Does Maternal Diet Increase Risk for Gastroschisis?

June 13, 2011

Clinicians and researchers have seen an increase in the prevalence of gastroschisis, with the greatest risk seen in women who are younger than 20 years. That, coupled with an evident increase in developing countries, has led researchers to believe that gastroschisis is associated with environmental factors (with or without underlying genetic susceptibility).

Clinicians and researchers have seen an increase in the prevalence of gastroschisis, with the greatest risk seen in women who are younger than 20 years. That, coupled with an evident increase in developing countries, has led researchers to believe that gastroschisis is associated with environmental factors (with or without underlying genetic susceptibility). Since adolescents and younger women tend to be concerned about their weight, and since women with lower-than-normal bodyweight appear to be at increased risk for adverse perinatal outcomes, researchers have hypothesized that inadequate nutrition may contribute to the increased risk of gastroschisis in this patient population.

To explore the possible link between young maternal age, body mass index (BMI), and nutrient intake, Dr Marcia L. Feldkamp, associate professor in the department of pediatrics at the University of Utah and director of Utah Birth Defect Network, and colleagues analyzed data from the National Birth Defects Prevention Study. The researchers looked at average intakes for micronutrients, amino acids, fatty acids, and macronutrients during the year before pregnancy to see if they were associated with an increased risk of gastroschisis. They further examined whether associations were modified by maternal intake of folic acid-containing supplements, maternal age, or BMI.

The National Birth Defects Prevention Study was conducted between 1997 and 2005 in study centers across 10 states. The study consisted of 694 cases with birth defects and 6157 controls (nonmalformed live born infants). Almost half (47%) the cases were younger than 20 years, while only 14% of controls were in the same age group. While more than half of all participants in each group were white/non-Hispanic, cases were more likely to be Hispanic or another race/ethnicity as compared to control participants. Cases were less likely to have completed 12 years of education than their control counterparts. Cases were also more likely to be primigravid (50.6%) as compared to control participants (30.0%). Cases also had more negative health factors; they had a lower BMI, were more likely to smoke cigarettes, use illicit drugs, and drink at least 5 drinks per occasion. Furthermore, they were less likely than their control counterparts to consume supplements with folic acid.

To assess the usual maternal dietary intake of micronutrients, macronutrients, amino acids, and fatty acids in the year prior to pregnancy, researchers used a modified Willett 58-item food frequency questionnaire. The questionnaire was used during a phone call; participants were asked to share their consumption and serving size of various foods. The researchers further queried participants regarding their soda, cereal, and tea consumption. The resulting data combined with the SR20 version of the US Department of Agriculture (USDA) National Nutrient Database for Standard Reference helped determine overall nutrient calculations. In total, the researchers looked at 22 micronutrients (vitamins and minerals), 2 fatty acids (linoleic acid and oleic acid), 4 amino acids (cysteine, glycine, glutamic acid, and methionine), and 3 macronutrients (carbohydrates, protein, and total fat) as well as total energy intake (kilocalories). Alcohol, smoking, and supplement information was also used in the analysis.

Overall, Feldkamp and colleagues did not detect an increased risk for gastroschisis based on preconception intakes of any micronutrient, macronutrient, amino acid, or fatty acid, with few exceptions. There was an apparent 27% reduction in risk when comparing the highest and lowest tertile of copper intake. The results are contrary to an earlier study using the same data that found a small increased risk when comparing highest and lowest tertile of fat intake.

“Our findings, based on a well-characterized and large sample of gastroschisis, indicate that maternal nutrient intake before pregnancy has a limited role, if any, in modifying the risk for gastroschisis in the offspring,” they concluded, adding “A broader look at nutrient pathways and diet quality (as opposed to individual nutrients), possibly in association with biomarker assessment, could provide additional insight about the role of nutrition in the etiology of and worldwide prevalence increase of gastroschisis.”

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Reference

Feldkamp ML, Carmichael SL, Shaw GM et al. Maternal nutrition and gastroschisis: findings from the National Birth Defects Prevention Study. Am J Obstet Gynecol. 2011 Mar 10 [Epub].