Comp A: Texas BD-STEPS III Core

PROJECT SUMMARY Birth defects are a major contributor to infant mortality, morbidity, and healthcare costs in the U.S., but the etiologies of these conditions remain unknown for most individuals, which has hindered development of population-level prevention strategies. Thus, a critical next step in the national birth defect research agenda is

to better understand the parental and infant determinants of these conditions to identify and implement strategies to reduce birth defect-related morbidity and mortality. As a founding member of the National Birth Defects Prevention Study (i.e., the predecessor of the Birth Defects Study to Evaluate Pregnancy exposureS

(BD-STEPS), the Texas Center for Birth Defects Research and Prevention has helped advance birth defects research and prevention since the founding of the Texas Birth Defects Registry in 1996. The Center represents a collaboration between the Texas Birth Defects Registry at the Texas Department of State Health Services,

UTHealth School of Public Health, and Baylor College of Medicine. The addition of our geographic region to BD-STEPS recruitment pool would allow for increased diversity, particularly among Mexican Americans, one of the fastest-growing racial/ethnic groups in the U.S. By leveraging one of the largest birth defects registries in

the world, our team has extensive experience in birth defects surveillance and epidemiology, and an exceptional track-record for both generating publications (N>500) that have contributed toward elucidation of birth defects risk factors and training the next generations of birth defects researchers. Building upon our

strong infrastructure for patient recruitment, data collection, and epidemiologic analyses, we now propose to contribute our experience and resources to BD-STEPS by collaborating with our long-term partners from other states to advance the study’s data collection and impact, through research and training. Our Center’s particular

research areas include 1) social determinants of health (led by the Texas Department of State Health Services); 2) genetic risk factors (led by Baylor College of Medicine); and 3) occupational exposures (led by UT Health School of Public Health). Thus, we are well-positioned to conduct, publish, and present at least

seven proposed research studies designed to identify associations with these and other exposures in BD- STEPS and to improve understanding of the specific mechanisms that underlie risk for particular birth defects. At its conclusion, we expect this work will have expanded the list of potentially modifiable maternal exposures

that are known to be associated with the risk of birth defects, contributed new knowledge that will aid in the design of risk reduction strategies, and empower the development of doctoral and post-doctoral trainees and junior faculty members. Most importantly, it is expected that these outputs will ultimately translate to a

reduction in the prevalence of birth defects and improved health among infants born with these conditions.