A Case Control Population-Based Study Investigating Smoking as a Risk Factor for Gastroschisis in Utah, 1997-2005

BACKGROUND: Smoking in pregnancy increases the risk for many different adverse pregnancy outcomes, including birth defects. Gastroschisis, a birth defect most commonly associated with young maternal age has been associated with smoking, but findings are inconsistent. We assessed whether smoking increases the risk for gastroschisis using poputation-based data from Utah. METHODS: Gastroschisis cases (n = 189) were identified from the Utah Birth Defect Network and all live births without birth defects (n = 423,499) occurring in Utah from January 1, 1.997 through December 31, 2005 served as controls. Exposure data were derived from birth certificates and fetal death certificates and, for terminated pregnancies, the Utah Birth Defect Network. RESULTS: Women who smoked during the first trimester of pregnancy had an increased risk of gastroschisis (OR 1.6; 95% CI: 1.1, 2.3) after adjusting for maternal age and preconception BMI. Discordance between birth certificate data and data from structured interviews increased exposure prevalence from 16.9 to 22.2% for case mothers and 7.4 to 13.2% for control mothers. Accounting for this misclassification, the crude OR decreased by 24%, 1.9 (1.3, 2.7). CONCLUSIONS: Though first trimester cigarette smoking was reported on birth certificates by more mothers of gastroschisis cases than controls, adjustment for confounders (maternal age and preconception BMI) and smoking misclassification suggests the association is weak. Despite a decrease in smoking prevalence among all women of childbearing years in Utah between 1997 and 2005, the prevalence of gastroschisis has not followed a similar trend. Birth Defects Research (Part A) 82:768-775, 2008. (c) 2008 Wiley-Liss, Inc.