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We explored factors associated with TAPVR using the National Birth Defects Prevention Study (NBDPS; 1997\u20132011) and Birth Defects Study To Evaluate Pregnancy exposureS (BD\u2010STEPS; 2014\u20132021) data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We identified potential risk or protective factors from the literature and used logistic regression to calculate crude and adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association between 22 factors encompassing maternal demographics, health history, and medication use and TAPVR. In an exploratory analysis among the subset of NBDPS cases and controls, we examined 163 potential factors using random forest.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>In the primary analysis including 393 cases with TAPVR and 13,914 non\u2010malformed controls, we observed positive associations between TAPVR and maternal age at delivery &lt;\u200920 (OR 2.00; 95% CI 1.30\u20133.06) and 20\u201324 (1.62; 1.19\u20132.22) vs. 25\u201329\u2009years, having one (1.40; 1.07\u20131.82) and two or more previous live births (1.69; 1.25\u20132.27) vs. none, and multiple gestation (1.85; 1.11\u20132.92). Non\u2010Hispanic Black mothers had the lowest risk (0.55; 0.35\u20130.85) while mothers of other races\/ethnicities had the highest risk (1.72; 1.19\u20132.44) compared to non\u2010Hispanic White mothers. The random forest identified an inverse effect of maternal fish consumption.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Our findings confirmed previously observed associations of younger maternal age and having previous live births with TAPVR. Maternal fish consumption may confer a protective effect and deserves further investigation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/bdr2.70059","type":"journal-article","created":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T04:09:43Z","timestamp":1779336583000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Potential Risk Factors for Total Anomalous Pulmonary Venous Return: National Birth Defects Prevention Study, 1997\u20132011 and the Birth Defects Study to Evaluate Pregnancy Exposures, 2014\u20132021"],"prefix":"10.1002","volume":"118","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3609-5665","authenticated-orcid":false,"given":"Eva M.","family":"Williford","sequence":"first","affiliation":[{"name":"Birth Defects Registry New York State Department of Health  Albany New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jada 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Defects Prevention  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew E.","family":"Oster","sequence":"additional","affiliation":[{"name":"National Center on Birth Defects and Developmental Disabilities Centers for Disease Control and Prevention  Atlanta Georgia USA"},{"name":"Emory University School of Medicine Children's Healthcare of Atlanta  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tania A.","family":"Desrosiers","sequence":"additional","affiliation":[{"name":"Department of Epidemiology, Gillings School of Global Public Health University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5322-7116","authenticated-orcid":false,"given":"Lorenzo D.","family":"Botto","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Medical Genetics University of Utah  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