An exploration of potential risk factors for gastroschisis using decision tree learning

Despite a wealth of research, the etiology of the abdominal wall defect gastroschisis remains largely unknown. The strongest known risk factor is young maternal age. Our objective was to conduct a hypothesis-generating analysis regarding gastroschisis etiology using random forests.

Data were from the Slone Birth Defects Study (case-control, United States and Canada, 1998-2015). Cases were gastroschisis-affected pregnancies (n = 273); controls were live-born infants, frequency-matched by center (n = 2591). Potential risk factor data were ascertained via standardized interviews. We calculated adjusted odds ratios (aOR) and 95 % confidence intervals (CIs) using targeted maximum likelihood estimation.

The strongest associations were observed with young maternal age (aOR 3.4, 95 % CI 2.9, 4.0) and prepregnancy body-mass-index < 30 kg/m² (aOR 3.3, 95 % CI 2.4, 4.5). More moderate increased odds were observed for parents not in a relationship, non-Black maternal race, young paternal age, marijuana use, cigarette smoking, alcohol intake, lower parity, oral contraceptive use, nonsteroidal anti-inflammatory drug use, daily fast food/processed foods intake, lower poly- or monounsaturated fat, higher total fat, and lower parental education.

Our research provides support for established risk factors and suggested novel factors (e.g., certain aspects of diet), which warrant further investigation.