NDLI: Is there epidemiologic evidence to support vascular disruption as a pathogenesis of gastroschisis?

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Werler, Martha M. Mitchell, Allen A. Moore, Cynthia A. Honein, Margaret A.
Description	Country affiliation: United States Author Affiliation: Werler MM ( Slone Epidemiology Center at Boston University, Boston, Massachusetts 02215, USA.)
Abstract	Gastroschisis is a congenital defect of the abdominal wall that occurs most commonly in the offspring of young women. The defect is often hypothesized to result from vascular disruption in the early embryo. We measured the associations between maternal vasoactive exposures in pregnancy, as possible markers of vascular disruption, and gastroschisis risk, using data collected as part of the National Birth Defects Prevention Study. Study participants included mothers of births from October 1997 to December 2003 in 10 states. The mothers of 514 gastroschisis cases were matched by age at delivery and state to 3,277 non-malformed controls and compared for periconceptional smoking and use of vasoconstrictors, non-steroidal anti-inflammatory drugs (NSAIDs), and vasodilators. Multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CI) were estimated from conditional logistic regression. Case mothers were more likely than control mothers to smoke (OR = 1.5, 95% CI = 1.2-1.9) and report use of non-aspirin NSAIDs (1.4, 1.1-1.7) and anti-hypertensive vasodilators (2.6, 0.9-8.0), but not vasoconstrictive decongestants (1.0, 0.7-1.4). Cigarette smoking had little effect on gastroschisis risk in mothers <25 years of age, but the OR was 3.0 (1.8-5.0) for those >or=25 years. Likewise, ORs were greatest in the older women for use of non-aspirin NSAIDs (1.6, 1.0-2.6) and bronchodilators (3.0, 1.8-5.0). These findings suggest that, overall, vasoactive risk factors play a minor role in the etiology of gastroschisis, and do not support the vascular disruption hypothesis. However, the observation that increased ORs for some vasoactive exposures were confined to older women raises the question of whether inherent maternal factors might influence risk.
File Format	HTM / HTML
ISSN	15524825
e-ISSN	15524833
DOI	10.1002/ajmg.a.32897
Journal	American Journal of Medical Genetics Part A
Issue Number	7
Volume Number	149A
Language	English
Publisher	Wiley-Blackwell
Publisher Date	2009-07-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Discipline Genetics Gastroschisis Epidemiology Etiology Vascular Diseases Complications Adolescent Case-control Studies Infant Maternal Age Pregnancy Prenatal Exposure Delayed Effects Smoking Adverse Effects Congenital Vasoconstrictor Agents Administration & Dosage Therapeutic Use Vasodilator Agents Multicenter Study Research Support, N.i.h., Extramural Research Support, U.s. Gov't, P.h.s.
Content Type	Text
Resource Type	Article
Subject	Genetics Genetics (clinical)

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