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Comment & Response
February 6, 2019

Gastroschisis and Autism—Dual Canaries in the Californian Coalmine—Reply

Author Affiliations
  • 1Department of Surgery, UC Davis Medical Center, University of California, Sacramento
  • 2UC Davis Medical Center, University of California, Sacramento
JAMA Surg. 2019;154(4):367-368. doi:10.1001/jamasurg.2018.4697

In Reply In their letter, Reece and Hulse suggest there may be a correlation between cannabis consumption and gastroschisis based on the high consumption of cannabis in counties where we have found high rates of gastroschisis. To be clear, Reece and Hulse are inaccurate in their statement that we “found rurality was a risk factor for cannabis use.” Instead, we found higher rates of gastroschisis in rural counties.1 In a follow-up study,2 we found that fetal exposure to drugs other than alcohol, cocaine, narcotics, or hallucinogenics (odds ratio [OR], 3.27; 95% CI, 1.05-10.15; P = .04) and other noxious substances (OR, 2.02; 95% CI, 1.29-3.18; P = .002) increased the risk of gastroschisis in univariate analyses. The risk of combined exposure to other drugs and noxious substances persisted even when adjusting for rurality in a multivariate analysis (OR, 1.58; 95% CI, 1.01-2.49; P = .005). These drugs could include cannabis, among others, although this is impossible to determine, given the limitations of International Classification of Diseases, Ninth Revision coding used in this administrative database.

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