Gastroschisis
Alaska, 2007-2021
Background
Gastroschisis, like omphalocele, is a birth defect in the abdominal wall that causes a newborn’s intestines and sometimes other organs (e.g. stomach and liver) to protrude outside of the baby’s body, usually through a hole next to the belly button. This condition occurs when the muscles that make up the baby’s abdominal wall do not form correctly, which happens early in the pregnancy. Unlike omphalocele, the organs that are pushed outside the body are not enveloped in a sac or membrane, but rather completely exposed to the surrounding environment. The organs are therefore immersed in the amniotic fluid, which can cause swelling or irritation. Surgery is necessary after birth to put the exposed organs back inside the body. However, even after repair infants may still have problems with feeding, digestion of food, and absorption of nutrients.They may need treatments such as intravenous fluids, antibiotics to prevent infection, and careful monitoring of their body temperature.[1]
The causes of gastroschisis are unknown and most likely a combination of genetics and the environment. However, certain risk factors, including young maternal age and alcohol and tobacco use during pregnancy, have been shown to increase the chances of having a child with gastroschisis.[2,3,4]
Epidemiology
Alaska Birth Defects Registry (ABDR) registers birth defects as reported from health care providers using International Classification of Disease (ICD) billing codes. The use of these ICD codes can lead to misclassification of diagnosed conditions. Prior to this report, all prevalence estimates were based on the number of unique children reported to ABDR with an ICD code representing a specified condition regardless of case confirmation status.
The estimates in this report were derived by conducting medical record review and case confirmation of a random sample of cases of the condition reported to ABDR. The confirmation probability from the sample was used to develop informed estimates of the actual diagnosed defect prevalence. See Defect prevalence calculation.
For explanations of table columns see Column descriptions.
Prevalence
Gastroschisis occurs in 4.94 (95% CI 4.76–5.13) out of every 10,000 live births in the United States. This results in about 2,000 babies diagnosed with gastroschisis nationally each year.[5][6]
In Alaska, during 2007-2021, the prevalence of gastroschisis was 5 per 10,000 live births.| Reports | Defects | Births | Prevalence (95% CI) |
|---|---|---|---|
| 121 | 82.2 | 162989 | 5.0 (4.1, 6.2) |
| Notes: 95% CI = 95% Confidence Interval | |||
Trend
Prevalence per 10,000 births of gastroschisis during 2007-2021 by three-year moving averages, with 95% confidence interval band and Poisson estimated fitted line.| Estimate | Std. Error | t value | Pr(>|t|) |
|---|---|---|---|
| -0.01290 | 0.00609 | -2.11742 | 0.06330 |
| Notes: 95% CI = 95% Confidence Interval | |||
Regional Distribution
Distribution of gastroschisis in Alaska by Public Health Region of maternal residence at the time of birth. A description of regional breakdowns can be found here. Data suppressed for # of reports < 6.
Demographics
Some subgroups may be more at risk for having a baby with gastroschisis. This section provides the descriptive epidemiology of specified maternal, birth, and child characteristics identified from the birth certificate.
Accompanying Diagnoses
The ten diagnoses most commonalty associated with gastroschisis.
Technical notes
Column descriptions
# Reports: Unless otherwise noted, the number of unique reports of the defect received by ABDR during the specified birth year(s). Each report represents a unique child with the specified defect.
# Defects: The estimated true number of reports that are diagnosed defects based on medical record review and case confirmation.
# Births: The number of live births among Alaskan residents that occurred in Alaska during the specified birth year(s).
Prevalence (95% CI): The estimated diagnosed prevalence of the condition and corresponding 95% Confidence Interval. (For information on how the defect prevalence was estimated see below).
Defect prevalence calculation
The estimated defect prevalence was calculated using a Bayesian approach based on the reported prevalence, PPV and 1-NPV (see formula below).
Through medical records review and case confirmation of a random sample of reported cases, the defect prevalence is calculated as:
\[PPV (Positive Predictive Value) = p(defect|report)\] \[NPV (Negative Predictive Value) = p(\overline{defect}|\overline{report})\]
\[p(defect) \approx [p(report)\cdot PPV]+[p(\overline{report})\cdot (1-NPV)]\]
Defect prevalence estimates are a more accurate estimation of the actual diagnosed prevalance of birth defects compared to the reported prevalance estimates in Alaska. ABDR obtains reports from medical providers using International Classification of Disease (ICD) codes that are extracted from individual systems which when aggregated may not reflect true diagnostics. Caution should be used when interpreting and comparing the reported prevalence estimates with national estimates.
See Data analysis methods for more information.
P-value estimate
To evaluate the trend over time and account for under/over-dispersion we constructed a quasi-Poisson regression model. This model assumes the variance is a linear function of the mean and models the estimated number of annual defects by year with a natural log (ln) offset of the annual births. P-values < 0.05 are considered significant, which indicates that the predicted slope is significantly different from a slope of zero.
Data suppression
For region and demographic data tables, values are suppressed based on the number of reports received during the observation period. Counts less than 6 are suppressed (as indicated by ‘-’ in the table). For regions or demographics with only one cell count suppressed a second is suppressed to eliminate the ability to back-calculate the estimate.
References
[1] Centers for Disease Control and Prevention. Facts about Gastroschisis, https://www.cdc.gov/ncbddd/birthdefects/gastroschisis.html#ref; 2015 [accessed 02.23.2017]
[2] Haddow J, Palomaki G, Holman M. Young maternal age and smoking during pregnancy as risk factors for gastroschisis. Teratology 1993; 47(3):225-228.
[3] Mac Bird T, Robbins JM, Druschel C, Cleves MA, Yang S, Hobbs CA. Demographic and environmental risk factors for gastroschisis and omphalocele in the National Birth Defects Prevention Study. Journal of Pediatric Surgery 2009; 44(8):1546-51
[4] Jones AM, Isenburg J, Salemi JL, et al. Increasing Prevalence of Gastroschisis - 14 States, 1995-2012. MMWR Morb Mortal Wkly Rep 2016;65:23-26.
[5] Centers for Disease Control and Prevention, Birth Defects Data and Statistics, https://www.cdc.gov/ncbddd/birthdefects/data.html; 2016 [accessed 02.23.2017]
[6] Mai CT, Isenburg JL, Canfield MA, Meyer RE, Correa A, Alverson CJ, Lupo PJ, Riehle‐Colarusso T, Cho SJ, Aggarwal D, Kirby RS. National population‐based estimates for major birth defects, 2010–2014. Birth Defects Research. 2019; 111(18): 1420-1435
Suggested Citation
State of Alaska Department of Health and Social Services, Division of Public Health, Section of Women’s, Children’s, and Family Health. Alaska Birth Defects Registry Condition Report: Gastroschisis, Alaska, 2007-2021. Updated April 11, 2024. Available at: http://rpubs.com/AK_ABDR/Gastroschisis
Contact
Alaska Birth Defects Registry (ABDR)
3601 C Street, Suite 358
Anchorage, AK 99503
(907) 269-3400 phone
(907) 754-3529 fax
hssbirthdefreg@alaska.gov
Updated: April 11, 2024
Code source:
R:\ABDR\Analysis_New\ABDR_CASECONF\cond_reports\Published_reports\Targets_publications\Gastroschisis_tar.Rmd
