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Although research on the safety of heparin products has been reassuring, previous studies have considered birth defects as a single outcome or by larger organ system and have not examined associations with specific birth defects.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We analyzed data from the National Birth Defects Prevention Study, a multisite, population\u2010based case\u2013control study from 1997 to 2011. We used unconditional logistic regression with Firth's penalized likelihood to calculate adjusted odds ratios (ORs) and profile likelihood 95% confidence intervals (CIs) for defects with at least five exposed cases. For defects with 3\u20134 exposed cases, we estimated crude ORs and exact 95% CIs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of the 42,743 women in our analysis, 117 (0.4%) case and 44 (0.4%) control mothers reported using a heparin product in early pregnancy. The adjusted ORs ranged from 0.9 to 3.9 and were elevated for anorectal atresia (OR\u00a0=\u00a02.0, 95% CI\u00a0=\u00a00.8\u20134.3), longitudinal limb deficiency (3.5, 1.3\u20137.8), transverse limb deficiency (1.8, 0.6\u20134.3), atrioventricular septal defect (3.9, 1.4\u20139.0), and secundum atrial septal defect (2.2, 1.2\u20133.8).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We observed elevated associations for some birth defects, although heparin is a rare exposure, which limited our ability to evaluate many associations. Future studies that can explore specific birth defects and adequately control for confounding by indication are needed. Given that women with an indication for heparin products during pregnancy often need to take medication, one must remain mindful of the underlying risk of a birth defect that exists regardless of medication use.<\/jats:p><\/jats:sec>","DOI":"10.1002\/bdr2.2074","type":"journal-article","created":{"date-parts":[[2022,8,15]],"date-time":"2022-08-15T05:49:37Z","timestamp":1660542577000},"page":"133-144","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Maternal exposure to heparin products and risk of birth defects in the National Birth Defects Prevention Study"],"prefix":"10.1002","volume":"115","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8420-5040","authenticated-orcid":false,"given":"Meredith M.","family":"Howley","sequence":"first","affiliation":[{"name":"Birth Defects Registry New York State Department of Health  Albany New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4702-1007","authenticated-orcid":false,"given":"Sarah C.","family":"Fisher","sequence":"additional","affiliation":[{"name":"Birth Defects Registry New York State Department of Health  Albany New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alissa R.","family":"Van Zutphen","sequence":"additional","affiliation":[{"name":"Birth Defects Registry New York State Department of Health  Albany New York USA"},{"name":"Department of Epidemiology and Biostatistics School of Public Health, University at Albany  Rensselaer New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4355-7557","authenticated-orcid":false,"given":"Eleni A.","family":"Papadopoulos","sequence":"additional","affiliation":[{"name":"Birth Defects Registry New York State Department of Health  Albany New York USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4875-7390","authenticated-orcid":false,"given":"Jenil","family":"Patel","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Human Genetics and Environmental Sciences University of Texas Health Science Center at Houston (UTHealth) School of Public Health  Dallas Texas USA"},{"name":"Arkansas Center for Birth Defects Research and Prevention Fay W. 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