Gastroschisis: mortality risks with each additional week of expectant management.
BACKGROUND
Prior studies have evaluated the overall risk of stillbirth in pregnancies with fetal gastroschisis. However, the gestational age at which mortality is minimized, balancing the risk of stillbirth against neonatal mortality, remains unclear.


OBJECTIVE
We sought to evaluate the gestational age at which prenatal and postnatal mortality risk is minimized for fetuses with gastroschisis.


METHODS
This was a retrospective cohort study of singleton pregnancies delivered between 24 0/7 and 39 6/7 weeks, using 2005 through 2006 US national linked birth and death certificate data. Among pregnancies with fetal gastroschisis, prospective risk of stillbirth and risk of infant death were determined for each gestational age week. Risk of infant death with delivery was further compared to composite fetal/infant mortality risk with expectant management for 1 additional week.


RESULTS
Among 2,119,049 pregnancies, 860 cases (0.04%) of gastroschisis were identified. The overall stillbirth rate among gastroschisis cases was 4.8%, and infant death occurred in 8.3%. Prospective risk of stillbirth became more consistently elevated beginning at 35 weeks, rising to 13.9 per 1000 pregnancies (95% confidence interval, 10.8-17.1) at 39 weeks. Risk of infant death concurrently nadired in the third trimester, ranging between 62.4-66.8 per 1000 live births between 32-39 weeks. Comparing mortality with expectant management vs delivery, relative risk was significantly greater with expectant management between 37-39 weeks, reaching 1.90 (95% confidence interval, 1.73-2.08) at 39 weeks with a number needed to deliver of 17.49 (95% confidence interval, 15.34-20.32) to avoid 1 excess death.


CONCLUSIONS
Risk of prenatal and postnatal mortality for fetuses with gastroschisis may be minimized with delivery as early as 37 weeks.
Department of Obstetrics, Gynecology, and Reproductive Sciences, and of Pediatrics, University of California, San Francisco, CA. Electronic address: teresa.sparks@ucsf.edu.
Teresa N
TN
Sparks
Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR.
Brian L
BL
Shaffer
Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, UT.
Jessica
J
Page
Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR.
Aaron B
AB
Caughey
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D020139:Gastroschisis / Q000628:therapy*; D005865:Gestational Age; D006801:Humans; D062071:Infant, Extremely Premature; D007231:Infant, Newborn; D007234:Infant, Premature; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D066087:Perinatal Death; D011247:Pregnancy; D047928:Premature Birth; D012189:Retrospective Studies; D050497:Stillbirth / Q000453:epidemiology*; D057832:Watchful Waiting; D055815:Young Adult
gastroschisis; intrauterine fetal demise; neonatal death; stillbirth