title: Descriptive and risk factor analysis for choanal atresia: The National Birth Defects Prevention Study, 1997-2007.
abstract: Choanal atresia causes serious posterior nasal obstruction. This defect is the leading cause of nasal surgery in newborns, although its etiology is largely unknown. Data from the National Birth Defects Prevention Study, a population-based case-control study, were used to examine associations between maternal self-reports of exposures and occurrence of choanal atresia in their offspring. Overall, 117 case and 8350 control mothers with deliveries from 1997 through 2007 provided telephone interview reports of pre-pregnancy (one year before conception) and periconceptional (one month before through three months after conception) exposures. The exposures analyzed were pre-pregnancy dietary intake, pre-pregnancy and periconceptional caffeine consumption, and periconceptional cigarette smoking, alcohol drinking, and medication use. Independent associations between each exposure and all choanal atresia cases combined (n = 117) and isolated choanal atresia cases (those without additional unrelated major defects; n = 61) were examined. Odds ratios (ORs), both unadjusted (uORs) and adjusted (aORs) for potential confounders, and 95% confidence intervals (CIs) were estimated using unconditional logistic regression analysis. For all choanal atresia cases combined, positive associations were observed with maternal pre-pregnancy intake in the highest quartile for vitamin B-12 (aOR = 1.9; CI = 1.1,3.1), zinc (aOR = 1.7; CI = 1.0,3.1), and niacin (aOR = 1.8; CI = 1.0,3.1), and intake in the lowest quartile for methionine (aOR = 1.6; CI = 1.0,2.6) and vitamin D (aOR = 1.6; CI = 1.0,2.4) compared to intake in the two intermediate quartiles combined. Further, a positive association was observed with periconceptional use of thyroid medications (uOR = 2.6; CI = 1.0,6.3) compared to no use of such medications. Among isolated choanal atresia cases, negative associations were observed for pantothenic acid (aOR = 0.4; CI = 0.2,0.9) and fat (aOR = 0.5; 95% CI = 0.2,1.0) intake in the lowest quartile compared to that in the intermediate quartiles, and positive associations were observed for periconceptional cigarette smoking (aOR = 2.3; CI = 1.1,4.7) compared to no smoking and pre-pregnancy daily coffee intake of 3 or more cups (aOR = 2.5; CI = 1.1,5.6) compared to intake of less than 1 cup per day. The positive association for periconceptional exposure to thyroid medications also persisted for isolated choanal atresia cases (uOR = 4.0; CI = 1.1,11.2). Because of the large number of associations tested, these findings may be due to chance. Alternatively, they may contribute new hypotheses regarding the etiology of choanal atresia; thus, requiring replication in additional studies.
authors.affiliation: Department of Epidemiology, The University of Iowa, Iowa City, IA, USA.
authors.forename: Vijaya
authors.initials: V
authors.lastname: Kancherla
authors.affiliation: Department of Epidemiology, The University of Iowa, Iowa City, IA, USA. Electronic address: paul-romitti@uiowa.edu.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Romitti
authors.affiliation: Department of Epidemiology, The University of Iowa, Iowa City, IA, USA.
authors.forename: Lixian
authors.initials: L
authors.lastname: Sun
authors.affiliation: Department of Pediatrics, University of Utah, Salt Lake City, UT, USA.
authors.forename: John C
authors.initials: JC
authors.lastname: Carey
authors.affiliation: Department of Epidemiology, The University of Iowa, Iowa City, IA, USA.
authors.forename: Trudy L
authors.initials: TL
authors.lastname: Burns
authors.affiliation: Department of Epidemiology and Nutrition, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Siega-Riz
authors.affiliation: New York State Department of Health, Albany, NY, USA.
authors.forename: Charlotte M
authors.initials: CM
authors.lastname: Druschel
authors.affiliation: Medical Genetics, MassGeneral Hospital for Children, Boston, MA, USA.
authors.forename: Angela E
authors.initials: AE
authors.lastname: Lin
authors.affiliation: National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, USA.
authors.forename: Richard S
authors.initials: RS
authors.lastname: Olney
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects; D002110:Caffeine / Q000009:adverse effects; D002754:Choanal Atresia / Q000209:etiology*; D004032:Diet; D005260:Female; D006801:Humans; D008297:Male; D011247:Pregnancy; D039401:Prenatal Nutritional Physiological Phenomena; D018570:Risk Assessment; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects
chemical_list: D002110:Caffeine
keywords: Alcohol drinking; Caffeine; Choanal atresia; Cigarette smoking; Diet