Yazdy Mahsa M, Werler Martha M, Feldkamp Marcia L, Shaw Gary M, Mosley Bridget S, Vieira Veronica M
Slone Epidemiology Center at Boston University, Boston, Massachusetts.
Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah.
Birth Defects Res A Clin Mol Teratol. 2015 Jun;103(6):544-53. doi: 10.1002/bdra.23375. Epub 2015 Apr 6.
Gastroschisis is a birth defect where loops of bowel are protruding from the abdominal wall at birth. Previous research has suggested that gastroschisis cases can occur in clusters. The objective of this study was to identify if there were areas of elevated gastroschisis risk using data from the National Birth Defects Prevention Study (NBDPS), 1997 through 2007.
We obtained data on cases (n = 371) through population-based birth defects surveillance systems in Arkansas, California, and Utah; controls (n = 2359) were selected from the same geographic areas as cases. Mothers were interviewed on demographic information and exposures during pregnancy, including residential history. We used first trimester maternal addresses and generalized additive models to create a continuous map surface of odds ratios (OR) by smoothing over latitude and longitude. Permutation tests were used to assess whether location of maternal residence was important and identify locations with statistically significant ORs.
In Arkansas, adjusted ORs in the southwest corner were 2.0 and the global deviance was not statistically significant (p-value: 0.57). Adjusted ORs for California indicated areas of increased risk with ORs 1.3 (p-value: 0.34). In Utah, the adjusted ORs were elevated (OR: 2.4) in the south-eastern corner of the study area (p-value: 0.34).
The results of this study, while not statistically significant, suggest there were spatial variations in gastroschisis births. We cannot rule out that these variations were due to edge effects or residual confounding.
腹裂是一种出生缺陷，即出生时肠袢从腹壁突出。先前的研究表明，腹裂病例可能呈聚集性发生。本研究的目的是利用1997年至2007年全国出生缺陷预防研究（NBDPS）的数据，确定是否存在腹裂风险升高的区域。
我们通过阿肯色州、加利福尼亚州和犹他州基于人群的出生缺陷监测系统获得了病例数据（n = 371）；对照（n = 2359）从与病例相同的地理区域中选取。对母亲进行了关于人口统计学信息和孕期暴露情况的访谈，包括居住史。我们使用孕早期母亲的住址和广义相加模型，通过对纬度和经度进行平滑处理，创建了优势比（OR）的连续地图表面。使用置换检验来评估母亲居住地的位置是否重要，并确定具有统计学显著OR值的位置。
在阿肯色州，西南角的调整后OR为2.0，全局偏差无统计学意义（p值：0.57）。加利福尼亚州的调整后OR表明存在风险增加的区域，OR为1.3（p值：0.34）。在犹他州，研究区域东南角的调整后OR升高（OR：2.4）（p值：0.34）。
本研究结果虽无统计学意义，但表明腹裂出生存在空间差异。我们不能排除这些差异是由于边缘效应或残余混杂因素导致的。
