title: Talipes equinovarus and maternal smoking: a population-based case-control study in Washington state.
abstract: 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 random 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.
authors.affiliation: Department of Epidemiology, University of Washington School of Public Health and Community Medicine, Seattle, Washington 98195-7236, USA. askelly@u.washington.edu
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Skelly
authors.forename: Victoria L
authors.initials: VL
authors.lastname: Holt
authors.forename: Vincent S
authors.initials: VS
authors.lastname: Mosca
authors.forename: Beth W
authors.initials: BW
authors.lastname: Alderman
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002648:Child; D003025:Clubfoot / Q000453:epidemiology* / Q000209:etiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011247:Pregnancy; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects*; D014861:Washington / Q000453:epidemiology