National trends in gastroschisis factors: maternal age, smoking status, race and ethnicity

After decades of increase, gastroschisis prevalence in the United States has recently declined. We aim to use birth certificate data to explore trends in maternal age and smoking as possible contributors, and to examine national racial and ethnic patterns in gastroschisis prevalence.

A retrospective cross sectional database review was performed on three national datasets: American College of Surgeons National Surgical Quality Improvement Program- Pediatric® (ACS NSQIP-P®), Healthcare Cost and Utilization Project National Inpatient Sample (HCUP-NIS), and Center for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research (CDC WONDER) for racial and ethnic trends in gastroschisis from 2016-2023. Maternal age and tobacco use were extracted from CDC WONDER.

Gastroschisis prevalence significantly declined among infants born to mothers aged 15-29. Maternal tobacco use also declined in both affected and unaffected births, with a significant drop in the population attributable risk from smoking. The proportion of White (but not Black or Asian/Pacific Islander) infants with gastroschisis declined in ACS NSQIP-P®. HCUP-NIS and CDC WONDER demonstrated constant racial proportions but an overall decline in cases. Both ACS NSQIP-P® and CDC WONDER showed an increasing proportion of Hispanic infants with gastroschisis as non-Hispanic cases decreased. CDC WONDER demonstrated disparate changes in prevalence by race and decreasing (though not equally) prevalence in Hispanic and non-Hispanic ethnicities.

Shifting maternal age demographics and declining maternal tobacco use are likely two reasons for the recent gastroschisis prevalence decline. The decline varies by race and ethnicity, suggesting multifactorial influences on disease prevalence.