Gastroschisis: epidemiology and mode of delivery, 2005–2013

Abstract

BACKGROUND Gastroschisis is a severe congenital anomaly the etiology of which is unknown. Research evidence supports attempted vaginal delivery for pregnancies complicated by gastroschisis in the absence of obstetric indications for cesarean delivery. OBJECTIVE The objectives of the study evaluating pregnancies complicated by gastroschisis were to: (i) determine the proportion of women undergoing planned cesarean versus attempted vaginal delivery; and (ii) provide up-to-date epidemiology on risk factors associated with this anomaly. STUDY DESIGN This population-based study of United States natality records from 2005–2013 evaluated pregnancies complicated by gastroschisis. Women were classified based on whether they attempted vaginal delivery or underwent a planned cesarean (n=24,836,777). Obstetrical, medical, and demographic characteristics were evaluated. Multivariable log-linear regression models were developed to determine factors associated with mode of delivery. Factors associated with the occurrence of the anomaly were also evaluated in log-linear models. RESULTS Of 5,985 pregnancies with gastroschisis, 63.5% (n=3,800) attempted vaginal delivery and 36.5% (n=2,185) underwent planned cesarean delivery. The rate of attempted vaginal delivery increased from 59.7% in 2005 to 68.8% in 2013. Earlier gestational age and Hispanic ethnicity were associated with lower rates of attempted vaginal delivery. Factors associated with the occurrence of gastroschisis included young age, smoking, high educational attainment, and being married. Protective factors included chronic hypertension, black race, and obesity. The incidence of gastroschisis was 3.1 per 10,000 pregnancies and did not increase during the study period. CONCLUSION Attempted vaginal delivery is becoming increasingly prevalent for women with a pregnancy complicated by gastroschisis. Recommendations from research literature findings may be diffusing into clinical practice. A significant proportion of women with this anomaly still deliver by planned cesarean suggesting further reduction of surgical delivery for this anomaly is possible.

Risk factors for abdominal wall defects

“…We found socioeconomic status (level of education and grade of profession) to be significantly higher in CG mothers compared to AWD mothers ( P = 0.05). Using multiple regression analysis, we confirmed this influence, and these results were supported by Shariff et al Among AWD mothers, the OC are employed significantly more often in higher rank or leading positions ( P = 0.039), and the data of Friedman et al confirmed these observations.…”

“…In our opinion, an essential factor to estimate if the mother's lifestyle was healthy or not was maternal nicotine, alcohol, and illicit drug use before and during pregnancy. Numerous studies described a relationship between the occurrence of GS and maternal smoking . In our cohort, GS mothers drank, smoked, and used illicit drugs more often than OC and CG mothers, yet we found a significance only for alcohol ( P = 0.05).…”

Prevalence, timing of diagnosis and pregnancy outcome of abdominal wall defects after the introduction of a national prenatal screening program

“…Fewer cases of gastroschisis were diagnosed in the first trimester compared to exomphalos cases. Gastroschisis is an opening of the abdominal wall on the right side of the umbilical cord . When the fetus is visualized in the mid‐sagittal view used for the crown–rump length measurement, the defect may be overlooked, unlike an abdominal wall defect within the umbilical cord insertion like exomphalos.…”

Prevalence trends of selected major birth defects: A multi‐state population‐based retrospective study, United States, 1999 to 2007

“…The observed trend in gastroschisis could be related to a variety of factors. In addition to young age, gastroschisis has been associated with smoking and being unmarried (Friedman et al, ), as well as with lower educational attainment (Husain et al, ; Friedman et al, ). Husain et al () also found increased parity to be related to decreased gastroschisis in general, which logically coincides with young mothers having fewer pregnancies and greater prevalence of gastroschisis.…”