Decline in maternal smoking linked to fewer cases of gastroschisis in US newborns

A nationwide decline in maternal smoking has corresponded with a measurable reduction in infants born with gastroschisis, according to research presented at the American Academy of Pediatrics 2025 National Conference & Exhibition in Denver. Gastroschisis is a rare but serious congenital anomaly in which a baby is born with their intestines outside of the body due to incomplete abdominal wall formation.

Study methods

Researchers analyzed a publicly available dataset from the US Department of Health and Human Services (HHS), which included 25,836,224 live births from 2017 to 2023. They evaluated maternal smoking behavior prior to conception and subsequent diagnoses of gastroschisis. The analysis focused on both overall rates and dose-response associations.

Findings

Across the study period, 5,121 newborns (approximately 2 per 10,000 births) were diagnosed with gastroschisis. Among these, 858 infants (16.75%) were born to mothers with a history of smoking before pregnancy.

Maternal smoking rates fell linearly from 9.4% in 2017 to 4.1% in 2023. During the same period, gastroschisis incidence also declined, from 2.4 cases per 10,000 births in 2017 to 1.6 per 10,000 in 2023.

Univariate analysis revealed that mothers with any smoking history within 3 months of conception were nearly three times more likely to deliver an infant with gastroschisis (OR, 2.82; 95% CI, 2.62–3.04; p < .001). Dose-response analysis demonstrated that each additional 10 cigarettes smoked daily prior to conception increased the odds of a gastroschisis diagnosis by 39% (OR, 1.39; 95% CI, 1.35–1.43; p < .001).

Implications

The findings underscore the long-term benefits of public health efforts that have successfully reduced smoking rates across the general population. “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 study author Zane Hellmann, MD, MHS, general surgery resident.

He added that investment in smoking cessation initiatives yields broader, sometimes unexpected benefits: “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.”

Conclusion

These results highlight the intergenerational impact of maternal health behaviors, reinforcing the need for continued investment in smoking cessation programs and proactive counseling for women of reproductive age.

References:

1. American Academy of Pediatrics. Smoking decline leads to fewer newborns with gastroschisis, research finds. Eurekalert. September 26, 2025. Accessed September 26, 2025. https://www.eurekalert.org/news-releases/1098765
2. Hellman Z. A Declining Incidence of Gastroschisis Parallels Trends in Maternal Smoking Rates in the United States. Abstract. Presented at: American Academy of Pediatrics 2025 National Conference & Exhibition. September 26-30, 2025. Denver, Colorado.