title: Environmental pesticides increase the risk of developing hypertrophic pyloric stenosis.
abstract: BACKGROUND
  Hypertrophic pyloric stenosis (HPS) is a condition noted within the first several weeks of life that results in hypertrophy of the pyloric muscle between the stomach and duodenum. The etiology has not been elucidated but genetic and environmental influences are suspected. We hypothesized that agricultural pesticides would be associated with an increased incidence of pyloric stenosis.
  
  
  METHODS
  Data from infants with HPS were obtained from the Indiana Birth Defects Registry (IBDR) for all counties in Indiana from 2005 to 2009. Data from all live births were obtained from the Indiana State Health Department (ISHD). Maternal demographics and clinical characteristics of infants were abstracted. The US Geological Survey (USGS) provided estimated use of agricultural pesticides (EPEST), and these values were correlated with HPS incidence. Univariate and multivariate logistical regression models were used to assess the association between HPS risk and pesticide use.
  
  
  RESULTS
  A total of 442,329 newborns were studied with 1313 HPS cases recorded. The incidence of HPS was 30/10,000 live births. HPS incidence was correlated with total county pesticide use, as well as subcategories of pesticides (fungicides, fumigants, insecticides, herbicides). Indiana counties were then divided into low, moderate and high pesticide use (mean±standard deviation: 127,722±73,374, 308,401±36,915, and 482,008±97,260pounds of pesticides). Incidence of HPS was 26, 29, and 36 cases per 10,000 in low, moderate and high pesticide-use counties respectively. Subset analysis showed that the positive association between HPS and county pesticide use was more likely for male infants from mothers who were white, aged 20-35 years, had education at high school or lower, and smoked (p<0.05).
  
  
  CONCLUSIONS
  Pesticide use correlated significantly with incidence of HPS. Positive correlations between HPS risk and pesticide use were found for most risk factors. Further studies will be needed to verify our findings and further delineate the nature of this correlation.
authors.affiliation: Pediatric Surgery, Indiana University School of Medicine/Riley Hospital, Indianapolis, IN, United States. Electronic address: tmarkel@iupui.edu.
authors.forename: Troy A
authors.initials: TA
authors.lastname: Markel
authors.affiliation: Neonatology, Indiana University School of Medicine/Riley Hospital, Indianapolis, IN, United States.
authors.forename: Cathy
authors.initials: C
authors.lastname: Proctor
authors.affiliation: Department of Environmental Health Sciences, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
authors.forename: Jun
authors.initials: J
authors.lastname: Ying
authors.affiliation: Neonatology, Indiana University School of Medicine/Riley Hospital, Indianapolis, IN, United States.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Winchester
mesh_terms: D005260:Female; D006801:Humans; D015994:Incidence; D007196:Indiana / Q000453:epidemiology; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D010575:Pesticides / Q000633:toxicity*; D046248:Pyloric Stenosis, Hypertrophic / Q000139:chemically induced* / Q000453:epidemiology; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D010575:Pesticides
keywords: Epidemiology; Genetic factors; Pesticide; Pyloric stenosis; Risk