title: Better diet quality before pregnancy is associated with reduced risk of gastroschisis in Hispanic women.
abstract: BACKGROUND
  Gastroschisis is unique because of its substantial risk in pregnancies of adolescent women. Adolescents may have poor diet quality, which places them at higher risk of gastroschisis.
  
  
  OBJECTIVE
  We investigated whether better maternal diet quality, measured by 2 different indices, reduced the risk of gastroschisis.
  
  
  METHODS
  We used case-control data from the National Birth Defects Prevention Study to investigate maternal diet quality among 1125 gastroschisis cases and 9483 controls (estimated delivery dates between 1997 and 2009). Cases were ascertained from 10 U.S. birth defect surveillance systems. Control subjects were randomly selected from birth certificates or hospital records. Using a 58-item food-frequency questionnaire, interviewers queried mothers about their average food and cereal intake during the year before conception. Diet quality scores [Diet Quality Index (DQI) and Mediterranean diet score (MDS)] were calculated using specific components. Women were excluded if they consumed <500 or >5000 kcal/d, reported pregestational diabetes, or had >1 missing food item. Quartile-specific adjusted ORs (aORs) were calculated, using as reference the lowest quartile.
  
  
  RESULTS
  Overall, we observed a statistically significant decrease with increasing diet quality for both the DQI and MDS. When stratified by maternal race/ethnicity, this finding was confined to Hispanic women. Among Hispanic women, the risk of gastroschisis decreased significantly with increasing DQI quartiles: quartile 2, aOR = 0.58 (95% CI: 0.40, 0.86); quartile 3, aOR = 0.52 (95% CI: 0.36, 0.79); and quartile 4, aOR = 0.48 (95% CI: 0.32, 0.76). Increasing diet quality, as measured by the MDS, showed reduced risk of gastroschisis among women, mostly Hispanic, who were born outside the United States: quartile 2, aOR = 0.62 (95% CI: 0.33, 1.16); quartile 3, aOR = 0.51 (95% CI: 0.28, 0.94); and quartile 4, aOR = 0.50 (95% CI: 0.28, 0.90).
  
  
  CONCLUSIONS
  Increasing diet quality was associated with a reduced risk of gastroschisis only among Hispanic and foreign-born women, but these findings require replication.
authors.affiliation: Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT; and Marcia.feldkamp@hsc.utah.edu.
authors.forename: Marcia L
authors.initials: ML
authors.lastname: Feldkamp
authors.affiliation: Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT; and.
authors.forename: Sergey
authors.initials: S
authors.lastname: Krikov
authors.affiliation: Division of Medical Genetics, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT; and.
authors.forename: Lorenzo D
authors.initials: LD
authors.lastname: Botto
authors.affiliation: Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA.
authors.forename: Gary M
authors.initials: GM
authors.lastname: Shaw
authors.affiliation: Division of Neonatology, Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA.
authors.forename: Suzan L
authors.initials: SL
authors.lastname: Carmichael
mesh_terms: D000293:Adolescent; D000328:Adult; D016022:Case-Control Studies; D004032:Diet / Q000592:standards*; D015930:Diet Records; D004034:Diet Surveys; D005247:Feeding Behavior; D005260:Female; D020139:Gastroschisis / Q000517:prevention & control*; D006630:Hispanic or Latino; D006801:Humans; D007231:Infant, Newborn; D039382:Maternal Nutritional Physiological Phenomena / Q000502:physiology; D016017:Odds Ratio; D011247:Pregnancy; D011795:Surveys and Questionnaires; D014481:United States; D055815:Young Adult