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gration of the data collection, review, and report prepara- tion; (2) development of software for statistical analysis and plotting of temporal trends; (3) linkage of MACDP data with MADDSP data to allow further evaluations of the prevalence of developmental disabilities among chil- dren with birth defects; (4) geocoding MACDP data to allow evaluation of regional variations in prevalence and mortality of birth defects; and (5) linkage of MACDP data with environmental data to facilitate environmental track- ing. Because MACDP covers a limited geographic area, we plan to continue to work with states to design, implement, and coordinate population-based birth defect programs to provide a nationwide coverage for birth defect surveillance and etiologic studies with the goal of preventing birth defects.


The development and operation of MACDP has been made possible through the efforts of many people. We are indebted to: Arthur Falik, William Flynt, and Clark Heath, for their vision and pioneering efforts in establishing MACDP; Lee James for his valuable contributions to the development and management of the monitoring database and software; Larry Edmonds for his commitment to man- agement over many years, Dave Erickson and Godfrey Oakley for their leadership and support; the staffs of par- ticipating hospitals and laboratories whose collaboration have made MACDP possible; Debra Adams, Fran Baxter, Jo Anne Croghan, Joann Donaldson, Joan Garcia, Debbie Nurmi, Kitty Peecher, Charlie Peters, and Wendy Sklenka for their dedication and effort in identification of cases and abstraction of case information, and all past abstractors for identifying cases and abstracting information over the years; Karen Thornton and Tineka Yowe for their commit- ment and efforts in ensuring the completeness and accu- racy of the abstracted information; Mike Atkinson, Don Gambrell, and Elaine Rhodenhiser for their technical sup- port with data management; Lorenzo Botto, Cynthia Moore, Richard Olney, and Sonja Rasmussen for their re- view of clinical data, classification of defects, and further development of our coding system; and to the many other individuals who over the years have contributed to MACDP.


Araneta MR, Moore CA, Olney RS, Edmonds LD, Karcher JA, McDonough C, Hiliopoulos KM, Schlangen KM, Gray GC. 1997. Goldenhar syn- drome among infants born in military hospitals to Gulf War veterans. Teratology 56:244-251. Becerra JE, Khoury MJ, Cordero JF, Erickson JD. 1990. Diabetes mellitus during pregnancy and the risks for specific birth defects: a population- based case-control study. Pediatrics 85:1-9. Berry RJ, Li Z, Erickson JD, Li S, Moore, CA, Wang H, Mulinare J, Zhao P, Wong L-Y, Gindler J, Hong S-X, Correa A. 1999. Preventing neural tube defects with folic acid in the People’s Republic of China. N Engl J Med 341:1485-1490. Botto LD, Khoury MJ, Mulinare J, Erickson JD. 1996. Periconceptional multivitamin use and the occurrence of conotruncal heart defects: results from a population-based case-control study. Pediatrics 98:911- 917. Botto LD, Correa A, Erickson JD. 2001. Racial and temporal variations in the prevalence of heart defects. Pediatrics 107:E32. Botto LD, Lynberg MC, Erickson JD. 2001. Congenital heart defects, mater- nal febrile illness, and multivitamin use: a population-based study. Epidemiology 12:485-490. Bower C, Stanley FJ. 1989. Dietary folate as a risk factor for neural-tube defects: evidence from a case-control study in Western Australia. Med J Austr 150:613-619.

British Paediatric Association. 1979. British Paediatric Association Classifi- cation of Diseases. London: British Paediatric Association. CDC. 1973. Epidemiologic notes and reports: spray adhesives, birth defects, and chromosomal damage. MMWR 22:365-366. CDC. 1979. Temporal trends in the incidence of birth defects. MMWR 28:401-402. CDC. 1981. Ventricular septal defect. MMWR 30:609-611. CDC. 1984. Vietnam veterans’ risks for fathering babies with birth defects. MMWR 33:457-459. CDC. 1988. Periconceptional use of multivitamins and the occurrence of anencephaly and spina bifida. MMWR 37:727-730. CDC. 1998. Trends in infant mortality attributed to birth defects—United States, 1980-1995. MMWR 47:773-778. CDC. 1989. Metropolitan Atlanta Congenital Defects Program Procedures Manual, Atlanta, Georgia. CDC. 1992. Recommendations for the use of folic acid to reduce the number of cases of spina bifida and other neural tube defects. MMWR 41(RR- 4):1-7. CDC. 1993. Pregnancy outcomes following systemic prenatal acyclovir ex- posure - June 1, 1984 to June 30, 1993. MMWR 42:806-809. CDC. 1995. Chorionic villus sampling and amniocentesis: recommendations for prenatal counseling. MMWR 44:1-12. CDC. 2000. State birth defects surveillance programs directory. Teratology 61:33-85. Chavez GF, Mulinare J, Cordero JF. 1989. Maternal cocaine use during early pregnancy as a risk factor for congenital urogenital anomalies. JAMA 262:795-798. Cochi SL, Edmonds LD, Dyer K, Greaves WL, Marks JS, Rovira EZ, Preblud SR, Orenstein WA. 1989. Congenital rubella syndrome in the United States, 1970-1985. On the verge of elimination. Am J Epidemiol 129: 349-361. Correa A, Botto L, Liu Y, Mulinare J, Erickson JD. 2003. Do multivitamin supplements attenuate the risk of diabetes-associated birth defects? Pediatrics 111;1146-1151. Edmonds LD, Layde PM, Erickson JD. 1979. Airport noise and teratogene- sis. Arch Environ Health 34:243-247 Edmonds LD, Layde PM, James LM, Flynt JW, Erickson JD, Oakley GP Jr. 1981. Congenital malformations surveillance: two American systems. Int J Epidemiol 10:247-252. Erickson JD, Oakley GP Jr., Flynt JW Jr., Hay S. 1976. Water fluoridation and congenital malformations: no association. J Am Dent Assoc 93:981-984. Erickson JD, Mulinare J, McClain PW, Fitch TG, James LM, McClearn AB, Adams MJ. 1984. Vietnam veterans’ risk for fathering babies with birth defects. JAMA 252:903-912. Food and Drug Administration. 1996. Food Standards. Federal Register 61:8781-8797. Hall JG, Powers EK, McIlavaine. 1978. The frequency and financial burden of genetic disease in a pediatric hospital. Am J Med Genetic 1:417-436. Honein MA, Paulozzi LJ. 1999. Birth defects surveillance: assessing the “gold standard”. Am J Public Health 89:1238-1240. Honein MA, Paulozzi LJ, Moore CA. 2000. Family history, maternal smok- ing, and clubfoot: an indication of a gene-environment interaction. Am J Epidemiol 152:658-665. Itikala PR, Watkins ML, Mulinare J, Moore CA, Liu Y. 2001. Maternal multivitamin use and orofacial clefts in offspring. Teratology 63:79-86. International Clearinghouse for Birth Defects Monitoring Systems (ICB- DMS). 2002. Annual report 2002. Rome: International Centre for Birth Defects. Khoury MJ, Waters G, Erickson JD. 1991. Patterns and trends of multiple congenital anomalies in birth defects surveillance systems. Teratology 44:57-64. Khoury MJ, Edmonds LD. 1992. Metropolitan Congenital Defects Program: 25 years of birth defects surveillance at the Centers for Disease Control. In: Maistrocovo P, editor Proceedings of the III ASM International Symposium on Birth Defects, Rome, Italy, December 3-5, 1992. Rome: ICARO-ASM Press House, pp.1-7. Khoury MJ, Moore CA, Mulinare J. 1996. Vitamin A and birth defects. Lancet 347:322. Layde PM, Edmonds LD, Erickson JD. 1980. Maternal fever and neural tube defects. Teratology 21:105-108. Lucas JM. 1985. Counted data cusums. Technometrics 27:129-144. Lynberg MC, Chavez GF, Edmonds LD, Mulinare J. 1993. Evaluation of the birth defects monitoring program, 1982-1985. Teratology 48:650-657. Lynberg MC, Khoury MJ, Lu X, Cocian T. 1994. Maternal flu, fever, and the risk of neural tube defects: a population based case-control study. Am J Epidemiol 140:244-245. MacLeod PM. 1993. Implication of the child with malformations for the family and society. In: Stevenson RE, Hall JG, Goodman RM, editors. Human malformations and related anomalies. Vol. I. Oxford Mono-

Birth Defects Research (Part A) 67:617–624 (2003)

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