Background
Methods
Study design
Subjects
Feature | Gastroschisis (n = 179) number (%) | Controls (n = 895) number (%) | p-valuea
|
---|---|---|---|
Gestational age (weeks) (mean ± sd) | 36 ± 2 | 36 ± 2 | 1.000 |
Maternal age (years) (mean ± sd) | 22 ± 4 | 30 ± 3 | <0.001 |
Age ≤ 20 years (%) | 69 (38.6) | 44 (5.0) | |
Age 20-24 years (%) | 70 (39.1) | 154 (17.2) | |
Age 25-29 years (%) | 31 (17.3) | 248 (27.7) | |
Age ≥ 30 years (%) | 9 (5.0) | 449 (50.2) | |
Maternal race | <0.001 | ||
Caucasian (%) | 140 (78.2) | 741 (82.8) | |
African American (%) | 7 (3.9) | 90 (10.1) | |
Asian (%) | 19 (10.6) | 38 (4.3) | |
Hispanic (%) | 8 (4.5) | 20 (2.2) | |
Native American (%) | 5 (2.8) | 6 (0.7) | |
Female | 84 (47.0) | 420 (47.0) | 1.000 |
Inborn (%) | 155 (86.6) | 697 (77.9) | 0.008 |
Birth weight <10th centileb (%) | 44 (24.6) | 69 (7.7) | <0.001 |
Gestational hypertension/pre-eclampsia (%) | 0 | 148 (16.5) | N/Ae
|
Single (%) | 113 (63.1) | 224 (25.0) | <0.001 |
Minor anomalies (%) | 24 (13.4) | 39 (4.4) | <0.001 |
Multiple gestation | 4 (2.2) | 20 (2.2) | 1.000 |
Primigravida | 110 (61.5) | 285 (31.8) | <0.001 |
Gestational diabetesf
| 1 (0.6) | 63 (7.3) | 0.010 |
Pre-existing (before pregnancy) diabetesf
| 0 | 27 (3.3) | N/Ae
|
Maternal smoking | 52 (29.1) | 138 (15.4) | <0.001 |
Maternal illicit drug use | 7 (3.9) | 32 (3.6) | 0.829 |
Maternal alcohol use | 7 (3.9) | 16 (1.8) | 0.082 |
Center (Minneapolis) | 155 (86.6) | 767 (85.7) | 0.754 |
Era (1999-2007) | 129 (72.1) | 581 (64.9) | 0.065 |
Birth weight (g) | 2400 ± 502 | 2750 ± 532 | <0.001 |
Birth weight z-score | -0.65 ± 0.86 | 0.11 ± 0.49 | <0.001 |
Crown-heel length (cm) | 45.7 ± 3.3 | 48.4 ± 2.7 | <0.001 |
Crown-heel length z-scorec,d
| -0.50 ± 1.19 | 0.68 ± 0.55 | <0.001 |
Occipitofrontal circumference (OFC) | 31.9 ± 1.9 | 32.9 ± 1.6 | <0.001 |
OFC z-scored (cm) | -0.36 ± 0.87 | 0.24 ± 0.45 | <0.001 |
Ponderal index | 2.51 ± 0.37 | 2.40 ± 0.16 | <0.001 |
Ponderal index z-score | -0.06 ± 0.85 | -0.30 ± 0.34 | <0.001 |
Neonatal clinical data
Clinical definitions
Placental analysis
Statistical analysis
Results
Patient population and demographics
#1 Analysis: Case-control comparison
Unadjusted | Adjusted | |||||
---|---|---|---|---|---|---|
Coefficienta
| 95% CIb
| p-value | Coefficientc
| 95% CIb
| p-value | |
Gastroschisis | -350 | -415, -286 | <0.001 | -317 | -415, -218 | <0.001 |
Gestational age (weeks) | 228 | 213, 244 | <0.001 | NDc
| ND | ND |
Male gender | 107 | -39, 253 | 0.151 | NDc
| ND | ND |
Multiple gestation | -241 | -391, -92 | 0.002 | NDc
| ND | ND |
Maternal race/ethnicity | ||||||
White | Referent | Referent | ||||
African American | -250 | -363, -136 | <0.001 | -236 | -368, -104 | 0.001 |
Native American | 1 | -429, 431 | 0.996 | 277 | -181, 735 | 0.235 |
Asian | -219 | -344, -95 | 0.001 | -178 | -301, -55 | 0.005 |
Hispanic | -182 | -480, 115 | 0.229 | -178 | -510, 155 | 0.292 |
Gestational diabetes | 134 | -53, 323 | 0.160 | 77 | -106, 260 | 0.407 |
Pre-existing diabetes | 628 | 348, 908 | <0.001 | 689 | 406, 973 | <0.001 |
Maternal smoking | -220 | -313, -128 | <0.001 | -142 | -249, -34 | 0.010 |
Maternal hypertension | -251 | -372, -129 | <0.001 | -354 | -473, -234 | <0.001 |
Maternal illicit drug use | -378 | -545, -211 | <0.001 | -255 | -453, -58 | 0.012 |
Maternal alcohol use | -390 | -603, -176 | 0.005 | -143 | -358, 71 | 0.189 |
Single mother | -234 | -316, -152 | <0.001 | -59 | -161, 42 | 0.250 |
Maternal age (years) | 13 | 7, 18 | <0.001 | -2 | -9, 6 | 0.654 |
Nullipara | -164 | -246, -82 | <0.001 | -98 | -192, -6 | 0.037 |
Outborn (yes = 1, no = 0) | 239 | 141, 337 | <0.001 | 136 | 42, 230 | 0.005 |
Era (1999-2007) | 1 | -72, 74 | 0.980 | 27 | -44, 98 | 0.452 |
#2 Analysis: Comparison of gastroschisis and other patients with anomalies
Gastroschisis (N = 179) | No major anomaly (N = 15,788) | Renal anomalies (N = 37) | Other GI anomalies (N = 130) | Chromosome abnormalities (N = 479) | Congenital heart disease (N = 405) | Any other major anomalies (N = 4,040) | |
---|---|---|---|---|---|---|---|
Gestational age (wks) | 35.7 ± 2.0 | 34.2 ± 4.0 | 34.1 ± 5.1 | 38.3 ± 2.7 | 36.5 ± 3.3 | 38.5 ± 2.2 | 33.7 ± 5.7 |
Unadjusted BW (g) | 2400 ± 502 | 2387 ± 918 | 2500 ± 1.140 | 3296 ± 701 | 2660 ± 861 | 3216 ± 638 | 2331 ± 118 |
BW z-score | -0.64 ± 0.86 | 0.01 ± 0.93 | 0.25 ± 1.00 | 0.13 ± 0.96 | -0.44 ± 1.3 | -0.11 ± 0.98 | -0.04 ± 1.14 |
BW coefficienta
| -310 (-366, -254)b
| Referent | 45 (-93, 184) | 26 (-55, 107) | -244 (-298, -192) b
| -94 (-141, -47) b
| -7 (-23, 10) |
Unadjusted LT (cm) | 45.7 ± 3.3 | 46.0 ± 5.7 | 44.8 ± 6.8 | 50.6 ± 3.6 | 46.7 ± 5.3 | 50.4 ± 3.7 | 44.3 ± 8.1 |
LT z-score | -0.50 ± 1.19 | 0.42 ± 1.15 | 0.05 ± 1.69 | 0.57 ± 1.04 | -0.37 ± 1.53 | 0.37 ± 1.24 | 0.11 ± 1.41 |
LT coefficienta
| -2.1 (-2.5, -1.7)b
| Referent | -1.3 (-2.6, -0.1)d
| -0.7 (-1.1, -0.2)c
| -2.3 (-2.7, -2.0)b
| -1.2 (-1.5, -0.9)b
| -1.1 (-1.2, -1.0)c
|
Unadjusted OFC (cm) | 31.9 ± 1.9 | 31.5 ± 3.5 | 31.0 ± 4.4 | 34.2 ± 2.3 | 31.9 ± 3.1 | 33.9 ± 1.9 | 30.7 ± 5.3 |
OFC z-score | -0.36 ± 0.86 | 0.16 ± 1.02 | 0.04 ± 1.01 | 0.04 ± 0.97 | -0.56 ± 1.30 | -0.24 ± 0.95 | 0.15 ± 1.52 |
OFC coefficienta
| -0.5 (-0.8, -0.3)b
| referent | -0.6 (-1.1, 0.1)d
| -0.6 (-0.8, -0.3)b
| -1.3 (-1.5, -1.2)b
| -1.0 (-1.2, -0.9)b
| -0.3 (-0.4, -0.2)b
|
Ponderal index | 2.5 ± 0.37 | 2.3 ± 0.48 | 2.6 ± 0.89 | 2.5 ± 0.33 | 2.5 ± 0.49 | 2.5 ± 0.34 | 2.4 ± 0.53 |
PI z-score | -0.06 ± 0.85 | -0.24 ± 0.91 | 0.32 ± 1.86 | -0.25 ± 0.53 | -0.02 ± 1.18 | -0.24 ± 0.59 | -0.02 ± 1.17 |
PI coefficienta
| 0.10 (0.04, 0.15)b
| referent | 0.27 (0.00, 0.53)d
| 0.01 (-0.04, 0.03) | 0.10 (0.05, 0.15)b
| -0.01 (-0.04, 0.03) | 0.08 (0.06, 0.10)b
|
#3 Analysis: Onset of decreased intrauterine growth
Last ultrasound measurement (N = 61)a
| Measurement at birth (N = 61)a
| p-valueb
| |
---|---|---|---|
Weight (grams) median ( IQRc) | 1956 (1607-2273) | 2300 (2050-2660) | <0.001 |
Weight percentile median (IQR) | 27 (8-38) | 28 (10-42) | 0.221 |
Gestational age (weeks) Median (IQR) | 34 (33-36) | 36 (34-37) | <0.001 |
#4 Analysis: Placental abnormalities associated with gastrochisis cases
Placental findings | Controls N = 29 | Gastroschisis N = 31 | p-value |
---|---|---|---|
Placental weight z-score (mean ± sd)a
| 0.24 ± 1.29 | -0.03 ± 1.07 | 0.804b
|
Chorioamnionitis (%) | 14 (48) | 13 (42) | 0.796c
|
Any chorangiosis (%)d
| 12 (41) | 25 (81) | 0.003c
|
Focal chorangiosis (%)d
| 8 (28) | 12 (39) | 0.419c
|
Diffuse chorangiosis (%)e
| 4 (14) | 13 (42) | 0.022c
|