Lifestyle risk factors for congenital anomalies Judith Greenacre November 2007

Common lifestyle risk factors Smoking Alcohol Over / under weight Recreational drugs ‘Maternal age’

Smoking and congenital anomalies Recent evidence for associations with Cleft lip / palate Digital anomalies Gastroschisis Estimated 30% women of childbearing age in Wales are smokers (Welsh Health Survey)

Adults who reported being a current smoker: 2003/05 Source: Welsh Health Survey, 2003/05 5 10 15 20 25 30 35 Monmouthshire Powys The Vale of Glamorgan Ceredigion Newport Wrexham Flintshire Swansea Denbighshire Pembrokeshire Merthyr Tydfil Cardiff Conwy Carmarthenshire Rhondda Cynon Taff Caerphilly Isle of Anglesey Bridgend Torfaen Neath Port Talbot Gwynedd Blaenau Gwent Age standardised % Welsh average = 27.1

Current smoker

CARIS data on maternal smoking Risk factor % for which status known Of which % ve for risk factor Notable associated anomalies Smoking 64% 28% Gastroschisis Biliary atresia Lung +/or renal agenesis

Adults whose average alcohol consumption was above the recommended guidelines Source: Welsh Health Survey, 2003/05 10 20 30 40 50 Ceredigion Conwy Denbighshire Monmouthshire Isle of Anglesey Flintshire Carmarthenshire Powys Newport Pembrokeshire Gwynedd Wrexham Cardiff Swansea The Vale of Glamorgan Torfaen Caerphilly Bridgend Neath Port Talbot Rhondda Cynon Taff Blaenau Gwent Merthyr Tydfil Age standardised % Welsh average = 39.8

CARIS data on alcohol abuse Risk factor % for which status known Of which % ve for risk factor Notable associated anomalies Alcohol abuse 63% 1% Fetal alcohol syndrome

Overweight / Obesity Association with structural birth defects* Spina bifida Heart defects Limb reduction defects Diaphragmatic hernia ? Related to undiagnosed diabetes *Waller et al. 2007

Overweight / obesity

CARIS data on maternal weight Some data available from Cardiff birth survey All Wales data collection started 2007 Only population based data from Welsh Health Survey

Maternal age distributions in Wales: 1998 - 2005

All other cases of anomaly 1998-2003 comparison of features of cases of gastroschisis to all other cases of congenital anomaly reported to CARIS, 1998-2003. Factor Gastroschisis 1998 – 2003 All other cases of anomaly 1998-2003 OR p (χ2) n % Maternal age <25yrs 69/94 73.4% 2375/8035 29.6% 6.6 (4.2-10.4) <0.001* +ve history maternal drug abuse 6/94 5.3% 69/8053 0.9% 7.9 (3.3-18.6) +ve history maternal smoking 50/82 61.0% 1512/5373 28.1% 4.0 (2.6-6.2) +ve history consanguinity 0/30 0% 32/2796 1.1% - +ve history any type maternal diabetes 4/82 4.9% 281/5355 5.2% 0.9 (0.3-2.5) 1.0 Presence other anomalies 27/94 28.7% 3767/8052 46.8% 0.5 (0.3-0.7) 0.001* * significant at 0.05 level

Welsh Index Multiple Deprivation

Life style factors and Gastroschisis Elizabeth S Draper 7th October 2007 CARIS Meeting Cardiff

Suggested Risk Factors for Gastroschisis – 2 main case control studies vasoactive medications: salicylates (aspirin) pseudoephedrine phenylpropanolamine solvents other factors including: poor diet, influenza, landfill sites, seasonality

Suggested Risk Factors for Gastroschisis – 2 main case control studies maternal age < 25 years low social class smoking heavy alcohol consumption recreational drug use cocaine

Study hypothesis the incidence of gastroschisis is positively associated with the use of recreational drugs in the weeks following conception Data collected at maternal interview concerning recreational drug use validated using maternal hair analysis

Controls 3 matched controls – mothers of congenitally normal births matched by region of residence and age (to within one year) selected from the initial intended place of delivery of the case Any refusing control mother replaced until full complement of 3 controls per case achieved.

Data Collection Notes review Maternal Interview Previous history, maternal details, demographic, current pregnancy, labour, delivery, outcome, post mortem results Maternal Interview Socio-demographics, occupational exposures, drug history (prescribed, over the counter, recreational), other risk behaviours, hair treatments Collection of hair sample LMP, EDD, date of collection

Adjusted conditional regression model for any RDU

Adjusted odds ratios for the use of recreational drugs in the first trimester in gastroschisis mothers OR adjusted for BMI, marital status, aspirin use, home owner, gynae disease & smoking

Study Conclusions 1: Statistically significant increased risk of gastroschisis with first trimester use of : Any recreational drug Vaso-constrictive recreational drugs

Study Conclusions 2: Hair analysis can be used to validate data collected at maternal interview - problems with adequate hair weight for 1st trimester analysis An additional 2.1% case mothers and 1.4% control mothers were identified as users of vaso-constrictive recreational drugs from hair analysis.

Thank you