Recreational Drug Use: A Major Risk Factor for Gastroschisis?

Abstract

The authors tested the hypothesis that the birth prevalence of gastroschisis is positively associated with use of recreational drugs in early pregnancy. A matched case-control study was carried out in three regions of the United Kingdom over the period January 2001 through August 2003. For each case, three liveborn controls were matched by initial intended place of delivery, region, and maternal age. Maternal hair analysis provided independent verification of recreational drug use. Conditional logistic regression was used to estimate mutually adjusted odds ratios. Estimates were revised using data from hair analysis. Statistically significant adjusted odds ratios for gastroschisis were associated with first-trimester use of 1) any recreational drug (odds ratio (OR) = 2.2, 95% confidence interval (CI): 1.2, 4.3) and 2) vasoconstrictive recreational drugs (defined as cocaine, amphetamines, and ecstasy) (OR = 3.3, 95% CI: 1.0, 10.5). Other significant exposures included aspirin use (OR = 20.4, 95% CI: 2.2, 191.5), cigarette smoking (OR = 1.7, 95% CI: 1.1, 2.6), and prior history of gynecologic infection/disease (OR = 2.6, 95% CI: 1.2, 5.6). Recreational drug use is a significant risk factor for gastroschisis and is one of a constellation of potentially preventable exposures which include cigarette smoking, aspirin use, and history of gynecologic infection/disease. Maternal hair analysis proved an acceptable and valuable method of independently verifying recreational drug use.

A Case-Control Study of Maternal Periconceptual and Pregnancy Recreational Drug Use and Fetal Malformation Using Hair Analysis

“…Our findings differ to those published in a study by Draper et al [25] which demonstrated a significantly higher level of any recreational drugs and vasoconstrictive recreational drugs in particular, defined as cocaine, amphetamines, and ecstasy, in women with a fetal gastroschisis. This study differed from ours in a number of ways.…”

“…The authors concluded that this was likely to be related to pre-existing increasing trends in gastroschisis incidence documented in several regions around the world rather than the effect of folic acid supplementation itself [30]. Draper et al [25] did not report periconceptual folic acid use in their study, but they had similar findings for maternal age, and smoking. Findings from a recent case control study supports the association of longer duration of folic acid use with a reduced risk of gastroschisis [32].…”

“…The objective method used can assess recreational drug use over a period of weeks to months [6], [7], [22], [25], and avoids inaccurate, self, and usually under-reporting. This method allows for timing of drug exposure to be assessed by analysing hair at different distances from the hair root, as hair grows continuously at an average rate of 1 cm per month [8].…”

Prevalence and Correlates of Gastroschisis in 15 States, 1995 to 2005

“…Although recreational drug use has been proposed as a potential risk factor, 17,18 the evidence for this association is limited and seems unlikely to account for much of the observed increase in prevalence. Similarly, Werler et al 19 considered the role of vasoactive medication and Browne et al 20 examined caffeine intake and found inconsistent evidence in support of the vascular disruption hypothesis.…”

Integrando la historia clínica ambiental en el consejo prenatal y cuidado de 2 casos de gastrosquisis

“…Además, en uno de los casos se documentó exposición a cocaína y a cannabis 15 , y una ortopantografía durante el embarazo 13 .…”