Lifestyle and Socio-Demographic Risk Factors for Gastroschisis: A Systematic Review and Meta-Analysis

ABSTRACT Background Gastroschisis is strongly associated with young maternal age. This association suggests the need for further investigations on non-genetic risk factors. Identifying these risk factors is a public health priority in order to develop prevention strategies aimed at reducing the prevalence and health consequences in offspring. Objective To systematically assess and quantitatively synthesize the available epidemiological studies to evaluate the association between non-genetic risk factors and gastroschisis. Methods Literature from PubMed, EMBASE, and Scopus was searched for the period 1990-2018. Epidemiological studies reporting risk estimates between lifestyle and socio-demographic risk factors and gastroschisis were included. Two pairs of reviewers independently extracted information on study characteristics following PRISMA and MOOSE guidelines. Relative risk (RR) estimates were calculated across the studies and meta-analysis was performed using random-effects model. Results We identified 58 studies. Meta-analyses were conducted on 29 studies. Maternal smoking (relative risk (RR) 1.56, 95% CI 1.40 to 1.74), illicit drug use (RR 2.14, 95% CI 1.48 to 3.07), and alcohol consumption (RR 1.40, 95% CI 1.13 to 1.70) were associated with an increased risk of gastroschisis. A decreased risk among Black mothers compared to non-Hispanic white mothers (RR 0.49, 95% CI 0.38 to 0.63) was found. For Hispanic mothers no association was observed. Conclusions Exposure to smoking, illicit drugs and alcohol during pregnancy is associated with an increased risk of gastroschisis. A significantly decreased risk for Black mothers was observed. Further epidemiological studies to assess the potential role of other environmental factors are strongly recommended. PROSPERO # CRD42018104284.