results We identified 20 articles to include in our review and focused on interpreting findings from the 12 that adjusted for potential confounders. We report findings by seven organ systems. Within the 12 articles, four reported on cardiac malformations, three reported on central nervous system malformations, one reported on eye malformations, three reported on gastrointestinal malformations, one reported on genitourinary malformations, one reported on musculoskeletal malformations, and two reported on orofacial malformations. Discussion Findings on associations between in utero cannabis exposure and birth defects reported in more than two articles were mixed (i.e., findings for cardiac, gastrointestinal, central nervous system malformations). Findings for associations between in utero cannabis exposure and birth defects reported in two articles (i.e., orofacial malformations) or in a single article (eye, genitourinary, and musculoskeletal) suggested that cannabis exposure was not associated with these types of malformations, but strong conclusions cannot be drawn from such sparce research. We review the limitations and gaps in the existing literature and call for more research to rigorously evaluate associations between in utero cannabis exposure and structural birth defects. Systematic Review Registration identifier CRD42022308130.
Collapse
Affiliation(s)
- Ayesha C. Sujan
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Anish Pal
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL, United States
| | - Lyndsay A. Avalos
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
| | - Kelly C. Young-Wolff
- Division of Research, Kaiser Permanente Northern California, Oakland, CA, United States
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, United States
| |
Collapse
|
3
|
Reece AS, Hulse GK. European Epidemiological Patterns of Cannabis- and Substance-Related Body Wall Congenital Anomalies: Geospatiotemporal and Causal Inferential Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9027. [PMID: 35897396 PMCID: PMC9330494 DOI: 10.3390/ijerph19159027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 12/24/2022]
Abstract
As body wall congenital anomalies (BWCAs) have a long history of being associated with prenatal or community cannabis exposure (CCE), it was of interest to investigate these epidemiological relationships in Europe given the recent increases in cannabis use prevalence, daily intensity, and Δ9-tetrahydrocannabinol (THC) potency. Methods: This study makes use of BWCA data from Eurocat, drug exposure data from the European Monitoring Centre for Drugs and Drug Addiction, and income from the World Bank. Results: The mapping analysis showed that BWCARs increased in France, Spain, and the Netherlands. The bivariate mapping analysis showed that the BWCA rates (BWCAR) and the cannabis resin THC concentration rose simultaneously in France, the Netherlands, Bulgaria, Sweden, and Norway. The bivariate ranking of the BWCARs by median minimum E-value (mEV) was omphalocele > diaphragmatic hernia > abdominal wall defects > gastroschisis. With inverse probability weighted multivariable panel regression, the series of BWCAs, including gastroschisis, omphalocele, and diaphragmatic hernia, was positively related to various metrics of cannabis use from p = 2.45 × 10−14, 4.77 × 10−7 and <2.2 × 10−16. With geospatial regression, the same series of BWCAs was related to cannabis metrics from p = 0.0016, 5.28 × 10−6 and 4.88 × 10−9. Seventeen out of twenty-eight (60.7%) of the E-value estimates were >9 (high range), as were 14/28 (50.0%) of the mEVs. Conclusion: The data confirm the close relationship of the BWCARs with the metrics of CCE, fulfill the quantitative criteria of causal inference, and underscore the salience of the public health impacts of cannabinoid teratogenicity. Of major concern is the rising CCE impacting exponential cannabinoid genotoxic dose-response relationships. CCE should be carefully restricted to protect the food chain, the genome, and the epigenome of coming generations.
Collapse
Affiliation(s)
- Albert Stuart Reece
- Division of Psychiatry, University of Western Australia, Crawley, WA 6009, Australia;
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
| | - Gary Kenneth Hulse
- Division of Psychiatry, University of Western Australia, Crawley, WA 6009, Australia;
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA 6027, Australia
| |
Collapse
|
4
|
Ho PSY, Quigley MA, Tucker DF, Kurinczuk JJ. Risk factors for hospitalisation in Welsh infants with a congenital anomaly. BMJ Paediatr Open 2022; 6:e001238. [PMID: 36053619 PMCID: PMC8845320 DOI: 10.1136/bmjpo-2021-001238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/12/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To investigate risk factor associated with hospitalisation of infants with a congenital anomaly in Wales, UK. DESIGN A population-based cohort study. SETTING Data from the Welsh Congenital Anomaly Register and Information Service linked to the Patient Episode Database for Wales and livebirths and deaths from the Office for National Statistics. PATIENTS All livebirths between 1999 and 2015 with a diagnosis of a congenital anomaly, which was defined as a structural, metabolic, endocrine or genetic defect, as well as rare diseases of hereditary origin. MAIN OUTCOME MEASURES Adjusted OR (aOR) associated with 1 or 2+ hospital admissions in infancy versus no admissions were estimated for sociodemographic, maternal and infant factors using multinomial logistic regression for the subgroups of all, isolated, multiple and cardiovascular anomalies. RESULTS 25 523 infants affected by congenital anomalies experienced a total of 50 705 admissions in infancy. Risk factors for ≥2 admissions were younger maternal age ≤24 years (aOR: 1.17; 95% CI 1.06 to 1.30), maternal smoking (aOR: 1.20; 1.10 to 1.31), preterm birth (aOR: 2.52; 2.25 to 2.83) and moderately severe congenital heart defects (aOR: 6.25; 4.47 to 8.74). Girls had an overall decreased risk of 2+ admissions (aOR: 0.84; 0.78 to 0.91). Preterm birth was a significant risk factor for admissions in all anomaly subgroups but the effect of the other characteristics varied according to anomaly subgroup. CONCLUSIONS Over two-thirds of infants with an anomaly are admitted to hospital during infancy. Our findings identified sociodemographic and clinical characteristics contributing to an increased risk of hospitalisation of infants with congenital anomalies.
Collapse
Affiliation(s)
- Peter S Y Ho
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Maria A Quigley
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- National Institute for Health Research (NIHR) Policy Research Unit- Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - David F Tucker
- Public Health Wales, Public Health Knowledge & Research, Congenital Anomaly Register & Information Service for Wales, Public Health Wales, Swansea, UK
| | - Jennifer J Kurinczuk
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- National Institute for Health Research (NIHR) Policy Research Unit- Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| |
Collapse
|
5
|
Shi M, Langholt EM, Butler LC, Harvey ME, Wheeler EC, Zhao L, MacLean JA, Oh Y, Sabrowsky E, Yu S, Watson S, Davis JF, Hayashi K. Vapor cannabis exposure generationally affects male reproductive functions in mice. Toxicol Sci 2021; 185:128-142. [PMID: 34865136 DOI: 10.1093/toxsci/kfab137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This study was performed to examine whether vapor exposure to cannabis plant matter negatively impacts male reproductive functions and testis development in mice. Adult CD-1 male mice (F0) were exposed to air (control) or 200 mg of vaporized cannabis plant matter 3x/day over a 10 day period. Subsequently, F0 males were bred with drug naïve CD-1 females to generate F1 males, and F1 offspring were used to generate F2 males. Cannabis vapor exposure decreased sperm count and/or motility in F0 and F1 males and disrupted the progression of germ cell development, as morphometric analyses exhibited an abnormal distribution of the stages of spermatogenesis in F0 males. Although plasma levels of testosterone were not affected by cannabis exposure in any ages or generations of males, dysregulated steroidogenic enzymes, Cyp11a1 and Cyp19a1, were observed in F0 testis. In the neonatal testis from F1 males, while apoptosis was not altered, DNA damage and DNMT1, but not DNMT3A and DNMT3B, were increased in germ cells following cannabis exposure. In contrast, the alterations of DNA damage and DNMT1 expression were not observed in F2 neonatal males. These results suggest that cannabis vapor exposure generationally affects male reproductive functions, probably due to disruption of spermatogenesis in the developing testis.
Collapse
Affiliation(s)
- Mingxin Shi
- School of Molecular Biosciences, Center for Reproductive Biology, Washington State University, 1770 NE Stadium Way, Pullman, WA, 99164, USA
| | - Esther M Langholt
- School of Molecular Biosciences, Center for Reproductive Biology, Washington State University, 1770 NE Stadium Way, Pullman, WA, 99164, USA
| | - Logan C Butler
- School of Molecular Biosciences, Center for Reproductive Biology, Washington State University, 1770 NE Stadium Way, Pullman, WA, 99164, USA
| | - Madeleine E Harvey
- School of Molecular Biosciences, Center for Reproductive Biology, Washington State University, 1770 NE Stadium Way, Pullman, WA, 99164, USA
| | - Emma C Wheeler
- Department of Integrative Physiology and Neuroscience, Washington State University, 1815 Ferdinand's Lane, Pullman, WA, 99164, USA
| | - Liang Zhao
- School of Molecular Biosciences, Center for Reproductive Biology, Washington State University, 1770 NE Stadium Way, Pullman, WA, 99164, USA
| | - James A MacLean
- School of Molecular Biosciences, Center for Reproductive Biology, Washington State University, 1770 NE Stadium Way, Pullman, WA, 99164, USA
| | - Yeongseok Oh
- School of Molecular Biosciences, Center for Reproductive Biology, Washington State University, 1770 NE Stadium Way, Pullman, WA, 99164, USA
| | - Emily Sabrowsky
- Department of Integrative Physiology and Neuroscience, Washington State University, 1815 Ferdinand's Lane, Pullman, WA, 99164, USA
| | - Sue Yu
- Department of Integrative Physiology and Neuroscience, Washington State University, 1815 Ferdinand's Lane, Pullman, WA, 99164, USA
| | - Shane Watson
- Department of Integrative Physiology and Neuroscience, Washington State University, 1815 Ferdinand's Lane, Pullman, WA, 99164, USA
| | - Jon F Davis
- Department of Integrative Physiology and Neuroscience, Washington State University, 1815 Ferdinand's Lane, Pullman, WA, 99164, USA
| | - Kanako Hayashi
- School of Molecular Biosciences, Center for Reproductive Biology, Washington State University, 1770 NE Stadium Way, Pullman, WA, 99164, USA
| |
Collapse
|
6
|
Grant KS, Conover E, Chambers CD. Update on the developmental consequences of cannabis use during pregnancy and lactation. Birth Defects Res 2020; 112:1126-1138. [PMID: 32770666 DOI: 10.1002/bdr2.1766] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/24/2020] [Accepted: 06/27/2020] [Indexed: 12/24/2022]
Abstract
There is a strong increase in prevalence trends for cannabis use during pregnancy and lactation as more states legalize use of this drug. Information on the teratogenic risk of cannabis is limited but some important themes can be gleaned. Studies have not found a unique phenotypic signature of prenatal exposure but an increased risk of congenital anomalies, particularly gastroschisis, has been reported. Changes in fetal growth have been described in some epidemiological studies but long-term patterns of physical growth appear unaffected. Prenatal exposure to cannabis is not generally associated with reductions in global IQ but specific cognitive skills, especially attention and memory, can be negatively impacted. Long-term impacts on psychological health include increased rates of depressive symptoms and anxiety as well as delinquency. Relatively little is known about the risk of maternal cannabis use during lactation but data suggest that infant exposure is relatively low compared to maternal exposure. As delta-9-tetrahydrocannabinol (THC) levels increase to meet consumer demand and routes of exposure diversify, there is a strong need for prospective birth-cohort studies that collect biological samples to quantify exposure. Data from such studies will be critical to overcoming the weaknesses of past cannabis research and are essential to establishing reliable information on the risks of maternal use. Until that time, health care providers should be encouraged to talk about the risks and benefits associated with cannabis use during pregnancy and lactation with their patients, emphasizing that fetal and neonatal risks cannot be excluded at this time.
Collapse
Affiliation(s)
- Kimberly S Grant
- Department of Environmental and Occupational Health Sciences, School of Public Health, University of Washington, Seattle, Washington, USA.,Washington National Primate Research Center, University of Washington, Seattle, Washington, USA
| | - Elizabeth Conover
- Department of Genetic Medicine, Munroe-Meyer Institute, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Christina D Chambers
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA
| |
Collapse
|
7
|
Dubovis M, Muneyyirci-Delale O. Effects of marijuana on human reproduction. Reprod Toxicol 2020; 94:22-30. [PMID: 32315745 DOI: 10.1016/j.reprotox.2020.04.071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 03/31/2020] [Accepted: 04/13/2020] [Indexed: 01/04/2023]
Abstract
As U.S. states steadily legalize its distribution and the prevalence of its use in people of reproductive age continues to rise, the need to understand the effects of marijuana on human physiology is becoming increasingly urgent. While marijuana is well-known for its psychoactive effects and applications in controlling pain and nausea, little is known about its effects on reproduction. This review includes in vitro studies which consistently demonstrate associations between marijuana consumption and low sperm count, dysregulated menstruation, and abnormal placentation. While many in vivo studies associate maternal marijuana use with stillbirth, neonatal intensive care unit (NICU) admission, and offspring psychosis, significant literature negates these relationships by controlling for poly-substance use and socioeconomic status. Data limited by self-reporting and confounds precludes the drawing of definitive conclusions regarding the effects of marijuana on reproduction. This review serves as a call to action to elucidate these effects and discourage marijuana use in people of reproductive age.
Collapse
Affiliation(s)
- Marina Dubovis
- Touro College of Osteopathic Medicine, New York, NY, USA.
| | | |
Collapse
|
8
|
Trends in incidence and outcomes of gastroschisis in the United States: analysis of the national inpatient sample 2010-2014. Pediatr Surg Int 2018; 34:919-929. [PMID: 30056479 DOI: 10.1007/s00383-018-4308-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE Gastroschisis is a severe congenital anomaly associated with a significant morbidity and mortality. There are limited temporal trend data on incidence, mortality, length of stay, and hospital cost of gastroschisis. Our aim was to study these temporal trends using the National Inpatient Sample (NIS). METHODS We identified all neonatal admissions with a diagnosis of gastroschisis within the NIS from 2010 through 2014. We limited admission age to ≤ 28 days and excluded all those transferred to other hospitals. We estimated gastroschisis incidence, mortality, length of hospital stay, and cost of hospitalization. For continuous variables, trends were analyzed using survey regression. Cochrane-Armitage trend test was used to analyze trends for categorical variables. P < 0.05 was considered as significant. RESULTS The incidence of gastroschisis increased from 4.5 to 4.9/10,000 live births from 2010 through 2014 (P = 0.01). Overall mortality was 3.5%, median length of stay was 35 days (95% CI 26-55 days), and median cost of hospitalization was $75,859 (95% CI $50,231-$122,000). After adjusting for covariates, there was no statistically significant change in mortality (OR = 1.13; 95% CI 0.87-1.48), LOS (β = - 2.1 ± 3.5; 95% CI - 9.0 to 4.8) and hospital cost (β = - 2.137 ± 10.813; 95% CI - 23,331 to 19,056) with each calendar year increase on multivariate logistic regression analysis. CONCLUSION The incidence of neonates with gastroschisis increased between 2010 and 2014. Incidence was highest in the West. No difference in mortality and resource utilization was observed.
Collapse
|
9
|
Abstract
PURPOSE OF REVIEW The diagnosis and treatment of gastroschisis spans the perinatal disciplines of maternal fetal medicine, neonatology, and pediatric surgery. Since gastroschisis is one of the commonest and costliest structural birth defects treated in neonatal ICUs, a comprehensive review of its epidemiology, prenatal diagnosis, postnatal treatment, and short and long-term outcomes is both timely and relevant. RECENT FINDINGS The incidence of gastroschisis has increased dramatically over the past 20 years, leading to a renewed interest in causation. The widespread availability of maternal screening and ultrasound results in very high rates of prenatal diagnosis, which enables evaluation of the optimal timing and mode of delivery. The preferred method of surgical closure continues to be an issue of debate among pediatric surgeons, whereas postsurgical treatment seeks to expedite the initiation and progression of enteral feeding and minimize complications. A small subset of babies with complex gastroschisis leading to intestinal failure benefit from the knowledge and expertise of dedicated interdisciplinary teams, which seek to bring novel therapies and improved clinical outcomes. SUMMARY The opportunities to increase the knowledge of causation, and identify best practices leading to improved outcomes, drive the ongoing need for collaborative clinical research in gastroschisis.
Collapse
|
10
|
Skarsgard ED, Meaney C, Bassil K, Brindle M, Arbour L, Moineddin R. Maternal risk factors for gastroschisis in Canada. ACTA ACUST UNITED AC 2015; 103:111-8. [DOI: 10.1002/bdra.23349] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 11/22/2014] [Accepted: 12/02/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Erik D. Skarsgard
- Department of Surgery; University of British Columbia; Vancouver Canada
| | - Christopher Meaney
- Department of Family and Community Medicine; University of Toronto; Toronto Canada
| | - Kate Bassil
- Dalla Lana School of Public Health; University of Toronto; Toronto Canada
| | - Mary Brindle
- Department of Surgery; University of Calgary; Calgary Canada
| | - Laura Arbour
- Department of Medical Genetics; University of British Columbia; Vancouver Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine; University of Toronto; Toronto Canada
| | | |
Collapse
|
11
|
Lepigeon K, Van Mieghem T, Vasseur Maurer S, Giannoni E, Baud D. Gastroschisis--what should be told to parents? Prenat Diagn 2014; 34:316-26. [PMID: 24375446 DOI: 10.1002/pd.4305] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 12/13/2013] [Accepted: 12/14/2013] [Indexed: 11/09/2022]
Abstract
Gastroschisis is a common congenital abdominal wall defect. It is almost always diagnosed prenatally thanks to routine maternal serum screening and ultrasound screening programs. In the majority of cases, the condition is isolated (i.e. not associated with chromosomal or other anatomical anomalies). Prenatal diagnosis allows for planning the timing, mode and location of delivery. Controversies persist concerning the optimal antenatal monitoring strategy. Compelling evidence supports elective delivery at 37 weeks' gestation in a tertiary pediatric center. Cesarean section should be reserved for routine obstetrical indications. Prognosis of infants with gastroschisis is primarily determined by the degree of bowel injury, which is difficult to assess antenatally. Prenatal counseling usually addresses gastroschisis issues. However, parental concerns are mainly focused on long-term postnatal outcomes including gastrointestinal function and neurodevelopment. Although infants born with gastroschisis often endure a difficult neonatal course, they experience few long-term complications. This manuscript, which is structured around common parental questions and concerns, reviews the evidence pertaining to the antenatal, neonatal and long-term implications of a fetal gastroschisis diagnosis and is aimed at helping healthcare professionals counsel expecting parents.
Collapse
Affiliation(s)
- Karine Lepigeon
- Materno-fetal & Obstetrics Research Unit, Department of Obstetrics and Gynecology, University Hospital, 1011, Lausanne, Switzerland
| | | | | | | | | |
Collapse
|
12
|
Ortega-García JA, Soldin OP, Sánchez-Sauco MF, Cánovas-Conesa A, Gomaríz-Peñalver V, Jaimes-Vega DC, Perales JE, Cárceles-Alvarez A, Martínez-Ros MT, Ruiz D. Violence against women and gastroschisis: a case-control study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:5178-90. [PMID: 24142184 PMCID: PMC3823316 DOI: 10.3390/ijerph10105178] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 09/29/2013] [Accepted: 09/29/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND Gastroschisis, a birth defect characterized by herniated fetal abdominal wall, occurs more commonly in infants born to teenage and young mothers. Ischemia of the vascular vitelline vessels is the likely mechanism of pathogenesis. Given that chronic stress and violence against women are risk factors for cardiovascular disease we explored whether these may represent risk factors for gastroschisis, when they occur during pregnancy. A case-control study was conducted, with 15 incident cases of children born with gastroschisis in the Region of Murcia, Spain, from December 2007 to June 2013. Forty concurrent controls were recruited at gestation weeks 20-24 or post-partum. All mothers of cases and controls completed a comprehensive, in-person, 'green sheet' questionnaire on environmental exposures. RESULTS Mothers of children with gastroschisis were younger, smoked more cigarettes per week relative to controls, were exposed to higher amounts of illegal drugs, and suffered from domestic violence more frequently than the controls. Multivariable logistic regression analysis highlights periconceptional 'gender-related violence' (OR: 16.6, 95% CI 2.7 to 101.7) and younger maternal age (OR 1.1, 95% CI 1.0-1.3). CONCLUSIONS Violence against pregnant women is associated with birth defects, and should be studied in more depth as a cause-effect teratogenic. Psychosocial risk factors, including gender-based violence, are important for insuring the health and safety of the pregnant mother and the fetus.
Collapse
Affiliation(s)
- Juan Antonio Ortega-García
- Paediatric Environmental Health Speciality Unit, Department of Paediatrics, Hospital Clinic University Virgen of Arrixaca, Murcia, 30120, Spain; E-Mails: (M.F.S.-S.); (A.C.-C.); (V.G.-P.); (D.C.J.-V.); (J.E.P.); (A.C.-A.); (D.R.)
| | - Offie P. Soldin
- Georgetown University Medical Center, Washington, DC 20007, USA; E-Mail:
| | - Miguel Felipe Sánchez-Sauco
- Paediatric Environmental Health Speciality Unit, Department of Paediatrics, Hospital Clinic University Virgen of Arrixaca, Murcia, 30120, Spain; E-Mails: (M.F.S.-S.); (A.C.-C.); (V.G.-P.); (D.C.J.-V.); (J.E.P.); (A.C.-A.); (D.R.)
| | - Alicia Cánovas-Conesa
- Paediatric Environmental Health Speciality Unit, Department of Paediatrics, Hospital Clinic University Virgen of Arrixaca, Murcia, 30120, Spain; E-Mails: (M.F.S.-S.); (A.C.-C.); (V.G.-P.); (D.C.J.-V.); (J.E.P.); (A.C.-A.); (D.R.)
| | - Virtudes Gomaríz-Peñalver
- Paediatric Environmental Health Speciality Unit, Department of Paediatrics, Hospital Clinic University Virgen of Arrixaca, Murcia, 30120, Spain; E-Mails: (M.F.S.-S.); (A.C.-C.); (V.G.-P.); (D.C.J.-V.); (J.E.P.); (A.C.-A.); (D.R.)
| | - Diana Carolina Jaimes-Vega
- Paediatric Environmental Health Speciality Unit, Department of Paediatrics, Hospital Clinic University Virgen of Arrixaca, Murcia, 30120, Spain; E-Mails: (M.F.S.-S.); (A.C.-C.); (V.G.-P.); (D.C.J.-V.); (J.E.P.); (A.C.-A.); (D.R.)
| | - Joseph E. Perales
- Paediatric Environmental Health Speciality Unit, Department of Paediatrics, Hospital Clinic University Virgen of Arrixaca, Murcia, 30120, Spain; E-Mails: (M.F.S.-S.); (A.C.-C.); (V.G.-P.); (D.C.J.-V.); (J.E.P.); (A.C.-A.); (D.R.)
| | - Alberto Cárceles-Alvarez
- Paediatric Environmental Health Speciality Unit, Department of Paediatrics, Hospital Clinic University Virgen of Arrixaca, Murcia, 30120, Spain; E-Mails: (M.F.S.-S.); (A.C.-C.); (V.G.-P.); (D.C.J.-V.); (J.E.P.); (A.C.-A.); (D.R.)
| | - Maria Teresa Martínez-Ros
- Direction of Healthcare System, Murcia Health Service, Regional Ministry of Health, Murcia, 30008, Spain; E-Mail:
| | - Daniel Ruiz
- Paediatric Environmental Health Speciality Unit, Department of Paediatrics, Hospital Clinic University Virgen of Arrixaca, Murcia, 30120, Spain; E-Mails: (M.F.S.-S.); (A.C.-C.); (V.G.-P.); (D.C.J.-V.); (J.E.P.); (A.C.-A.); (D.R.)
| |
Collapse
|
13
|
Brindle ME, Flageole H, Wales PW. Influence of maternal factors on health outcomes in gastroschisis: a Canadian population-based study. Neonatology 2012; 102:45-52. [PMID: 22507959 DOI: 10.1159/000336564] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 01/11/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Gastroschisis is increasing in incidence worldwide. There is a need for a disease-specific, population-based approach to determining factors linked with gastroschisis and its outcome. OBJECTIVES To examine racial, socioeconomic, health and geographic predictors of gastroschisis and its outcome in Canada. METHODS 535 cases of gastroschisis from the Canadian Pediatric Surgery Network national database were included from May 2005 to May 2010. Baseline characteristics of mothers were compared with those reported by Statistics Canada. Factors associated with adverse neonatal outcomes were examined using regression analyses. RESULTS Mothers of infants with gastroschisis are young, often from small communities. Smoking (37%) and illicit drug use are common in this population. Single mothers receive less perinatal care (OR 0.06; 95% CI 0.02-0.28). Geographically isolated mothers are more likely to undergo caesarian section (OR 3.84; 95% CI 1.26-11.74). Cocaine use predicts a lower odds of delivering at a planned center (OR 0.25; 95% CI 0.08-0.79), and is also associated with an increased likelihood of intestinal injury at birth (OR 6.26; 95% CI 1.52-25.72). Infants of mothers from isolated communities will spend a mean of 31.9 days longer in hospital. Aboriginal status is not independently predictive of perinatal or neonatal outcome. CONCLUSION Gastroschisis in Canada occurs frequently in young mothers, aboriginals and smokers. Features associated with worse outcomes include single parent status, cocaine use and maternal hometown geographic isolation.
Collapse
Affiliation(s)
- Mary E Brindle
- Division of Pediatric General and Thoracic Surgery, Department of Surgery, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada.
| | | | | | | |
Collapse
|
14
|
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: 69] [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.
Collapse
Affiliation(s)
- Polina Frolov
- Department of Surgery, Children's Hospital of Michigan, Wayne State University, 3901 Beaubien Street, Detroit, MI 48201-2119, USA
| | | | | |
Collapse
|
15
|
Radmacher PG, Looney SW, Myers SR. Polycyclic Aromatic Hydrocarbons in Maternal and Cord Blood Plasma. Polycycl Aromat Compd 2010. [DOI: 10.1080/10406631003800639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
16
|
Benjamin BG, Ethen MK, Van Hook CL, Myers CA, Canfield MA. Gastroschisis prevalence in Texas 1999-2003. BIRTH DEFECTS RESEARCH. PART A, CLINICAL AND MOLECULAR TERATOLOGY 2010; 88:178-85. [PMID: 19950387 DOI: 10.1002/bdra.20642] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The worldwide prevalence of gastroschisis is increasing. Maternal age, race/ethnicity, and place of residence have been associated with increased risk. METHODS We obtained descriptive characteristics of mothers of infants with gastroschisis and mothers of all live births from the Texas Birth Defects Registry and Texas vital records for 1999-2003. We calculated prevalence, crude prevalence ratios, and prevalence ratios adjusted for maternal age, parity, education, race/ethnicity, and geographic entity (Mexican border proximity, urban/rural residence, health service region, and county). RESULTS We observed 764 cases of gastroschisis among 1,827,317 live births, for a prevalence of 4.18 per 10,000 births (95% confidence interval 3.88-4.48). Prevalence increased during 1999-2003 (p for trend <0.02). Infants of young and nulliparous mothers were at greatest risk in crude analyses. Other characteristics associated with increased risk were 12 or fewer years of education, border residence, and Hispanic ethnicity. Black mothers were at lower risk. When adjusted for maternal age, race/ethnicity, education, parity, and residence, we found that border residence, educational level, and Hispanic race/ethnicity were no longer significant, but young mothers and nulliparous mothers remained at higher risk, and blacks at reduced risk. Differences in prevalence observed between regions and counties largely disappeared when adjusted for maternal factors. No significant difference between urban and rural residence was found. CONCLUSION The prevalence of gastroschisis increased in Texas during 1999-2003. Black mothers were at lower risk, and Hispanic mothers were at no greater risk than whites. No differences were found between urban/rural or border/nonborder residents.
Collapse
Affiliation(s)
- Bonna G Benjamin
- Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, Texas 79106, USA.
| | | | | | | | | |
Collapse
|
17
|
|
18
|
Payne NR, Pfleghaar K, Assel B, Johnson A, Rich RH. Predicting the outcome of newborns with gastroschisis. J Pediatr Surg 2009; 44:918-23. [PMID: 19433170 PMCID: PMC2703663 DOI: 10.1016/j.jpedsurg.2009.01.036] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Accepted: 01/15/2009] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of the study was to determine factors predicting outcome in newborns with gastroschisis. METHODS A retrospective analysis of 155 consecutive cases admitted from 1 January 1990 to 31 December 2007 was performed. Prenatal ultrasound findings were available for 89 of 155 (57%) patients and were compared with final outcome. Both univariate and multiple regression analyses were used. RESULTS All patients survived to discharge home. The primary outcome measure was length of stay. Multiple regression identified 4 factors associated with length of stay: (1) gestational age (P = .004), (2) nonelective silo (P < .001), (3) gastrointestinal (GI) complication (intestinal atresia, perforation, or resection) (P < .001), and (4) non-GI anomaly (P = .029). Non-GI anomalies occurred in 17 of 155 (11%) patients and tended to increase the risk of a nonelective silo or GI complication (59% vs 39%, P = .190). Dilated bowel (>10 mm) on prenatal ultrasound was associated with GI complications (22% vs 3%, P = .010). However, 78% of patients with dilated bowel on prenatal ultrasound did not have a GI complication. The absence of dilated bowel on prenatal ultrasound accurately predicted the absence of GI complications in 97% of cases. CONCLUSION Prematurity, nonelective silo, GI complications, and non-GI anomalies predict the short-term outcome of newborns with gastroschisis. Prenatal ultrasound serves primarily to predict the absence of GI complications.
Collapse
Affiliation(s)
- Nathaniel R Payne
- Division of Neonatology, Children's Hospital and Clinics of Minnesota, Minneapolis, MN 55404, USA.
| | - Kathleen Pfleghaar
- Division of Perinatology, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Barbara Assel
- Division of Perinatology, Abbott Northwestern Hospital, Minneapolis, Minnesota
| | - Aubrey Johnson
- Division of Neonatology, Children's Hospital and Clinics of Minnesota, Minneapolis, Minnesota
| | - R, Hampton Rich
- Division of Surgery, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota, and Pediatric Surgical Associates, Ltd., Minneapolis, Minnesota
| |
Collapse
|