Texas Birth Defects M ONITOR A Semi-Annual Data and Research Update Texas Department of Health, Bureau of Epidemiology
VOLUME 10, NUMBER 1, June 2004
FROM THE DIRECTOR The web site also has a useful glossary linked to risk factor summaries for a number of birth defects. INTERACTIVE WEB PAGE ALLOWS EASY RESEARCH SYMPOSIUM ACCESS TO TEXAS BIRTH DEFECTS DATA Birth defects data were recently highlighted at the Texas In partnership with Texas Department of Health's Center for Birth Defects Research Symposium on April 9 in San Anto- Health Statistics, birth defects data are now available on the nio. The following speakers provided insight into the causes Texas Health Data web site. Visitors to the site (http://soup- of birth defects: fin.tdh.state.tx.us/) will be able to query data from the Texas Birth Defects Registry. Linking Birth Defects and the Environment, with Prelimi- nary Findings from an Air Pollution Study in Texas (Peter The Registry uses active surveillance to collect information Langlois, Ph.D., TBDMD and Suzanne Gilboa, M.H.S., U.S. about infants and fetuses with birth defects, born to women Environmental Protection Agency) residing in Texas. Data are presented for 49 defect catego- ries, plus a category for “infants and fetuses with any moni- Neural Tube Defects: Multiple Risk Factors Among the tored birth defect” beginning with deliveries in 1999, when Texas-Mexico Border Population (Lucina Suarez, Ph.D., the Texas Birth Defects Registry became statewide. Texas Department of Health) The Embryonic Consequences of Abnormal Folate Trans- Birth defects data are available in 4 modules: port and Metabolism; (Rick Finnell, Ph.D., Texas A&M Uni- *statewide versity Institute for Biomedical Research) *by public health region Selected Contaminants and NTDs: Heavy Metals, Pesticides, *by county and PCBs; (Jean Brender, Ph.D., Texas State University; Marilyn Felkner, Ph.D., Zunera Gilani, M.P.H., Texas *by border/nonborder residence (a Texas county that Department of Health) or does not border Mexico) Continued on Page 5 Using statewide data, tables of birth defect counts and rates can be created by year, maternal age group, maternal race- ethnicity, and infant sex. Additionally, statewide data tables WHAT’S INSIDE can be restricted to a particular age group, race-ethnic group, and sex. Report to Include Birth Years 1999-2001...... 2 Birth Defects and Maternal Education ...... 2 For public health region, county, and border/nonborder data, Teen Pregnancy and Birth Defects...... 3 tables of birth defects can be produced by year and geo- Valproic Acid Use and Metopic Craniosynostosis . . . 4 graphic area. Research Center ...... 4 In all modules, available statistics include counts (cases or Recent Publications...... 4 frequencies), rates (cases per 10,000 live births) and confi- Highly Fortified Grain Products and NTD Rates . . . 5 dence intervals for the rate (either 95% or 99%). By the end County Clerks and Folic Acid Education ...... 6 of 2004, 2001 data will be added to the system. Announcements ...... 6 HHSC Consolidation...... 6 March of Dimes Advocacy Initiatives ...... 7 FROM THE Figure 1: Selected Birth Defects by Maternal Education among 1999-2001 Deliveries EGISTRY R Hirschsprung disease REPORT TO INCLUDE BIRTH YEARS 1999-2001 Tracheoesophogeal The Report of Birth Defects Among fistula
BIRTH DEFECTS AND Microcephaly
0 1020304050 HS = High School Diploma Cases per 10,000 Live Births
MONITOR VOL. 10-1 PAGE 2 TEEN PREGNANCY AND BIRTH DEFECTS Table 1: Births to Mothers While many birth defects are strongly associated with Age 13-17, 2002 Total Births to Birth Rate per advanced maternal age, certain anomalies have been found County mothers Age 13-17 1,000 Women to be associated with young maternal age. For example, the Brooks 323 74.3 Texas Birth Defects Regis- Menard 88 68.2 try found significantly Motley 46 65.2 higher rates for the birth Culberson 114 61.4 defects in the table (below) Foard 55 54.5 when mother's age was Cottle 74 54.1 under 20 (compared to one Lipscomb 113 53.1 or more older age groups): Zavala 548 52.9 Hudspeth 152 52.6 Although teen birth rates in Terry 513 52.6 Texas have continued to fall Webb 9,143 51.6 over the past five years, the Starr 2,697 50.8 counties in the table (right) had 2002 rates well above the Terrell 40 50.0 state rate of 28.5 per 1,000 women age 13-17. Hale 1,452 46.8 Source: Potter 4,089 46.7 Zapata 581 46.5 Texas Bureau of Vital Statistics, Texas Department of Camp 436 45.9 Health, www.tdh.state.tx.us/chs/vstat/latest/t14b.HTM Wilbarger 573 45.4 Dawson 513 44.8 Sherman 136 44.1
Defect Description Rate for Births to Mothers <20 Years (per 10,000 live births) Pyloric A narrowing of the pyloric sphincter at the outlet 23.6 stenosis of the stomach. This causes a blockage of food Significantly higher than for all age groups 25 and from the stomach into the small intestine. Usually older, and more than twice the rate compared to births treated surgically. among mothers age 40 and older (10.9). Stenosis or A narrowing or incomplete formation of the small 4.9 atresia of the intestine obstructing movement of food through Significantly higher than among births to mothers age small intestine the digestive tract. 20-34. About twice as common among births to mothers under 20 as to those who were 20-24 (2.9) or 25-34 (2.3) at delivery. Gastroschisis A congenital opening of the abdominal wall with 11.9 protrusion of the intestines. This condition is Significantly higher among births to younger mothers surgically treated. than for all older age groups. This defect is more than twice as common among births to mothers under 20 than to those 20-24, and as much as 14 times as common than for mother ages 35-39.
ERRATA Volume 9-2, Page 4, Differences in Defects between Male chromosomal syndromes for females), others are not so and Female Infants/Fetuses should read, “Certain defects obvious and may help to generate hypotheses about the show markedly different patterns between male and female underlying causes of these defects.” In addition, the printed offspring. While the reason for the differences is obvious in version incorrectly included the following rows under some cases (as with hypospadias among males, or X-linked Defects More Prevalent among Females than Males:
Trisomy 21 (Down syndrome) Male 469 12.88 11.72 - 14.05 (p=0.0103) Female 376 10.79 9.70 - 11.88
MONITOR 3 REGISTRY PUBLICATIONS Before a conclusion is made about case-control study of Mexican Amer- valproic acid and metopic synostosis, ican women enrolled in the Texas Langlois P, Driggers D, Phelps A. several other factors must be consid- Neural Tube Defect Study. Women Applying statistical methods to ered. With each case, information who reported taking drugs classified improve the efficiency of case clues in such as when the fetus was exposed to as nitrosatable (this would include an active birth defects surveillance the drug, the level of exposure, the some antihistamines, antibiotics, and system. J Registry Management metabolism of the baby and the beta blockers which have been 2004;31:19-26. mother, and the duration of the expo- reported in the literature as being nit- SPECIAL REPORT sure, needs to be known. Based on the rosatable) were nearly three times many variables that are needed for more likely to have an NTD-affected MATERNAL VALPROIC ACID USE AND each patient, another full research pregnancy than women without this METOPIC CRANIOSYNOSTOSIS:The fol- project, in which every detail of the exposure. However, the effect of nit- lowing article was submitted by Jared mother's pregnancy is recorded, rosatable drugs was observed only in Willey, who will be a junior at Plano would have to be completed in order women with higher intakes of dietary Senior High School in fall 2004. to determine if valproic acid causes nitrite and total nitrite (dietary nitrite Jared has been doing a summer rota- craniosynostosis. + 5% dietary nitrate). The effect was tion with Dr. Angela Scheuerle, a clin- also stronger in women whose water ical geneticist. nitrate levels were higher. For more RESEARCH Valproic acid is a medication used to information on this study, conatct treat epilepsy. Valproic acid use dur- CENTER Jean Brender, Ph.D., R.N.,Texas ing pregnancy has been known to State University at San Marcos, cause some birth defects in infants. NEW PROJECT DIRECTOR Department of Health Services Research, 512-245-9267, The purpose of this investigation was Peter DeForest began as Project [email protected]. to determine if valproic acid use dur- Director in February 2004. During ing pregnancy causes metopic cranio- the past three years, Peter served as Johnson KM et al. Prevalence of synostosis (premature closure of the Epidemiology Project Director for the craniorachischisis in a Texas-Mexico metopic cranial suture) in offspring. Nueces County Public Health District. border population. Birth Def Res Part Using data from the Texas Birth During this time, he was awarded two A 2004;70:92-4. Craniorachischisis, Defects Registry, a database of chil- TDH Innovation grants and conducted a severe form of neural tube defect, dren with metopic craniosynostosis projects on infectious disease surveil- exhibits both anencephaly and open was created. Of the 188 cases found, lance, vector borne disease, and pub- spina bifida from the cervical to the two cases had maternal valproic acid lic health policy improvement. He lumbar region. This study describes monotherapy (use of only one rather can be contacted at 512-458-7232, the prevalence of craniorachischisis than more than one drug) recorded in [email protected]. among the Texas-Mexico border the database. This means that about population between 1993-1999. 1% of children born with metopic RECENT PUBLICATIONS Data was collected through an active surveillance system that identified all craniosynostosis had mothers who The following studies were funded in clinically apparent NTD-affected used valproic acid. One study part through the Texas Center for fetuses and infants born to mothers recorded 1,600 patients with metopic Birth Defects Research and Preven- residing and delivering in any of the synostosis, 17 of whom had maternal tion, one of ten such programs in the 14 Texas-Mexico border counties, valproic acid exposure. This also rep- U.S. funded by the National Center including live-born, stillborn, and resents about l%. for Birth Defects and Developmental therapeutic abortions. Sixteen cran- Disabilities: After examining this information, we iorachischisis cases were identified looked at the Anti-Epileptic Drug Brender JD et al. Dietary nitrites and for a total prevalence of 0.51 per Registry , which presented the infor- nitrates, nitrosatable drugs, and neu- 10,000 live births (Mexican Ameri- mation in a different way. They exam- ral tube defects. Epidemiology can prevalence, 0.52 per 10,000) and ined 149 patients with valproic acid 2004;15:330-336. Researchers a prevalence of 0.28 per 10,000 live monotherapy and found 1 with examined a proposed link between births for cases of 20 weeks gestation metopic synostosis in the child nitrosatable drugs and neural tube or greater. The prevalence of cranio- (0.75%). defects, taking into account dietary rachischisis was higher than that nitrite and total nitrite intake in a reported in Atlanta (0.1 per 10,000
MONITOR VOL. 10-1 PAGE 4 live births), but much lower than PREVENTION have been made to increase public that reported in Northern China awareness of the crucial role of folic (10.7 per 10,000 births). For more INCREASINGLY AVAILABLE acid in preventing NTDs. Together, information on this study, contact HIGHLY FORTIFIED GRAIN the food industry and other public Lucina Suarez, Ph.D.Texas Depart- health institutes have worked dili- PRODUCTS & NTD RATES ment of Health, Epidemiology gently to introduce easily attainable Research Service Branch, 512-458- Mandatory fortification of cereal sources of folic acid to help the pub- 7111, [email protected] grain products by the U.S. Food and lic, specifically women of childbear- Volcik K et al. Evaluation of the Drug Administration has proven to ing age, consume the 400 µg of folic Jumonji gene and risk for spina be a successful step in reducing the acid daily, as recommended by the bifida and congenital heart defects. prevalence of babies born with neural FDA.3 tube defects (NTDs) in the United Am J Med Genet 2004;126A(2): A stroll down the breakfast aisles of 215-7. States. Although there is still much work to be done, recent research some local grocery stores reveals the Volcik K et al. Evaluation of the shows a significant drop in NTDs concerted effort made by the cereal cited2 Gene and risk for spina bifida that can be chronologically linked industry in increasing awareness and and congenital heart defects. Am J with fortification of the food supply availability of folic acid-containing Med Genet 2003;126A(3):324-5. products. A large number of cereal with folic acid.1 Overall, the “esti- Zhu H et al. Promoter haplotype manufacturers have fortified their mated number of NTD-affected preg- combinations for the human PDG- products with even more than the nancies in the United States declined FRA gene are associated with risk of FDA regulation requires, further from 4,000 in 1995-1996 to 3,000 in neural tube defects. Mol Genet ensuring that women of childbearing 1999-2000,” 1 a 25% reduction. Metab 2004;81:127-32 age can easily consume the needed More specifically, a 23% decline in amounts of folic acid each day. The the birth prevalence of spina bifida SYMPOSIUM, CONTINUED list of fortified cereals has more than and an 11% decline in the birth prev- FROM PAGE 1 doubled just over the past few years, alence of anencephaly were observed now totaling over 100 cereals from from October 1998 through Decem- In addition, the following sessions well-known brands including Gen- 2 focused on epidemiology and out- ber 1999. This decline in the preva- eral Mills, Kellogg's, Malt-O-Meal, comes from TBDMD staff: lence of NTD-affected pregnancies Post, and Quaker, that offer products can be significantly attributed to the Texas Patterns and Prevalence of containing at least 50% of the total regulation of folic acid fortification daily-recommended amount of folic Birth Defects in Texas (Mark Can- 2 field, Ph.D.) of the food supply. acid. Fifty-four of these cereals con- tain 100% of the daily requirement, Pregnancy Outcomes for Selected The regulation, which went into providing the total suggested amount Birth Defects in Texas (Mary Ethen, effect in January 1998, requires that of folic acid in just one serving. M.P.H.) all enriched cereal grains be fortified with 140 micrograms (µg) of folic Twenty-five of the cereals on this list Update on Orofacial Clefting (Jac- 2 are Women, Infants and Children queline Hecht, Ph.D., University of acid per 100 grams of grain or (WIC) approved, offering attainable Texas-Houston School of Public approximately 10% of the daily rec- sources of folic acid to lower income Health) ommended value of folic acid per women and their children. Local 3 Finally, a clinical resident from Uni- serving. Since 1998, many efforts store brands, such as HEB and Ran- versity of Texas at El Paso presented dall's, have joined the folic acid cam- an unusual case study, Balanced paign, providing over 30 highly Maternal Chromosomal Transloca- fortified cereals at lower prices than tion (3;22), resulting in partial Tri- name brands. somy 3 and Monosomy 22 (Sridev In addition to the growing list of Abboy, M.D.) highly fortified cereals, several nutri- If you would like to contact any of tion bar manufacturers such as EAS these speakers about the topics cov- Myoplex, Luna, and Power Bar now ered, please send an email to provide products containing at least [email protected] or call 512- 50% of the daily-recommended dose 458-7232. of folic acid, providing yet another
MONITOR 5 means of daily consumption. These COUNTY CLERKS ANNOUNCEMENTS findings are encouraging and prove PARTICIPATE IN FOLIC that efforts are being made on several ACID EDUCATION EFFORT HHSC CONSOLIDATION fronts to reduce the prevalence of NTDs by incorporating simple, Nearly 170,000 marriage licenses NEW NAME: BIRTH DEFECTS affordable sources of folic acid into each year are issued in Texas to cou- EPIDEMIOLOGY AND SURVEILLANCE: Pur- the daily diet. ples with a bride under age 45-and suant to Texas House Bill 2292, each of those couples must go the Further, the National Council on which directed the consolidation of their county clerk's office to obtain Folic Acid (www.folicacidinfo.org) 12 Texas Health and Human Services their license. That is why, in May has made it a priority to encourage agencies into four, the Texas Depart- 2004, the Texas Folic Acid Council tortilla manufacturers to increase the ment of Health will be known by it's mailed 254 packets of folic acid amount of folic acid available to con- new name, the Department of State information to county clerks sumers through their products. Health Services. The Texas Birth throughout the state. These packets, Defects Monitoring Division at that For more information or a copy of the funded in part by the March of time will also take on a new name: cereal list containing brands specific Dimes, included examples of free Birth Defects Epidemiology and Sur- to HEB and Randall's grocery store educational materials from the Cen- veillance Branch. Working within chains, contact Amy Case at the ters for Disease Control and Preven- the Prevention and Preparedness Ser- Texas Birth Defects Monitoring tion (CDC), order forms for these vices Division, our mission and oper- Division, 512-458-7232, materials and sticky note and pen ation will remain essentially [email protected]. “reminders.” unchanged, as will our commitment --Contributed by Christine Creecy, Because couples may be more likely to the prevention of birth defects. Texas A&M Intern, Texas Birth to consider their potential for child- More information about the HHSC Defects Monitoring Division bearing when they are preparing to consolidation process can be References marry, they would at that time (at obtained at www.hhsc.state.tx.us/ 1. CDC. Spina Bifida and Anenceph- least temporarily) be considered Consolidation/Consl_home.html or aly Before and After Folic Acid “contemplators” rather than “precon- by calling 512-424-6500 Mandate --- United States, 1995- templators,” making them 1996 and 1999-2000 (May 7). much more open to a life- MMWR. 2004; 53(17): 362-365. style change such as taking folic acid (Transtheoretical 2. Honein MA, Paulozzi LJ, Model, Prochaska). Thus, Mathews TJ, Erickson JD, Wong it is hoped that the message Proposed New Logo LYC. Impact of Folic Acid Forti- about folic acid and the prevention of fication of the US Food Supply birth defects will find a more “fer- NATIONAL GROUP on the Occurrence of Neural tile” ground in this initiative. ACKNOWLEDGES TEXAS' Tube Defects. JAMA. 2001; LEADERSHIP ROLE 285(23): 2981-2986. As of June 2004, 28 county clerk orders have been placed with the The National Birth Defects Preven- 3. Kurtzweil P. How Folate Can Help CDC for the materials-a response tion Network (NBDPN), a group of Prevent Birth Defects. FDA rate of more than 10%. The Texas individuals involved in birth defects Consumer. 1999. Folic Acid Council greatly appreci- surveillance, research, and preven- ates the participation of the Texas tion, held its annual meeting in Janu- Department of Health's Bureau of ary in Salt Lake City. This year, the To be added to our mailing list and Vital Statistics and each county group presented Texas with its State for other free publications from the worker who participates in the cam- Leadership Award. This prestigious Division, please contact us at 512- paign. award, established in 2001, honors 458-7232 or e-mail For more information about the Texas the outstanding contribution (or lead- bobbie.mankowski@ tdh. Folic Acid Council, please contact ership) by a state birth defects regis- state.tx.us. Chan McDermott, Bureau of Women’s try in the development or expansion MORE INFORMATION CAN BE FOUND AT Health, 512-458-7111 Ext. 6663, email of birth defects surveillance, or its WWW.TDH.STATE.TX.US/TBDMD/INDEX.HTM . [email protected]. use in the promotion of prevention services. The NBDPN is a vital
MONITOR VOL. 10-1 PAGE 6 group with many opportunities for Birth Defects Registry and for related so that children are protected from active participation and collabora- prevention initiatives. preventable diseases and opposes tion. Membership information can exemptions from immunizations, be obtained at www.nbdpn.org, or by NEWBORN SCREENING:Screening except in the case of a conflict in reli- contacting Member-at-Large Ruth infants at birth for early detection of gious beliefs or due to a medical con- Merz, [email protected], 808- serious, inherited disorders plays an dition. 587-4120. integral part in helping babies live healthier lives. The March of Dimes SMOKING CESSATION:Women who MARCH OF DIMES recommends that all states screen smoke during pregnancy are twice as ADVOCACY INITIATIVES newborns for a core group of disor- likely as nonsmokers to give birth to FOR 2005 ders. These disorders have no imme- a low birthweight baby. Women diate, visible effects on a baby; under the age of 20 are almost twice TEXAS BIRTH DEFECTS REGISTRY:After however, unless they are detected as likely to smoke during pregnancy a cluster of babies were born with and treated early, they can cause than those over age 25. The March of anencephaly in South Texas, the physical problems, mental retarda- Dimes supports efforts to educate March of Dimes worked to help pass tion and even death. Texas currently women on the dangers of smoking the Texas Birth Defects Act of 1993 screens newborns for six disorders, during pregnancy, including the risk which established the Texas Birth which falls short of the March of of premature birth. Defects Monitoring Division Dimes testing threshold. The March For more information, contact Jorey (BDMD) within the Texas Depart- of Dimes supports funding to pur- Berry, Texas Chapter of the March of ment of Health. The Texas Birth chase technology needed to expand Dimes, 512-477-3221, JBerry@mar- Defects Registry is the cornerstone of newborn screening in Texas. chofdimes.com. the BDMD. ACCESS TO HEALTHCARE COVERAGE: The Texas Birth Defects Registry MARCH OF DIMES exists to identify and describe pat- The Children's Health Insurance Pro- LICENSE PLATES AVAILABLE gram (CHIP) benefits working fami- terns of birth defects in Texas and On June 22, 2003, Governor Perry collaborate with others in finding lies whose income is too high to qualify for Medicaid, but not enough signed House Bill 2971 into law. causes of birth defects, working Among other things, the legislation towards prevention, and linking fam- to purchase private health insurance for their children. The March of allowed for the production of March ilies with services. In 2002, Trust for of Dimes specialty license plates. America's Health, a Washington, Dimes supports restoration of CHIP funding cut during the 78th Regular The license plates will cost an addi- D.C.-based nonprofit organization tional $30 above a normal renewal or gave Texas an “A” for its birth Session of the Texas Legislature, spe- cifically cuts affecting newborns. In purchase price, of which $8 will go defects surveillance system. In 2003, towards administrative costs and $22 the National Birth Defects Preven- addition, the March of Dimes recom- mends restoration of funding for pre- will support the Texas Birth Defects tion Network presented Texas with Registry. Support of the Texas Birth the prestigious State Leadership natal care for pregnant women on Medicaid, restoring eligibility to Defects Registry is a March of Dimes Award, which honors the outstanding public affairs priority. The design contribution and leadership by a state 185% of the Federal Poverty Level. Women who receive prenatal care are can be seen at the Texas Department birth defects registry. In addition, of Transportation's web site at Texas receives almost a million dol- more likely to have access to services that identify problems early and may www.txdot.state.tx.us/vtr/spplates/ lars in funding each year from the allplates.htm. Centers for Disease Control and Pre- help improve the health of mothers vention to operate the Texas Center and infants. for Birth Defects Research and Pre- IMMUNIZATION:Vaccines are one of the vention. Texas is one of only ten most cost effective means to prevent states to receive this funding. The infectious diseases. Historically, the March of Dimes continues to advo- March of Dimes has been involved in cate for full funding for the Texas vaccine issues, beginning with the founding mission to prevent polio. The March of Dimes supports efforts to increase immunization coverage
MONITOR 7 First Class U.S. Postage Paid Austin TX Texas Birth Defects Monitoring Division Permit 28 Texas Department of Health 1100 West 49th Street Austin, Texas 78756 512-458-7232 www.tdh.state.tx.us/tbdmd/index.htm
Address Service Requested
TDH Pub. No. 58-10955 Vol. 10-1 Vol. 58-10955 No. Pub. TDH
Creecy, Texas A&M University. A&M Texas Creecy,
Defects Monitoring Division; Christine Christine Division; Monitoring Defects
866-935-1959. 866-935-1959. and Mary Ethen, M.P.H., Texas Birth Birth Texas M.P.H., Ethen, Mary and
: : C Mark A. Canfield, Ph.D. Ph.D. Canfield, A. Mark Austin. Contact: Karen O'Briant, O'Briant, Karen Contact: Austin. ONTRIBUTORS
Obstetricians and Gynecologists, Gynecologists, and Obstetricians
Texas Birth Defects Monitoring Division Division Monitoring Defects Birth Texas Bifida Awareness Month Awareness Bifida
Texas Association of of Association Texas A 8-9: PRIL
nications Specialist/Acting Director, Director, Specialist/Acting nications Awareness Month; National Spina Spina National Month; Awareness
: : E Amy Case, M.A.H.S., Commu- M.A.H.S., Case, Amy DITOR National Down Syndrome Syndrome Down National : O 312-915-9221, [email protected] 312-915-9221, CTOBER
bition Dallas. Contact: Melvina Ivy, Ivy, Melvina Contact: Dallas. bition
Texas Birth Defects Monitoring Monitoring Defects Birth Texas [email protected]
Society Annual Conference & Exhi- & Conference Annual Society
Mark A. Canfield, Ph.D., Director, Director, Ph.D., Canfield, A. Mark Antonio, Texas Contact: Contact: Texas Antonio,
mation and Management Systems Systems Management and mation
Bureau of Epidemiology of Bureau Annual Meeting & Conference, San San Conference, & Meeting Annual
Healthcare Infor- Healthcare 13-17: F EBRUARY
Ernest Oertli, D.V.M., Ph.D., Chief, Chief, Ph.D., D.V.M., Oertli, Ernest Texas AWHONN AWHONN Texas 23-25: S EPTEMBER
Mai, 404-498-3918, [email protected]. 404-498-3918, Mai, and Prevention Prevention and
Spectrum Disorders Day. Disorders Spectrum
Meeting, Phoenix, AZ. Contact: Cara Cara Contact: AZ. Phoenix, Meeting, Disease Control Control Disease Commissioner, ate
National Fetal Alcohol Alcohol Fetal National
9: S
EPTEMBER Lucina Suarez, Lucina Ph.D., Acting Associ- Acting Ph.D., Defects Prevention Network Annual Annual Network Prevention Defects
National Birth Birth National 24-26: 24-26: J ANUARY Deputy Commissioner Deputy
ence.htm Contact: [email protected]. Contact: ence.htm
Nick Curry, M.D., M.P.H., Executive Executive M.P.H., M.D., Curry, Nick
D.C. www.cdc.gov/ncbddd/confer- D.C. 2005
Commissioner Disabilities Conference, Washington, Washington, Conference, Disabilities
Eduardo Sanchez, M.D., M.P.H., M.P.H., M.D., Sanchez, Eduardo
Birth Defects and Developmental Developmental and Defects Birth 7405.
of Health of National Center on on Center National 26-28: 26-28: J [email protected], 512-657- [email protected], ULY
George McClesky, Chair, Texas Board Board Texas Chair, McClesky, George inants, Austin. C Austin. inants, ontact: Sarah Jones, Jones, Sarah ontact:
2004
Impacted by Environmental Contam- Environmental by Impacted Division, Texas Department of Health. Health. of Department Texas Division,
Symposium on Children's Health as as Health Children's on Symposium by the Texas Birth Defects Monitoring Monitoring Defects Birth Texas the by
C ALENDAR
Biennial Scientific Scientific Biennial 24-25: S Monitor The is published twice a year year a twice published is EPTEMBER