{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T11:49:27Z","timestamp":1789904967088,"version":"4.0.1"},"reference-count":38,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2017,11,24]],"date-time":"2017-11-24T00:00:00Z","timestamp":1511481600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000030","name":"Centers for Disease Control and Prevention","doi-asserted-by":"publisher","award":["CDC\u2010RFA\u2010DD16\u20101605"],"award-info":[{"award-number":["CDC\u2010RFA\u2010DD16\u20101605"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Birth Defects Research"],"published-print":{"date-parts":[[2018,3,15]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>There are limited population\u2010based studies on microcephaly. We characterized the epidemiology of microcephaly in Texas during a 5\u2010year period (2008\u20132012), prior to the Zika epidemic in the Western hemisphere (2015). The associations of suspected risk factors were compared across four clearly defined case groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Data from the Texas Birth Defects Registry were used to calculate the prevalence of congenital microcephaly and crude and adjusted prevalence ratios using Poisson regression. Twelve maternal and infant factors were assessed across case groups, which included total (explained\u2009+\u2009unexplained), explained (e.g., syndromic), unexplained, and severe unexplained microcephaly (head circumference &lt;3<jats:sup>rd<\/jats:sup> percentile).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The birth prevalence for total and total severe microcephaly were 14.7 and 4.8 per 10,000 livebirths, respectively. For explained and unexplained cases, significantly elevated risks were noted for mothers who were older (35+), less educated (\u226412 years), diabetic (pre\u2010pregnancy or gestational), or had a preterm delivery. Unlike explained cases, however, mothers who were non\u2010White or smoked had an increased risk for unexplained microcephaly. Furthermore, young maternal age (&lt;20), multiparity, and higher BMI reduced the risk for unexplained microcephaly. For severe unexplained cases, the risk profile was similar to that for all unexplained cases\u2014with the exception of null associations noted for diabetes and birth year.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We found that risk patterns for microcephaly varied across case groupings. Risk factors included maternal race\/ethnicity, age, and smoking during pregnancy. Among severe unexplained cases, notable positive associations were seen among mothers who were non\u2010Hispanic Black or less educated, while inverse associations were noted for obesity.<\/jats:p><\/jats:sec>","DOI":"10.1002\/bdr2.1164","type":"journal-article","created":{"date-parts":[[2017,11,24]],"date-time":"2017-11-24T06:56:29Z","timestamp":1511506589000},"page":"395-405","source":"Crossref","is-referenced-by-count":15,"title":["Pre\u2010Zika descriptive epidemiology of microcephaly in Texas, 2008\u20132012"],"prefix":"10.1002","volume":"110","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1605-9536","authenticated-orcid":false,"given":"Adrienne T.","family":"Hoyt","sequence":"first","affiliation":[{"name":"Birth Defects Epidemiology and Surveillance Branch Texas Department of State Health Services Austin Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark A.","family":"Canfield","sequence":"additional","affiliation":[{"name":"Birth Defects Epidemiology and Surveillance Branch Texas Department of State Health Services Austin Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter H.","family":"Langlois","sequence":"additional","affiliation":[{"name":"Birth Defects Epidemiology and Surveillance Branch Texas Department of State Health Services Austin Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2211-4773","authenticated-orcid":false,"given":"Dorothy K.","family":"Waller","sequence":"additional","affiliation":[{"name":"UT Health School of Public Health Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. J.","family":"Agopian","sequence":"additional","affiliation":[{"name":"UT Health School of Public Health Houston Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles J.","family":"Shumate","sequence":"additional","affiliation":[{"name":"Birth Defects Epidemiology and Surveillance Branch Texas Department of State Health Services Austin Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noemi B.","family":"Hall","sequence":"additional","affiliation":[{"name":"Birth Defects Epidemiology and Surveillance Branch Texas Department of State Health Services Austin Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa K.","family":"Marengo","sequence":"additional","affiliation":[{"name":"Birth Defects Epidemiology and Surveillance Branch Texas Department of State Health Services Austin Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary K.","family":"Ethen","sequence":"additional","affiliation":[{"name":"Birth Defects Epidemiology and Surveillance Branch Texas Department of State Health Services Austin Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela E.","family":"Scheuerle","sequence":"additional","affiliation":[{"name":"Birth Defects Epidemiology and Surveillance Branch Texas Department of State Health Services Austin Texas"},{"name":"University of Texas Southwestern Medical Center Dallas Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,11,24]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-2005-867089"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.AOG.0000158124.96300.c7"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0b013e3181b783f7"},{"key":"e_1_2_8_5_1","unstructured":"Bianchi D. W. &Crombleholme T. M.(2010). Fetology: Diagnosis and Management of the Fetal Patient Second Edition. Microcephaly. Chapter 20. McGraw\u2010Hill Medical\/Jaypee Brothers Medical Publishers. p166\u2013171."},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(69)80404-X"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(16)00651-6"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/0378-3782(77)90015-9"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/bdra.23587"},{"key":"e_1_2_8_10_1","unstructured":"EUROCAT Prevalence Data Tables [Internet]. Ispra: European Surveillance of Congenital Anomalies; (2016). 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