Gastroschisis in Europe – A prevalence and case-malformed control study

A strong relationship between gastroschisis and young maternal age, and reports of increasing prevalence, point to the need for further research into environmental risk factors. A prevalence and case-malformed control study was conducted using data on 1,587 gastroschisis cases (of which 4% stillbirths, 11% terminations of pregnancy) from 18 European population based congenital anomaly registries, covering 8 million births 1995-2012. The prevalence of gastroschisis was 2.0 (95% CI 1.9-2.1) cases per 10,000 births and has stabilised over time. Maternal age-adjusted geographic variation in prevalence was however more than eightfold across registries. Associations or “signals” arising from the literature regarding first trimester maternal illness or medication use which were supported, or strongly supported, by our European data after adjustment for maternal age, registry and time period, were for maternal depression (OR 2.52, 95% CI 1.45-4.39), antidepressant use (OR 2.03, 95% CI 1.22-3.38), postnatal depression/psychosis (OR 8.32, 95% CI 2.56-27.01), sexually transmitted infections (OR 2.85, 95% CI 1.13-7.24), topical antivirals (OR 5.31, 95% CI 1.63–17.33) diclofenac (OR 2.70, 95% CI 0.98-7.45) and continuation of oral contraceptives in early pregnancy (OR 2.17, 95% CI 1.13-4.18). Exploratory analyses suggested associations with a wider range of maternal infections. Better understanding of these risk factors leading to appropriate interventions should help reduce the prevalence of gastroschisis.