Complicated gastroschisis and maternal smoking: a causal association?

The incidence of gastroschisis appears to be rising in developed nations, with epidemiological studies indicating association with young maternal age and smoking. Is there an association between maternal smoking and the development of complicated gastroschisis? A retrospective population-based review of all cases of gastroschisis over 11 years was conducted in three Canadian provinces. Complicated cases were defined as those with an associated intestinal atresia or other vascular compromise of the bowel, those requiring a prolonged time to full enteral feeding (>42 days). Univariate and multivariate regression analyses were conducted. Fifty-four cases of gastroschisis were treated. Seventeen patients had complicated gastroschisis (CG). 47.1% of infants were born to smoking mothers; of those 56.25% were in the CG group. On univariate analysis statistically significant associations with complicated cases were young maternal age (<19 years) (OR = 6.0, CI: 1.3, 28.1), low maternal weight gain (<12 kg) (OR = 4.6, CI: 2.5, 8.5), low birth weight (<2,400 g), (OR = 7.7, CI: 2.0, 28.9), and gestational age under 36 weeks (OR = 11.0, CI: 2.6, 46.2). Seven of 24 cases involving maternal smoking developed atresias or vascular intestinal compromise versus 4 of 27 cases with no maternal smoking, with an odds ratio of 2.1 (CI: 0.60, 7.2). On multivariate analysis, atresias and vascular compromise remained significantly associated with young maternal age, low gestational age and low 1-min Apgar score. Although a positive trend is seen, no statistically significant relationship between maternal smoking and the development of complicated gastroschisis was found. Further clinical and epidemiologic studies are needed to validate our findings.