Laurel Cavallo1, Erin M Kovar2, Amal Aqul3, Lucille McLoughlin4, Naveen K Mittal5, Norberto Rodriguez-Baez3, Benjamin L Shneider1, Robert J Zwiener6, Tiffany M Chambers2, Peter H Langlois7, Mark A Canfield8, A J Agopian9, Philip J Lupo2, Sanjiv Harpavat10. 1. Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX. 2. Division of Hematology-Oncology, Department of Pediatrics, Baylor College of Medicine, Houston, TX. 3. Section of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX. 4. Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Children's Hospital of San Antonio, San Antonio, TX. 5. Section of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, TX. 6. Division of Pediatric Gastroenterology, Department of Pediatrics, Dell Children's Medical Center, Austin, TX. 7. Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas School of Public Health - Austin Regional Campus, Austin, TX. 8. Birth Defects Epidemiology and Surveillance Branch, Texas Department of State Health Services, Austin, TX. 9. Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas School of Public Health, Houston, TX. 10. Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, TX. Electronic address: harpavat@bcm.edu.
Abstract
OBJECTIVE: To identify key epidemiologic factors relevant to fetal development that are associated with biliary atresia. STUDY DESIGN: This population-based registry study examined infants born in Texas between 1999 and 2014. Epidemiologic data relevant to fetal development were compared between cases of biliary atresia identified in the Texas Birth Defects Registry (n = 305) vs all live births (n = 4 689 920), and Poisson regression was used to calculate prevalence ratios (PRs) and 95% CIs. RESULTS: The prevalence of biliary atresia over the study period was 0.65 per 10 000 live births. Biliary atresia was positively associated with female sex (adjusted PR, 1.68; 95% CI, 1.33-2.12), delivery before 32-37 weeks of gestation (adjusted PR, 1.64; 95% CI, 1.18-2.29), delivery before 32 weeks of gestation (adjusted PR, 3.85; 95% CI, 2.38-6.22), and non-Hispanic Black vs non-Hispanic White maternal race/ethnicity (adjusted PR, 1.54, 95% CI, 1.06-2.24), while biliary atresia was inversely associated with season of conception in the fall relative to spring (adjusted PR, 0.62; 95% CI, 0.45-0.86). In addition, biliary atresia was associated with maternal diabetes (adjusted PR, 2.34; 95% CI, 1.57-3.48), with a stronger association with pregestational diabetes compared with gestational diabetes. In subgroup analyses, these associations were present in isolated biliary atresia cases that do not have any additional birth defects. CONCLUSIONS: Biliary atresia is associated with multiple factors related to fetal development, including pregestational maternal diabetes, female sex, and preterm birth. These associations also were observed in isolated cases of biliary atresia without other malformations or laterality defects. Our results are consistent with early life events influencing the pathogenesis of biliary atresia, and support further studies investigating in utero events to better understand etiology and time of onset.
OBJECTIVE: To identify key epidemiologic factors relevant to fetal development that are associated with biliary atresia. STUDY DESIGN: This population-based registry study examined infants born in Texas between 1999 and 2014. Epidemiologic data relevant to fetal development were compared between cases of biliary atresia identified in the Texas Birth Defects Registry (n = 305) vs all live births (n = 4 689 920), and Poisson regression was used to calculate prevalence ratios (PRs) and 95% CIs. RESULTS: The prevalence of biliary atresia over the study period was 0.65 per 10 000 live births. Biliary atresia was positively associated with female sex (adjusted PR, 1.68; 95% CI, 1.33-2.12), delivery before 32-37 weeks of gestation (adjusted PR, 1.64; 95% CI, 1.18-2.29), delivery before 32 weeks of gestation (adjusted PR, 3.85; 95% CI, 2.38-6.22), and non-Hispanic Black vs non-Hispanic White maternal race/ethnicity (adjusted PR, 1.54, 95% CI, 1.06-2.24), while biliary atresia was inversely associated with season of conception in the fall relative to spring (adjusted PR, 0.62; 95% CI, 0.45-0.86). In addition, biliary atresia was associated with maternal diabetes (adjusted PR, 2.34; 95% CI, 1.57-3.48), with a stronger association with pregestational diabetes compared with gestational diabetes. In subgroup analyses, these associations were present in isolated biliary atresia cases that do not have any additional birth defects. CONCLUSIONS: Biliary atresia is associated with multiple factors related to fetal development, including pregestational maternal diabetes, female sex, and preterm birth. These associations also were observed in isolated cases of biliary atresia without other malformations or laterality defects. Our results are consistent with early life events influencing the pathogenesis of biliary atresia, and support further studies investigating in utero events to better understand etiology and time of onset.
Authors: Daan B E van Wessel; Thomas Boere; Christian V Hulzebos; Ruben H J de Kleine; Henkjan J Verkade; Jan B F Hulscher Journal: J Pediatr Gastroenterol Nutr Date: 2017-10 Impact factor: 2.839
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Authors: Jeremy M Schraw; Renata H Benjamin; Daryl A Scott; Brian P Brooks; Robert B Hufnagel; Scott D McLean; Hope Northrup; Peter H Langlois; Mark A Canfield; Angela E Scheuerle; Christian P Schaaf; Joseph W Ray; Han Chen; Michael D Swartz; Laura E Mitchell; A J Agopian; Philip J Lupo Journal: Ophthalmic Epidemiol Date: 2020-12-20