1. Lifestyle risk factors for congenital anomalies Judith Greenacre November 2007

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

3. 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)

4. 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

5. Current smoker

6. 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

7. 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

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

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

10. Overweight / obesity

11. 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

12. Maternal age distributions in Wales: 1998 - 2005

13. All other cases of anomaly 1998-2003
comparison of features of cases of gastroschisis to all other cases of congenital anomaly reported to CARIS,
Factor
Gastroschisis
1998 – 2003
All other cases of anomaly OR p
(χ2) n %
Maternal age <25yrs
69/94
73.4%
2375/8035
29.6%
6.6
( )
<0.001*
+ve history maternal drug abuse
6/94
5.3%
69/8053
0.9%
7.9
( )
+ve history maternal smoking
50/82
61.0%
1512/5373
28.1%
4.0
( )
+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
( )
1.0
Presence other anomalies
27/94
28.7%
3767/8052
46.8%
0.5
( )
0.001*
* significant at 0.05 level

14. Welsh Index Multiple Deprivation

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

16. 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

17. 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

18. 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

19. 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.

20. 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

21. Adjusted conditional regression model for any RDU

22. 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

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

24. 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.

25. Thank you