Werler Martha M, Mitchell Allen A, Moore Cynthia A, Honein Margaret A
Slone Epidemiology Center at Boston University, Boston, Massachusetts 02215, USA.
Am J Med Genet A. 2009 Jul;149A(7):1399-406. doi: 10.1002/ajmg.a.32897.
Gastroschisis is a congenital defect of the abdominal wall that occurs most commonly in the offspring of young women. The defect is often hypothesized to result from vascular disruption in the early embryo. We measured the associations between maternal vasoactive exposures in pregnancy, as possible markers of vascular disruption, and gastroschisis risk, using data collected as part of the National Birth Defects Prevention Study. Study participants included mothers of births from October 1997 to December 2003 in 10 states. The mothers of 514 gastroschisis cases were matched by age at delivery and state to 3,277 non-malformed controls and compared for periconceptional smoking and use of vasoconstrictors, non-steroidal anti-inflammatory drugs (NSAIDs), and vasodilators. Multivariable-adjusted odds ratios (ORs) and 95% confidence intervals (CI) were estimated from conditional logistic regression. Case mothers were more likely than control mothers to smoke (OR = 1.5, 95% CI = 1.2-1.9) and report use of non-aspirin NSAIDs (1.4, 1.1-1.7) and anti-hypertensive vasodilators (2.6, 0.9-8.0), but not vasoconstrictive decongestants (1.0, 0.7-1.4). Cigarette smoking had little effect on gastroschisis risk in mothers <25 years of age, but the OR was 3.0 (1.8-5.0) for those >or=25 years. Likewise, ORs were greatest in the older women for use of non-aspirin NSAIDs (1.6, 1.0-2.6) and bronchodilators (3.0, 1.8-5.0). These findings suggest that, overall, vasoactive risk factors play a minor role in the etiology of gastroschisis, and do not support the vascular disruption hypothesis. However, the observation that increased ORs for some vasoactive exposures were confined to older women raises the question of whether inherent maternal factors might influence risk.
腹裂是一种腹壁先天性缺陷，最常见于年轻女性的后代。通常假设该缺陷是由早期胚胎中的血管破坏引起的。我们利用作为国家出生缺陷预防研究一部分收集的数据，测量了孕期母亲血管活性物质暴露（作为血管破坏的可能标志物）与腹裂风险之间的关联。研究参与者包括1997年10月至2003年12月在10个州出生婴儿的母亲。514例腹裂病例的母亲按分娩时年龄和州与3277例无畸形对照进行匹配，并比较受孕前后吸烟情况以及血管收缩剂、非甾体抗炎药（NSAIDs）和血管扩张剂的使用情况。通过条件逻辑回归估计多变量调整后的比值比（OR）和95%置信区间（CI）。病例母亲比对照母亲更有可能吸烟（OR = 1.5，95%CI = 1.2 - 1.9），并报告使用非阿司匹林NSAIDs（1.4，1.1 - 1.7）和抗高血压血管扩张剂（2.6，0.9 - 8.0），但使用血管收缩性减充血剂的情况无差异（1.0，0.7 - 1.4）。吸烟对25岁以下母亲的腹裂风险影响较小，但对25岁及以上母亲的OR为3.0（1.8 - 5.0）。同样，年龄较大的女性使用非阿司匹林NSAIDs（1.6，1.0 - 2.6）和支气管扩张剂（3.0，1.8 - 5.0）的OR最高。这些发现表明，总体而言，血管活性危险因素在腹裂病因中起次要作用，并不支持血管破坏假说。然而，某些血管活性物质暴露的OR增加仅限于年龄较大女性这一观察结果，引发了关于母亲内在因素是否可能影响风险的问题。
