Epidemiology of Gastroschisis: A Population-Based Study in California from 1995-2012

BACKGROUND: Although the incidence of gastroschisis is increasing, risk factors are not clearly identified. METHODS: Using the Linked Birth Database from the California Office of Statewide Health Planning and Development from 1995–2012, patients with gastroschisis were identified by ICD-9 diagnosis/procedure code or birth certificate designation. Logistic regressions examined demographics, birth factors, and maternal exposures on risk of gastroschisis. RESULTS: The prevalence of gastroschisis was 2.7 cases per 10,000 live births. Patients with gastroschisis had no difference in fetal exposure to alcohol (p=0.609), narcotics (p=0.072), hallucinogenics (p=0.239), or cocaine (p=0.777), but had higher exposure to unspecified/other noxious substances (OR 3.27, p=0.040; OR 2.02, p=0.002). Gastroschisis was associated with low/very low birthweight (OR 5.08–16.21, p<0.001) and pre-term birth (OR 3.26–10.0, p<0.001). Multivariable analysis showed lower risk in black (OR 0.44, p<0.001), Asian/Pacific Islander (OR 0.76, p=0.003), and Hispanic patients (OR 0.72, p<0.001) compared to white patients. Risk was higher in rural areas (OR 1.24–1.76, p=0.001). Compared to women age<20, risk decreased with advancing maternal age (OR 0.49-OR 0.03, p<0.001). Patients with gastroschisis had increased total charges ($336,270 vs. $9,012, p<0.001) and length of stay (38.1 vs. 2.9 days, p<0.001). Mortality was 4.6%. CONCLUSIONS: This is the largest population-based study summarizing current epidemiology of gastroschisis in California.