The following FAQ may help answer questions you have regarding the gastroschisis study recently completed by Dr. Leslie Elliott, Assistant Professor in Community Health Sciences, and the Washoe County Health District. Should you have additional questions or concerns regarding gastroschisis, please consult MedlinePlus, a service of the U.S. National Library of Medicine and the National Institutes of Health at http://www.nlm.nih.gov/medlineplus/ency/article/000992.htm or Centers for Disease Control and Prevention at http://www.cdc.gov/ncbddd/birthdefects/Gastroschisis.htm.http://www.cdc.gov/ncbddd/birthdefects/Gastroschisis.htm
What is gastroschisis?
Why was the study conducted?
What were the major findings of the study?
How did these findings compare with other previous research on risk factors for gastroschisis?
How are babies with gastroschisis cared for?
What conclusions emerged from the study?
What questions remain?
Should we be alarmed?
What further research may be or will be conducted?
Where can I find more information about gastroschisis?
Where can I get medical or prenatal care if I am pregnant?
What is gastroschisis?
Gastroschisis is a birth defect that occurs early in pregnancy, characterized by incomplete closure of the baby’s abdominal wall. Babies with this birth defect are born with part of their intestines outside their bodies, which necessitates repair of the abdominal wall in the first week of life.
Why was the study conducted?
The public health investigation began when local public health nurses and perinatologists noticed an increase in the number of babies being diagnosed with the defect in Washoe County, and reported this to the Epidemiology Division of the Washoe County Health District.
Leslie Elliott, senior epidemiologist of chronic diseases with the Washoe County Health District and a researcher with an adjunct faculty position at the University of Nevada, Reno, School of Community Health Sciences, analyzed available Washoe County birth data to determine whether the recent rate of gastroschisis was significantly different from rates during previous years (1991 to 2005). This initial investigation showed that a baby born in Washoe County during 2007 was 10 times more likely to have gastroschisis than a baby born in any of the years from 1991 through 2005. A total of 16 babies were born with gastroschisis during the 15-year span of 1991 to 2005, while 14 babies were born with gastroschisis during the one-year span of April 2007 to April 2008. (It is important to note that from April 2008 to October 2009, the cluster has subsided, with five babies being born with gastroschisis in Washoe County during this period.)
This led Elliott to launch a more formal investigation to identify risk factors that may have contributed to this recent dramatic increase. In collaboration with the Washoe County Health District’s public health nurses, the University of Nevada Reno’s School of Community Health Sciences, Renown Health, and Perinatal Associates of Northern Nevada, Elliott and Lisa Lottritz, a public health nurse, began gathering data. Key to success of the investigation was the cooperation of mothers in the community, both those who had given birth to babies with gastroschisis and those who had given birth to babies without the defect who served as a control group. This formal investigation included births that occurred in Washoe County during a one-year period, from April 5, 2007, the date the first baby in this cluster was born, through April 4, 2008.
What were the major findings of the study?
Case mothers (those who had babies with gastroschisis) were more likely to report some infections, such as sore throat (about 13 times more likely) and chest colds (about 17 times more likely), in early pregnancy than control group mothers (those who did not have babies with gastroschisis during the period of the study). In addition, the case mothers were nine times more likely than the control-group mothers to report having taken over-the-counter medications for these infections during pregnancy.
Case mothers were seven times more likely than control-group mothers to report methamphetamine use at some time before pregnancy.
Case mothers were more than four times as likely as control-group mothers to report use of some vasoconstrictive recreational drug (including methamphetamine, amphetamine, cocaine or Ecstasy) before pregnancy.
How did these findings compare with other previous research on risk factors for gastroschisis?
This study adds significant support to the findings of other studies that certain cold medications, such as pseudoephedrine, and some recreational drugs, may be contributing factors in the development of gastroschisis. This study is the first to find an association between gastroschisis and methamphetamine use.
Research has indicated a rise in gastroschisis prevalence globally over the past 20 years. The rate, on average, was less than one case in 10,000 live births in the 1970s, compared with a rate of two to five cases in 10,000 live births in the early 2000s, depending on the country. The rate in the United States is about two in 10,000 live births. This compares to the Washoe County cluster rate of 22.6 cases per 10,000 live births during the study period, about 10 times greater than the national rate.
Consistent with previous research, this study found that young mothers, age 21 or younger, are at the highest risk of having a baby with gastroschisis.
This study added another data point to the finding that bladder infections in pregnancy are associated with gastroschisis, although the estimate was not very precise due to small numbers.
How are babies with gastroschisis cared for?
- When diagnosed prior to birth, proper care for babies with gastroschisis can be planned in advance so that at the time of their birth, they receive the immediate care they need. When this is done, the defect is corrected, and the babies can lead normal, healthy lives. Washoe County is fortunate to have perinatologists Robert Nathan Slotnick and Earle Oki who are experts in diagnosing the defect prior to birth and providing medical guidance and care to the expectant mothers. In addition, local pediatric surgeon Frieda M. Hulka, an expert in gastroschisis repair, performed the necessary surgery on all of the affected newborns.
What conclusions emerged from the study?
Washoe County experienced a cluster of gastroschisis from April 2007 to April 2008. The cluster has subsided since April 2008. The investigation found associations between gastroschisis and the following:
Reports of infections, such as colds or sore throats, during early pregnancy.
Reports of taking cold medications sometime during pregnancy.
Use of vasoconstrictive recreational drugs sometime prior to pregnancy
Use of methamphetamine sometime prior to pregnancy
The study did not find associations between gastroschisis and a variety of other factors, such as area of residence, water source or occupational exposures.
Some case mothers in the cluster did NOT report any of the identified risk factors.What questions remain?
The main question is: Why did this cluster occur in Washoe County when we know that these same risk factors exist in communities across the country? In addition, the study raises many more questions and calls for further research regarding possible associations between gastroschisis and:
Infections during pregnancy
Use of medications during pregnancy, particularly cold medications
Recreational drug use prior to or during pregnancy
Methamphetamine use prior to or during pregnancy
Lifestyle factorsShould we be alarmed?
While further scientific research definitely is needed to address this issue, our medical community is effectively diagnosing and treating this defect when expectant mothers seek appropriate care, which allows the affected babies to get the defect corrected at birth and lead normal healthy lives.
What further research may be or will be conducted?
Elliott, now assistant professor of epidemiology at the University of Nevada, Reno School of Community Health Sciences, is working with colleagues at the University to develop a larger case-control study of gastroschisis and other birth defects in Washoe County. A larger study could be instrumental in confirming the findings of the cluster investigation, as well as identifying additional risk factors.
Where can I find more information about gastroschisis?
MedlinePlus, a service of the U.S. National Library of Medicine and the National Institutes of Health:
http://www.nlm.nih.gov/medlineplus/ency/article/000992.htm
Centers for Disease Control and Prevention: http://www.cdc.gov/ncbddd/birthdefects/Gastroschisis.htmWhere can I get medical or prenatal care if I am pregnant?
If you are pregnant or are thinking of becoming pregnant and have concerns about gastroschisis, please contact your family physician or OB-GYN (obstetrics and gynecology doctor).
If you have insurance but do not currently have a doctor, please contact your health plan for a list of providers who accept your insurance. If you do not have insurance and do not currently have a doctor, please contact:
Health Access Washoe County (HAWC) Clinic
(775) 329-6300, http://www.hawcinc.org/