title: The role of maternal stress in early pregnancy in the aetiology of gastroschisis: an incident case control study.
abstract: OBJECTIVE
  The incidence of gastroschisis, a congenital anomaly where the infant abdominal wall is defective and intestines protrude from the abdominal cavity, is increasing in many countries. The role of maternal stress in some adverse birth outcomes is now well established. We tested the hypothesis that major stressful life events in the first trimester are risk factors for gastroschisis, and social support protective, in a case-control study in the United Kingdom.
  
  
  METHODS
  Gastroschisis cases and three controls per case (matched for maternal age) were identified at routine 18-20 week fetal anomaly ultrasound scan, in 2007-2010. Face to face questionnaire interviews were carried out during the antenatal period (median 24 weeks gestation) asking about serious stressful events and social support in the first trimester. Data were analysed using conditional logistic regression.
  
  
  RESULTS
  Two or more stressful life events in the first trimester (adjusted OR 4.9; 95% CI 1.2-19.4), and moving address in the first trimester (aOR 4.9; 95% CI 1.7-13.9) were strongly associated with risk of gastroschisis, independent of behavioural risk factors including smoking, alcohol, and poor diet. Perceived availability of social support was not associated with reduced risk of gastroschisis (aOR 0.8; 95% CI 0.2-3.1).
  
  
  CONCLUSIONS
  Stressful maternal life events in the first trimester of pregnancy including change of address were strongly associated with a substantial increase in the risk of gastroschisis, independent of stress related high risk behaviours such as smoking, alcohol consumption and poor diet. This suggests that stress pathways are involved in the aetiology of gastroschisis.
authors.affiliation: Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, United Kingdom.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Palmer
authors.forename: Annette
authors.initials: A
authors.lastname: Evans
authors.forename: Hannah
authors.initials: H
authors.lastname: Broughton
authors.forename: Simon
authors.initials: S
authors.lastname: Huddart
authors.forename: Mark
authors.initials: M
authors.lastname: Drayton
authors.forename: Judith
authors.initials: J
authors.lastname: Rankin
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Draper
authors.forename: Alan
authors.initials: A
authors.lastname: Cameron
authors.forename: Shantini
authors.initials: S
authors.lastname: Paranjothy
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D005260:Female; D020139:Gastroschisis / Q000209:etiology*; D006801:Humans; D016015:Logistic Models; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D012307:Risk Factors; D012944:Social Support; D013315:Stress, Psychological / Q000150:complications*; D006113:United Kingdom; D055815:Young Adult