Maternal and paternal risk factors for anorectal malformations: a Dutch case-control study.
BACKGROUND
Anorectal malformations (ARM) are major congenital malformations that usually require a multitude of surgical procedures at a very early age and have a large impact on the lives of patients and their parents. The causes of ARM are still largely unknown, but they are assumed to have a multifactorial etiology. A few studies focused on environmental risk factors, but evidence is still scarce.


METHODS
In this Dutch case-control study (1996-2008), we investigated the role of maternal and paternal risk factors in the etiology of ARM. Parents of 85 ARM cases and 650 controls filled in a questionnaire. Controls were children treated with ear ventilation tubes.


RESULTS
A higher occurrence of fever during the first trimester of pregnancy was found for case mothers compared to control mothers (odds ratio [OR], 5.1; 95% Confidence Interval [CI], 0.9, 28.1). Maternal occupational exposure to industrial cleaning agents and solvents increased the risk of ARM three times (OR, 2.9; 95% CI, 0.9, 9.3). Overweight (Body Mass Index [BMI] > or = 25 kg/m(2)) before pregnancy also seemed to be associated with ARM (OR, 1.8; 95% CI, 1.1, 2.8), as well as maternal multivitamin use during pregnancy (OR, 1.6; 95% CI, 1.0, 2.7), paternal smoking (OR, 1.8; 95% CI, 1.1, 2.9), and paternal occupational exposure to exhaust fumes (OR, 1.9; 95% CI, 1.0, 3.6). Reported ARM in at least one first- or second-degree family member greatly increased the risk of having a child with an ARM (OR, 40.3; 95% CI, 4.8, 342.8).


CONCLUSIONS
This study revealed potential risk factors for ARM, including fever during pregnancy, maternal overweight, use of multivitamins, paternal smoking, and occupational exposures, but a familial component seems important as well.
van Rooij
Iris A L M
IA
Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands. i.vanrooij@ebh.umcn.nl
Wijers
Charlotte H W
CH
Rieu
Paul N M A
PN
Hendriks
Hester S
HS
Brouwers
Marijn M
MM
Knoers
Nine V
NV
de Blaauw
Ivo
I
Roeleveld
Nel
N
D000328:Adult; D001003:Anal Canal / Q000002:abnormalities*; D001006:Anus, Imperforate / Q000453:epidemiology / Q000209:etiology; D016022:Case-Control Studies; D004065:Digestive System Abnormalities / Q000453:epidemiology* / Q000209:etiology; D005192:Family Health; D005260:Female; D005334:Fever / Q000150:complications; D020022:Genetic Predisposition to Disease / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D018811:Maternal Exposure / Q000009:adverse effects; D009426:Netherlands / Q000453:epidemiology; D016273:Occupational Exposure / Q000009:adverse effects; D018812:Paternal Exposure / Q000009:adverse effects; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D012007:Rectum / Q000002:abnormalities*; D012307:Risk Factors