Rising incidence of gastroschisis in teenage pregnancies
C R Nichols1, J E Dickinson, P J Pemberton
1Department of Obstetrics, King Edward Memorial Hospital for Women, Perth, Western Australia.
Insights
Gastroschisis incidence increased significantly, particularly in teenage mothers, from 1980-1993. This rise in gastroschisis (a birth defect) is strongly linked to young maternal age and associated with preterm birth and low birthweight.
Area of Science:
- Pediatric Surgery
- Maternal-Fetal Medicine
- Public Health Epidemiology
Background:
- Gastroschisis is a congenital anomaly where the intestines exit the body through a defect in the abdominal wall.
- Understanding population-based incidence and trends is crucial for resource allocation and public health interventions.
- Geographically isolated populations with single tertiary centers offer unique opportunities for accurate incidence studies.
Purpose of the Study:
- To determine the population-based incidence of gastroschisis in a geographically isolated state.
- To analyze trends in gastroschisis incidence over a 14-year period (1980-1993).
- To investigate associations between gastroschisis and maternal age, lifestyle factors, and perinatal outcomes.
Main Methods:
- Retrospective data review of births within a single, geographically isolated state.
- Identification of gastroschisis cases from 1980 to 1993.
- Calculation of incidence rates per 10,000 births, stratified by maternal age and year; analysis of associated factors and outcomes.
Main Results:
- A total of 64 gastroschisis cases were identified from 332,530 deliveries, yielding an overall incidence of 1.80 per 10,000 births.
- Incidence rose from 0.48 in 1980 to 3.16 per 10,000 births in 1993, primarily driven by a sharp increase in mothers aged 15-19 years.
- Gastroschisis was strongly associated with preterm delivery (46.1% vs. 6.6%) and low birthweight (50% vs. state incidence), with significant rates of maternal smoking (46%) and recreational drug use (19%).
Conclusions:
- The study reveals a significant increase in gastroschisis incidence, strongly associated with young maternal age.
- The observed rise necessitates further investigation into potential etiologic factors contributing to gastroschisis in adolescent mothers.
- High rates of preterm birth, low birthweight, and emergency cesarean sections highlight the complex perinatal challenges associated with gastroschisis.
Abstract:
A population-based incidence of gastroschisis using the unique characteristics of a geographically isolated state with a single tertiary obstetric and pediatric hospital has been developed via retrospective data review. Sixty-four cases of gastroschisis were identified during the period 1980 to 1993. With 332,530 deliveries in the 14-year review period, the population incidence of gastroschisis is 1.80 per 10,000 births (95% CI 1.40-2.32). There has been a rise in incidence from 0.48 per 10,000 births in 1980 to 3.16 per 10,000 births in 1993 (NS). This alteration in incidence is an age-group specific event. The age group 15-19 years, which accounts for a consistent 6.5% of total deliveries, has 10 times the incidence of the age range 25-29 years. A sharp rise in the occurrence of gastroschisis in women 15-19 years was observed, with the incidence increasing from 4.0 to 26.5 per 10,000 births over the period of review. Increased use of prenatal ultrasound has made antenatal diagnosis usual and consequent referral to the tertiary referral hospital for delivery. There was a 46% incidence of smoking, and 19% of women admitted to recreational drug use. A strong association with preterm delivery and low birthweight was present with a 50% incidence of low birthweight, eight times the state incidence (OR 14.82, 95% CI 8.97-24.51). The rate of preterm birth was 46.1% vs. 6.6% in the general obstetric population (OR 12.11, 95% CI 6.45-22.73). There was a high incidence of perceived fetal distress, reflected in an increased rate of emergency cesarean section (23% vs. 8%, OR 4.31, 95% CI 1.91-9.74). The early neonatal outcome was satisfactory with three neonatal deaths and an overall perinatal survival rate of 85%. The increase in incidence of gastroschisis in this population-based study reveals a strong association with young maternal age. Investigation into possible etiologic factors to explain this observation is required.
