title: Prenatal Risk Factors and Outcomes in Gastroschisis: A Meta-Analysis.
abstract: OBJECTIVE
  Gastroschisis is a congenital anomaly with increasing incidence, easy prenatal diagnosis and extremely variable postnatal outcomes. Our objective was to systematically review the evidence regarding the association between prenatal ultrasound signs (intraabdominal bowel dilatation [IABD], extraabdominal bowel dilatation, gastric dilatation [GD], bowel wall thickness, polyhydramnios, and small for gestational age) and perinatal outcomes in gastroschisis (bowel atresia, intra uterine death, neonatal death, time to full enteral feeding, length of total parenteral nutrition and length of in hospital stay).
  
  
  METHODS
  Medline, Embase, and Cochrane databases were searched electronically. Studies exploring the association between antenatal ultrasound signs and outcomes in gastroschisis were considered suitable for inclusion. Two reviewers independently extracted relevant data regarding study characteristics and pregnancy outcome. All meta-analyses were computed using individual data random-effect logistic regression, with single study as the cluster unit.
  
  
  RESULTS
  Twenty-six studies, including 2023 fetuses, were included. We found significant positive associations between IABD and bowel atresia (odds ratio [OR]: 5.48, 95% confidence interval [CI] 3.1-9.8), polyhydramnios and bowel atresia (OR: 3.76, 95% CI 1.7-8.3), and GD and neonatal death (OR: 5.58, 95% CI 1.3-24.1). No other ultrasound sign was significantly related to any other outcome.
  
  
  CONCLUSIONS
  IABD, polyhydramnios, and GD can be used to an extent to identify a subgroup of neonates with a prenatal diagnosis of gastroschisis at higher risk to develop postnatal complications. Data are still inconclusive on the predictive ability of several signs combined, and large prospective studies are needed to improve the quality of prenatal counseling and the neonatal care for this condition.
authors.affiliation: Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, United Kingdom;
authors.forename: Francesco
authors.initials: F
authors.lastname: D'Antonio
authors.affiliation: Department of Paediatric and Neonatal Surgery, St George's Healthcare National Health Service Trust and University of London, London, United Kingdom;
authors.forename: Calogero
authors.initials: C
authors.lastname: Virgone
authors.affiliation: Department of Obstetrics and Gynecology, Università di Roma Tor Vergata, Roma, Italy;
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rizzo
authors.affiliation: Fetal Medicine Unit, Division of Developmental Sciences, St George's University of London, London, United Kingdom;
authors.forename: Asma
authors.initials: A
authors.lastname: Khalil
authors.affiliation: Materno-Fetal and Obstetrics Research Unit, Department of Obstetrics and Gynaecology, University Hospital, Lausanne, Switzerland;
authors.forename: David
authors.initials: D
authors.lastname: Baud
authors.affiliation: Department of Obstetrics and Gynaecology, Division of Obstetrics and Prenatal Medicine, Erasmus MC, Rotterdam, The Netherlands;
authors.forename: Titia E
authors.initials: TE
authors.lastname: Cohen-Overbeek
authors.affiliation: Maternité, Hôpital Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris, Université Paris Descartes, Paris, France;
authors.forename: Marina
authors.initials: M
authors.lastname: Kuleva
authors.affiliation: Maternité, Hôpital Necker-Enfants Malades, Assistance Publique des Hôpitaux de Paris, Université Paris Descartes, Paris, France;
authors.forename: Laurent J
authors.initials: LJ
authors.lastname: Salomon
authors.affiliation: Department of Medicine and Aging Sciences, University of Chieti-Pescara, Chieti, Italy; and EMISAC (Epidemiologia e Management dell'Invecchiamento, e Salubrità degli Ambienti Confinati), CeSI Biotech, Chieti, Italy.
authors.forename: Maria Elena
authors.initials: ME
authors.lastname: Flacco
authors.affiliation: Department of Medicine and Aging Sciences, University of Chieti-Pescara, Chieti, Italy; and EMISAC (Epidemiologia e Management dell'Invecchiamento, e Salubrità degli Ambienti Confinati), CeSI Biotech, Chieti, Italy.
authors.forename: Lamberto
authors.initials: L
authors.lastname: Manzoli
authors.affiliation: Department of Paediatric and Neonatal Surgery, St George's Healthcare National Health Service Trust and University of London, London, United Kingdom; Stefano.giuliani@nhs.net.
authors.forename: Stefano
authors.initials: S
authors.lastname: Giuliani
mesh_terms: D005260:Female; D020139:Gastroschisis / Q000175:diagnosis / Q000453:epidemiology*; D005865:Gestational Age; D014943:Global Health; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome; D011379:Prognosis; D012307:Risk Factors; D016216:Ultrasonography, Prenatal / Q000379:methods*