{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T15:13:07Z","timestamp":1780413187619,"version":"3.54.1"},"reference-count":19,"publisher":"Wiley","issue":"14","license":[{"start":{"date-parts":[[2021,4,19]],"date-time":"2021-04-19T00:00:00Z","timestamp":1618790400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100006087","name":"National Center on Birth Defects and Developmental Disabilities","doi-asserted-by":"publisher","award":["FOA DD09\u2010001"],"award-info":[{"award-number":["FOA DD09\u2010001"]}],"id":[{"id":"10.13039\/100006087","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006087","name":"National Center on Birth Defects and Developmental Disabilities","doi-asserted-by":"publisher","award":["FOA DD13\u2010003"],"award-info":[{"award-number":["FOA DD13\u2010003"]}],"id":[{"id":"10.13039\/100006087","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006087","name":"National Center on Birth Defects and Developmental Disabilities","doi-asserted-by":"publisher","award":["NOFO DD18\u2010001"],"award-info":[{"award-number":["NOFO DD18\u2010001"]}],"id":[{"id":"10.13039\/100006087","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006087","name":"National Center on Birth Defects and Developmental Disabilities","doi-asserted-by":"publisher","award":["PA 02081"],"award-info":[{"award-number":["PA 02081"]}],"id":[{"id":"10.13039\/100006087","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100006087","name":"National Center on Birth Defects and Developmental Disabilities","doi-asserted-by":"publisher","award":["PA 96043"],"award-info":[{"award-number":["PA 96043"]}],"id":[{"id":"10.13039\/100006087","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth Defects Research"],"published-print":{"date-parts":[[2021,8,15]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Maternal pregestational diabetes and obesity are risk factors for birth defects. Diabetes and obesity often occur together; it is unclear whether their co\u2010occurrence compounds birth defect risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analyzed 1997\u20132011 data on 29,671 cases and 10,963 controls from the National Birth Defects Prevention Study, a multisite case\u2010control study. Mothers self\u2010reported height, pregestational weight, and diabetes (pregestational and gestational; analyzed separately). We created four exposure groups: no obesity or diabetes (referent), obesity only, diabetes only, and both obesity and diabetes. We estimated odds ratios (ORs) using logistic regression and the relative excess risk due to interaction (RERI).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among mothers with pregestational obesity without diabetes, modest associations (OR range: 1.1\u20131.5) were observed for neural tube defects, small intestinal atresia, anorectal atresia, renal agenesis\/hypoplasia, omphalocele, and several congenital heart defects. Pregestational diabetes, regardless of obesity, was strongly associated with most birth defects (OR range: 2.0\u201375.9). Gestational diabetes and obesity had a stronger association than for obesity alone and the RERI (in parentheses) suggested additive interaction for hydrocephaly (1.2; 95% confidence interval [CI]: \u22120.1, 2.5), tetralogy of Fallot (0.9; 95% CI: \u22120.01, 1.8), atrioventricular septal defect (1.1; 95% CI: \u22120.1, 2.3), hypoplastic left heart syndrome (1.1; 95% CI: \u22120.2, 2.4), and atrial septal defect secundum or not otherwise specified (1.0; 95% CI: 0.3, 1.6; only statistically significant RERI).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our results do not support a synergistic relationship between obesity and diabetes for most birth defects examined. However, there are opportunities for prevention by reducing obesity and improving glycemic control among women with pregestational diabetes before conception.<\/jats:p><\/jats:sec>","DOI":"10.1002\/bdr2.1900","type":"journal-article","created":{"date-parts":[[2021,4,20]],"date-time":"2021-04-20T05:44:58Z","timestamp":1618897498000},"page":"1084-1097","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Modification of the association between diabetes and birth defects by obesity, National Birth Defects Prevention Study, 1997\u20132011"],"prefix":"10.1002","volume":"113","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7610-6288","authenticated-orcid":false,"given":"Sarah C.","family":"Tinker","sequence":"first","affiliation":[{"name":"National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suzanne M.","family":"Gilboa","sequence":"additional","affiliation":[{"name":"National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4224-2692","authenticated-orcid":false,"given":"Cynthia A.","family":"Moore","sequence":"additional","affiliation":[{"name":"National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2211-4773","authenticated-orcid":false,"given":"D. Kim","family":"Waller","sequence":"additional","affiliation":[{"name":"School of Public Health The University of Texas Health Science Center at Houston  Houston Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Regina M.","family":"Simeone","sequence":"additional","affiliation":[{"name":"National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shin Y.","family":"Kim","sequence":"additional","affiliation":[{"name":"National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise J.","family":"Jamieson","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics Emory University School of Medicine  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorenzo D.","family":"Botto","sequence":"additional","affiliation":[{"name":"Division of Medical Genetics, Department of Pediatrics University of Utah School of Medicine  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4702-1007","authenticated-orcid":false,"given":"Sarah C.","family":"Fisher","sequence":"additional","affiliation":[{"name":"Birth Defects Research Section New York State Department of Health  Albany New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennita","family":"Reefhuis","sequence":"additional","affiliation":[{"name":"National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the National Birth Defects Prevention Study","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,4,19]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000001211"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/AOG.0000000000002960"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ede.0000147122.97061.bb"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2014.08.031"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2015.01.026"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2008.06.028"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm665152a3"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6743a2"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2013.02.015"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125-004-1337-3"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajog.2009.08.005"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/00001648-200011000-00013"},{"key":"e_1_2_7_14_1","unstructured":"National Heart Lung and Blood Institute.2000.The practical guide: Identification evaluation and treatment of overweight and obesity in adults. 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