SELECTIVE SEROTONIN REUPTAKE INHIBITOR USE ASSOCIATED WITH GASTROSCHISIS IN A DIZYGOTIC TWIN GESTATION

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ESPR299
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Abstract: :

Introduction:

Estimated prevalence of gastroschisis (GS) in the United States ranges from 2.6 to 5.1 per 10,000 live births [2]. Etiology of GS is unknown, and many studies have attempted to identify endogenous or exogenous risk factors. Well documented risk factors for GS include young maternal age, which is by far the most well accepted risk factor, genetic predisposition, opioid use and maternal smoking [1, 3]. A Classic Twin Study of Isolated GS, the largest twin study found in our literature review, supported environmental factors being stronger co-founders based on higher concordance rates in dizygotic twins compared to monozygotic twins with GS [3].  There were also a number of studies associating the use of selective serotonin re-uptake inhibitors (SSRIs) with GS [4, 5]. 


History:

This is a rare case of GS in both male di-di twins born to a 27 year old Caucasian G3P1103 female at 33 weeks gestation. Twin A was born via spontaneous vaginal delivery, and Twin B was delivered via emergent cesarean section secondary to failure to progress. Maternal history was significant for anxiety, chronic migraines, and anorexia. Previous pregnancies included a daughter born full term and male twins born at 35 weeks gestation. There was no family history of abdominal wall defects. During pregnancy, sertraline 50 mg and prenatal vitamins were taken daily. Of note, an SSRI was not used in previous pregnancies. There was no maternal history of tobacco, alcohol, or recreational drug use during this pregnancy. The mother lived on a military base and had adequate prenatal care. All maternal prenatal laboratory screenings were normal. 


Diagnostic Prenatal Imaging: 

There was a negative noninvasive prenatal test, and maternal serum alpha fetoprotein testing was not performed due to maternal preference. GS was detected on 20 week anatomy scan ultrasound (US). Remainder of the anatomy scan, and fetal echo, were normal except for the finding of right sided GS. The size of the GS defect was noted to be moderate for both infants on US, and there was no evidence of abnormal intestinal dilatation concerning for atresia on initial or repeat ultrasounds. 


Physical exam:

Initially the patients required NICU care for unstable vitals signs and prematurity but they were stable on room air with normal vitals on DOL 3. 

Both twins shared a similar clinical course and had near identical degrees of simple GS, that was managed by primary reduction and sutureless closure with the use of umbilical cord remnant on day of life (DOL) 0. They were managed using total parenteral nutrition with Replogle gastric decompression for 8 days, and were initiated on enteral feeds on DOL 10 with slow advancement towards full feeds. They were both discharged home at 38 weeks corrected gestational age on full oral feeds. 


Final Diagnosis: Gastroschisis in dizygotic twins. 


Discussion:

Both twins were born with simple GS, and had a similar defect size and clinical courses. In this case there were no typical risk factors in maternal history and no contributory familial history, therefore the etiology is more likely to have been exogenous [1, 3]. A study published in the European Journal of Epidemiology showed an association between SSRI use (Fluoxetine, Paroxetine, Citalopram, Sertraline and Escitolopramuse) and congenital anomalies, where all except Paroxetine showed an association with GS [4]. Based on this study by Wemakor, it is possible that SSRIs were associated with GS in the case of these twins. Further studies need to be conducted to evaluate the association between SSRI use and the occurrence of GS. 


References


[1] Baldacci, Silvia, et al. "Lifestyle and sociodemographic risk factors for gastroschisis: a systematic review and meta-analysis." Archives of Disease in Childhood (2020).


[2] Stallings, Erin B., et al. "Population‐based birth defects data in the United States, 2012–2016: A focus on abdominal wall defects." Birth defects research 111.18 (2019): 1436-1447.


[3] Schulz, Anna Carina, et al. "A classic twin study of isolated gastroschisis." Fetal and pediatric pathology 31.5 (2012): 324-330.


[4] Wemakor, Anthony, et al. "Selective serotonin reuptake inhibitor antidepressant use in first trimester pregnancy and risk of specific congenital anomalies: a European register-based study." European Journal of Epidemiology 30.11 (2015): 1187-1198.


[5]Jordan, Sue, et al. "Selective serotonin reuptake inhibitor (SSRI) antidepressants in pregnancy and congenital anomalies: analysis of linked databases in Wales, Norway and Funen, Denmark." PLoS One 11.12 (2016): e0165122.



Cooper University Hospital
Cooper University Hospital
Cooper University Hospital
Cooper University Hospital
Cooper University Hospital

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