The young age of mothers of infants with gastroschisis, a congenital defect
of the abdominal wall, suggested that deficient nutrition, with maternal-f
etal competition for nutrients, could be a risk factor for gastroschisis. T
his population-based hypothesis-generating study consisted of 55 cases of g
astroschisis and 182 matched controls. We assessed maternal nutrient intake
during the trimester before conception with a self-reported food-frequency
questionnaire and screened 38 nutrients to identify those most likely to b
e associated with gastroschisis. We used statistical classification trees t
o empirically generate cutpoints that determined the low and high levels of
nutrient intakes corresponding to the risk of gastroschisis; cutpoints for
most nutrients were similar to the corresponding recommended daily dietary
allowances (RDAs), In univariate analysis, low intake of several nutrients
emerged as the leading risk factors: carotenoids, e.g., alpha-carotene (od
ds ratio (OR) = 4.6; 95% confidence interval (CI) = 2.2-9.5), beta-carotene
(OR = 3.1; 95% CI = 1.6-6.0); amino-acid compounds, e.g., total glutathion
e (OR = 3.5; 95% CI = 1.7-7.2); vitamin C (OR = 2.2; 95% CI = 1.5-7.8); vit
amin E (OR = 2.3; 95% CI = 1.2-4.4); and minerals, fiber, and the fruit-and
-vegetable group (OR = 3.1; 95% CI = 1.5-6.2), High intake of nitrosamines
(OR = 2.4; 95% CI = 1.3-4.5) was also a good candidate. Many nutrient value
s were correlated and, in multivariate analysis, those most associated with
gastroschisis were low alpha-carotene (OR = 4.3; 95% CI = 1.9-9.8), low to
tal glutathione (OR = 3.3; 95% CI = 1.4-7.6), and high nitrosamines (OR = 2
.6; 95% CI = 1.3-5.4). Adjusting for variables associated with gastroschisi
s in previous analyses of this population did not substantially alter those
risks. These results suggest that maternal dietary inadequacy may be a ris
k factor for gastroschisis, and the three nutrients that emerged from the n
utrient screening appear to be the best candidates to examine in further ep
idemiological analyses or biological studies. (C) 1998 Wiley-Liss, Inc.