Recreational Drug Use: A Major Risk Factor for Gastroschisis?

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A higher prevalence of recreational drug use has been described in women whose infants have the abdominal wall defect gastroschisis. However, the case-control studies dealing with this possible association have relied on maternal reporting and retrospective interviews, which may not be completely reliable. The authors conducted a large-scale population-based case-control study in 3 areas of the United Kingdom over a 32-month period in the years 2001–2003 in order to test the hypothesis that the risk of gastroschisis is positively associated with recreational drug use in the first trimester of pregnancy. Each case was matched for delivery site and maternal age with 3 live-born controls. Maternal drug use was ascertained by trained interviewers and independently verified by hair analysis. Adjusted odds ratios were estimated by conditional logistic regression analysis.

A total of 165 infants with gastroschisis were born to 164 mothers, for an overall fetal/birth prevalence of 4.24 per 10,000 births. A large majority (93%) were isolated anomalies. The adjusted odds ratio (OR) indicated a statistically significant association between gastroschisis and the first trimester use of any recreational drug [OR, 2.2; 95% confidence interval (CI), 1.2–4.3], as well as the use of vasoconstrictive recreational drugs including cocaine, amphetamines, and ecstasy (OR, 3.3; 95% CI, 1.0–10.5). Other significant risk factors included the use of aspirin (OR, 20.4; 95% CI, 2.2–91.5), cigarette smoking (OR, 1.7; 95% CI, 1.1–2.6), and a history of gynecological infection or disease before the current pregnancy (OR, 2.6; 95% CI, 1.2–5.6).

The investigators conclude from these findings that recreational drug use is a significant risk factor for gastroschisis and one that—like other risk factors such as cigarette smoking, aspirin use, and gynecological infection/disease—is preventable.

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