title: Growth restriction in gastroschisis: quantification of its severity and exploration of a placental cause.
abstract: BACKGROUND
  Gastroschisis patients are commonly small for gestational age (SGA, birth weight [BW] < 10th centile). However, the extent, symmetry and causes of that growth restriction remain controversial.
  
  
  METHODS
  We compared BW, crown-heel length (LT), occipitofrontal circumference (OFC) and ponderal index (PI) in 179 gastroschisis cases and 895 matched controls by univariate and multiple regression. Fetal ultrasounds (N = 80) were reviewed to determine onset of growth restriction. Placental histology was examined in 31 gastroschisis patients whose placental tissue was available and in 29 controls.
  
  
  RESULTS
  Gastroschisis cases weighed less than controls (BW = 2400 ± 502 g vs. 2750 ± 532 g, p < 0.001) and their BW frequency curve was shifted to the left, indicating lower BW as a group compared to controls (p < 0.001 by Kolmogorov-Smirnov test). BW differences varied from -148 g at 33 weeks to -616 g at 38 weeks gestation. Intrauterine growth restriction was symmetric with gastroschisis patients having a shorter LT (45.7 ± 3.3 vs. 48.4 ± 2.7 cm, p < 0.001), smaller OFC (31.9 ± 1.9 vs. 32.9 ± 1.6 cm, p < 0.001), but larger ponderal index (2.51 ± 0.37 vs. 2.40 ± 0.16, p < 0.001) compared to controls. Gastroschisis patients had a similar reduction in BW (-312 g, 95% confidence interval [CI] = -367, -258) compared to those with chromosomal abnormalities (-239 g, CI = -292, -187). Growth deficits appeared early in the second trimester and worsened as gestation increased. Placental chorangiosis was more common in gastroschisis patients than controls, even after removing all SGA patients (77% vs. 42%, p = 0.02).
  
  
  CONCLUSIONS
  Marked, relatively symmetric intrauterine growth restriction is an intrinsic part of gastroschisis. It begins early in the second trimester, and is associated with placental chorangiosis.
authors: Department of Epidemiology, Michigan State University, East Lansing, MI 48824, USA. rob.payne@childrensmn.org
authors: Nathaniel R
authors: NR
authors: Payne
authors: Susan C
authors: SC
authors: Simonton
authors: Sam
authors: S
authors: Olsen
authors: Mark A
authors: MA
authors: Arnesen
authors: Kathleen M
authors: KM
authors: Pfleghaar
mesh_terms: D001724:Birth Weight; D001827:Body Height; D016022:Case-Control Studies; D002508:Cephalometry; D002824:Chorionic Villi / Q000098:blood supply* / Q000473:pathology; D005260:Female; D005317:Fetal Growth Retardation / Q000209:etiology*; D020139:Gastroschisis / Q000150:complications*; D006801:Humans; D007231:Infant, Newborn; D007236:Infant, Small for Gestational Age; D008297:Male; D010922:Placenta Diseases / Q000175:diagnosis*; D011247:Pregnancy; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016216:Ultrasonography, Prenatal