Development of gastroschisis: Review of hypotheses, a novel hypothesis, and implications for research

Abstract

Gastroschisis, a ventral body wall defect, is a continuing challenge and concern to researchers, clinicians, and epidemiologists seeking to identify its cause(s) and pathogenesis. Concern has been renewed in recent years because, unlike most other birth defects, rates of gastroschisis are reportedly increasing in many developed and developing countries. No tenable explanation or specific causes have been identified for this trend. Rates of gastroschisis are particularly high among pregnancies of very young women. Such an intriguing association, not observed to this degree with other birth defects, may afford clues to the defect's cause. Understanding the causes of gastroschisis may provide insight to the defect's origin. In pursuing such causal studies, it would be helpful to understand the embryogenesis of gastroschisis. To date, four main embryologic hypotheses have been proposed: (1) Failure of mesoderm to form in the body wall; (2) Rupture of the amnion around the umbilical ring with subsequent herniation of bowel; (3) Abnormal involution of the right umbilical vein leading to weakening of the body wall and gut herniation; and (4) Disruption of the right vitelline (yolk sac) artery with subsequent body wall damage and gut herniation. Although based on embryological phenomena, these hypotheses do not provide an adequate explanation for how gastroschisis would occur. Therefore, we propose an alternative hypothesis, based on well described embryonic events. Specifically, we propose that abnormal folding of the body wall results in a ventral body wall defect through which the gut herniates, leading to the clinical presentation of gastroschisis. This hypothesis potentially explains the origin of gastroschisis as well as that of other developmental defects of the ventral wall.

Maternal nativity as a risk factor for gastroschisis: A population‐based study

“…Young maternal age is the most consistently reported risk factor (Baerg et al, 2003;Feldkamp et al, 2007;Hougland et al, 2005;Saada et al, 2005). Other maternal factors that have been suspected to increase gastroschisis risk include maternal smoking, maternal use of vasoactive substances, low socioeconomic status, low pregnancy body mass index, and Hispanic ethnicity (Haddow et al, 1993;Torfs et al, 1994;Lam et al, 1999;Werler et al, 2002;Salihu et al, 2003;Saada et al, 2005;Canfield et al, 2006;Feldkamp et al, 2007;Stothard et al, 2009). More recently, maternal birthplace (nativity) has been reported to affect the risk of congenital malformations, including gastroschisis; foreign-born women have a lower risk of delivering an infant with gastroschisis than U.S.-born women (Zhu et al, 2006;Vu et al, 2008).…”

Management of Gastroschisis in a Tertiary Care Hospital

“…1,20 It has been reported that the incidence of gastroschisis has increased in recent years. 21 There is an increased incidence when the mother has a history of cigarette smoking, use of recreational drugs, alcohol consumption, low body mass index, increased frequency of genitourinary infection. 22,23,24 ,25,26,27 During our study period a total of 32 patients were admitted in our unit.…”

Congenital defects of abdominal wall

“…Эта гипотеза подтверждается тем, что гастрошизис формируется на более ранних этапах внутриутробной жизни, чем омфалоцеле. Несмотря на то что наблюдается увеличение числа новорожденных с га-строшизисом, ни один из предполагаемых тератогенных факторов (табакокурение, низкий социальный статус, мо-лодой возраст матери) не нашел подтверждения в научных исследованиях [2][3][4][5].…”