Impact of maternal substance abuse and smoking on children with gastroschisis.
OBJECTIVE
Conflicting information exists regarding the effects of maternal substance abuse on gastroschisis. The objectives of this study are to determine if maternal smoking is associated with an increased risk of gastroschisis and whether substance abuse is associated with the severity of gastroschisis.


METHODS
The Canadian Pediatric Surgery Network (CAPSNET) database was evaluated for associations between maternal substance abuse and the severity of the gastroschisis. We also compared smoking rates from this group to overall Canadian maternal smoking rates.


RESULTS
One hundred fourteen cases of gastroschisis acquired over 18 months were evaluated. After adjusting for covariates, illicit drug use was associated with bowel necrosis (OR, 9.4; 95% CI,1.3-70) and marijuana use with matting of the intestines (OR, 4.0; 95% CI, 1.0-16). Functional outcomes assessment revealed that slower initiation of enteral feeds was associated with maternal smoking (OR, 3.8; 95% CI, 1.4-10). The overall maternal smoking rate in this cohort (30.7%) was significantly higher than the known Canadian rate (13.4%). This may be accounted for by the considerably higher smoking rate of mothers 20 to 24 years of age in our cohort (48.9%).


CONCLUSIONS
Substance abuse and smoking are associated with a greater severity of gastroschisis in terms of both the degree of intestinal injury and functional outcomes. High smoking rates among young mothers may be putting children with gastroschisis at risk for poor outcomes.
Weinsheimer
Robert L
RL
Division of Pediatric General Surgery, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada B3J 3G9.
Yanchar
Natalie L
NL
D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D015984:Causality; D015897:Comorbidity; D005260:Female; D005492:Folic Acid / Q000008:administration & dosage; D020139:Gastroschisis / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D013287:Illicit Drugs; D015994:Incidence; D007231:Infant, Newborn; D007902:Length of Stay / Q000706:statistics & numerical data; D002189:Marijuana Abuse / Q000453:epidemiology; D008423:Maternal Age; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D011297:Prenatal Exposure Delayed Effects / Q000453:epidemiology*; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology*; D019966:Substance-Related Disorders / Q000453:epidemiology*
D013287:Illicit Drugs; D005492:Folic Acid