The Role of Maternal Stress in Early Pregnancy in the Aetiology of Gastroschisis: An Incident Case Control Study

Stephen R Palmer,Judith Rankin,Alan Cameron,Shantini Paranjothy,Hannah Broughton,Elizabeth S Draper,Mark Drayton,Annette Evans,Simon Huddart,Claire Thorne

doi:10.1371/journal.pone.0080103

Abstract

ObjectiveThe incidence of gastroschisis, a congenital anomaly where the infant abdominal wall is defective and intestines protrude from the abdominal cavity, is increasing in many countries. The role of maternal stress in some adverse birth outcomes is now well established. We tested the hypothesis that major stressful life events in the first trimester are risk factors for gastroschisis, and social support protective, in a case-control study in the United Kingdom.MethodsGastroschisis cases and three controls per case (matched for maternal age) were identified at routine 18-20 week fetal anomaly ultrasound scan, in 2007-2010. Face to face questionnaire interviews were carried out during the antenatal period (median 24 weeks gestation) asking about serious stressful events and social support in the first trimester. Data were analysed using conditional logistic regression.ResultsTwo or more stressful life events in the first trimester (adjusted OR 4.9; 95% CI 1.2-19.4), and moving address in the first trimester (aOR 4.9; 95% CI 1.7-13.9) were strongly associated with risk of gastroschisis, independent of behavioural risk factors including smoking, alcohol, and poor diet. Perceived availability of social support was not associated with reduced risk of gastroschisis (aOR 0.8; 95% CI 0.2-3.1).ConclusionsStressful maternal life events in the first trimester of pregnancy including change of address were strongly associated with a substantial increase in the risk of gastroschisis, independent of stress related high risk behaviours such as smoking, alcohol consumption and poor diet. This suggests that stress pathways are involved in the aetiology of gastroschisis.

Highlights

The aetiology of gastroschisis, a congenital anomaly of the abdominal wall with herniation of the intestines and serious morbidity [1,2], is unknown [3]
Case control studies of gastroschisis have consistently found associations with the behaviour-related risk factors of low maternal BMI, younger age of mother, smoking [8], and more recently risks associated with recreational drug use [9], genitourinary infection [10] and diet poor in fruit and vegetables, and reduced folic acid intake [11] have been reported
Hypotheses have mainly focussed on vascular abnormality and consequent infarction and necrosis of the body wall at about 6-10 weeks of gestation, but Feldkamp et al [26] have argued that animal model data suggest that the causes may operate even earlier in embryogenesis than previously thought and propose that gastroschisis is caused by abnormal folding of the body wall resulting in a ventral body wall defect and gut herniation at 3-5 weeks post conception

Summary

Introduction

The aetiology of gastroschisis, a congenital anomaly of the abdominal wall with herniation of the intestines and serious morbidity [1,2], is unknown [3]. In addition to exploring these risk factors we have drawn on growing scientific interest in the potential role of maternal stress in causing adverse birth outcomes [12,13] including congenital anomalies [14,15,16].

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Results

Conclusion