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Lifestyle and sociodemographic risk factors for gastroschisis: a systematic review and meta-analysis
  1. Silvia Baldacci1,
  2. Michele Santoro1,
  3. Alessio Coi1,
  4. Lorena Mezzasalma1,
  5. Fabrizio Bianchi1,2,
  6. Anna Pierini1,2
  1. 1Institute of Clinical Physiology National Research Council, Pisa, Italy
  2. 2Fondazione Toscana Gabriele Monasterio, Pisa, Italy
  1. Correspondence to Dr Silvia Baldacci, Institute of Clinical Physiology National Research Council, Pisa 56124, Italy; silviab{at}


Background Gastroschisis is strongly associated with young maternal age. This association suggests the need for further investigations on non-genetic risk factors. Identifying these risk factors is a public health priority in order to develop prevention strategies aimed at reducing the prevalence and health consequences in offspring.

Objective To systematically assess and quantitatively synthesise the available epidemiological studies to evaluate the association between non-genetic risk factors and gastroschisis.

Methods Literature from PubMed, EMBASE and Scopus was searched for the period 1990–2018. Epidemiological studies reporting risk estimates between lifestyle and sociodemographic risk factors and gastroschisis were included. Two pairs of reviewers independently extracted information on study characteristics following Preferred Reporting Items for Systematic Reviews and Meta-Analyses and MOOSE (Meta-analysis Of Oservational Studies in Epidemiology) guidelines. Relative risk (RR) estimates were calculated across the studies and meta-analysis was performed using random-effects model.

Results We identified 58 studies. Meta-analyses were conducted on 29 studies. Maternal smoking (RR 1.56, 95% CI 1.40 to 1.74), illicit drug use (RR 2.14, 95% CI 1.48 to 3.07) and alcohol consumption (RR 1.40, 95% CI 1.13 to 1.70) were associated with an increased risk of gastroschisis. A decreased risk among black mothers compared with non-Hispanic white mothers (RR 0.49, 95% CI 0.38 to 0.63) was found. For Hispanic mothers no association was observed.

Conclusions Exposure to smoking, illicit drugs and alcohol during pregnancy is associated with an increased risk of gastroschisis. A significantly decreased risk for black mothers was observed. Further epidemiological studies to assess the potential role of other environmental factors are strongly recommended.

PROSPERO registration number CRD42018104284.

  • congenital abnorm
  • epidemiology
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  • Contributors SB, MS, AC, LM and AP contributed to the writing of the study protocol. SB conceived the study, conducted the literature search, screened and reviewed the studies, extracted the data, carried out a quality assessment of the studies and prepared the first draft of the manuscript. MS and AC carried out the statistical analyses, screened and reviewed the studies, extracted the data, carried out a quality assessment of the studies. LM screened and reviewed the studies, extracted the data and carried out a quality assessment of the studies. FB and AP supervised data collection. All authors were involved in revising the manuscript and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement Data sharing not applicable as no datasets generated and/or analysed for this study. The study is a systematic review, thus data sharing is not applicable.

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