Background Maternal stress is associated with increased risk of spina bifida and anencephaly¹. We investigated the effect of major stressful life events in the first trimester on risk of gastroschisis, accounting for the mediatory effects of social support and known risk factors such as cigarette smoking, low body mass index and poor nutrition.
Method We analysed data from an incident case control study of pregnant women resident in five UK regions between 01.07.2007 and 28.02.2010. Three controls were recruited for each case. Major stressful life events and social support were assessed using questions from several validated assessment tools, during interviews in the antenatal period. Logistic regression was used to obtain odds ratios for the association between maternal stress and risk of gastroschisis.
Results During the study period, 124 gastroschisis cases were identified by collaborating centres. 73% of cases (n = 91) and 70% of controls (n = 217) were recruited. In the multivariable model including social class of the mother, cigarette smoking, alcohol consumption, body mass index, folic acid and fruit and vegetable consumption, major stressful life events had an independent effect on the risk of gastroschisis (aOR 4.9 95% CI 22.214.171.124). Moving house in first trimester was also an independent risk factor (aOR 4.9 95% CI 126.96.36.199). Lack of social support was found to be a partial mediator for stress.
Conclusion These findings provide new evidence that maternal stress plays a role in the aetiology of gastroschisis, possibly through increased production of corticosteroids that have been shown to be teratogenic in animal models.
Carmichael SL, Shaw GM, Yang W, et al, Maternal stressful life events and risks of birth defects. Epidemiology 2007;18:356–361.
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