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For all analyses except for neural tube defects (NTDs), we classified mothers who reported influenza vaccination 1 month before through the third pregnancy month as exposed; the exposure window for NTDs was 1 month before through the first pregnancy month. For defects with five or more exposed case children, we used logistic regression to estimate propensity score\u2010adjusted odds ratios (aORs) and 95% confidence intervals (CIs), adjusting for estimated delivery year and season; plurality; maternal age, race\/ethnicity, smoking and alcohol use, low folate intake; and, for NTDs, folate antagonist medications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 334 (4.1%) case and 197 (4.0%) control mothers who reported influenza vaccination from 1 month before through the third pregnancy month. Adjusted ORs ranged from 0.53 for omphalocele to 1.74 for duodenal atresia\/stenosis. Most aORs (11 of 19) were\u2009\u22641 and all adjusted CIs included the null. The unadjusted CIs for two defects, hypospadias and craniosynostosis, excluded the null. These estimates were attenuated upon covariate adjustment (hypospadias aOR: 1.25 (95% CI 0.89, 1.76); craniosynostosis aOR: 1.23 (95% CI: 0.88, 1.74)).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Results for several non\u2010cardiac major birth defects add to the existing evidence supporting the safety of inactivated influenza vaccination during pregnancy. Under\u2010reporting of vaccination may have biased estimates downward.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pds.5435","type":"journal-article","created":{"date-parts":[[2022,4,2]],"date-time":"2022-04-02T12:04:42Z","timestamp":1648901082000},"page":"851-862","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Influenza vaccination during pregnancy and risk of selected major structural noncardiac birth defects, National Birth Defects Prevention Study 2006\u20132011"],"prefix":"10.1002","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0134-6228","authenticated-orcid":false,"given":"Kristin","family":"Palmsten","sequence":"first","affiliation":[{"name":"HealthPartners Institute  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan","family":"Suhl","sequence":"additional","affiliation":[{"name":"Department of Epidemiology College of Public Health, The University of Iowa  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin M.","family":"Conway","sequence":"additional","affiliation":[{"name":"Department of Epidemiology College of Public Health, The University of Iowa  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1806-6502","authenticated-orcid":false,"given":"Elyse O.","family":"Kharbanda","sequence":"additional","affiliation":[{"name":"HealthPartners Institute  Minneapolis Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth C.","family":"Ailes","sequence":"additional","affiliation":[{"name":"Division of Birth Defects and Infant Disorders National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet D.","family":"Cragan","sequence":"additional","affiliation":[{"name":"Division of Birth Defects and Infant Disorders National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention  Atlanta Georgia USA"},{"name":"Metropolitan Atlanta Congenital Defects Program  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eirini","family":"Nestoridi","sequence":"additional","affiliation":[{"name":"Center for Birth Defects Research and Prevention, Massachusetts Department of Public Health  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleni A.","family":"Papadopoulos","sequence":"additional","affiliation":[{"name":"Birth Defects Registry New York State Department of Health  Albany New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen M.","family":"Kerr","sequence":"additional","affiliation":[{"name":"Slone Epidemiology Center Boston University  Boston Massachusetts USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0054-0627","authenticated-orcid":false,"given":"Sean G.","family":"Young","sequence":"additional","affiliation":[{"name":"Arkansas Center for Birth Defects Research and Prevention  Little Rock Arkansas USA"},{"name":"Department of Environmental and Occupational Health Fay W. 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