title: The risk of birth defects in multiple births: a population-based study.
abstract: OBJECTIVE
  To determine if multiple births have higher risks of birth defects compared to singletons and to identify types of birth defects that occur more frequently in multiple births, controlling for seven sociodemographic and health-related variables.
  
  
  METHODS
  A retrospective cohort study was conducted of all resident live births in Florida during 1996-2000 using data from a population-based surveillance system. Birth defects were defined as in the 9th edition of the International Classification of Diseases-Clinical Modification (ICD-9-CM) code for the 42 reportable categories in the Centers for Disease Control and Prevention (CDC) Birth Defects Registry list and eight major birth defects classifications. Relative risks (RR) before and after adjusting for control variables and 95% confidence intervals (95% CI) were calculated. The control variables included mother's race, age, previous adverse pregnancy experience, education, Medicaid participation during pregnancy, infant's sex and number of siblings.
  
  
  RESULTS
  This study included 972,694 live births (27,727 multiple births and 944,967 singletons). Birth defects prevalence per 10,000 live births was 358.50 for multiple births and 250.54 for singletons. After adjusting for control variables, multiple births had a 46% increased risk of birth defects compared to singletons. Higher risks were found in 23 of 40 birth defects for multiple births. Five highest adjusted relative risks for birth defects among multiple births were: anencephalus, biliary atresia, hydrocephalus without spina bifida, pulmonary valve atresia and stenosis, and bladder exstrophy. Increased risks were also found in 6 out of 8 major birth defects classifications.
  
  
  CONCLUSIONS
  Multiple births have increased risks of birth defects compared to singletons.
authors.affiliation: Department of Pediatrics, College of Medicine, University of Florida, PO Box 100296, Gainesville, FL, 32610, USA. tyiwei@ufl.edu
authors.forename: Yiwei
authors.initials: Y
authors.lastname: Tang
authors.forename: Chang-Xing
authors.initials: CX
authors.lastname: Ma
authors.forename: Wei
authors.initials: W
authors.lastname: Cui
authors.forename: Vivian
authors.initials: V
authors.lastname: Chang
authors.forename: Mario
authors.initials: M
authors.lastname: Ariet
authors.forename: Steven B
authors.initials: SB
authors.lastname: Morse
authors.forename: Michael B
authors.initials: MB
authors.lastname: Resnick
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Roth
mesh_terms: D000328:Adult; D000367:Age Factors; D015331:Cohort Studies; D000013:Congenital Abnormalities / Q000453:epidemiology* / Q000208:ethnology; D004522:Educational Status; D005260:Female; D005431:Florida / Q000453:epidemiology; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D009099:Multiple Birth Offspring / Q000706:statistics & numerical data*; D010298:Parity; D016012:Poisson Distribution; D011159:Population Surveillance; D011247:Pregnancy; D015995:Prevalence; D044469:Racial Groups; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014798:Vital Statistics