The rising prevalence of gastroschisis and omphalocele in Tennessee

Rates of the major congenital abdominal wall defects gastroschisis and omphalocele have been shown to be increasing over the past 10 to 20 years. Although much of the increase was seen in the 1970s and 1980s, there has been conflicting evidence as to whether similar trends exist for more recent years. Clinical observations from the major neonatal referral networks in Tennessee led us to question whether the rates of abdominal wall defects were continuing to increase throughout the 1990s. The purpose of this study was to describe the rates of congenital abdominal wall defects between 1985 and 2002 for the state of Tennessee using 2 independently collected data sources: birth certificates and Medicaid claims. There was nearly a 3-fold increase in congenital abdominal wall defects between 1989 and 2001 identified from birth certificates, and a doubling of these defects was identified from claims. Temporal increases persisted when controlling for maternal age, race, and education. We conclude that the increase in these important birth defects seen in earlier decades has persisted in Tennessee in recent years. Further elucidation of risk factors associated with the increase is warranted.