Endocrine Disruptors in the Workplace, Hair Spray, Folate Supplementation, and Risk of Hypospadias: Case–Control Study Risk factor patterns for cryptorchidism and hypospadias. Craniosynostosis and maternal smoking. Maternal body mass index and lifestyle exposures and the risk of bilateral renal agenesis or hypoplasia: the National Birth Defects Prevention Study. A snapshot of the striking decrease in cigarette smoking prevalence in Brazil between 1989 and 2008. Is Maternal Obesity a Risk Factor for Anencephaly and Spina Bifida? Oral clefts and life style factors — A case-cohort study based on prospective Danish data Hypospadias in Washington State: Maternal Risk Factors and Prevalence Trends Risk factors for gastroschisis. Risk Factors for Congenital Cryptorchidism in a Prospective Birth Cohort Study In-utero exposure to smoking, alcohol, coffee, and tea and risk of strabismus. The possible role of endocrine disrupting chemicals in the aetiology of cryptorchidism and hypospadias: a population-based case-control study in rural Sicily. Maternal consumption of coffee and caffeine-containing beverages and oral clefts: a population-based case-control study in Norway. Maternal exposure to chemical and physical factors during pregnancy and cardiovascular malformations in the offspring. Differential misclassification of alcohol and cigarette consumption by pregnancy outcome. Maternal use of oral contraceptives during early pregnancy and risk of hypospadias in male offspring. Cryptorchidism According to Maternal Gestational Smoking Multiple malformations and maternal smoking. Geographic and occupational risk factors for ventricular septal defects: Washington State, 1987-2003. Maternal smoking and the risk for clubfoot in infants. Risk factors for cardiovascular malformation--a study based on prospectively collected data. Maternal, Delivery, and Perinatal Characteristics Associated with Cryptorchidism: A Population-Based Case-Control Study among Births in Washington State Infants with single ventricle: a population-based epidemiological study. Maternal Exposures to Cigarette Smoke, Alcohol, and Street Drugs and Neural Tube Defect Occurrence in Offspring Risk factors for cryptorchism among populations at differing risks of testicular cancer. Hypospadias and maternal exposures to cigarette smoke. Parental and neonatal risk factors for cryptorchidism. Periconceptional consumption of vitamins containing folic acid and risk for multiple congenital anomalies Periconceptional intake of vitamin supplements and risk of multiple congenital anomalies. Increased risk of craniosynostosis with maternal cigarette smoking during pregnancy. Congenital malformations and maternal smoking during pregnancy. A case-control study of maternal smoking and congenital malformations. Talipes equinovarus and maternal smoking: a population-based case-control study in Washington state. Etiological study of omphalocele Maternal smoking during pregnancy and the risk of congenital urinary tract anomalies. Maternal and gestational factors in cryptorchidism. Congenital Heart Defects, Maternal Febrile Illness, and Multivitamin Use: A Population-Based Study The National Birth Defects Prevention Study Young maternal age and smoking during pregnancy as risk factors for gastroschisis. Maternal smoking and congenital malformations: an epidemiological study. Maternal socioeconomic and lifestyle factors during pregnancy and the risk of congenital heart defects. Use of Prescription Drugs in the First Trimester and Congenital Malformations Multistate study of the epidemiology of clubfoot.
Background Hypospadias is one of the most common urogenital congenital anomalies affecting baby boys . Prevalence estimates in Europe range from 4 to 24 per 10,000 births , depending on definition , with higher rates reported from the United States . Relatively little is known about potential risk factors , but a role for endocrine-disrupting chemicals ( EDCs ) has been proposed . Objective Our goal was to eluci date the risk of hypospadias associated with occupational exposure of the mother to endocrine-disruptor chemicals , use of folate supplementation during pregnancy , and vegetarianism . Design We design ed a case – control study of 471 hypospadias cases referred to surgeons and 490 r and omly selected birth controls , born 1 January 1997–30 September 1998 in southeast Engl and .  Telephone interviews of mothers elicited information on folate supplementation during pregnancy and vegetarianism . We used a job exposure matrix to classify occupational exposure . Results In multiple logistic regression analysis , there were increased risks for self-reported occupational exposure to hair spray [ exposed vs. nonexposed , odds ratio ( OR ) = 2.39 ; 95 % confidence interval ( CI ) , 1.40–4.17 ] and phthalate exposure obtained by a job exposure matrix ( OR = 3.12 ; 95 % CI , 1.04–11.46 ) . There was a significantly reduced risk of hypospadias associated with of folate use during the first 3 months of pregnancy ( OR = 0.64 ; 95 % CI , 0.44–0.93 ) . Vegetarianism was not associated with hypospadias risk . Conclusions Excess risks of hypospadias associated with occupational exposures to phthalates and hair spray suggest that anti and rogenic EDCs may play a role in hypospadias .  Folate supplementation in early pregnancy may be protective To evaluate the hypothesis of a common etiology for cryptorchidism and hypospadias , we conducted two case-control studies nested in a nationwide cohort in Sweden , using record linkage between the Inpatient and Birth Registries . Cases were 2,782 and 1,220 boys operated for cryptorchidism or hypospadias , respectively . Five matched controls per case were r and omly selected . Pregnancy and perinatal data were prospect ively recorded in the Birth Registry . Data were modeled through conditional logistic regression . Both cryptorchidism ( odds ratio ( OR ) = 2.22 ) and hypospadias ( OR = 2.75 ) were positively associated with other congenital malformations and inversely with maternal parity ( OR = 0.77 and 0.52 , respectively , for parity 4 + compared with primiparae ) . There is evidence that being born small-for-gestational-age and before the 33rd gestational week have a greater-than-additive effect with respect to both cryptorchidism ( OR = 6.19 vs 1.72 expected ) and hypospadias ( OR = 4.39 vs 2.60 expected ) compared with non-small-for-gestational-age boys born at term . Hypospadias was positively associated with severe preeclampsia ( OR = 2.11 ) . We conclude that the etiologies of the two conditions are partly shared BACKGROUND Several previous studies suggested increased risk of craniosynostosis among infants born to women who smoked . METHODS This study used data from the National Birth Defects Prevention Study , a multi-state , population -based case-control study of infants delivered from 1997 - 2003 . Nonmalformed , liveborn controls were selected r and omly from birth certificates or birth hospitals . Data from maternal telephone interviews were available for 531 cases and 5008 controls . RESULTS Smoking during the first month of pregnancy was not associated with craniosynostosis . Smoking later in pregnancy was associated with increased risk , but only among mothers who smoked at least one pack/day . For example , during the second trimester , the odds ratio for smoking < 5 cigarettes/day was 1.0 ( 95 % confidence interval [ CI ] 0.6 , 1.8 ) , but the odds ratio ( OR ) for smoking 15 or more cigarettes/day was 1.6 ( 95 % CI 0.9 , 2.8 ) , after adjustment for maternal age , education , race-ethnicity , sub-fertility , parity , folic acid supplement intake , body mass index , and study center . Among women who did not smoke , adjusted odds ratios suggested that secondh and smoke exposure at home , but not at work/school , was associated with modestly increased risk ; the OR for home exposure was 1.3 ( 95 % CI 0.9 , 1.9 ) . Results followed a similar pattern for some , but not all , specific suture types , but numbers for some groupings were small . CONCLUSIONS The results suggest moderately increased risk of craniosynostosis among mothers who were the heaviest smokers and who continued to smoke after the first trimester . Results are somewhat equivocal , given that most confidence intervals included one Increased maternal body mass index , maternal smoking , and alcohol exposure during pregnancy have been inconsistently reported as potential risk factors for renal birth defects .  The low incidence of the most severe renal anomaly , bilateral renal agenesis or hypoplasia ( RA/H ) , has limited the ability to study this fatal defect . Using data from the National Birth Defects Prevention Study , a multicenter case-control study , the authors explored potential relations between RA/H and maternal body mass index , smoking , alcohol , and caffeine exposures . Data available for 75 infants with RA/H born between 1997 and 2003 and for r and omly selected control infants without known birth defects ( n = 868 ) were assessed by a model adjusted for folic acid use , all four exposures of interest , and study center . Bilateral RA/H was associated with a body mass index of greater than 30 kg/m(2 ) prior to pregnancy ( adjusted odds ratio ( aOR ) = 1.92 , 95 % confidence interval ( CI ) : 1.00 , 3.67 ) , smoking during the periconceptional period ( aOR = 2.09 , 95 % CI : 1.08 , 4.03 ) , and binge drinking during the second month of pregnancy ( aOR = 3.64 , 95 % CI : 1.19 , 11.1 ) . These results support the need for further exploration into the potential mechanisms by which such exposures could interfere with early fetal kidney formation result ing in OBJECTIVE To evaluate the differences in  cigarette smoking prevalence rates in Brazil between 1989 and 2008 . METHODOLOGY We calculated absolute and relative differences in smoking prevalences , overall and stratified by gender , age , place of residence , educational level and birth cohort . Data were obtained from r and om sample s from two National Household Surveys ( 1989,n=39,969 ; 2008,n=38,461 ) . GLM models were specified to obtain estimates and assess whether differences in proportions of smokers differed by categories of the stratification variables . RESULTS Adjusted absolute and relative differences in smoking prevalence rates between 1989 and 2008 were , respectively , -12.4 % and -41.0 % . Individuals aged 15 - 34 years and those with 9 or more years of education presented larger relative declines than their counterparts ( p(s)≤0.001 ) . After stratification by birth cohort , men presented larger reductions than women , only in the absolute scale ( p(s)≤0.001 ) , with the exception of the youngest birth cohort ( i.e.,1965 - 1974 ) . CONCLUSIONS In Brazil , several tobacco control measures have been adopted since 1986 , in particular increasing taxation of tobacco products and strong health warnings , which may have contributed to the marked decline in smoking prevalence . It is important to underst and the evolution of the tobacco epidemic to propose new actions to prevent initiation and encourage cessation among those who started/continued smoking & NA ; To determine whether the risk of having an infant with anencephaly or spina bifida is greater among obese women than among average‐weight women , we compared 307 Atlanta‐area women who gave birth to a liveborn or stillborn infant with anencephaly or spina bifida ( case group ) with 2,755 Atlantaarea women who gave birth to an infant without birth defects ( control group ) . The infants of control women were r and omly selected from birth certificates and frequency‐matched to the case group by race , birth hospital , and birth period from 1968 through 1980 . After adjusting for maternal age , education , smoking status , alcohol use , chronic illness , and vitamin use , we found that , compared with average‐weight women , obese women ( pregravid body mass index greater than 29 ) had almost twice the risk of having an infant with spina bifida or anencephaly ( odds ratio = 1.9 ; 95 % confidence limits = 1.1 , 3.4 ) . A woman 's risk increased with her body mass index : adjusted odds ratios ranged from 0.6 ( 95 % confidence limits = 0.3 , 2.1 ) for very underweight women to 1.9 for obese women This study examines the association between  oral clefts  and first trimester maternal lifestyle factors based on prospect i ve data from the Danish National Birth Cohort . The cohort includes approximately 100,000 pregnancies . In total 192 mothers gave birth to child with an oral cleft during 1997–2003 . Information on risk factors such as smoking , alcohol consumption , tea , coffee , cola , and food supplements was obtained during pregnancy for these and 828 r and omly selected controls . We found that first trimester maternal smoking was associated with an increased risk of oral clefts ( odds ratio ( OR ) : 1.50 ; 95 % confidence interval ( CIs ) : 1.05 , 2.14 ) . Although not statistically significant , we also saw associations with first trimester consumption of alcohol ( OR : 1.11 ; CIs : 0.79 , 1.55 ) , tea ( OR : 1.31 ; CIs : 0.93 , 1.86 ) , and drinking more than 1 l of cola per week ( OR : 1.40 ; CIs : 0.92 , 2.12 ) . Furthermore supplementation with ≥400 mcg folic acid daily during the entire first trimester ( OR : 0.75 ; CIs : 0.46 , 1.22 ) suggested an inverse associated with oral clefts , similar to our results on coffee drinking . No effects were found for smaller doses of folic acid , vitamin A , B6 or B12 in this study . The present study found an association between oral clefts and smoking and , although not conclusive , supports an association of oral cleft with alcohol Objective . Maternal risk factors for hypospadias are poorly defined , and there is debate about temporal trends in hypospadias prevalence . We examined select maternal characteristics as possible risk factors for hypospadias among male offspring and evaluated yearly prevalence rates in Washington State . Methods . We performed a population -based , case-control study using linked birth-hospital discharge data from Washington State for 1987–1997 and prevalence data for 1987–2002 . All cases of hypospadias were identified on the basis of International Classification of Diseases , Ninth Revision , codes from the birth hospitalization ( N = 2155 ) . Five control subjects were r and omly selected for each case subject from the remaining singleton births , frequency matched according to year of birth ( N = 10775 ) . Maternal and infant characteristics were ascertained from the birth certificate . Logistic regression was used to calculate odds ratios ( ORs ) and 95 % confidence intervals ( CIs ) . Yearly prevalence was determined by dividing the total number of hypospadias cases by the number of male singleton live births for each year . Results . The risk of delivering an affected male infant increased with advancing maternal age ; relative to women < 20 years of age , those > 40 years of age were at greatest risk ( OR : 1.70 ; 95 % CI : 1.17–2.48 ) . Infants of nonwhite women were generally at decreased risk . Infants born to women with preexisting diabetes mellitus were at greater risk than those born to women without diabetes ( OR : 2.18 ; 95 % CI : 1.03–4.60 ) ; however , this was not observed for infants born to women with gestational diabetes . The birth prevalence of hypospadias in 2002 was 5.0 cases per 1000 male births , not significantly different from that in 1987 . Conclusion . Older maternal age , white race , and preexisting diabetes were associated with increased risk of hypospadias among male offspring . The prevalence of hypospadias in Washington State did not increase significantly between 1987 and 2002 The prevalence at birth of  gastroschisis  , a rare abnormality of the abdominal wall , appears to have increased over the past decade . To characterize risk factors that might explain this increase , birth certificates for Washington State residents were compared for 62 infants born with gastroschisis during the years 1984 to 1987 and 617 r and omly selected unaffected infants matched for birth year . After simultaneously adjusting for 14 potential risk factors , 4 factors stood out . Infants born during January , February , or March were at greater risk than infants born in any other months ( odds ratio 2.2 , 95 % confidence interval 1.1 , 4.1 ) . Mothers less than 25 years old were at greater risk than mothers 25 years and older , with the highest risk to mothers less than 20 years old ( odds ratio 4.1 , 95 % confidence interval 1.4 , 12.0 ) . Women who smoked during pregnancy were at greater risk than women who did not smoke ( odds ratio 2.0 , 95 % confidence interval 1.03 , 3.8 ) . Finally , mothers receiving inadequate prenatal care were at greater risk than mothers receiving adequate prenatal care ( odds ratio 2.1 , 95 % confidence interval 0.99 , 4.6 ) . Unidentified behavioral and environmental exposures may explain the associations with month of birth , maternal age , and prenatal care . However , smoking during pregnancy is a plausible risk factor that should be examined further as an explanation of the apparently increasing prevalence at birth of gastroschisis in developed nations Background Risk factors for  congenital cryptorchidism  were investigated in a prospect i ve birth cohort study in Denmark and Finl and from 1997 to 2001 . Methodology and Principal Findings In total , 2,496 boys were examined for cryptorchidism at birth ( cryptorchid/healthy : 128/2,368 ) and three months old ( 33/2,215 ) . Information on risk factors was obtained antenatally ( question naire/interview ) or at birth from birth records . Use of nicotine substitutes during pregnancy ( n = 40 ) and infertility treatment by intrauterine insemination ( n = 49 ) were associated with an increased risk for cryptorchidism , adjusted odds ratio ( 95 % confidence interval ) ( OR ( 95%CI ) ) 3.04 ( 95%CI 1.00–9.27 ) and 3.01 ( 95%CI 1.27–7.15 ) , respectively . No association was seen for mothers ( n = 79 ) who had infertility treatment in form of intracytoplasmic sperm injection ( ICSI ) or in vitro fertilization ( IVF ) treatment ( OR 0.71 95%CI 0.21–2.38 ) . In total , 728 ( 29 % ) reported to have smoked during pregnancy , however , no increased risk among maternal smokers was found . Furthermore , we found statistically significant associations between cryptorchidism and low birth weight , prematurity , being small for gestational age , substantial vaginal bleeding , and breech presentation , which are in accordance with other studies . Conclusions and Significance Our study revealed two novel risk factors for cryptorchidism : intrauterine insemination and the use of nicotine substitutes in pregnancy . This suggests that cryptorchidism may not only be associated to genetic factors , but also to maternal lifestyle and exposure In a prospect i ve , population -based cohort study , the authors investigated the effect of in-utero exposure to maternal smoking and consumption of alcohol , coffee , and tea on the risk of strabismus .  They review ed medical records for children in the Danish National Birth Cohort identified through national registers as possibly having strabismus . Relative risk estimates were adjusted for year of birth , social class , maternal smoking , maternal age at birth , and maternal coffee and tea consumption . The authors identified 1,321 cases of strabismus in a cohort of 96,842 Danish children born between 1996 and 2003 . Maternal smoking was associated with a significantly elevated risk of strabismus in the child , increasing with number of cigarettes smoked per day ( < 5 cigarettes/day : relative risk ( RR ) = 0.95 , 95 % confidence interval ( CI ) : 0.80 , 1.14 ; 5-<10 cigarettes/day : RR = 1.38 , 95 % CI : 1.12 , 1.70 ; > or = 10 cigarettes/day : RR = 1.90 , 95 % CI : 1.57 , 2.30 ) . Nicotine replacement therapy was not associated with strabismus risk ( RR = 1.22 , 95 % CI : 0.92 , 1.61 ) . Light maternal alcohol consumption was inversely associated with strabismus risk , whereas maternal coffee and tea drinking were not associated with strabismus risk . In conclusion , smoking during pregnancy is associated with an increased risk of strabismus in the offspring . Conversely , light alcohol consumption is associated with decreased risk Abstract This was an open case-control study of the possible association between parental occupational and domestic exposures to potential endocrine disrupting chemicals ( EDC ) assessed by question naire and cryptorchidism and hypospadias in their offspring in the agricultural area of Ragusa . Cases of infants born between 1998 and 2002 with either of these two malformations ( n=90 ) , and controls ( n=203 ) , were recruited through the paediatric services ( for cases ) and a r and om sample of healthy infants attending the same services born in the same period of time ( for controls ) . Data on occupational and environmental exposures of parents prior to and during the index case ( or control ) , were collected through interviews with both parents . Concerning occupational exposures , we did not find a statistically significant increase in risk among parents directly involved in agricultural work . We did find a non-statistically significant increase in risk for cryptorchidism in mothers employed in agriculture [ adjusted odds ratios ( OR ) 2.97 ; 95 % confidence interval ( CI ) 0.77 - 11.47 ] and with probable exposure to pesticides ( adjusted OR 2.74 ; 95 % CI 0.72 - 10.42 ) . Fathers who had indirect contact with agricultural products ( transport and retail ) had an increased risk ( not statistically significant ) for cryptorchidism ( adjusted OR 2.45 ; 95 % CI 0.63 - 9.59 ) and hypospadias and cryptorchidism combined ( adjusted OR 2.24 ; 95 % CI 0.67 - 7.48 ) . Increases in risk of the two malformations pooled were also observed in relation to the mother 's age below 25 ( adjusted OR 1.99 ; 95 % CI 0.97 - 4.09 ) , to the presence of genital disease of the father ( adjusted OR 2.41 ; 95%C I0.94 - 6.17 ) , and the mother ( adjusted OR 3.47;95 % CI 1.34 - 8.99 ) , to low birth weight of the infant ( adjusted OR 4.49 ; 95 % CI 1.23 - 16.31 ) . Increased risk was also observed for mothers consuming alcohol during pregnancy ( adjusted OR 3.09 ; 95 % CI 0.98 - 9.66 ) , and for couples who conceived while using condoms ( adjusted OR 2.12 ; 95 % CI 1.02 - 4.41 ) . The study therefore provides only limited support to the hypothesis of a possible association between the risk of cryptorchidism and hypospadias and the occupational exposure to EDC and agricultural work A large , population -based case-control study of facial clefts was carried out in Norway between 1996 and 2001 . The study included 573 cases -- 377 with cleft lip with or without cleft palate and 196 with cleft palate only -- and 763 r and omly selected controls . Maternal consumption of coffee and other caffeine-containing beverages in early pregnancy was recorded shortly after birth . Compared with that for no coffee consumption , the adjusted odds ratios for cleft lip with or without cleft palate were 1.39 ( 95 % confidence interval : 1.01 , 1.92 ) for less than 3 cups a day and 1.59 ( 95 % confidence interval : 1.05 , 2.39 ) for 3 cups or more . Coffee consumption was not associated with risk of cleft palate only ( for > or = 3 cups vs. none , adjusted odds ratio = 0.96 , 95 % confidence interval : 0.55 , 1.67 ) . Tea consumption was associated with a reduced odds ratio of both cleft lip with or without cleft palate and cleft palate only . There was little evidence of an association between caffeine exposure and clefts when all sources of caffeine were considered . Adjustment for known confounding factors in general had minor effects on risk estimates . Still , the authors could not rule out the possibility of uncontrolled confounding by factors associated with the habit of drinking coffee The possible effect of chemical and physical factors during pregnancy on the occurrence of  cardiovascular malformations in the offspring was studied in 573 cases and 1,055 controls . The cases represented all verified cardiovascular malformations in Finl and during 1982 - 1984 . The controls were r and omly selected from all babies born during the same period . Case and control mothers were interviewed by midwives approximately 3 months after delivery using a structured question naire . Maternal alcohol consumption during the first trimester of pregnancy was more common among the mothers of case infants ( 45.9 % ) than those of controls ( 39.6 % ) . Exposure to organic solvents at work was slightly more prevalent among the ventricular septal defect group ( 12.1 % ) than the control mothers ( 7.8 % ) . However , neither association was significant when adjusted for maternal age in logistic regression analysis . Moreover , one or both of these associations may be chance effects result ing from multiple comparisons . The risk of cardiovascular malformations was not associated with maternal smoking , or coffee , tea , or cola consumption , and was equal in urban and rural areas . Maternal exposures to anesthetic gases , pesticides , wood preservatives , microwave ovens , and video display terminals at work or home were not associated with the risk of cardiovascular malformations . It is concluded that some common environmental exposures during early pregnancy to physical and chemical factors should not necessarily be considered hazardous for the developing fetal heart . The causes of the majority of cardiovascular malformations remain unknown BACKGROUND The validity of the results of studies using retrospectively collected information on exposures is often criticized , because cases may report differently from controls even if their true exposure status is the same . This study was performed to quantify the extent to which this effect ( differential misclassification ) may occur for alcohol and cigarette consumption by pregnancy outcome . METHODS Prospect i ve as well as retrospective information on alcohol and cigarette consumption was collected for 2806 mothers resident in all 12 provinces of the Netherl and s , who gave birth between 1978 and 1979 . Changes in mean reported consumption and changes from user to non-user based on retrospective and prospect i ve information were compared for cases and controls . This was done by calculating absolute differences ( retrospective minus prospect i ve ) in reported consumption and by calculating ' misclassification odds ratios ' . Further , conventional odds ratios based on retrospective information were compared with those based on prospect i ve information . Outcome measures were stillbirth , small for gestational age ( SGA ) , congenital malformations , preterm birth and low birthweight . RESULTS The only statistically significant result was found for smoking and SGA . Mothers with an SGA child retrospectively reported a higher number of cigarettes smoked than they had prospect ively , more so than mothers of a control child . However , the odds ratios of the relation between SGA and smoking based on prospect i ve and retrospective information , respectively , were virtually the same . CONCLUSIONS Our results suggest that information bias is unlikely to have a large influence on effect estimates in studies using retrospective information on alcohol and cigarette consumption OBJECTIVES To examine the association between maternal use of oral contraceptives in early pregnancy and increased prevalence of hypospadias in male offspring . METHODS We conducted a nationwide population -based case-control study using data from nationwide medical data bases . Among live male births between January 1 , 1996 , and December 31 , 2005 , we identified all cases of hypospadias recorded anytime postpartum ( n = 1683 ) and r and omly selected 10 controls per case without such a diagnosis ( n = 15 650 ) , matched by year and hospital of birth . We used conditional logistic regression to estimate prevalence ratios stratified according to time of diagnosis ( within 6 months postpartum , > 6 months postpartum ) , controlling for potential confounding factors including maternal age , birth order , maternal smoking , prescriptions for ovulation-inducing drugs , antiepileptics , and antidiabetics , and a maternal diagnosis of pre-eclampsia . RESULTS We included 1683 cases of hypospadias and 15,650 population controls during 1996 - 2005 . Among the 1186 boys who had their hypospadias diagnosis recorded within 6 months postpartum , 28 ( 2.4 % ) had been exposed to  oral contraceptives between 30 days before conception until the end of the first trimester . Among the controls , 307 ( 2.8 % ) were similarly exposed , corresponding to a prevalence ratio of 0.85 ( 95 % CI : 0.57 - 1.27 ) after adjusting for possible confounders . For a diagnosis registered > 6 months postpartum , the adjusted prevalence ratio was 1.12 ( 95 % CI : 0.61 - 2.06 ) . CONCLUSIONS Our data do not support the hypothesis that maternal use of oral contraceptives around conception is associated with an increased prevalence of hypospadias in the offspring Background : It has been suggested that maternal smoking during pregnancy is a risk factor for low sperm counts and testicular cancer in the offspring . Cryptorchidism is associated with both of these disorders and might share causal mechanisms . Methods : We used prospect i ve information on prenatal exposures and obstetric information on the birth of 5716 boys , collected from 1984 to 1987 . During the 16–19 years of follow-up , 270 cases of cryptorchidism were diagnosed , and 185 of these boys underwent orchiopexy . Results : Compared with nonsmokers , the adjusted risk ratio for being diagnosed with cryptorchidism was 1.1 ( 95 % confidence interval = 0.8–1.6 ) if the mothers smoked 10–19 cigarettes/day and 2.3 ( 1.1–5.0 ) if they smoked ≥20 cigarettes/day . The risk ratios for orchiopexy were 1.4 ( 0.9–2.1 ) and 1.8 ( 0.6–5.0 ) , respectively . Conclusion : An excess risk of cryptorchidism was observed among sons of mothers who smoked 10 cigarettes or more per day during pregnancy . In recognition of the limited power of this study , the findings should be replicated in larger cohorts The Swedish health registries were used to investigate a possible effect of  maternal smoking  on the incidence of  multiple malformations .  Among 1413811 infants born in 1983 - 96 and with known smoking exposure in early pregnancy , 26619 with isolated malformations and 1409 with two or more malformations were selected . After controlling for year of birth , maternal age , parity and educational level , a statistically significant association between maternal smoking and multiple malformations was found ( OR 1.15 ; 95 % CI 1.02 , 1.29 ) . Among isolated malformations , the estimated OR for maternal smoking was close to unity ( OR 1.02 ; 95 % CI 0.99 , 1.05 ) , but a strong heterogeneity of the magnitude of the association between maternal smoking and the different malformations was found . Among multimalformed , no such heterogeneity was indicated . The ORs for maternal smoking were calculated for all possible pairwise combinations of 44 selected malformations , but no association between maternal smoking and any specific combination could be detected . The ORs for maternal smoking among probable cases of VATER , CHARGE or OEIS non-r and om associations , respectively , were estimated , but no association was indicated between maternal smoking and any of the malformation complexes . The results of the present study indicate that maternal smoking is associated with a non-specific increased risk of multiple malformations , but further research is needed before such an inference can be made OBJECTIVE Ventricular septal defect ( VSD ) is currently the most common congenital cardiac malformation in the United States , but little is known about its etiology . The objective of this study was to address the hypothesis that parents ' residence in eastern Washington , a region heavily dominated by the agricultural industry , and employment in agriculturally related occupations can influence the presence of a VSD in their offspring . DESIGN Population -based case-control study . SETTING Washington State from January 1 , 1987 , through December 31 , 2003 . PATIENTS Children aged 0 to 2 years diagnosed as having a VSD ( n = 3489 ) , and other infants selected at r and om as control subjects ( n = 13 290 ) . MAIN EXPOSURES Parental occupation and county of maternal residence were obtained from the birth certificate . The latter was categorized according to region ( east vs west ) , rural-urban classification , and the proportion of farm and crop l and . MAIN OUTCOME MEASURES Diagnosis of VSD within the first 2 years of life . RESULTS The risk of VSD was greater for infants whose mothers resided in eastern Washington ( odds ratio , 1.30 ; 95 % confidence interval , 1.03 - 1.65 ) . The risk of VSD with other cardiac malformations ( n = 1205 ) exhibited a stronger geographic association than did isolated VSD ( n = 2284 ) . Analyses restricted to eastern Washington did not reveal a clear relationship between the risk of VSD and an increasing proportion of agricultural l and in the mother 's county of residence . Parental occupation in agriculture was not associated with the presence of VSD . CONCLUSION Although these findings suggest regional variation in Washington State in the occurrence of VSD , the basis for this variation remains to be determined BACKGROUND Clubfoot is one of the most common major birth defects , with a prevalence of approximately 1 per 1,000 live births . The etiology of clubfoot is complex and not well understood , and yet , few epidemiologic studies of risk factors have been conducted . Maternal smoking has been suggested as a possible risk factor . The purpose of this population -based , case-control study was to examine the association between maternal smoking and clubfoot . METHODS  Data from the North Carolina Birth Defects Monitoring Program matched to North Carolina birth certificates and health services data  were used in the analysis of 443 cases of clubfoot and 4,492 r and omly sample d controls for the years 1999 - 2003 . Smoking data were ascertained from the birth certificates , and the reliability of the data was assessed by comparing them with reported smoking from the North Carolina Pregnancy Risk Assessment Monitoring System . Multiple logistic regression was used to calculate crude and adjusted ORs and 95 % CIs for smoking and clubfoot . RESULTS The crude OR for maternal smoking during pregnancy and clubfoot was 1.49 ( 95 % CI : 1.15 , 1.92 ) . Controlling for maternal age , race/ethnicity , infant 's sex , and timing of prenatal care initiation did not appreciably change the results ( adjusted OR 1.40 ; 95 % CI : 1.07 , 1.83 ) . CONCLUSIONS This study is consistent with the hypothesis that smoking during pregnancy is associated with a slightly increased risk of an infant being born with clubfoot . Further research is needed to confirm this association , and to identify potential genetic factors that may modify the magnitude of the risk OBJECTIVES The aim of this study was to identify risk factors for cardiovascular malformation . METHODS In a case-referent study prospect ively collected data were obtained from original medical records . The study included 277 woman who had infants with a severe cardiac defect , and for each case two referents (  medical records study ) were included . Data on parental age , maternal reproductive history , disease in early pregnancy , reported maternal use of drugs and alcohol , smoking habits , parental occupation , and maternal body mass index ( BMI ) were extracted . When data were available from Swedish medical health registers , a comparison was made ( register study ) between all infants with cardiovascular defects ( 2208 ) and all infants born ( 175 768 ) . RESULTS Maternal diabetes mellitus was associated with an increased risk for cardiovascular malformation [ odds ratio ( OR ) 2.38 , 95 % confidence interval ( 95 % CI ) 1.36 - 4.15 ] , as was a high BMI ( > 29 ) ( OR 1.46 , 95%CI 1.12 - 1.90 ) . A tendency towards an increased risk was found for involuntary childlessness , spontaneous abortion , thyroid drugs , and nonsteroid anti-inflammatory drugs . CONCLUSIONS Some known risk factors for cardiac defects ( eg , maternal diabetes mellitus and the use of antiepileptics ) could be identified . Other postulated risk factors could not be verified , for example , paternal age and parental occupation . The use of medicinal drugs seems not to be a major factor in the etiology of cardiac defects . It is possible , however , that there is an association with the use of nonsteroid anti-inflammatory drugs or drugs for thyroid disease . The relationship between a high BMI and cardiovascular malformation observed in this study may be explained by impaired maternal glucose tolerance Background . The etiology of cryptorchidism is largely unknown . To identify maternal , perinatal , and delivery characteristics associated with cryptorchidism at birth , we conducted a population -based case-control study using Washington State birth certificates linked to birth hospitalization records . Methods . We identified 2,395 cases of cryptorchidism among male infants born in Washington State during 1986–1996 , and , for comparison , we r and omly selected four controls per case ( N = 9,580 ) , frequency-matched by year of birth . Results . Infant characteristics associated with cryptorchidism included low birth weight ( OR = 1.5 ; 95 % CI = 1.3–1.8 ) , small size for gestational age ( OR = 1.9 ; 95 % CI = 1.6–2.2 ) , and breech presentation ( OR = 1.7 ; 95 % CI = 1.4–2.1 ) . In addition to cryptorchidism , cases were more likely to have another type of congenital malformation ( OR = 3.7 ; 95 % CI = 3.2–4.2 ) , particularly digestive ( OR = 6.8 ; 95 % CI = 3.7–12.7 ) or genitourinary ( OR = 4.1 ; 95 % CI = 3.0–5.6 ) . Maternal and pregnancy characteristics associated with cryptorchidism included nulliparity ( OR = 1.2 ; 95 % CI = 1.1–1.3 ) , maternal smoking during pregnancy ( OR = 1.2 ; 95 % CI = 1.1–1.4 ) , and the following pregnancy complications : oligohydramnios ( OR = 1.8 ; 95 % CI = 1.3–2.6 ) , placental abnormality ( OR = 1.3 ; 95 % CI = 1.0–1.8 ) , and pregnancy-induced hypertension ( OR = 1.6 ; 95 % CI = 1.4–1.9 ) . Odds ratios were similar when the analysis was restricted to term infants . Conclusions . These findings suggest that factors affecting fetal growth and development may increase the risk of cryptorchidism BACKGROUND Single ventricle , a rare congenital cardiac defect , often occurs as part of a complex group of cardiovascular abnormalities . Little is known of its epidemiologic associations . METHODS Using data from the Baltimore-Washington Infant Study [ BWIS ] , ( 1981 - 89 ) , a population based case-control study of cardiovascular malformations , infants with single ventricle were evaluated with respect to infant and family characteristics and maternal and paternal exposures . The cases were analyzed according to presence/absence of abnormal cardio-visceral situs . Controls were 3,572 infants without heart defects r and omly selected from the regional cohort of live births . Odds ratios and 95 % confidence intervals were used as measures of association . RESULTS Single ventricle occurred in 1.25 % of infants with congenital cardiovascular defects in the BWIS . Fifty-five infants had  single ventricle . In 48 families ( 87.3 % ) the parents were interviewed . Thirty-three infants had normal situs and 15 had abnormal situs . Paternal alcohol consumption ( OR = 2.0 , 95 % CI 1.1 - 3.9 ) and paternal cigarette smoking ( OR = 2.4 , 95 % CI 1.1 - 5.1 ) were associated with all cases of single ventricle . These associations were even stronger in the subset of infants with abnormal situs . Maternal history of a previous induced abortion was also associated with infants born with abnormal situs ( OR = 3.2 , 95 % CI 1.1 - 11.5 ) . Paternal marijuana use was associated with cases of single ventricle in normal situs ( OR = 2.2 , 95 % CI 1.0 - 5.2 ) . CONCLUSIONS Potential risk factors included paternal smoking and alcohol consumption , highlighting the need for future studies to consider environmental factors in the pathogenesis of this cardiac defect Objectives Cigarettes , alcoholic beverages , and street drugs contain substances potentially toxic to the developing embryo . We investigated whether maternal cigarette smoking , secondh and smoke exposure , and alcohol or street drug use contributed to neural tube defect ( NTD ) occurrence in offspring . Methods We conducted a population -based case-control study among Mexican American women who were residents of the 14 Texas counties bordering Mexico . Case women had an NTD-affected pregnancy and delivered during 1995–2000 . Control women were those who delivered live born infants in the same study area , without an apparent congenital malformation , r and omly selected by year and facility . We interviewed women in person , 1–3 months postpartum , to solicit relevant information . Results Nonsmoking mothers exposed to secondh and smoke during the first trimester had an NTD odds ratio ( OR ) of 2.6 ( 95 % confidence interval ( CI ) = 1.6 , 4.0 ) compared to those who neither smoked nor were exposed to secondh and smoke . Compared to the referent , the OR among women who smoked less than half a pack a day during the first trimester was 2.2 ( 95 % CI = 1.0 , 4.8 ) and 3.4 ( 95 % CI = 1.2 , 10.0 ) among those who smoked a half pack or more . Adjustment for maternal age , education , body mass index , and folate intake had a negligible effect on results . Alcohol and street drug use had no relation to NTD risk when adjusted for cigarette smoking . Conclusions This study suggests that cigarette smoke including secondh and exposure is not only hazardous to the mother but may also interfere with neural tube closure in the developing embryo BACKGROUND Cryptorchism is strongly associated with the development of testicular germ cell tumours ( TGCTs ) , possibly owing to a common aetiology . However , while TGCT incidence varies greatly between white and black men , little variability has been reported between the two groups in cryptorchism prevalence . This may suggest that cryptorchism risk factors differ by ethnicity . METHODS To examine this hypothesis , a prospect i ve analysis was conducted among black and white participants in the US Collaborative Perinatal Project . White participants included 238 cryptorchid sons and 12,296 non-cryptorchid sons , while black participants included 188 cryptorchid sons and 11,942 non-cryptorchid sons . RESULTS While cryptorchism was significantly more common among white sons ( 1.90 % vs 1.55 % ; P = 0.04 ) , the difference was incompatible with the 5-fold difference in TGCT rates . The principal maternal risk factors among white sons were age ( P = 0.03 ) , hypertension/proteinuria ( P = 0.006 ) , and length of time to become pregnant ( P = 0.055 ) , while major maternal risk factors among black sons were age ( P = 0.06 ) , height ( P = 0.007 ) , weight ( P = 0.06 ) , and radiation exposure ( P = 0.02 ) . Only maternal height , however , had a different relationship with risk among black and white sons . Neonatal associations with risk ( shorter gestational age , lower birthweight , shorter length ) were similar in the two groups . CONCLUSIONS These results do not support the hypothesis that the risk factors for cryptorchism vary dramatically by ethnicity but may suggest that cryptorchism is not as closely linked to TGCT  among black men as among white men The few previous studies of hypospadias and smoking have suggested either no association or a reduced risk . This study , which uses data from the National Birth Defects Prevention Study , a multi-state , population -based case-control study , includes data on males born with severe hypospadias ( i.e. the urethra opens at the penile shaft , scrotum or perineum ) from 1997 to 2000 . Non-malformed , liveborn male controls were selected r and omly from birth certificates or from birth hospitals .  Maternal interviews were completed by telephone with 453 case mothers and 1267 control mothers . Maternal smoking was not associated with hypospadias risk . For example , during the third month of pregnancy , smoking < 0.5 pack/day had an odds ratio ( OR ) of 1.1 [ 95 % CI 0.6 , 1.9 ] ; 0.5 pack/day , 0.6 [ 0.4 , 1.1 ] ; and > or = 1 pack/day , 0.8 [ 0.4 , 1.6 ] . Exposure to any secondh and smoke at home during the third month of pregnancy showed an OR of 0.6 [ 95 % CI 0.4 , 1.0 ] , and exposure at work or school , an OR of 0.7 [ 0.5 , 1.1 ] . Similar risks were observed for other months during the periconceptional period , and adjustment for several potential confounders did not substantially alter results . This analysis does not confirm a recent report suggesting that maternal smoking is associated with a reduced risk of having offspring with hypospadias BACKGROUND Cryptorchidism is one of the most common congenital malformations in males . As male sexual differentiation is critically dependent on normal and rogen concentrations , increased exposure to environmental factors affecting and rogen homeostasis during fetal life may cause cryptorchidism . We investigated the relation between cryptorchidism and lifestyle , occupational exposure and the characteristics of parents and /or the perinatal and delivery characteristics . MATERIAL / METHODS Case-control study conducted among the eligible 96 cases underwent orchiopexy between 1990 and 2003 and 116 controls were enrolled among boy out patients born in between 1985 and 2001 and who were determined by pediatricians not to have genitourinary malformation . All the cases and controls were surveyed between 1999 and 2003 in Japan . RESULTS We found significant positive associations between cryptorchidism and cesarean section ( OR=2.19 , 95 % CI=1.09 - 4.40 ) , paternal smoking before and during pregnancy ( OR=1.87 , 95 % CI=1.03 - 3.37 and OR=1.94 , 95 % CI=1.08 - 3.50 , respectively ) and paternal exposure to diesel exhaust before and during pregnancy ( OR=2.42 , 95 % CI=1.06 - 5.55 and OR=2.35 , 95 % CI=0.99 - 5.59 , respectively ) . CONCLUSIONS We found associations of cryptorchidism with unusual delivery and paternal smoking during pregnancy . These findings suggested that cryptorchidism might be associated with not only genetic factors but also increased parental exposure to environmental factors . In the future , prospect i ve study is needed to do risk assessment accurately in the hormone-dependent stages of pregnancy critical for testicular descent Although it has been well established that periconceptional use of multivitamins containing folic acid ( FA ) reduces the risk for neural tube defects , two recent U.S. studies have shown an increased risk for multiple congenital anomalies ( MCAs ) associated with periconceptional use of vitamins containing FA . This study assessed the association between the periconceptional use of vitamins containing FA and MCAs in a third U.S. population . Mothers of infants with MCAs and a r and om sample of live births ( control infants ) born in Iowa during 1993–1995 were eligible to participate in the Birth Defects Risk Factor Surveillance case‐control study . During a telephone interview , participants reported on exposure to FA through vitamins , cereal , and food supplements . There was no association between taking vitamins containing FA during the periconceptional period ( 3 months before conception through the first trimester ) and MCAs in the crude estimates or after adjusting for maternal race or ethnicity , education , gravidity , smoking , or alcohol use in the first trimester , or body mass index prior to pregnancy [ adjusted odds ratio ( aOR ) = 1.12 , 95 % confidence interval ( CI ) 0.75–1.69 ] . There was also no association between vitamin exposure beginning in the first trimester and MCAs outcome ( aOR = 1.05 , 95 % CI 0.59–1.87 ) . In contrast to the two recently published reports , there was no association between periconceptional vitamin exposure and MCAs in the Iowa population . Published 2007 Wiley‐Liss , Numerous studies have reported reduced risks for a variety of single congenital anomaly phenotypes associated with maternal periconceptional use of vitamin supplements containing folic acid . Here we investigated whether periconceptional use of vitamin supplements containing folic acid by women altered their risk for delivering infants with multiple congenital anomalies ( MCAs ) .  Data were derived from a case-control study representing deliveries ( fetal deaths and infants ) from 2 California counties between January 1993 and July 1996 .  MCAs were defined as 2 or more congenital anomalies affecting more than one organ system or a major anomaly in combination with 2 minor anomalies . Controls were r and omly selected from nonmalformed live-born infants .  Telephone interviews were conducted with 112 ( 73.7 % of eligible ) case and 195 ( 78.0 % of eligible ) control mothers . Compared to women who did not use multivitamin supplements containing folic acid in the period 3 months before through 3 months after conception , women who used in this time period were observed to have an elevated risk to deliver fetuses or infants with MCAs , odds ratio = 2.6 ( 95 % confidence interval 1.1 - 6.2 ) . This elevated risk was not substantially altered ( adjusted odds ratio = 2.9 [ 0.8 - 10.3 ] ) by adjusting for maternal race/ethnicity , education , gravidity , body mass index , alcohol consumption , and cigarette smoking . No particular organ system seemed to be uniquely represented among the MCA fetuses and infants whose mothers used vitamin supplements . The observed elevated risk associated with maternal vitamin use is considered to be preliminary and needs to be replicated in other population We analyzed data from a population -based case control study to determine whether maternal prenatal smoking or alcohol drinking  might increase the  risk of craniosynostosis . Between 1986 and 1989 , the Colorado Craniosynostosis Registry ascertained 233 children whose diagnoses were confirmed by an independent radiologist . Of the 212 ( 91 % ) cases who participated 86 had lambdoid , 69 had sagittal , 25 had coronal , 18 had metopic , and 14 had multiple suture synostosis . R and om sampling of birth certificate records yielded 367 eligible controls , of whom 291 ( 79 % ) participated . Study staff interviewed case and control mothers between 1989 and 1991 for  prenatal smoking and alcohol drinking .  We used Mantel-Haenszel and polychotomous logistic regression techniques to estimate the relative odds of craniosynostosis for smoking and drinking in all cases and in relevant case subgroups . Smoking was associated with a relative odds of craniosynostosis of 1.7 ( 95 % confidence interval , 1.2 - 2.6 ) . For smoking of more than one pack per day , the relative odds were 3.5 ( 1.5 - 8.4 ) for all types of synostosis combined , and 5.6 ( 2.1 - 15.3 ) for coronal synostosis . No strong or significant association was noted for drinking .  Maternal prenatal smoking may increase the risk of craniosynostosis in this population The relationship between  smoking during pregnancy and congenital malformations was studied in prospect i ve studies of 33,434 live births in the Kaiser-Permanente Birth Defects Study and 53,512 live births in the Collaborative Perinatal Project ( CPP ) . In the Kaiser study , statistically significant positive associations ( P less than .05 ) were observed for ventral hernias , omphaloceles , and " other major gut abnormalities , " but , for each comparison the estimates were based on one or two unexposed cases . Statistically significant negative associations were found for ventricular septal defects ( odds ratio , 0.5 [ 95 % confidence interval , 0.2 - 0.96 ] ) , hydroceles ( 0.7 [ 0.6 - 0.9 ] ) , clubfoot ( 0.7 [ 0.6 - 0.9 ] ) , pigmented nevi ( 0.7 [ 0.6 - 0.9 ] ) , hemangiomas ( 0.8[0.7 - 0.98 ] ) and Down syndrome ( 0.2 [ 0.1 - 0.9 ] ) . To determine if the findings noted above were an artifact of multiple comparisons , seven of these nine malformations were analyzed by smoking status for women in the CPP . All but one of the associations were not confirmed in the CPP . Previously described associations between smoking and specific congenital malformations were also tested using data from the CPP . We conclude that smoking is unlikely to be responsible for a large increase in malformations at birth We conducted a population -based case-control study to assess the association between  maternal smoking during pregnancy and the risk of giving birth to a child with a congenital malformation . Cases were all singleton livebirths with a congenital malformation recorded on the 1984 - 1986 Washington State Birth Records ( n = 3284 ) . The smoking histories of these mothers were compared to a r and omly selected group of mothers with a singleton livebirth of a child without a malformation during these same years ( n = 4500 ) . When all malformations were taken as a group , there was no association with maternal smoking ( relative risk ( RR ) = 1.0 , 95 % CI 0.9 - 1.1 ) . However , increased risks were observed for a number of specific malformations , including microcephalus ( RR = 2.0 , 95 % CI 1.0 - 4.0 ) , cleft defects ( RR = 1.4 , 95 % CI 1.0 - 2.0 ) , and club foot ( RR = 1.4 , 95 % CI 1.0 - 2.0 ) . We did not find any association with Down 's syndrome ( RR = 0.8 95 % CI 0.5 - 1.3 ) or any other malformation . We conclude that maternal smoking during pregnancy may be associated with an increased risk for some malformations BACKGROUND Talipes equinovarus ( TEV ) , also called congenital idiopathic clubfoot , true clubfoot and common clubfoot , is one of the most common major birth defects . Its correction is often difficult and expensive . Its etiology is poorly understood and few analytic epidemiological studies have been devoted to exploring specific risk factors for TEV . METHODS Our population -based study consists of 239 documented cases of idiopathic TEV obtained from hospital and outpatient sources and 365 controls identified via r and om digit dialing from five Western Washington counties .  Structured maternal interviews were conducted by trained interviewers and multiple logistic regression used to evaluate associations between maternal smoking and birth of a child with TEV . RESULTS Our study shows strong associations between maternal smoking and idiopathic TEV .  Case mothers were more likely to have smoked during pregnancy ( OR = 2.2 ; 95 % CI = 1.5 , 3.3 ) . Increased TEV risk was seen with increased smoking and estimates ranged from 1.5 for the lightest smokers to 3.9 for the heaviest smokers . Gender specific differences in risk were also noted with risk estimates of 1.8 ( 95 % CI = 1.2 , 3.0 ) for boys whose mothers smoked during pregnancy and 2.8 ( 95 % CI = 1.4 , 5.4 ) for girls . Trends for increased risk with higher numbers of cigarettes were noted for both genders . For isolated TEV , the overall odds ratio ( OR ) for smoking was 2.4 ( 95 % CI = 1.6 , 3.6 ) with a range from 1.4 - 4.6 . No confounders were noted . CONCLUSIONS As postulated , maternal smoking during pregnancy appears to increase the risk of having a child with  idiopathic clubfoot  and the number of cigarettes smoked influence that risk . Further delineation of dose-response is warranted as are continued efforts to decrease maternal smoking during pregnancy Summary The epidemiological , teratological and genetic data on 134 index patients with omphalocele ( 79 isolated and 55 multiple ones ) and on 134 matched controls born in Hungary 1970–1976 were studied from medical records and by retrospective interview . The stillbirth rate and infant mortality are significantly higher , and there is intrauterine weight retardation and more frequent preterm delivery . The distribution of maternal age-groups shows a ‘ U-shaped ’ trend in isolated omphalocele . Spontaneous abortions were significantly higher , particularly in previous pregnancies of mothers of index patients . A strikingly higher incidence of early and late toxaemia was found in the pregnancies of mothers of the isolated omphalocele group . Sib occurrence was not found in 161 brothers and sisters . Thus amniotic fluid AFP examination is not recommended in subsequent pregnancies . The occurrence of other congenital abnormalities corresponds to ‘ r and om ’ risk To study maternal smoking during pregnancy and the risk of congenital urinary tract anomalies , we interviewed mothers of 118 affected infants born to residents of western Washington State during 1990 and 1991 and mothers of 369 control infants r and omly selected from those without birth defects delivered during those years in five hospitals in King County , Washington . Maternal smoking was associated with an increased risk of congenital urinary tract anomalies in offspring ( adjusted odds ratio [ OR ] = 2.3 ; 95 % confidence interval [ CI ] = 1.2 , 4.5 ) . This risk was higher among light smokers ( 1 - 1000 cigarettes during the pregnancy ) ( OR = 3.7 ; 95 % CI = 1.7 , 8.6 ) than among heavy smokers ( OR = 1.4 ; 95 % CI = 0.6 , 3.3 ) . Our results corroborate previous findings and support the hypothesis of a causal relation Previous epidemiological studies of cryptorchidism have led to the hypothesis that the risk of undescended testis is associated with excess oestrogen exposure during pregnancy . A case-control study was undertaken to test this hypothesis , comparing mothers of affected boys ( 244 ) and normal male births ( 488 ) born within six months of a case selected r and omly from the British Columbia population . Information was collected on the mother 's reproductive history , family history , and past medical history , and events surrounding all pregnancies ending in a birth . The results were analysed using both the population -based sample of male births and the male sibs of cases as control groups . Neither exogenous oestrogen exposure , nor any of the pregnancy-related variables hypothesized to be indirect indicators of endogenous oestrogen exposure , including bleeding and nausea and /or vomiting , were found to be significantly associated with risk of undescended testes in either comparison . More mothers with later index births reported menstrual irregularity greater than half the time , and smoking , thought to have a protective effect , was more prevalent among case mothers than control mothers . No other variables were significantly different between case and control mothers . The results of this study do not support the hypothesis that elevated exogenous or endogenous oestrogen exposure during pregnancy increases the risk of undescended testis in male children We assessed the relation between febrile illness during pregnancy and cardiac defects in the offspring in a population -based case-control study in metropolitan Atlanta . Case infants ( 905 ) with cardiac defects were actively ascertained from multiple sources . Control infants ( 3,029 ) were infants without birth defects who were selected from birth certificates by stratified r and om sampling . We compared those whose mothers reported febrile illness from 1 month before pregnancy through the third month of pregnancy with those whose mothers reported no illness during the same period . Febrile illness was positively associated with the occurrence of heart defects in the offspring ( odds ratio [ OR ] = 1.8 ; 95 % confidence interval = 1.4–2.4 ) . When influenzalike illness was the reported febrile illness , the OR was 2.1 ( 95 % confidence interval = 0.8–5.5 ) . The association with febrile illness was strongest for tricuspid atresia ( OR = 5.2 ) , left obstructive defects ( OR = 2.7 ) , transposition of the great arteries ( OR = 1.9 ) , and ventricular septal defects ( OR = 1.8 ) . These ORs were generally lower among mothers who used multivitamins during the periconceptional period The National Birth Defects Prevention Study was design ed to identify infants with major birth defects and evaluate genetic and environmental factors associated with the occurrence of birth defects . The ongoing case-control study covers an annual birth population of 482,000 and includes cases identified from birth defect surveillance registries in eight states . Infants used as controls are r and omly selected from birth certificates or birth hospital records . Mothers of case and control infants are interviewed and parents are asked to collect buccal cells from themselves and their infants for DNA testing . Information gathered from the interviews and the DNA specimens will be used to study independent genetic and environmental factors and gene-environment interactions for a broad range of birth defects . As of December 2000 , 7470 cases and 3821 controls had been ascertained in the eight states . Interviews had been completed with 70 % of the eligible case and control mothers , buccal cell collection had begun in all of the study sites , and research ers were developing analysis plans for the compiled data . This study is the largest and broadest collaborative effort ever conducted among the nation 's leading birth defect research ers . The unprecedented statistical power that will result from this study will enable scientists to study the epidemiology of some rare birth defects for the first time . The compiled interview data and banked DNA of approximately 35 categories of birth defects will facilitate future research as new hypotheses and improved technologies emerge Three maternal risk factors ( maternal age , cigarette smoking , and infant 's month of birth ) have been reported to be associated with  fetal gastroschisis .  In order to study these risk factors further , a prospect i ve population -based study was design ed , using 62,103 consecutive second-trimester singleton pregnancies enrolling in a maternal serum alpha-fetoprotein screening program between January 1 , 1980 and April 30 , 1989 . Gastroschisis  occurred in 21 of those pregnancies . Pregnancies in women younger than 20 years of age were at 7.3 times greater odds for being affected with gastroschisis than pregnancies in women aged 25 or older ( 95 % confidence interval 2.4 to 22 ) . For pregnant women aged 20 to 24 years , the odds were 1.9 times greater ( 95 % confidence interval 0.7 to 5.0 ) . Pregnant women who smoked cigarettes were at 2.1 times greater odds than non-smokers ( 95 % confidence interval 0.9 to 4.8 ) . When these smoking data were combined with smoking data from two other published studies , the consensus odds ratio was 1.6 ( 95 % confidence interval 1.2 to 2.2 ) . Infant 's month of birth was not associated with gastroschisis . Evidence from the present study and other published studies clearly establishes a greater risk for fetal gastroschisis in pregnant women younger than age 20 , even after adjustment for smoking status . Cigarette smoking also appears to be a risk factor , when data from this and two previously published studies are combined In a case-control study undertaken in several hospitals in Connecticut , it was found that women who reported smoking more than 20  cigarettes a day during pregnancy had a relative risk of about 1.6 for congenital malformations in the offspring of that pregnancy compared with women who said they had not smoked at all during pregnancy . However , there was no significant increase in risk among women who reported smoking 20 or fewer cigarettes a day during pregnancy compared with those who said they had not smoked at all during pregnancy . The higher risk among moderate and heavy smokers could not be attributed to any of the potentially confounding variables considered in this study ; furthermore , it was specific to smoking during pregnancy rather than before pregnancy , and increased with the average amount smoked a day . Nevertheless , because the increase in risk was modest , because response bias could exist in a study of this type , and because no other studies have examined in detail the smoking-congenital malformation hypothesis , further research is needed to determine whether the relationship between maternal smoking  and congenital malformations in offspring is causal UNLABELLED The objective of study was to estimate the importance of maternal socioeconomic and lifestyle factors during pregnancy in the risk of congenital heart defects in Kaunas infant population in 1999 - 2005 . MATERIAL AND METHODS An epidemiological case-control study was conducted . The study comprised 187 newborns with congenital heart defects ( cases ) and 643 r and omly selected newborns without any defects ( controls ) , born in Kaunas city during 1999 - 2005 . Modern epidemiological methods were used for data analysis . A multivariate logistic regression was used to determine adjusted risk factors of congenital heart defects . RESULTS The logistic multivariate regression analysis showed that low and moderate maternal education significantly increased the risk of congenital heart defects ( primary or basic [ OR=3.43 ; 95 % CI , 1.54 - 7.64 ] and secondary [ OR=1.56 ; 95 % CI , 1.00 - 2.45 ] vs advanced vocational or higher education ) . The housewives and workers had a higher risk of delivering a newborn with congenital heart defects than the office workers ( OR=2.34 ; 95 % CI , 1.34 - 4.10 and OR=1.28 ; 95 % CI , 0.79 - 2.07 , respectively ) . Maternal smoking during pregnancy tended to increase the risk of congenital heart defects by 48 % ( OR=1.48 ; 95 % CI , 0.82 - 2.67 ) . CONCLUSIONS According to our study results , unfavorable maternal socioeconomic factors and smoking during pregnancy increased the risk of congenital heart defects Summary : A prospect i ve survey of prenatal use of prescription drugs in Tasmania yielded detailed information on drug exposure , delivery and outcome for 56,037 births from 1982 to 1989 . First trimester drug use was reported by 30.9 % of women , and 17.9 % used only supplements of vitamins and /or minerals ; 40 % used alcohol during the first trimester , and 28.8 % smoked cigarettes . There were 1,035 ( 1.85 % ) congenital malformations , of which 885 ( 85.5 % ) were major . The malformation rate was not significantly different in the following exposure categories : supplements only ( 1.62 % ) ; other pharmaceuticals ( 1.92 % ) ; smokers ( 1.88 % ) ; alcohol users ( 1.89 % ) ; and maternal age 35 or more years ( 1.95 % ) . Adjusting for alcohol use , smoking , maternal age and diabetes mellitus , significant associations [ expressed as adjusted odds ratio and 95 % confidence intervals ( CI ) ] were found between aspirin and hypospadias ( 3.5 , 95 % CI 1.4 to 8.8 ) ; dicyclomine and phocomelia ( 4.4 , 95 % CI 1.0 to 19.5 ) ; and between oral contraceptive use and pes cavus ( 9.7 , 95 % CI 2.3 to 40.4 ) . Although significant , these associations were based on very few cases and no direct supporting evidence could be found from other data sources BACKGROUND Although clubfoot is a common birth defect , with a prevalence of approximately 1 per 1000 livebirths , the etiology of clubfoot remains largely unknown . Studies of the prevalence and risk factors for clubfoot in the United States have previously been limited to specific states . The purpose of this study was to pool data from several birth defects surveillance programs to better estimate the prevalence of clubfoot and investigate its risk factors . METHODS The 10 population -based birth defects surveillance programs that participated in this study ascertained 6139 cases of clubfoot from 2001 through 2005 . A r and om sample of 10 controls per case , matched on year and state of birth , was selected from birth certificates . Data on infant and maternal risk factors were collected from birth certificates . Prevalence was calculated by pooling the state-specific data . Conditional logistic regression was used to investigate the association between risk factors and clubfoot . RESULTS The overall prevalence of clubfoot was 1.29 per 1000 livebirths ; 1.38 among non-Hispanic whites , 1.30 among Hispanics , and 1.14 among non-Hispanic blacks or African Americans .  Maternal age , parity , education , and marital status were significantly associated with clubfoot . Maternal smoking and diabetes also showed significant associations . Several of these observed associations were consistent between surveillance programs . CONCLUSIONS We estimated the prevalence of clubfoot using data from several birth defects programs , representing one-quarter of all births in the United States . Our findings underline the importance of birth defects surveillance programs and their utility in monitoring population -based prevalence and investigating risk factors
This systematic review aim ed to investigate the association between maternal smoking during pregnancy and birth defects in children .