Gastroschisis in Europe - A Case-malformed-Control Study of Medication and Maternal Illness during Pregnancy as Risk Factors
Por:
Given JE, Loane M, Garne E, Nelen V, Barisic I, Randrianaivo H, Khoshnood B, Wiesel A, Rissmann A, Lynch C, Neville AJ, Pierini A, Bakker M, Klungsoyr K, Latos Bielenska A, Cavero-Carbonell C, Addor MC, Zymak-Zakutnya N, Tucker D and Dolk H
Publicada:
1 nov 2017
Ahead of Print:
25 ago 2017
Resumen:
BackgroundGastroschisis, a congenital anomaly of the abdomen, is associated with young maternal age and has increased in prevalence in many countries. Maternal illness and medication exposure are among environmental risk factors implicated in its aetiology.
MethodsA population-based case-malformed control study was conducted using data from 18 European congenital anomaly registries, with information on first trimester medication use, covering 8 million births 1995-2012. 1577 gastroschisis cases (of which 4% stillbirths, 11% terminations of pregnancy) were compared to 153357 non-chromosomal/monogenic controls. Literature review identified previous associations concerning maternal illness and medication exposure to be tested as signals. Logistic regression adjusted for maternal age group, registry, and time period was used to evaluate associations.
ResultsComparing gastroschisis to other congenital anomalies, the data supported signals concerning maternal depression (aOR 2.52, 95% CI 1.45, 4.39), antidepressant use (aOR 2.03, 95% CI 1.22, 3.38), postnatal depression/psychosis following a previous pregnancy (aOR 8.32, 95% CI 2.56, 27.01), sexually transmitted infections (aOR 2.85, 95% CI 1.13, 7.24), topical antivirals (aOR 5.31, 95% CI 1.63, 17.33), and continuation of oral contraceptives in early pregnancy (aOR 2.17, 95% CI 1.13, 4.18). Exploratory analyses suggested associations with a wider range of maternal infections and medications, including tonsillitis and the expectorant bromhexine.
ConclusionsWhile it is difficult to disentangle the effects of the medication and underlying indication, our results add to the evidence base on preventable risk factors for gastroschisis. These risk factors may contribute to the higher risk among young mothers, and geographical and temporal variation in prevalence.
Filiaciones:
Given JE:
Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
Loane M:
Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
Garne E:
Paediatric Department, Hospital Lillebaelt, Kolding, Denmark
Nelen V:
Provinciaal Instituut voor Hygiene (PIH), Antwerp, Belgium
Barisic I:
Children's Hospital Zagreb, Medical School University of Zagreb, Zagreb, Croatia
Randrianaivo H:
Registre des Malformations Congenitales de la Reunion, St Pierre, Ile de la Reunion
Khoshnood B:
Paris Registry of Congenital Anomalies, Maternite de Port-Royal, Paris, France
Wiesel A:
Mainz Model Birth Registry, University Children's Hospital Mainz, Mainz, Germany
Rissmann A:
Malformation Monitoring Centre Saxony-Anhalt, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
Lynch C:
Department of Public Health, Health Service Executive - South East, Kilkenny, Ireland
Neville AJ:
IMER Registry (Emilia Romagna Registry of Birth Defects), University of Ferrara and Azienda Ospedaliero Universitaria di Ferrara, Ferrara, Italy
Pierini A:
Tuscany Registry of Congenital Defects, CNR Institute of Clinical Physiology/Fondazione Toscana "Gabriele Monasterio", Pisa, Italy
Bakker M:
Eurocat Northern Netherlands, University of Groningen, Groningen, The Netherlands
Klungsoyr K:
Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
Latos Bielenska A:
Department of Medical Genetics, Polish Registry of Congenital Malformations, Poznan, Poland
:
Rare Diseases Joint Research Unit, FISABIO-UVEG, Valencia, Spain
Addor MC:
Medical Genetics, CHUV, Lausanne, Switzerland
Zymak-Zakutnya N:
OMNI-Net, Khmelnytsky Regional Medical Genetic Center, Khmelnytsky, Ukraine
Tucker D:
Congenital Anomaly Register and Information Service for Wales, Public Health Wales, Cardiff, UK
Dolk H:
Institute of Nursing and Health Research, Ulster University, Newtownabbey, UK
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