Maternal medical and behavioral risk factors for congenital diaphragmatic hernia.
OBJECTIVE
Maternal factors contributing to the etiology of congenital diaphragmatic hernia (CDH) remain unclear. We hypothesized that specific maternal medical conditions (pregestational diabetes, hypertension), and behaviors (alcohol, tobacco) would be associated with CDH.


METHODS
We conducted a population-based case-control study using Washington State birth certificates linked to hospital discharge records (1987-2009). We identified all infants with CDH (n=492). Controls were randomly selected among non-CDH infants. Maternal data were extracted from the birth record. Logistic regression was used to adjust for covariates.


RESULTS
Cases and controls were generally similar regarding demographics, although CDH infants were more likely to be male than controls (58.5% vs. 52.5%). Isolated and complex (multiple-anomaly) CDH had similar characteristics. Each of the exposures of interest was more common among case mothers than among control mothers. In univariate analysis, alcohol use, hypertension, and pregestational diabetes were each significantly associated with the outcome. After multivariate adjustment, only alcohol use (OR=3.65, p=0.01) and pregestational diabetes (OR=12.53, p=0.003) maintained significance. Results were similar for both isolated and complex CDH.


CONCLUSIONS
Maternal pregestational diabetes and alcohol use are significantly associated with occurrence of CDH in infants. These are important modifiable risk factors to consider with regard to efforts seeking to impact the incidence of CDH.
Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA 98105; Department of Surgery University of Washington School of Medicine, Seattle, WA 98105. Electronic address: jarodmc@uw.edu.
Jarod P
JP
McAteer
Department of Otolaryngology University of California San Diego, San Diego, CA 92103.
Avram
A
Hecht
Department of Environmental and Occupational Health Drexel University School of Public Health, Philadelphia, PA 19102.
Anneclaire J
AJ
De Roos
Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital, Seattle, WA 98105; Department of Surgery University of Washington School of Medicine, Seattle, WA 98105.
Adam B
AB
Goldin
D000293:Adolescent; D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology*; D015992:Body Mass Index; D016022:Case-Control Studies; D016001:Confidence Intervals; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006548:Hernia, Diaphragmatic / Q000453:epidemiology / Q000209:etiology; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D012959:Socioeconomic Factors; D014861:Washington / Q000453:epidemiology; D055815:Young Adult
Congenital diaphragmatic hernia; Development; Maternal; Prenatal; Risk factors