title: Anencephaly and spina bifida among Hispanics: maternal, sociodemographic, and acculturation factors in the National Birth Defects Prevention Study.
abstract: BACKGROUND
  We used data from the multisite National Birth Defects Prevention Study for expected delivery dates from October 1997 through 2003, to determine whether the increased risk in anencephaly and spina bifida (neural tube defects (NTDs)) in Hispanics was explained by selected sociodemographic, acculturation, and other maternal characteristics.
  
  
  METHODS
  For each type of defect, we examined the association with selected maternal characteristics stratified by race/ethnicity and the association with Hispanic parents' acculturation level, relative to non-Hispanic whites. We used logistic regression and calculated crude odds ratios (ORs) and their 95% confidence intervals (CIs).
  
  
  RESULTS
  Hispanic mothers who reported the highest level of income were 80% less likely to deliver babies with spina bifida. In addition, highly educated Hispanic and white mothers had 76 and 35% lower risk, respectively. Other factors showing differing effects for spina bifida in Hispanics included maternal age, parity, and gestational diabetes. For spina bifida there was no significant elevated risk for U.S.-born Hispanics, relative to whites, but for anencephaly, corresponding ORs ranged from 1.9 to 2.3. The highest risk for spina bifida was observed for recent Hispanic immigrant parents from Mexico or Central America residing in the United States <5 years (OR = 3.28, 95% CI = 1.46-7.37).
  
  
  CONCLUSIONS
  Less acculturated Hispanic parents seemed to be at highest risk of NTDs. For anencephaly, U.S.-born and English-speaking Hispanic parents were also at increased risk. Finally, from an etiologic standpoint, spina bifida and anencephaly appeared to be etiologically heterogeneous from these analyses.
authors.affiliation: Birth Defects Epidemiology and Surveillance Branch, MC 1964, Texas Department of State Health Services, P.O. Box 149347, Austin, TX 78714-9347, USA. mark.canfield@dshs.state.tx.us
authors.forename: Mark A
authors.initials: MA
authors.lastname: Canfield
authors.forename: Tunu A
authors.initials: TA
authors.lastname: Ramadhani
authors.forename: Gary M
authors.initials: GM
authors.lastname: Shaw
authors.forename: Suzan L
authors.initials: SL
authors.lastname: Carmichael
authors.forename: D Kim
authors.initials: DK
authors.lastname: Waller
authors.forename: Bridget S
authors.initials: BS
authors.lastname: Mosley
authors.forename: Marjorie H
authors.initials: MH
authors.lastname: Royle
authors.forename: Richard S
authors.initials: RS
authors.lastname: Olney