title: Associations between Maternal Water Consumption and Birth Defects in the National Birth Defects Prevention Study (2000-2005).
abstract: BACKGROUND
  Water and water-based beverages constitute a major part of daily fluid intake for pregnant women, yet few epidemiologic studies have investigated the role of water consumption on birth outcomes.
  
  
  METHODS
  We used data from the National Birth Defects Prevention Study to conduct a case-control study investigating associations between maternal water consumption during pregnancy and birth defects (BD). We used interview data on water consumption during the first trimester of pregnancy in 14,454 cases (major BDs n ≥ 50) and 5,063 controls. Total water consumption was analyzed as a continuous variable and in quartiles. We evaluated the role of dietary quality and sugar sweetened beverage consumption. Logistic regression models were used to assess effects of water consumption on risk of BDs with adjustment for relevant covariates.
  
  
  RESULTS
  Mean daily maternal water consumption among controls was 4.4 eight-ounce glasses. We observed decreases in estimated risk associated with increases in water consumption for several BDs, including neural tube defects (spina bifida), oral clefts (cleft lip), musculoskeletal defects (gastroschisis, limb deficiencies), and congenital heart defects (hypoplastic left heart syndrome, right-sided obstructions, pulmonary valve stenosis). Our results were generally unchanged when an indicator for overall dietary quality was included; however, there was evidence of effect measure modification by heavy consumption of sugar-sweetened beverages for some defects, but not all.
  
  
  CONCLUSIONS
  These analyses suggest the importance of sufficient water consumption during early pregnancy, above and beyond it being a marker of higher diet quality. Additional analyses are warranted to understand the biological mechanism for this association. Birth Defects Research 109:193-202, 2017. © 2016 Wiley Periodicals, Inc.
authors: Office of Air Quality Planning and Standards, Office of Air and Radiation, US Environmental Protection Agency, Research Triangle Park, North Carolina.
authors: Breanna L
authors: BL
authors: Alman
authors: Oak Ridge Institute for Science Education (ORISE) at the National Center for Environmental Assessment, Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, North Carolina.
authors: Evan
authors: E
authors: Coffman
authors: Department of Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina.
authors: Anna Maria
authors: AM
authors: Siega-Riz
authors: National Center for Environmental Assessment, Office of Research and Development, US Environmental Protection Agency, Research Triangle Park, North Carolina.
authors: Thomas J
authors: TJ
authors: Luben
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D000013:Congenital Abnormalities / Q000209:etiology* / Q000517:prevention & control*; D016208:Databases, Factual; D004326:Drinking; D005260:Female; D006330:Heart Defects, Congenital / Q000209:etiology; D006801:Humans; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D009436:Neural Tube Defects / Q000209:etiology; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011297:Prenatal Exposure Delayed Effects / Q000503:physiopathology; D014481:United States; D014867:Water / Q000494:pharmacology / Q000502:physiology*
chemical_list: D014867:Water
keywords: National birth defects prevention study; birth defects; maternal water consumption; nutrition; pregnancy