Environmental and infectious risk factors for gastroschisis
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Abstract
Gastroschisis is a rare congenital malformation where loops of bowel are protruding from the abdominal wall of an infant. The prevalence of gastroschisis has been increasing over the past 20 years, particularly in younger women. However, as the number of studies on gastroschisis increases each year, it continues to remain unclear why the prevalence is increasing and why it disproportionately affects younger mothers. Previous research has suggested that environmental or infectious factors may be involved in the pathogenesis of gastroschisis. This dissertation aims to explore the possibility of these two factors in relation to gastroschisis.
In study 1, clusters of gastroschisis were identified in space or the combination of space and time. Cases and controls came from the National Birth Defects Study (NBDPS) or for some study centers from the birth defects surveillance systems. Generalized additive models were used to create a continuous map surface of odds ratios (OR) by smoothing over latitude and longitude. Data from the NBDPS were used for the Arkansas, California, and Utah study centers and the highest adjusted ORs detected were 2.0, 1.3, and 2.4, respectively. In Massachusetts and Texas, where surveillance data were used, the highest adjusted ORs observed were 2.4 and 1.3, respectively, with only the latter state achieving statistical significance. Texas had sufficient data to assess the combination of space and time, which identified an increased risk (OR=2.9) in the center of Texas in 2003. The results of this study suggest that clusters of gastroschisis may exist and further exploration of environmental or behavioral factors are warranted. [TRUNCATED]
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Thesis (Ph.D.)--Boston University