Time trends, geographic variation and risk factors for gastroschisis in Canada: A population‐based cohort study 2006–2017

Abstract

Background Previous studies showed increases in rates of gastroschisis in Canada in the first decade of the 21st century. Objective We sought to examine the epidemiologic characteristics of gastroschisis in Canada in recent years. Methods We conducted a retrospective population‐based cohort study of all livebirths and stillbirths delivered in Canada (excluding Quebec) from 2006 to 2017, with information obtained from the Canadian Institute for Health Information. Gastroschisis rates by maternal age, region of residence, and maternal and infant characteristics were quantified using prevalence rate ratios (RR) and 95% confidence intervals (CI). Log‐binomial regression was used to quantify the associations between risk factors and gastroschisis. Results There were 1314 gastroschisis cases among 3 364 116 births. The prevalence rate was 3.7 per 10 000 total births in 2006 and 3.4 per 10 000 total births in 2017, with substantial annual variation in rates. The proportion of mothers aged 20–24 years decreased from 16.5% in 2006 to 11.3% in 2017, while the proportion of mothers aged <20 years halved from 4.8% to 2.3%. The prevalence of gastroschisis at birth remained unchanged among mothers aged <20, 20–24 and 30–49 years but increased among mothers aged 25–29 years. The age‐adjusted prevalence rate of gastroschisis increased across the period (for 2016–2017 versus 2006–2007 rate ratio [RR] 1.28, 95% CI 1.05, 1.56), and there was substantial regional variation. Risk factors included problematic use of substances (RR 2.61, 95% CI 2.01, 3.39) and hypothyroidism (RR 2.76, 95% CI 1.56, 4.88). There was a North‐to‐South difference in gastroschisis prevalence (adjusted RR Far North compared with South 1.54, 95% CI 1.11, 2.15). Conclusion Gastroschisis birth prevalence rates in Canada have stabilised in recent years compared with the increase documented previously. The substantial geographic variation and North‐to‐South difference in gastroschisis prevalence may indicate variation in socio‐economic status, lifestyle and nutritional patterns.

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

“…Analyses of other data sets have yielded a wide range of effect estimates associated with alcohol consumption treating maternal age as a confounder rather than an effect modifier. Studies from California 9 and Canada 35 observed estimates similar to those from NBDPS (ORs 1.6–1.7), while others report protective effects (OR 0.8) 11 as well as ORs well above null (OR 15.1) 17 . Many studies rely on administrative exposure data 9,17,35 and differences in alcohol consumption measurement makes it difficult to compare results.…”

“…Studies from California 9 and Canada 35 observed estimates similar to those from NBDPS (ORs 1.6–1.7), while others report protective effects (OR 0.8) 11 as well as ORs well above null (OR 15.1) 17 . Many studies rely on administrative exposure data 9,17,35 and differences in alcohol consumption measurement makes it difficult to compare results. 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 .…”

“…Our study adds 6 years of additional data to the Richardson et al analysis and eight to Bird 11 as well as ORs well above null (OR 15.1) 17. Many studies rely on administrative exposure data9,17,35 and differences in alcohol consumption measurement makes it difficult to compare results.…”

Association of maternal depression and hypothyroidism with infant gastroschisis: A population-based cohort study in Canada

“…Our secondary analysis of gestational diabetes by conception season may also elucidate the inverse associations of gastroschisis with gestational diabetes observed in previous studies. 9,24,25 However, several limitations must be noted. Firstly, some risk factors that are associated with gastroschisis may be tested after the occurrence of a congenital anomaly or other adverse pregnancy outcome.…”

“…Our previous study reported a signi cantly increasing temporal trend in the maternal age-adjusted rate, and identi ed maternal hypothyroidism, substance use and northern residence as signi cant risk factors for gastroschisis in Canada. 9 A recent study of global gastroschisis patterns among 23 countries showed an extremely wide range in the prevalence for teen women (< 20 years): from 2.1 in Slovak Republic or 3.7 per 10 000 births in Spain to 21.5 in Utah (U.S) and 26.2 per 10 000 in Canada. 3 However, researchers have paid little attention to why gastroschisis varies with location (e.g., northern area) of residence and the complex relationship and interplay between maternal characteristics, conditions and identi ed risk factors, as well as the mechanistic pathway.…”