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November 2, 2009

Case-control Study of a Gastroschisis Cluster in Nevada

Author Affiliations

Author Affiliations: School of Community Health Sciences, University of Nevada (Drs Elliott and Loomis); Washoe County Health District (Drs Elliott and Todd, and Ms Lottritz); Perinatal Associates of Northern Nevada (Drs Slotnick and Oki); and University of Nevada School of Medicine, Reno, Nevada (Dr Slotnick).

Arch Pediatr Adolesc Med. 2009;163(11):1000-1006. doi:10.1001/archpediatrics.2009.186

Objective  To identify potential risk factors associated with a sudden increase in gastroschisis cases in northern Nevada.

Design  Case-control study.

Setting  Medical centers and a pregnancy care center in Reno, Nevada.

Participants  Participants (n = 14) were women who gave birth to infants with gastroschisis at either of the 2 medical centers in Reno, Nevada, from April 5, 2007, through April 4, 2008. Controls (n = 57) were selected from the same pregnancy center providing perinatal care to the cases and were matched 4:1 to the case mothers by maternal date of birth within 1 year.

Main Exposures  Environmental exposures and illnesses during pregnancy.

Outcome Measures  Association of gastroschisis with illnesses, medications, or environmental exposures.

Results  Gastroschisis was associated with the use of methamphetamine (odds ratio [OR], 7.15; 95% confidence interval [CI], 1.35-37.99) or any vasoconstrictive recreational drug (methamphetamine, amphetamine, cocaine, ecstasy) (OR, 4.46; 95% CI, 1.21-16.44) before pregnancy. When we limited self-reported illnesses to those occurring during the first trimester of pregnancy, chest colds (OR, 16.77; 95% CI, 1.88-150.27) and sore throats (OR, 12.72; 95% CI, 1.32-122.52) were associated with gastroschisis.

Conclusions  These findings add strength to the hypothesis that use of methamphetamine and related drugs is a risk factor for gastroschisis and raise questions about the risks associated with infections.