Influence of Maternal Factors on Health Outcomes in Gastroschisis: A Canadian Population-Based Study

BACKGROUND: Gastroschisis is increasing in incidence worldwide. There is a need for a disease-specific, population-based approach to determining factors linked with gastroschisis and its outcome. OBJECTIVES: To examine racial, socioeconomic, health and geographic predictors of gastroschisis and its outcome in Canada. METHODS: 535 cases of gastroschisis from the Canadian Pediatric Surgery Network national database were included from May 2005 to May 2010. Baseline characteristics of mothers were compared with those reported by Statistics Canada. Factors associated with adverse neonatal outcomes were examined using regression analyses. RESULTS: Mothers of infants with gastroschisis are young, often from small communities. Smoking (37%) and illicit drug use are common in this population. Single mothers receive less perinatal care (OR 0.06; 95% CI 0.02-0.28). Geographically isolated mothers are more likely to undergo caesarian section (OR 3.84; 95% CI 1.26-11.74). Cocaine use predicts a lower odds of delivering at a planned center (OR 0.25; 95% CI 0.08-0.79), and is also associated with an increased likelihood of intestinal injury at birth (OR 6.26; 95% CI 1.52-25.72). Infants of mothers from isolated communities will spend a mean of 31.9 days longer in hospital. Aboriginal status is not independently predictive of perinatal or neonatal outcome. CONCLUSION: Gastroschisis in Canada occurs frequently in young mothers, aboriginals and smokers. Features associated with worse outcomes include single parent status, cocaine use and maternal hometown geographic isolation.