© 1995 Oxford University Press
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Increased Risk of Craniosynostosis with Higher Antenatal Maternal Altitude
* Department of Epidemiology, University of Washington Seattle, WA, USA.
** Disease Control and and Environmental Epidemiology Division, Colorado Department of Health Denver, CO, USA.
Department of Preventive Medicine and Biometrics, University of Colorado Medical School Denver, Co, USA.
Department of Anesthesiology, University of Colorado Health Sciences Center Denver, CO, USA.
Department of Radiology, Children's Memorial Hospital Chicago, IL, USA
|| Department of Pediatrics, University of Colorado Health Sciences Center, and The Children's Hospital Denver, CO, USA.
Background. During the 1980s, the Colorado Department of Health received reports from several high-altitude communities of clusters of the malformation craniosynostosis. In a population-based, case-control study, we examined the association between overall and trimester-specific maternal antenatal altitude exposure and the occurrence of infant craniosynostosis
Methods. We identified case children through a statewide registry and randomly sampled control children from birth records. By telephone interview, each mother provided data on the locations of all antenatal residences and places of employment as well as other factors. Staff mapped all locations and abstracted the corresponding altitudes.
Results. The odds ratio (OR) of any synostosis for a time-weighted mean antenatal altitude of >2000 metres (high altitude) versus <2000 metres (low altitude) was 1.4 (lower bound of the one-side 95% test-based confidence interval (Cl): 0.9). The OR was elevated in smokers but not in non-smokers. As compared to non-smokers, the OR of any synostosis for high-altitude smokers was 4.6 (lower bound of the 95% one-sided exact Cl: 1.7). Particularly elevated were the correspondinding OR of coronal (18.1, 4.4) and metopic synostosis (16.3, 2.8), and OR for high-altitude exposure during the second trimester (any synostosis: 6.4, 1.99; coronal 28.6, 6.1; metopic: 26.7, 4.1).
Conclusions. Antenatal maternal high-altitude exposure and smoking are associated with increased risk of infant craniosynostosis, perhaps through generation of intermittent hypoxaemia.
Received 1 September 1994
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