Gastroschisis is a birth defect where the infant’s intestines, and sometimes other abdominal organs, protrude through a small opening in the abdominal wall. Corrective surgery is performed shortly after birth to place the organs back into the abdomen and close the wall. For adults who underwent this procedure as infants, the primary concern when planning a family is whether this history impacts their reproductive health and the safety of a future pregnancy.
Fertility Outcomes for Adults Who Had Gastroschisis
Gastroschisis primarily involves a localized defect of the abdominal wall, meaning it does not typically affect the internal reproductive organs. The female reproductive system—the ovaries, fallopian tubes, and uterus—is situated inside the pelvis, separate from the abdominal wall defect. Consequently, the ability of women who had gastroschisis to conceive is generally comparable to the overall population. Most individuals who survived the condition experience normal growth and good health into adulthood, suggesting that their reproductive capability is not impaired by the abdominal wall repair. However, a small number of survivors, particularly those with complicated gastroschisis involving extensive intestinal damage, may have complex long-term health issues requiring ongoing care that could indirectly affect the ability to sustain a pregnancy.
Managing Pregnancy with a History of Gastroschisis
A pregnancy in a woman with a history of gastroschisis is typically managed as a high-risk scenario, largely due to the structural changes from the abdominal wall repair. As the uterus expands during pregnancy, it places increasing tension on the surgically repaired abdominal wall and scar tissue. This expansion can lead to abdominal pain and potentially increase the risk of a new hernia forming at or near the original surgical site. Specialized prenatal care, often involving a maternal-fetal medicine specialist, is necessary to monitor both the mother and the developing fetus closely. These pregnancies have an elevated risk of intrauterine growth restriction (IUGR), where the fetus does not grow as expected, requiring regular ultrasound monitoring and surveillance for complications like premature labor.
Delivery Method Considerations
The decision regarding the method of delivery—vaginal birth versus Cesarean section (C-section)—requires consultation with the obstetric and surgical care teams. Having a history of gastroschisis is not an automatic indication for a C-section, and many women successfully deliver vaginally. The primary concern is whether the intense muscular effort of the pushing phase of labor could compromise the integrity of the mother’s repaired abdominal wall. The significant intra-abdominal pressure generated during pushing might cause an incisional hernia or put undue strain on the connective tissue and muscle repaired in infancy. A full evaluation of the abdominal scar’s strength is performed before a delivery plan is finalized, and a planned C-section may be considered if the abdominal wall is significantly compromised or has excessive scarring.
Understanding the Recurrence Risk
Gastroschisis is primarily considered a sporadic birth defect, meaning it occurs without a clear inheritance pattern. The baseline risk of gastroschisis in the general population is very low, approximately 2 to 4 cases per 10,000 live births. Studies suggest that the risk for a child born to a parent who had gastroschisis is notably higher than the general population risk, with recurrence rates estimated to be in the range of 1% to 5.7% for first-degree relatives. This suggests that a combination of environmental and familial factors contributes to the development of the condition. Couples planning a pregnancy should seek detailed counseling from a genetic counselor or a maternal-fetal medicine specialist to review their history and discuss prenatal screening options, such as ultrasound monitoring.