Impact of maternal substance abuse and smoking on children with gastroschisis

• Published in: Journal of pediatric surgery 2008-05, Vol.43 (5), p.879-883
• Main Authors: Weinsheimer, Robert L, Yanchar, Natalie L
• Format: Article
• Language: English
• Subjects: Adult; Alcohol Drinking - epidemiology; Canada - epidemiology; Causality; Comorbidity; Female; Folic Acid - administration & dosage; Gastroschisis; Gastroschisis - epidemiology; Gastroschisis - prevention & control; Humans; Incidence; Infant, Newborn; Length of Stay - statistics & numerical data; Marijuana Abuse - epidemiology; Maternal Age; Maternal smoking; Maternal substance abuse; Outcomes; Pediatrics; Pregnancy; Pregnancy Complications - epidemiology; Prenatal Exposure Delayed Effects - epidemiology; Risk Factors; Smoking - epidemiology; Street Drugs; Substance-Related Disorders - epidemiology; Surgery
• ISSN: 0022-3468; 1531-5037
• DOI: 10.1016/j.jpedsurg.2007.12.032

Abstract Background/Purpose Conflicting information exists regarding the effects of maternal substance abuse on gastroschisis. The objectives of this study are to determine if maternal smoking is associated with an increased risk of gastroschisis and whether substance abuse is associated with the severity of gastroschisis. Methods The Canadian Pediatric Surgery Network (CAPSNET) database was evaluated for associations between maternal substance abuse and the severity of the gastroschisis. We also compared smoking rates from this group to overall Canadian maternal smoking rates. Results One hundred fourteen cases of gastroschisis acquired over 18 months were evaluated. After adjusting for covariates, illicit drug use was associated with bowel necrosis (OR, 9.4; 95% CI,1.3-70) and marijuana use with matting of the intestines (OR, 4.0; 95% CI, 1.0-16). Functional outcomes assessment revealed that slower initiation of enteral feeds was associated with maternal smoking (OR, 3.8; 95% CI, 1.4-10). The overall maternal smoking rate in this cohort (30.7%) was significantly higher than the known Canadian rate (13.4%). This may be accounted for by the considerably higher smoking rate of mothers 20 to 24 years of age in our cohort (48.9%). Conclusions Substance abuse and smoking are associated with a greater severity of gastroschisis in terms of both the degree of intestinal injury and functional outcomes. High smoking rates among young mothers may be putting children with gastroschisis at risk for poor outcomes.