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

Abstract

BACKGROUND:The prevalence of gastroschisis is increasing in many parts of the world, although the etiology is largely unexplained. Young maternal age has been the only consistently identified, strong risk factor. The objective of this study was to examine the role of maternal nativity in relation to other suspected risk factors for gastroschisis in Florida. METHODS: We conducted a retrospective cohort study of singleton infants born in Florida from 1998-2003. Gastroschisis cases were identified from the Florida Birth Defects Registry. Demographic and perinatal data were obtained from birth records. Multivariable Poisson regression was used to estimate adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) for each factor of interest. RESULTS: The 6-year birth prevalence of gastroschisis was 3.26 per 10,000 live births, and the annual rate increased 41% during the study period. In addition to maternal age and marital status, maternal race/ethnicity and nativity were significantly associated with the risk of delivering an infant with gastroschisis. Compared with non-Hispanic white women, non-Hispanic black women had the lowest risk of delivering an infant with gastroschisis (PR, 0.19; 95% CI, 0.13-0.26), followed by Hispanic women (PR, 0.60; 95% CI, 0.43-0.83). Women born outside the United States were significantly less likely than U.S.-born women to deliver an infant with gastroschisis (PR, 0.59; 95% CI, 0.41-0.86). CONCLUSIONS: Although young maternal age remains a strong significant risk factor for gastroschisis in Florida, other factors such as maternal race/ ethnicity and nativity could be important in explaining the increasing prevalence of gastroschisis. Birth

Abdominal Wall Defects Among Mexican American Infants: The Effect of Maternal Nativity

“…First, documentation of birth defects on birth certificates can be inconsistent, with variable sensitivities reported in existing literature. 37,38 However, the abdominal wall defect rate in this study is comparable to recent national estimates, 18,20,34 suggesting our data provide a reasonable representation of abdominal wall defect rates. Second, the vast majority of states used the 1989 version of the birth certificate in which omphalocele and gastroschisis were identified by the same code, making separation of the two conditions impossible.…”

“…20,21 Hispanic ethnicity and young maternal age are the major risk factors for gastroschisis. 18,34 Most pertinent, a handful of prior studies show that US-born (compared with foreign-born) Hispanic mothers have a greater risk of delivering an infant with gastroschisis. 19,30 Notwithstanding the grouping of gastroschisis and omphalocele into a single category, our data highlight this phenomenon among Mexican American mothers.…”

“…24 Major maternal risk factors for gastroschisis include young age, low socioeconomic status, and Hispanic ethnicity. 18,22,[25][26][27] Minor risk factors include cigarette smoking, non-steroidal anti-inflammatory and illicit drug use. 22,26,28,29 Omphalocele is a herniation of abdominal contents into the base of the umbilical cord with a protective membrane enclosing the displaced abdominal contents.…”

“…18,19,30 However, Hispanics are a heterogeneous group that includes Mexican Americans, Puerto Ricans, Cubans, and Central-South Americans. There is also heterogeneity within the Mexican American population with respect to region of immigration from Mexico, US migration patterns, and region of residence in the United States.…”

“…1 Interestingly, prior studies found a higher incidence of congenital anomalies among US-born (compared to foreign-born) Hispanics. [17][18][19] The extent to which maternal nativity is associated with non-lethal congenital anomalies among Mexican Americans is incompletely understood.…”