Last data update: May 13, 2024. (Total: 46773 publications since 2009)
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Perspectives from the founding CDC leadership of the National Birth Defects Prevention study
Moore CA , Yoon PW , Edmonds LD , Erickson JD . Birth Defects Res A Clin Mol Teratol 2015 103 (8) 649-51 The Centers for Disease Control and Prevention (CDC) conducted its first formal case-control study to better understand the causes of major birth defects in the early 1980s (Erickson et al., 1984). The primary purpose of the study was to evaluate the possible causal contribution of paternal experiences during military service in Vietnam, with particular emphasis on exposures to the herbicide known as “Agent Orange.” The cases and controls were drawn from births that occurred in the Atlanta, Georgia area, where CDC has operated a birth defects surveillance program since 1967. The case-control design permitted evaluation of a wide array of potential maternal exposures that might cause birth defects, as well as additional paternal influences (Erickson, 1991). For example, the study identified a neural tube defect preventive benefit of periconceptional multivitamin use which paved the way for folic acid intervention to prevent neural tube defects (Mulinare et al., 1988). | Building on this experience, the CDC launched the multicenter National Birth Defects Prevention Study (NBDPS) in 1997 to advance understanding of the causes of birth defects. Because the causes of most birth defects are unknown and might be preventable if risk factors are identified, the NBDPS focused on birth defects of unknown etiology (Holmes, 1989). These included neural tube defects, congenital heart defects, orofacial clefts, limb deficiencies, abdominal wall defects, intestinal atresias, and other major birth defects that can be reliably ascertained in early infancy. One unique aspect of the NBDPS addressed the variability of birth defects classification across previous epidemiologic studies. In an effort to increase homogeneity within analytic groups of defects, clinical geneticists collaborated to develop classification guidelines that were applied across the study sites (Rasmussen et al., 2003). This and other efforts to coordinate work and maintain consistent methodology across participating Centers in multiple states, improved the power of NBDPS to identify potential causes of specific birth defects despite the relatively low prevalence of each individual defect type. This is particularly important for studying the epidemiology of birth defects because to date, exposures identified as causing birth defects have a relatively specific impact on one or a few types of birth defects rather than increasing the risk of all birth defects (Tinker, Gilboa, et al., 2015). The NBDPS methods and final counts of data collected are summarized by Reefhuis et al. in this issue (Reefhuis et al., 2015), and the strengths and weaknesses of the NBDPS have been assessed (Dolk, 2015). |
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