5 to <25, 25 to <30, 30+), mother's state of residence at the time of infant's birth, and dichotomous variables for gestational diabetes and hypertension during pregnancy. We also considered folic acid-containing vitamin supplement use (1 month before pregnancy through month 1, later in pregnancy/none) and periconceptional exposure to the following: cigarette smoking (yes, no), maximum number of alcoholic drinks on 1 occasion (none, 1-3, 4+), and family history of the same birth defect in a first-degree relative. Bivariate analyses were conducted to assess potential confounding. Variables associated

with exposure among control mothers were included in multiple logistic regression models. Family history of the same birth defect in a first-degree relative was included in all adjusted models. For birth defect case groups click here with 5 or more exposed cases, adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were calculated. For birth defects with 3 or 4 exposed cases, crude ORs and

exact CIs were calculated. ORs are not shown for birth defect phenotypes with fewer than 3 exposed cases. Analyses using the same models were restricted to isolated birth defects only. All analyses were performed using SAS software, version 9.1 (SAS Institute Inc., Cary, NC, USA). To determine Navitoclax whether any associations between butalbital and birth defects were due either to other active ingredients in butalbital products or to confounding by indication, we evaluated 2 additional exposure groups. First, we calculated effect estimates for “other ingredients in butalbital products,” defined as periconceptional exposure to any combination products containing acetaminophen, aspirin, caffeine, and/or codeine that do not contain butalbital but are also prescribed for tension headaches or migraines, eg, Excedrin extra strength, Excedrin migraine, and Tylenol with codeine. In addition, we calculated

effect estimates for periconceptional exposure selleck compound to any triptan (selective serotonin agonist) antimigraine medication: sumatriptan, zolmitriptan, naratriptan, rizatriptan, frovatriptan, almotriptan, and eletriptan to examine whether other factors related to migraine or tension-type headaches may have contributed to our findings. Triptan medications were chosen for this evaluation of confounding by indication because they are prescribed specifically for treatment of migraine headaches. The analysis plan (birth defect case groups and statistical models) used in analysis of butalbital exposure was applied to the analysis of exposures to combination products not containing butalbital and to the analysis of triptan medications; infants with maternal exposure to butalbital were excluded from these analyses. We conducted several sensitivity analyses to examine factors that might influence our effect estimates. First, if “as needed” or “once or twice per year” butalbital use was reported for the entire interval from 3 months preconception through delivery, exposure was flagged as uncertain.

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