Risk factors for gastroschisis: A case–control study in a Brazilian population

Abstract

Objective: To evaluate risk factors associated with fetal gastroschisis.Methods: As a secondary aim of a larger case-control study, pregnant women attending the Fetal Medicine Unit at the Department of Obstetrics and Gynecology at Hospital das Clinicas, Sao Paulo University Medical School between July 1, 2013, and July 31, 2015, were allocated into either the gastroschisis group, where the woman was carrying a fetus with gastroschisis, or the control group, where the fetus was normal. Patients in the control group were matched at study entry for maternal age, preconception body mass index and weeks of gestation. In-person interviews were conducted during pregnancy to obtain data on demographic, medical, and social characteristics; exposure to substances; pregnancy history; the presence of chronic disease, urinary tract infections (UTIs), influenza, and fever; and the occurrence of stress events between the month before the last menstrual period and the first trimester of pregnancy. Results:Of 171 women included in the study, 57 were allocated to the gastroschisis group and 114 to the control group. There were significant associations between gastroschisis and maternal UTI (P=0.011), tobacco use (P=0.001), alcohol consumption (P≤0.001), and illicit drug use (P=0.012). After analysis by standard logistic regression, the remaining significant factors were UTI, tobacco use, and alcohol consumption.Conclusion: UTI and exposure to tobacco or alcohol just before conception and during early pregnancy were associated with an increase in the likelihood of fetal gastroschisis.

Fetal gastroschisis: Maternal and fetal methylation profile

“…For this methylation study, we used the mother-infant pairs from the previously described case-control study to investigate nutrition and other risk factors in gastroschisis. 8,28,29 The patients were treated, blood was drawn, and data were collected at the Departamento de Obstetrícia e Ginecologia do Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo between July 2013 and July 2015. Briefly, consenting singleton pregnant women at gestational age under 34 weeks and with isolated fetal gastroschisis were included in this study.…”

“…[4][5][6] A likely explanation is the association with risk factor-related life habits, and these are mainly smoking, regular alcohol consumption, and genitourinary tract infections. [7][8][9] Family history is also evidence of a genetic contribution associated with gastroschisis, and the recurrence risk lies between 2.4% and 6.9%. 10,11 However, genetic studies are still controversial and have been unable to provide enough data on the etiopathology of gastroschisis (Table 1).…”

“…In the last few decades, there has been a significant increase in the prevalence of gastroschisis to five to every 10,000 newborns, a rise strongly associated with low maternal age (<20 years) 4–6 . A likely explanation is the association with risk factor‐related life habits, and these are mainly smoking, regular alcohol consumption, and genitourinary tract infections 7–9 …”

Maternal periconceptional alcohol consumption and gastroschisis in the National Birth Defects Prevention Study, 1997–2011

“…8 The existing literature generallyalthough not universally [9][10][11] -supports the hypothesis that periconceptional alcohol consumption is associated with increased risk of gastroschisis. [12][13][14][15][16][17] However, previous studies were limited in their ability to assess effects of different levels of alcohol intake (i.e. binge drinking) or joint effects with other factors strongly associated with gastroschisis, such as maternal age.…”

“…However one age-matched case-control study in Brazil used a modified version of the NBDPS questionnaire and reported a moderately strong association between periconceptional alcohol consumption and gastroschisis (OR 2.6) 16. That this estimate is higher than among NBDPS participants may reflect different consumption patterns be-…”