Maternal nutrition and gastrointestinal atresia/stenosis: National Birth Defects Prevention Study 1997-2009 Open Access
Schaeffer, Marcy (2015)
Abstract
This thesis investigates the association between maternal nutrition (as measured by dietary intake of macronutrients, micronutrients and vitamins, and elements) in the year before pregnancy and risk for gastrointestinal atresia/stenosis (esophageal, duodenal, jejunal/ileal, and anorectal). Due to the increasing prevalence of obesity among reproductive-age women, maternal nutrition before and during pregnancy is of growing interest in the study of birth defects, but the association between specific nutrients and gastrointestinal atresia/stenosis is not well-understood. The associations between maternal nutrition and these gastrointestinal atresia/stenosis were examined using data from the National Birth Defects Prevention Study (NBDPS) and pregnancies with estimated dates of delivery between 1997 and 2009. The categories of gastrointestinal atresia/stenosis included in the analysis were identified based on case definition criteria developed by clinical geneticists at each Center. Controls were liveborn infants with no major birth defects randomly selected based on the proportion of number of births in the same geographic area from which the cases were ascertained. Covariate and nutritional information was obtained from a computer-assisted telephone interview (CATI) with case and control mothers. We chose to focus on the maternal characteristics of maternal age, race/ethnicity, education, pre-pregnancy body mass index (BMI), first trimester nausea/vomiting, and use of folic acid supplements and Study Center as covariates for our analyses. We examined the differences in these covariates between case and control mothers with chi-square tests of association and crude odds ratios. We computed multivariate logistic regression models for each gastrointestinal atresia/stenosis and obtained adjusted odds ratios of risk of each gastrointestinal atresia/stenosis by quartile of nutrient intake, adjusting for all covariates and average total energy intake. Our crude analyses showed that the maternal characteristics associated with esophageal and anorectal atresia/stenosis risk were generally consistent with previous studies. Our adjusted odds ratios did not support clear associations between the examined macronutrients, micronutrients/vitamins, and elements, and risk for esophageal, duodenal, jejunal/ileal, or anorectal atresia/stenosis. Some visual trends between risk for the gastrointestinal atresia/stenosis outcomes and quartiles of nutrient intake suggest that further investigation might be warranted.
Table of Contents
Chapter I
Introduction & Background...1
Chapter II
Literature Review...5
Chapter III
Methodology...9
Chapter IV
Results...14
Chapter V
Discussion...17
Tables and Figures...20
Table 1...20
Figure 1...21
Figure 2...22
Table 2...23
Figure 3...24
Table 3...25
Table 4...26
Table 5...27
Figure 4 A-L...32
References...44
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