title: Maternal autoimmune disease and birth defects in the National Birth Defects Prevention Study.
abstract: BACKGROUND
  Little is known about the association between maternal autoimmune disease or its treatment and the risk of birth defects. We examined these associations using data from the National Birth Defects Prevention Study, a multi-site, population-based, case-control study.
  
  
  METHODS
  Analyses included 25,116 case and 9897 unaffected control infants with estimated delivery dates between 1997 and 2009. Information on autoimmune disease, medication use, and other pregnancy exposures was collected by means of telephone interview. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for birth defects with five or more exposed cases; crude ORs and exact 95% CIs were estimated for birth defects with three to four exposed cases.
  
  
  RESULTS
  Autoimmune disease was reported by 373 mothers (279 case and 94 control mothers). The majority of birth defects evaluated were not associated with autoimmune disease; however, a statistically significant association between maternal autoimmune disease and encephalocele was observed (OR, 4.64; 95% CI, 1.95-11.04). Eighty-two mothers with autoimmune disease used an immune modifying/suppressing medication during pregnancy; this was associated with encephalocele (OR, 7.26; 95% CI, 1.37-24.61) and atrial septal defects (OR, 3.01; 95% CI, 1.16-7.80).
  
  
  CONCLUSIONS
  Our findings suggest maternal autoimmune disease and treatment are not associated with the majority of birth defects, but may be associated with some defects, particularly encephalocele. Given the low prevalence of individual autoimmune diseases and the rare use of specific medications, we were unable to examine associations of specific autoimmune diseases and medications with birth defects. Other studies are needed to confirm these findings. Birth Defects Research (Part A) 106:950-962, 2016. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Congenital Malformations Registry, New York State Department of Health, Albany, New York.
authors.forename: Meredith M
authors.initials: MM
authors.lastname: Howley
authors.affiliation: Congenital Malformations Registry, New York State Department of Health, Albany, New York.|Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York.
authors.forename: Marilyn L
authors.identifier: http://orcid.org/0000-0002-1872-2787
authors.initials: ML
authors.lastname: Browne
authors.affiliation: Congenital Malformations Registry, New York State Department of Health, Albany, New York.|Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York.
authors.forename: Alissa R
authors.initials: AR
authors.lastname: Van Zutphen
authors.affiliation: Congenital Malformations Registry, New York State Department of Health, Albany, New York.
authors.forename: Sandra D
authors.initials: SD
authors.lastname: Richardson
authors.affiliation: Department of Pediatrics, Arkansas Children's Hospital Research Institute, Little Rock, Arkansas.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Blossom
authors.affiliation: Division of Birth Defects and Developmental Disabilities, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia.
authors.forename: Cheryl S
authors.initials: CS
authors.lastname: Broussard
authors.affiliation: Department of Pediatrics, Stanford University, Stanford, California.
authors.forename: Suzan L
authors.initials: SL
authors.lastname: Carmichael
authors.affiliation: Congenital Malformations Registry, New York State Department of Health, Albany, New York.|Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, Rensselaer, New York.
authors.forename: Charlotte M
authors.initials: CM
authors.lastname: Druschel
mesh_terms: D000328:Adult; D001327:Autoimmune Diseases / Q000453:epidemiology*; D000013:Congenital Abnormalities / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D009313:National Health Programs; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology
keywords: autoimmune disease; autoimmune medication; birth defects; congenital malformations; pregnancy