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We estimated the associations between maternal exposure to EHEs in the summer season and OFCs in offspring and investigated the potential modifying effect of body mass index on these associations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a population\u2010based case\u2013control study among mothers who participated in the National Birth Defects Prevention Study for whom at least 1 day of their first two post\u2010conception months occurred during summer. Cases were live\u2010born infants, stillbirths, and induced terminations with OFCs; controls were live\u2010born infants without major birth defects. We defined EHEs using the 95th and the 90th percentiles of the daily maximum universal apparent temperature distribution. We used unconditional logistic regression with Firth's penalized likelihood method to estimate adjusted odds ratios and 95% confidence intervals, controlling for maternal sociodemographic and anthropometric variables.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We observed no association between maternal exposure to EHEs and OFCs overall, although prolonged duration of EHEs may increase the risk of OFCs in some study sites located in the Southeast climate region. Analyses by subtypes of OFCs revealed no associations with EHEs. Modifying effect by BMI was not observed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We did not find a significantly increased risk of OFCs associated with maternal exposure to EHEs during the relevant window of embryogenesis. Future studies should account for maternal indoor and outdoor activities and for characteristics such as hydration and use of air conditioning that could modify the effect of EHEs on pregnant women.<\/jats:p><\/jats:sec>","DOI":"10.1002\/bdr2.1385","type":"journal-article","created":{"date-parts":[[2018,10,19]],"date-time":"2018-10-19T09:39:26Z","timestamp":1539941966000},"page":"1468-1477","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["A population\u2010based case\u2013control study of the association between weather\u2010related extreme heat events and orofacial clefts"],"prefix":"10.1002","volume":"110","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7687-751X","authenticated-orcid":false,"given":"Aida","family":"Soim","sequence":"first","affiliation":[{"name":"Congenital Malformations Registry New York State Department of Health Albany New York"},{"name":"Department of Environmental Health Science 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