LAUSR

Abstract Background Maternal exposure to pesticides during early pregnancy is associated with increased risks of birth defects, while the association between maternal exposure to chemical fertilizer during pregnancy and the risk of birth defects remains unknown. Methods Data were from a population-based birth defects surveillance system between 2007 and 2012 in Pingding County, Shanxi Province, northern China. A total of 14 074 births with 235 birth defects were used to estimate spatial clustering and correlations at the village level. A population-based case–control study of 157 cases with birth defects and 204 controls was performed to investigate the association between maternal chemical fertilizer exposure and the risk of birth defects by a two-level logistic model. Results The total prevalence of birth defects between 2007 and 2012 was 167.0/10 000 births. The spatial analysis indicated a remarkable high-risk area of birth defects in the southeast of Pingding County and the use of chemical fertilizer was associated with the risk of birth defects at the village level. After adjusting for confounders at the individual level, mothers who live in villages with chemical fertilizer application ≥65 tons/y had an increased risk of birth defects (adjusted odds ratio 2.06 [95% confidence interval 1.23 to 3.46]) compared with those of <65 tons/y. Conclusions Our findings suggest that the risk of birth defects may be associated with the use of chemical fertilizer in rural northern China. The findings must be cautiously interpreted and need to be investigated on larger samples.