Cases Of Gastroschisis Research Articles

Descriptive epidemiology of gastroschisis in China from 2007 to 2020: a nationwide surveillance-based study

BackgroundGastroschisis is a common abdominal wall defect that increases infant mortality risk and health care costs. However, recent epidemiological data on gastroschisis in China is limited.MethodsUsing 2007–2020 data from the Chinese Birth Defects Monitoring Network (CBDMN), we analyzed gastroschisis prevalence rates stratified by birth year, maternal age group, residence area, geographical region, and infant sex. We also examined the temporal variations in prevalence, pregnancy outcomes of affected infants, prenatal diagnoses, and co-occurring anomalies.ResultsFrom 2007 to 2020, a total of 6,813 cases of gastroschisis were identified among 25,909,000 births, comprising 4,675 isolated and 2,138 non-isolated cases. Prevalence rates per 10,000 live and still births were 2.63, 1.80, and 0.83 for the overall, isolated, and non-isolated gastroschisis, respectively, all showing a decreasing trend over the study period. The prevalence of overall gastroschisis varied significantly by maternal age (< 20 years, 9.88/10,000; 20–24 years, 4.17/10,000; 25–29 year, 2.08/10,000; 30–34 years, 1.88/10,000;≥35 years, 2.24/10,000), maternal residence (urban, 2.45/10,000; rural, 2.85/10,000), geographic region (central, 2.54/10,000; east, 2.57/10,000; west, 2.80/10,000), and infant sex (male, 2.13/10,000; female, 1.79/10,000). Non-isolated gastroschisis cases had a higher early neonatal mortality rate than isolated cases (41.91% vs. 28.10%) and frequently co-occurred with musculoskeletal anomalies.ConclusionsThis study highlights a declining trend in gastroschisis prevalence in Chinese population, a contrast to previous studies, and underscores the need for improved perinatal management due to adverse pregnancy outcomes associated with this condition.

Anterior abdominal wall defects and their management outcomes in Tikur Anbessa Specialized Hospital, neonatal intensive care unit

AbstractIntroductionGastroschisis and omphalocele are common malformations of the anterior abdominal wall and can lead to significant morbidity and mortality in neonates. Despite advances in surgical care, these conditions remain challenging to manage effectively.ObjectiveThis retrospective institutional study aimed to assess the management outcomes of neonates with anterior abdominal wall defects, specifically gastroschisis and omphalocele, in the Neonatal Intensive Care Unit (NICU) of Tikur Anbessa Specialized Hospital (TASH) (Tertiary Hospital).MethodA retrospective review was conducted on cases of gastroschisis and omphalocele managed in the NICU of TASH from August 2018 to August 2022. Patient charts of neonates with omphalocele and gastroschisis were identified and retrieved from the NICU records. The collected data were analyzed using statistical software such as SPSS.ResultsThe study included a total of 50 neonates with abdominal wall defects, consisting of 39 cases of omphalocele and 11 cases of gastroschisis. Maternal age ranged from 18 to 40 years, with a mean age of 27.6 ± 4.5 years. Associated malformations were documented in 33.3% of omphalocele cases and 18.2% of gastroschisis cases. Cardiac anomalies were the most frequently associated malformation with omphalocele. Surgical intervention was performed in 27.3% of gastroschisis cases (3 out of 11) and 41% of omphalocele cases (16 out of 39). The postsurgery mortality rate was 12.5% for both major and minor omphaloceles, with 11 deaths occurring in gastroschisis cases. Sepsis was identified as the cause of death in all neonates who did not survive.ConclusionsThe study revealed a significantly higher mortality rate in gastroschisis cases compared to omphalocele cases. Sepsis was identified as the primary cause of death in the neonates. These findings underscore the importance of effective management strategies to prevent and manage sepsis in neonates with abdominal wall defects.

Frequency of gastroschisis and omphalocele and possible influence of maternal folic acid supplementation. A narrative review.

There is an increase in the worldwide prevalence of congenital abdominal wall defects (CAWD), with gastroschisis (GS) and omphalocele (OC) being the most common. It is widely accepted that folic acid supplementation (FAS) in the maternal diet decreases the incidence of anomalies such as neural tube defects, but there is controversy regarding the possible beneficial role for other congenital malformations. Several epidemiological studies raise controversy regarding a possible relationship between vitamin supplementation with the occurrence of abdominal wall malformations. The aim of the present study is to obtain an updated review of the global frequency of CAWD in neonates and the relationship with FAS in the mothers. For this we have carried out a systematic search of epidemiological studies in different article databases between 2011 and 2022. The analysis of 25 studies conducted in different countries where cases of OC and/or GS are registered directly or together with other congenital defects shows that 60% inquire into the relationship of FAS with the incidence of CAWD. Half of them proposes a beneficial effect of FAS and the other half find no association, concluding that there is no unanimous evidence that FAS in the maternal diet decreases the incidence of CAWD. However, it seems that an influential factor to take into account is the nutritional habits of the mothers.

Evaluation of the Management of Gastroschisis in Aristide Le Dantec University Hospital Center in Dakar: A Cross Sectional Study.

The management of gastroschisis remains problematic in low- and middle-income countries with high perioperative mortality. The objective of this work was to make an initial assessment of our management of gastroschisis. This was a monocentric and cross-sectional study including all newborns with gastroschisis between January 2017 and December 2021 in the Pediatric Surgery and Anesthesia Resuscitation Department of the Aristide Le Dantec University Hospital Center from Dakar. The socio-demographic, diagnostic, therapeutic and evolutionary parameters were studied. Eighteen cases of gastroschisis (11 males and 7 females). The mothers' mean age were 23.1 ± 5.7 years old. Only one antenatal diagnosis was made. The mean gestation age were 36.5 ± 1.5 weeks. On admission, the mean age was 16.8 ± 6.3 h and the mean weight 2244 ± 260.3 g. Gastroschisis was complex in four patients. Primary bowel reintegration was performed in 8 cases (44.4%) and progressive reintegration using an Applied Alexis retractor in 9 newborns (55.6%). Main complications were respiratory distress (28.3%) and sepsis (22.2%). The mean duration of return of oral feeding was 5.1 ± 1.9 days. Mortality was 94.4% (17/18). Reducing gastroschisis-related mortality in our low-income countries remains a major challenge.

Gastroschisis: diagnosis and surgical treatment

Gastroschisis is a congenital malformation of the anterior abdominal wall with a defect to the right of the normally formed umbilical cord and eventration of the abdominal organs. Evented internal organs not covered with amniotic membrane are under the direct influence of amniotic fluid. Despite the increase in the incidence of the defect from 3.6 to 4.9 per 10,000 live births, over the past ten years mortality has sharply decreased to 5%. Antenatal diagnosis makes it possible to reliably identify cases of gastroschisis, starting from the 12th week of gestation, which is important especially when diagnosing complicated forms. Surgical correction involves primary radical plastic surgery of the anterior abdominal wall with simultaneous immersion of the eventrated organs into the abdominal cavity. However, in approximately every fifth patient, immediate correction is impossible due to the occurrence of viscero-abdominal disproportion and concomitant diseases. In these cases, temporary abdominal cavity occurs with delayed plasty of the anterior abdominal wall, enterostomy for intestinal decompression, resection of non-viable areas and interintestinal anastomoses. Among patients with complicated forms, there was an 8-fold increase in mortality. Despite significant advances in reducing mortality, the development of various treatment methods continues to provide an alternative method of correcting this lesion.

Gastroschisis prevalence patterns in 27 surveillance programs from 24 countries, International Clearinghouse for Birth Defects Surveillance and Research, 1980-2017.

Gastroschisis is a serious birth defect with midgut prolapse into the amniotic cavity. The objectives of this study were to evaluate the prevalence and time trends of gastroschisis among programs in the International Clearinghouse for Birth Defects Surveillance and Research (ICBDSR), focusing on regional variations and maternal age changes in the population. We analyzed data on births from 1980 to 2017 from 27 ICBDSR member programs, representing 24 countries and three regions (Europe+ (includes Iran) , Latin America, North America). Cases were identified using diagnostic codes (i.e., 756.7, 756.71, or Q79.3). We excluded cases of amniotic band syndrome, limb-body wall defect, and ruptured omphalocele. Programs provided annual counts for gastroschisis cases (live births, stillbirths, and legally permitted pregnancy terminations for fetal anomalies) and source population (live births, stillbirths), by maternal age. Overall, gastroschisis occurred in 1 of every 3268 births (3.06 per 10,000 births; 95% confidence intervals [CI]: 3.01, 3.11), with marked regional variation. European+ prevalence was 1.49 (95%CI: 1.44, 1.55), Latin American 3.80 (95%CI: 3.69, 3.92) and North American 4.32 (95%CI: 4.22, 4.42). A statistically significant increasing time trend was observed among six European+ , four Latin American, and four North American programs. Women <20 years of age had the highest prevalence in all programs except the Slovak Republic. Gastroschisis prevalence increased over time in 61% of participating programs, and the highest increase in prevalence was observed among the youngest women. Additional inquiry will help to assess the impact of the changing maternal age proportions in the birth population on gastroschisis prevalence.

Omphalocele and gastroschisis: An analysis of prenatal diagnosis and neonatal outcomes

AbstractBackgroundOmphalocele and gastroschisis are the most frequent congenital developmental abdominal wall defects. Prenatal diagnosis of omphalocele and gastroschisis is critical in the management of the pregnancy, affording patients the option of termination. This study aims to evaluate the prenatal diagnosis and postnatal outcomes of omphalocele and gastroschisis cases.Materials and MethodsThe cases of gastroschisis and omphalocele diagnosed prenatally and followed up at our university were evaluated retrospectively between January 2019 and January 2022. Maternal demographic and clinical characteristics and perinatal outcomes were compared between the cases.ResultsThis study evaluated 42 omphalocele and nine gastroschisis cases. All gastroschisis cases were isolated (p = .001). Additional anomalies were present in 61.9% of omphalocele cases. While two patients with gastroschisis refused the invasive procedure, the genetic results of the others were normal. The karyotype was abnormal in 42.9% of omphalocele cases (p = .008). Half of the omphalocele cases were terminated, and 38.1% (n = 8) of the terminated omphalocele cases were trisomy 18. The coexistence of multiple system anomalies and cystic hygroma was high in the terminated cases. In all cases of gastroschisis, only the intestines protruded from the abdominal wall into the amniotic fluid. The number of survivors of omphalocele was 23.8%. The median hospital stay was 25 and 14 days for gastroschisis and omphalocele, respectively.ConclusionPrenatal diagnosis of omphalocele and gastroschisis is critical in pregnancy management. The presence of associated anomalies determines the prognosis of omphalocele and gastroschisis.

A23Wrapping a gastroschisis baby: an MDT simulation programme

Gastroschisis is a congenital defect of the anterior abdominal wall characterized by the herniation of abdominal contents through a defect usually located to the right-side of the umbilical cord [1]. Team-working, collaboration and clear communication between the obstetric, neonatal, and paediatric surgical teams are critical to achieving optimal outcomes in gastrochisis [2]. A national cohort study of all surgical units in the UK and Ireland identified primary closure as the optimal surgical management for antenatally detected cases of simple gastroschisis [3]. A local retrospective audit in RBHSC identified a higher rate of staged gastroschisis repair in the last 10 years with 66% of patients requiring initial silo placement, when compared to 45% national average. Data also demonstrated that patient with silo placement took longer to achieve full feeds, prolonged TPN, delayed discharge, and increased complications rates. To create an interprofessional simulation programme for the preparation and management of a gastroschisis delivery, resuscitation, and initial stabilization. Aims of this project are to improve awareness of optimal stabilization management, efficiency of bowel wrapping and clear communication amongst the MDT with the overall goal of improving the rate of primary closure and outcomes in our unit. A gastroschisis simulation model was created using vegan-sausage casings, jelly, and food colouring to create the bowel. The simulation programme focused on; team education of optimal gastroschisis management, team and delivery room preparation, primary resuscitation and bowel wrapping with clingfilm. Following a lecture of gastroschisis management and demonstration of delivery room stabilization participants were divided into teams of five, given a scenario, asked to prepare equipment, allocate roles and work in sync to achieve effective resuscitation and stabilization of the new-born. Pre and Post simulation feedback was collected and course adapted using a PDSA cycle. For continued learning a post-course video for delivery room management of gastroschisis was created and available for everyone to reference at any time in any location. Pre-simulation: 56% of participants had no previous training or clinical experience of the management of gastroschisis and 78% didn’t feel confident in providing delivery suite management and stabilization. 100% of attendees felt the simulation training improved their confidence of initial management and stabilization of gastroschisis and all would recommend this course to their peers. Simulation-based interdisciplinary team training can serve as a channel for the acquisition and maintenance of clinical skills. It is crucial to improving the management of complex neonatal conditions. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

EP10.23: Two cases of gastroschisis resulting in preterm birth

EP10.23: Two cases of gastroschisis resulting in preterm birth

The Long-Term Outcome of Abdominal Wall Defects Exomphalos &amp; Gastroschisis Retrospective Single Centre Study Children Hospital at Westmead, Sydney, Australia

Objective: To examine the natural history and detailed outcome of diagnosed cases of abdominal wall defects that admitted to The Children`s Hospital at Westmead. Methods: This was A retrospective single centre study of all cases of abdominal wall defects admitted between the 1st of October 1998 and the 1st of January 2007 to The Children`s Hospital at Westmead. The study had been conducted through a retrospective review of the neonatal, pediatric surgery records and subsequent follow-up information of all cases of Omphalocele and Gastroschisis diagnosed. Results: Ninety cases with anterior abdominal wall defects were admitted. Majority of the cases were born at Westmead Hospital. There were 25 neonates with Gastroschisis (27 females, 28 males), and 35 neonates with Exomphalos (15 females, 20 males). Eighty-one neonates had prenatal ultrasound diagnosis. Some neonates had associated congenital anomalies which results in five deaths (4 Exomphalos, 1 Gastroschisis). Post operative complications were common and the postoperative hospital stay was often lengthy. Twenty-five patients out of the ninety (15 Gastroschisis, 10 exomphalos) required further operations which were related to their primary diagnosis of Gastroschisis or Exomphalos, mostly for abdominal wall hernias. Conclusions: Long-term outcome was favourable in majority of cases with abdominal wall defects and mortality substantially happened in neonates with associated anomalies. Reoperations were necessary in those patients who had postoperative hernias.

Are individual-level risk factors for gastroschisis modified by neighborhood-level socioeconomic factors?

Two strong risk factors for gastroschisis are young maternal age (<20 years) and low/normal pre-pregnancy body mass index (BMI), yet the reasons remain unknown. We explored whether neighborhood-level socioeconomic position (nSEP) during pregnancy modified these associations. We analyzed data from 1269 gastroschisis cases and 10,217 controls in the National Birth Defects Prevention Study (1997-2011). To characterize nSEP, we applied the neighborhood deprivation index and used generalized estimating equations to calculate odds ratios and relative excess risk due to interaction. Elevated odds of gastroschisis were consistently associated with young maternal age and low/normal BMI, regardless of nSEP. High-deprivation neighborhoods modified the association with young maternal age. Infants of young mothers in high-deprivation areas had lower odds of gastroschisis (adjusted odds ratio [aOR]: 3.1, 95% confidence interval [CI]: 2.6, 3.8) than young mothers in low-deprivation areas (aOR: 6.6; 95% CI: 4.6, 9.4). Mothers of low/normal BMI had approximately twice the odds of having an infant with gastroschisis compared to mothers with overweight/obese BMI, regardless of nSEP (aOR range: 1.5-2.3). Our findings suggest nSEP modified the association between gastroschisis and maternal age, but not BMI. Further research could clarify whether the modification is due to unidentified biologic and/or non-biologic factors.

Perinatal Outcomes of Neonates with Complex and Simple Gastroschisis after Planned Preterm Delivery-A Single-Centre Retrospective Cohort Study.

This research analysed early neonatal outcomes of complex and simple gastroschisis following planned elective preterm delivery in relation to prenatal ultrasound assessment of bowel conditions. A retrospective study of 61 neonates with prenatal gastroschisis diagnosis, birth, and management at a single tertiary centre from 2011 to 2021 showed a 96.72% survival rate with no intrauterine fatalities. Most cases (78.7%) were simple gastroschisis. Neonates with complex gastroschisis had longer hospital stays and time to full enteral feeding compared to those with simple gastroschisis-75.4 versus 35.1 days and 58.1 versus 24.1 days, respectively. A high concordance of 86.90% between the surgeon's and perinatologist's bowel condition assessments was achieved. The caesarean delivery protocol demonstrated safety, high survival rate, primary closure, and favourable outcomes compared to other reports. Prenatal ultrasound effectively evaluated bowel conditions and identified complex gastroschisis cases.

Neighborhood-level Socioeconomic Position During Early Pregnancy and Risk of Gastroschisis.

Neighborhood-level socioeconomic position has been shown to influence birth outcomes, including selected birth defects. This study examines the un derstudied association between neighborhood-level socioeconomic position during early pregnancy and the risk of gastroschisis, an abdominal birth defect of increasing prevalence. We conducted a case-control study of 1,269 gastroschisis cases and 10,217 controls using data from the National Birth Defects Prevention Study (1997-2011). To characterize neighborhood-level socioeconomic position, we conducted a principal component analysis to construct two indices-Neighborhood Deprivation Index (NDI) and Neighborhood Socioeconomic Position Index (nSEPI). We created neighborhood-level indices using census socioeconomic indicators corresponding to census tracts associated with addresses where mothers lived the longest during the periconceptional period. We used generalized estimating equations to estimate odds ratios (ORs) and 95% confidence intervals (CIs), with multiple imputations for missing data and adjustment for maternal race-ethnicity, household income, education, birth year, and duration of residence. Mothers residing in moderate (NDI Tertile 2 aOR = 1.23; 95% CI = 1.03, 1.48 and nSEPI Tertile 2 aOR = 1.24; 95% CI = 1.04, 1.49) or low socioeconomic neighborhoods (NDI Tertile 3 aOR = 1.28; 95% CI = 1.05, 1.55 and nSEPI Tertile 3 aOR = 1.32, 95% CI = 1.09, 1.61) were more likely to deliver an infant with gastroschisis compared with mothers residing in high socioeconomic neighborhoods. Our findings suggest that lower neighborhood-level socioeconomic position during early pregnancy is associated with elevated odds of gastroschisis. Additional epidemiologic studies may aid in confirming this finding and evaluating potential mechanisms linking neighborhood-level socioeconomic factors and gastroschisis.

Trends in prevalence of gastroschisis in Brazil from 2007 to 2020: A national population-based cross-sectional study.

Gastroschisis is a congenital abnormality of the abdominal wall which worldwide prevalence is increasing with time. Up to now, young maternal age is the main factor associated with gastroschisis. Brazil has a great proportion of adolescent mothers. To estimate prevalence of gastroschisis in Brazil, explore the effect of very young maternal age, and analyze regional distribution and time trends. Cross-sectional population-based study using data from official national information systems from 2007 to 2020, covering 9,831 gastroschisis cases. Low maternal age was assessed as risk factor through odds ratio. Prevalence time trends by maternal age and geographic area were analyzed using joinpoint regression. Overall prevalence of gastroschisis in Brazil was 2.47 per 10,000 births. From first to last biennium, there was a 23% relative increase. Last biennium prevalence was higher in the Central-west region and lower in the Northeast. Compared to mothers of 20-34 years old (YO), the odds-ratio for prevalence and 95% confidence intervals for gastroschisis were, as follows: (a) 10-14 YO-4.9 (4.3,5.5); (b) 15-19 YO-3.6 (3.5,3.8); and (c) 35-49 YO-0.3 (95% CI 0.3, 0.4). Prevalence of gastroschisis in Brazil relatively increased 23% from 2007 to 2020. This happened in all maternal age groups. Differences between regions may be associated to data quality. Young mothers had a higher prevalence of gastroschisis and still higher for those under 15 YO. Mother age over 34 YO was a protective factor.

Gastroschisis in monozygotic twins: A successful approach in a developing country

Gastroschisis is a congenital birth defect of the abdominal wall, with a high mortality rate in middle-income countries, especially among twins. We report a monozygotic twin pregnancy in a 14-year-old girl with a low socioeconomic status and living in a rural area 4 hours away from our II-III health care level hospital, which has medical expertise for handling gastroschisis, in a developing country (Mexico). Prenatal screening was performed using ultrasonography and magnetic resonance imaging, followed by close monitoring and lung maturity induction. A caesarean section was scheduled at 36 weeks, with three available operating rooms for the mother, twin 1, and twin 2, with three teams of specialists. Birth management was done under sedation and analgesia, without intubation. Primary closure was performed for twin 1 and a preformed silo was used for twin 2, who had associated arthrogryposis. Both twins underwent defect sealing with hydrocolloid dressings and sutureless closures, and subsequent neonatal intensive care unit treatment. They had 46XY chromosomes and an identical genetic profile, and were discharged on days 23 and 49, respectively. A specialized multidisciplinary team with state-of-the-art technology, adapted to the hospital conditions of a middle-income country, is paramount for the positive outcomes of twins with gastroschisis. • A novel report of twin gastroschisis, one twin with associated arthrogryposis. • Successful handling involves adapting advanced technology to a developing country. • Planned caesarean sections for twin gastroschisis cases in developing countries.

Is anemia frequently recognized in gastroschisis compared to omphalocele? A multicenter retrospective study in southern Japan.

We compared cases of anemia in gastroschisis versus omphalocele and investigated this clinical question. A multicenter study of five pediatric surgery departments in southern Japan was planned. Sixty patients were collected between 2011 and 2020, with 33 (gastroschisis: n = 19, omphalocele: n = 14) who met the selection criteria ultimately being enrolled. Anemia was evaluated before discharge and at the first outpatient visit. Despite gastroschisis cases showed more frequent iron administration during hospitalization than omphalocele (p = 0.015), gastroschisis cases tended to show lower hemoglobin values at the first outpatient visit than omphalocele cases (gastroschisis: 9.9g/dL, omphalocele: 11.2g/dL). Gastroschisis and the gestational age at birth were significant independent predictors of anemia at the first outpatient visit, (gastroschisis: adjusted odds ratio [OR] 19.00, p = 0.036; gestational age at birth: adjusted OR 0.341, p = 0.028). A subgroup analysis for gastroschisis showed that the ratio of anemia in the 35-36weeks group (8/10, 80.0%) and the > 37weeks group (6/6, 100%) was more than in the < 34weeks group (0/3, 0.0%). Gastroschisis may carry an increased risk of developing anemia compared with omphalocele due to the difference of direct intestinal exposure of amnion fluid in utero.

Gastroschisis at the León University Hospital, Nicaragua

Abstract Objective: The prevalence of midline birth defects, such as gastroschisis, has increased worldwide, over the last few decades. This study aims to explore the prevalence, maternal epidemiological characteristics, and natural history of neonates affected by gastroschisis at the University Hospital of León city, Nicaragua. Methods: Data were collected from the birth defect surveillance system of the Hospital Oscar Danilo Rosales (HEODRA). The analysis included all pregnancies that had gastroschisis complications between January 1 and December 31, 2020. The prevalence of gastroschisis was calculated according to maternal age. The mothers were interviewed, and the clinical records of the newborns were reviewed. Results: Among the 4,460 deliveries included in this study, four cases of gastroschisis were identified, including three live births and one stillbirth. The gastroschisis rate was 8.9 per 10,000 live births (95% confidence interval [CI]: 0.18–17.8). The prevalence among mothers younger than 20 years and those older than 20 years was 26.4 (95% CI: –3.43 to 56.25) and 3.01 (95% CI: 2.89–8.90)/10,000 births, respectively. Mothers of gastroschisis-affected fetuses were of rural origin (n = 3), had normal body mass indexes (n = 3), were exposed to tobacco and wood smoke (n = 2), and one was exposed to pesticides during the periconceptional period. Primary closure of the gastroschisis was performed on one patient, and complex gastroschisis for intestinal perforation was observed in another patient. The mean hospitalization duration was 33 days, and two patients were discharged alive. Conclusions: Gastroschisis was a significant birth defect among children delivered at HEODRA in 2020. Its prevalence in Nicaragua was higher than that in other countries in the region. All complicated pregnancies were young women with unplanned pregnancies, from rural areas, with exposure to secondhand smoke, and without vitamin supplements before or during the first trimester of pregnancy. Only 67% of infants survived after hospital discharge.

Maternal periconceptional alcohol consumption and gastroschisis in the National Birth Defects Prevention Study, 1997-2011.

Gastroschisis is particularly prevalent among offspring of young women and has increased over recent decades. Although previous studies suggest that maternal alcohol consumption is associated with increased gastroschisis risk, none have explored whether maternal age modifies that association. The objective of the study was to evaluate associations between self-reported maternal periconceptional alcohol consumption (1month prior through the third month after conception) and risk of gastroschisis among offspring, by maternal age. We used data from the National Birth Defects Prevention Study (NBDPS), a multi-site population-based case-control study. The analysis included 1450 gastroschisis cases and 11,829 unaffected liveborn controls delivered during 1997-2011 in ten US states. We estimated adjusted odds ratios (aOR) and 95% confidence intervals (CI) for the individual and joint effects of alcohol consumption and young maternal age at delivery (<25years vs ≥25years) on gastroschisis risk. We estimated the relative excess risk due to interaction (RERI) to quantify additive interaction. Periconceptional alcohol consumption was common regardless of maternal age (women <25years: cases 38.8%, controls 29.3%; women ≥25: cases 43.5%, controls 39.5%). Compared with women ≥25years who did not consume alcohol, we observed increased risk of gastroschisis among women <25years, with higher estimates among those who consumed alcohol (women <25years who did not consume alcohol. aOR 5.90, 95% CI 4.89, 7.11; women <25years who did consume alcohol: aOR 8.21, 95% CI 6.69, 10.07). Alcohol consumption among women ≥25years was not associated with gastroschisis (aOR 1.12, 95% CI 0.88, 1.42). This suggests super-additive interaction between alcohol consumption and maternal age (RERI-2.19, 95% CI 1.02, 3.36). Periconceptional alcohol consumption may disproportionately increase risk of gastroschisis among young mothers. Our findings support public health recommendations to abstain from alcohol consumption during pregnancy.

Supraumbilical gastroschisis

Gastroschisis is a rare congenital defect of the ventral abdominal wall through which abdominal contents herniate outside of the body without a peritoneal sac. The most common location of the defect is to the right of the umbilicus, however, there have been case reports of defects in alternate locations along the abdominal wall, particularly on the left side. Here we describe a case of a baby born with a gastroschisis-like defect in the midline supraumbilical abdominal wall, the only such case described in the literature, to our knowledge. The defect was small with herniated bowel and loss of domain in the abdomen requiring delayed closure with a silo. Cases of gastroschisis in unusual locations bring into question the pathogenesis of such defects, a topic which remains controversial.

Ultrasonographic detection of gastroschisis in the first trimester: Actualities in pregnancy management and outcome

Gastroschisis is a congenital anterior abdominal wall defect that occurs in 4 to 5 in 10,000 births, consisting in the evisceration of bowel in the amniotic cavity without a membranous covering. Gastroschisis cases can be detected during the first trimester using ultrasonography or at the beginning of the second trimester with a detection rate of 100%. Although an isolated condition in most of the cases, further complications such as malrotation, atresia, stenosis, perforation or volvulus can be associated. Periodic monitoring is required to assess the progress of the pregnancy with measurements of the level of amniotic fluid, fetal biometry and bowel diameters at every ultrasound examination. Gastroschisis is most frequently associated with oligohydramnios, intrauterine fetal growth restriction, increased bowel wall thickness and bowel dilatation. The outcome of the disease is favorable with a survival rate of around 90% for born infants. The long time on ventilator and multiple intestinal surgeries that delay the moment of oral feeding with a long-term use of total parental nutrition and short bowel syndrome are the most important comorbidities. Delivery is recommended at 38 weeks of gestation, preserving caesarean delivery for complicated gastroschisis. Although a complex pathology, gastroschisis is associated with normal intellectual development and few to none long-term complications.