O2178: A Declining Incidence of Gastroschisis Parallels Trends in Maternal Smoking Rates in the United States

Background: Previous studies have shown that smoking prior to conception and during pregnancy is a risk factor for gastroschisis. Since smoking rates among young adults have declined between 2011 and 2022, we hypothesized that this would be associated with a concurrent decrease in gastroschisis rates among live births in the United States.

Methods: Data were obtained from a publicly available, de-identified dataset released by the U.S. Department of Health and Human Services (HHS) encompassing all live births in the United States from 2017 to 2023. The daily number of cigarettes smoked by the mother prior to conception was included as an independent variable. The primary outcome was a diagnosis of gastroschisis in the newborn.

Results: A total 25,836,224 live births with complete information were recorded by the HHS between 2017 and 2023. Within this cohort, 5,121 newborns (~2:10,000 births) were diagnosed with gastroschisis. Among these, 858 (16.75%) were born to mothers with a history of smoking prior to pregnancy. Maternal smoking decreased in a linear fashion from 9.4% in 2017 to 4.1% in 2023. Concurrently, the incidence of gastroschisis also decreased linearly from 2.4 per 10,000 births in 2017 to 1.6 per 10,000 births in 2023 (Figure 1). Univariate analysis revealed that mothers with any history of smoking within three months of conception were significantly more likely to deliver a newborn with gastroschisis (OR = 2.82, 95% CI 2.62–3.04, p < 0.001). A dose-response analysis demonstrated that for every additional 10 cigarettes smoked daily prior to conception prior to pregnancy, the odds of a gastroschisis diagnosis increased by 39% (OR = 1.39, 95% CI 1.35–1.43, p < 0.001, Figure 2).

Conclusion: Consistent with prior research, these findings confirm a significant association between maternal smoking prior to conception and gastroschisis. Additionally, there was a significant decline in the proportion of mothers who reported smoking within three months prior to conception, which was paralleled by a similar decline in annual gastroschisis rates between 2017 and 2023 among live births in the United States.