A population-based study of gastroschisis: demographic, pregnancy, and lifestyle risk factors

Gastroschisis, an abdominal wall defect, most often occurs in infants of young mothers. To identify risk factors for gastroschisis, we conducted a case-control study in the population surveyed by the California Birth Defects Monitoring Program (CBDMP). From structured questionnaire data, we compared sociodemographic, reproductive, and lifestyle factors for 110 mothers of infants with gastroschisis with those for 220 age-matched mothers of normal infants. Univariate matched-pair analysis showed significant associations of gastroschisis with mother's education, yearly family income, marital status, a history of mother's mother smoking, mother's father's absence from home during the mother's youth, more than one elective abortion, a short interval between menarche and first pregnancy, siblings from different fathers, and use of either a recreational drug (either cocaine, amphetamine, marijuana, or LSD), alcohol, or tobacco during the trimester preceding pregnancy. For cocaine, amphetamine, and marijuana, use of more than one drug showed a stronger association than single drug use. The association was stronger if both parents used drugs. Although many variables were correlated, odds ratios (OR) were significant (95% confidence intervals) in multivariate conditional logistic analysis for: yearly family income < $10,000 [OR = 4.34 (1.54, 12.22)] or $10,000-$49,999 [OR = 3.93 (1.43, 10.80)]; mother's mother's smoking status not known [OR = 3.99 (1.66, 9.56)]; mother's father's absence from home during her youth [OR = 3.11 (1.14, 8.46)]; and drug use by mother [OR = 2.21 (1.21, 4.03)], father [OR = 1.66 (1.02, 2.69)], or both [OR = 3.05 (1.48, 6.28)]. The best predictive model explained 32% of the deviance. Young, socially disadvantaged women with a history of substance use were at highest risk for a child with a gastroschisis.

Thyroid antibodies as a risk factor for Down syndrome and other trisomies

To test whether the presence of thyroid antibodies in a parent is a risk factor for meiotic nondisjunction, we measured the levels of thyroid antibodies in serum samples drawn during early pregnancy from 101 gravidas who delivered a child with a trisomy, from 11 gravidas who had had a trisomic child in a previous pregnancy, and from 44 of their husbands. For each case mother, three controls were randomly selected from the same population and matched for age, race, sex of the child, and hospital of birth. Cases and controls came from two longitudinal populations, the Child Health and Development Studies (CHDS) and the national Collaborative Perinatal Project (CPP), together comprising more than 70,000 live births. All cases with both a definite diagnosis of trisomy-Down syndrome (DS) or other-and available serum were included. Overall, there was no association between the presence of thyroid antibodies in a mother and a trisomy in her offspring (odds ratio [OR] = .98, confidence interval [CI] = .54-1.85). The lack of association was seen in all three subgroups (DS only, other trisomies, and DS in a previous pregnancy), in all ethnic groups, and in the age groups of white mothers either less than 30 years of age (OR = .80, CI = .40-1.6) or greater than or equal to 30 years of age (OR = 1.26, CI = .82-1.9). In the CHDS population, case fathers, as compared with control fathers, did not have a higher prevalence of thyroid antibodies.(ABSTRACT TRUNCATED AT 250 WORDS)

Prenatal and perinatal factors in the etiology of cerebral palsy

Among 19,044 children born to mothers with monitored pregnancies and followed medically for at least 5 years, 41 (0.2%) had cerebral palsy that was not the result of a progressive disease or of a neural tube defect. All children without cerebral palsy were entered as controls subjects in the analysis. Significant prenatal or gestational predictors of cerebral palsy were a severe or nonsevere birth defect other than cerebral palsy or its sequelae, low birth weight, low placental weight, abnormal fetal position, and premature separation of the placenta. Maternal antecedents of cerebral palsy were unusually long or unusually short intervals between pregnancies and unusually long menstrual cycles. Perinatal risk factors were delayed crying as a measure of birth asphyxia and abnormal delivery. Children who had seizures within 48 hours of birth were at high risk for the development of cerebral palsy. Seventy-eight percent of children with cerebral palsy did not have birth asphyxia, and the 22% who did had other prenatal risk factors that may have compromised their recovery.

The California Child Health and Development Studies of the School of Public Health, University of California at Berkeley

The Child Health and Development Studies are prospective longitudinal studies on medical and social aspects of pregnancies and on the health and development of children. Data have been assembled on about 20,000 pregnancies occurring in one hospital between 1959 and 1967, and on follow-up of the children through adolescence. A currently ongoing project updates certain vital statistics of the entire study population. The data assembled in this longitudinal study supported a wide range of research projects, several of which proved to be important for the health of mothers and children. Notwithstanding, subsets of the assembled data, with potential value for public health, have not yet been explored. The data archive has been made accessible to the research community at large so that other significant research topics can be investigated. In the following article, brief descriptions are given of the history and design of the Child Health and Development Studies, of the contents of the data archive, and of the major areas of research that have been explored. Procedures to obtain access to the data and to the user's manual are explained, and a bibliography is included.

Adolescent smoking and early respiratory disease: a longitudinal study

The data from a longitudinal study involving 1,445 white boys and girls from the San Francisco Bay area revealed a significant association between the adoption of cigarette smoking in adolescents with a history of either asthma or bronchitis in childhood and in early and middle teenage years. The association, present in both sexes, is stronger for bronchitis than for asthma, with the strength and direction of the association unaffected by such potentially confounding variables as parental smoking, socioeconomic status, psychosocial traits, etc. Age of onset of asthma (primarily in early childhood) preceded the commencement of smoking in 90% of subjects, indicating that cigarette smoking is not causally related to the development of childhood and adolescent asthma. With respect to bronchitis, however, as a result of the data on age of onset and the temporal relationship with the adoption of smoking, the possibility that cigarette smoking among adolescents may contribute to bronchitis cannot be dismissed.

Psychosocial characteristics of adolescent smokers before they started smoking: evidence of self-selection. A prospective study

Evidence of noncomparability of self-formed smoker and nonsmoker groups of adolescents from the Child Health and Development Studies of the University of California, Berkeley, was found in a study of antecedent psychosocial characteristics (observed at age 10) before the adoption of the smoking habit. With possible confounding factors controlled, eventual smokers showed significantly greater prevalence than nonsmokers of Type A personality traits, extraversion, psychoticism, anger, and restless sleep. Eventual smokers were lower in socioeconomic status than nonsmokers, and also exhibited significantly lower mean scores for the Raven Progressive Matrices and Peabody Picture Vocabulary tests. For each trait, the trends of the data were consistent in boys and girls. Since many of these traits are shown to "track" into adult life, where they are then related to coronary heart disease, the role of self-selection requires further consideration in causal inferences about smoking and coronary heart disease.

Incidence of congenital anomalies among white and black live births with long-term follow-up

The incidence of congenital anomalies at birth and accumulated to five years is presented for live-born children in a large prospective study. Congenital anomalies are not all diagnosable at birth; our data demonstrate that the incidence rate increases approximately three-and-one-halffold for Blacks and approximately fivefold for Whites between six days of age and five years of age. The incidence of congenital anomalies at birth was higher among Black children than White children, but there were no notable differences between the groups in incidence accumulated to age five years. At five years, the incidence rate of severe and moderate (but not trivial) congenital anomalies amounted to 15 per cent; for severe congenital anomalies, 4 per cent. Severe congenital anomalies diagnosed through age five years were observed to have a much higher incidence among children who weighted 2500 gm or less at birth than among those who were heavier.

Contraceptive risk-taking in a population with limited access to abortion

At a time when abortion was not readily available, among married women over half of unintended pregnancies occurred with no use or discontinued use of contraception. Many of these contraceptive drifters had prior experience with effective contraception. Contraceptive drifting was more common for low parity births. Different characteristics differentiated drifters from contraception failures in low- (1–2) and high- (3+) parity women. Among low-parity women, more drifting was found where the husband was enthusiastic about having the child, the woman's education or occupation was low, the husband's occupation was craftsman or operative, his education was low or his income was high. Among high-parity women, drifting was more common for white mothers, those with a previous marriage or a child by another father, or for mothers or fathers with low education. Policy implications of these findings are discussed.