Is there a Potential Link Between the Opioid Crisis in Communities and Gastroschisis?

Gastroschisis is a birth defect of the abdominal (belly) wall. Several studies show increased rates of babies born with gastroschisis. Most of these babies are born to young mothers. A study from the Centers for Disease Control and Prevention (CDC) found that the number of babies born with gastroschisis was higher in U.S. counties with high opioid (pain medicine) prescription rates, compared to those with low opioid prescription rates. These findings should not be interpreted to mean that maternal opioid exposure during pregnancy causes babies to be born with gastroschisis, but they may signal a potential link to be examined in future studies. More research is needed to understand the full effects of opioids on mothers and babies and what factors may contribute to this observed association.

Read the full scientific article.

U.S. Opioid Prescribing Rate Map

For detailed information on opioid prescription rates, use CDC’s interactive maps.

Main Findings

* Researchers estimated that, from 2006-2015, about 1 in every 2,300 babies was born with gastroschisis in twenty U.S. states.
* This study looked at reported cases of gastroschisis by county in these states and found that counties where doctors frequently prescribe opioids had 1.6 times more babies born with gastroschisis compared to counties with low opioid prescription rates.
* Researchers aren’t currently able to explain why gastroschisis rates are more common in these counties. More research is needed to understand what factors may contribute to this observed association.
* Tracking rates of birth defects and opioid prescriptions are key to understanding how mothers and babies may be impacted by the opioid crisis.

About This Study

* Researchers used information from birth defects tracking programs in 20 states. Participating states were Arizona, Georgia, Illinois, Kansas, Kentucky, Louisiana, Massachusetts, Minnesota, Nebraska, New Jersey, New York, North Carolina, Ohio, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, and Virginia.
* In this study, researchers looked at the number of babies affected by gastroschisis in these 20 states between 2006 and 2015, and compared it with opioid prescription rates in the counties where babies were born. More research is needed to understand whether there is a potential link between these observations.
* This study has some limitations that should be considered:

     – This report uses an ecological study design, which means that these findings do not show cause and effect. However, they may signal a potential link to be looked at in future studies.
     – Researchers were not able to look at the impact of other factors at the county or individual level that may affect the risk for gastroschisis.

Key Findings
Full report

Note from AAGF’s President, Meghan Rauen:

Yesterday I had a wonderful conversation with the CDC researchers and chiefs of the Birth Defects and Surveillance division of the CDC. We knew that the study could potentially raise concerns, with regards that people would assume that this meant that opioids have been show to cause gastroschisis. By no means is this what the research showed. There is an unfortunate stigma associated with birth defects and we all recognize that an increase trend with certain risk factors may bolster that poorly held and misinformed belief.

First, the research showed that in the years following the 2016 study from 1995 to 2005 that saw an considerably increase of gastroschisis frequency, this study noted that while still increasing in frequency, that it is not increasing as quickly as it once had.

The other trend they noted that was communities with higher rates of prescribed opioids had higher instances of gastroschisis. This by no means proves a link. There are a myriad of factors and much more research to be done to even begin to show that. It was just a trend they noted. It also did not mean that gastroschisis only happened in these areas, it clearly was happening in other areas without the same prescribed opioid frequency. The trend could also correlate to poorer access to maternal/fetal care, poorer socioeconomic factors and thus health and nutritional implications, etc. Just because opioids were present in higher frequency does not automatically posit causation. And the CDC was clear about that.

It should also be noted that this was not illegal or illicit opioid use, but *prescribed* opioids.

There is a significant difference between trend, risk factors and causation. Causation means that a + b = c. Per the CDC we are far from that. The CDC also emphasized this study did not significantly move to a better understanding of what causes gastroschisis. It does show that risky behaviors are associated with an increased risk of birth defects, something we all knew any way. It also made implications about our opioid crisis at large, highlighting a need to better manage, help and treat the issue as it has associated other *risks* namely the implications for birth defects. What it means for physicians who are working with pregnant moms and/or families trying to get pregnant. This study, however, did not establish a formal causal link between opioids and gastroschisis.

This study should not be used as “proof” that opioids cause gastroschisis, as that is not what the study proved. It is not true that everyone who had a child with gastroschisis was using opioids. There has been the same sort of research in trends associated with atrazine, UTIs, chlamydia, nutrition and SSRIs. This is just another “trend” for a risk factor. Not causation. Please rest assured we are still working very hard to partner with multiple research teams and organizations to understand better the causes of gastroschisis, but this study has not established causation. Merely a noted risk factor. The positive news is that frequency is not increasing as much as it once had, there is encouragement there. Additionally where the 2016 study included only 13 sites, this included 20. So interest and effort to study this defect is mounting. Finally, the CDC team discussed passionately wanting to reengage with gastroschisis research in the year and coming years as well, including outcomes studies. We are making progress to trend the disease and better understand it.

If you have any further questions myself and our medical and research teams are happy to answer.