Smoking decline leads to fewer newborns with gastroschisis, research finds

DENVER —A decline in smoking in the general population, including pregnant people, over the last few decades corresponded with a decline in infants born with a birth defect called gastroschisis, according to research presented during the American Academy of Pediatrics 2025 National Conference & Exhibition at the Colorado Convention Center Sept. 26-30.

Authors of an abstract, “A Declining Incidence of Gastroschisis Parallels Trends in Maternal Smoking Rates in the United States,” point to the success of public health efforts to discourage smoking within the general population. Consequently, a decline in maternal smoking prior to conception led to fewer diagnoses of gastroschisis, a condition in a baby is born with their organs outside of their body due to their abdominal wall not forming completely in the womb, according to the study.

Researchers reviewed live birth data released by the U.S. Department of Health and Human Services between 2017 and 2023, identifying 5,121 newborns out of a total 25,836,224 live births who 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, according to the research. 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. The odds of a gastroschisis diagnosis increased by 39% for each additional 10 cigarettes smoked daily prior to conception, researchers found.

"Epidemiologic studies such as this demonstrate that rare diseases, such as gastroschisis, may be significantly altered at a population level by the most common of health interventions, such as cessation of maternal smoking," said Zane Hellmann, MD MHS, general surgery resident.

“Public health investments in initiatives such as this can pay dividends in ways that are not initially obvious, such as reducing the rates of congenital abnormalities in the progeny of those encouraged to lead healthier lives,” he said. 

The authors did not receive financial support for this research.

Study author Dr. Hellmann is scheduled to present the research, which is below, from 10:26 a.m. to 10:31 a.m. on Saturday, Sept. 27, in the Colorado Convention Center, Mile High Ballroom 2B-3B. To request an interview with the authors, contact Dr. Hellmann at zane.hellmann@yale.edu.

In addition, Dr. Hellmann will be among highlighted abstract authors who will give a brief presentation and be available for interviews during a press conference from noon-1:30 p.m. Saturday, Sept. 27, in the National Conference Press Room, CCC 705/707. During the meeting, you may reach AAP media relations staff at 303-228-8338.  

Please note: only the abstract is being presented at the meeting. In some cases, the researcher may have more data available to share with media, or may be preparing a longer article for submission to a journal. 

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The American Academy of Pediatrics is an organization of 67,000 primary care pediatricians, pediatric medical subspecialists and pediatric surgical specialists dedicated to the health, safety and well-being of infants, children, adolescents and young adults. For more information, visit www.aap.org. Reporters can access the meeting program and other relevant meeting information through the AAP meeting website at http://www.aapexperience.org/

Program Name: 2025 Call for Abstracts

Submission Type: Section on Surgery

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

Zane Hellmann

CT, United States

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.

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.

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).

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.

Rate of Maternal Smoking and Incidence of Gastroschisis

Incidence of Gastroschisis by Pregestational Smoking Volume