Maternal risk factors associated with complex gastroschisis: Cannabis exposure and recurrent urinary tract infections...

Maternal risk factors associated with gastroschisis occurrence have been identified, but predisposing factors to the complex variant are unknown. This study aimed to identify factors associated with complex gastroschisis by comparing the maternal risk factor profiles of simple and complex gastroschisis pregnancies.

All cases of gastroschisis managed in one tertiary care hospital between 1991 and 2022 were identified from a retrospective clinical database. Cases were classified as 'complex' if severe matting, necrosis, atresia or perforation were present; 'simple' gastroschisis was defined as absence of these features. Data on maternal peri-conception and gestational health and lifestyle habits were extracted from the clinical database and a population-based administrative data repository. Logistic regression odds ratios (OR) and Poisson regression rate ratios (RaR) for each variable, or combination of variables, were calculated for 'complex' versus 'simple' mothers.

A total of 194 cases of gastroschisis were included, 155 (80 %) simple and 39 (20 %) complex. Univariable analysis showed no effect of smoking, narcotics, cannabis, alcohol, rural residency and low-income. When adjusted for exposure to smoking, narcotics and alcohol use, cannabis use was more likely to have occurred in mothers of children with complex gastroschisis (adjusted OR = 2.64). While single urinary tract infection was not associated with complex gastroschisis (OR = 2.20), mothers of children with complex gastroschisis had more recurrent urinary tract infections (RaR = 3.78). Pelvic inflammatory disease was not associated with complex gastroschisis.

Our results suggest that peri-conceptional and gestational cannabis exposure and recurrent urinary tract infections are associated with complex gastroschisis. These exposures may be modifiable targets to reduce the risk of gastroschisis-related bowel complications and warrant further investigation in larger populations.