Project Summary The New York State Center for Birth Defects Research and Prevention (NYSCBDRP) proposes to continue its strong record of conducting epidemiologic research to identify the causes of birth defects through its participation in the Birth Defects Study to Evaluate Pregnancy exposureS (BD-STEPS). The NYSCBDRP has been a major contributor to CDC’s collaborative National Birth Defects Prevention Study (NBDPS) and BD- STEPS since 1996. The NYSCBDRP is situated in the New York State Department of Health (NYSDOH) Birth Defects Registry and enjoys a strong collaborative relationship with the University at Albany School of Public Health. The Specific Aims of this project are to: (1) identify birth defect cases and controls from two geographically and sociodemographically diverse catchment areas in New York State; (2) conduct epidemiologic investigations on non-genetic risk factors for specific birth defects, including medications, chronic and infectious disease, occupational factors, social determinants of health, and health equity, resulting in at least 7 publications and 7 presentations over 3.5 years; (3) contribute residual newborn bloodspots and investigate genetic factors for birth defects; (4) link individuals to the NYS National Electronic Disease Surveillance System to ascertain and characterize the impact of infections before and during pregnancy on birth defects; (5) evaluate and develop existing and novel modes of information collection for BD-STEPS; and (6) mentor and train future birth defects researchers by offering internships and thesis/dissertation data for graduate students at the University at Albany School of Public Health and training opportunities for junior NYSCBDRP analysts. From its position within the NYSDOH, the NYSCBDRP will leverage considerable resources through donated staff time, privileged access to individual medical records, the Birth Defects Registry, infectious disease surveillance systems, and affiliation with the world-renowned Wadsworth Center laboratory for genetic studies. The NYSCBDRP has demonstrated success implementing the NBDPS and BD- STEPS studies and conducting birth defects research, with the highest BD-STEPS participation rate and more than 50 peer-reviewed publications of NBDPS/BD-STEPS analyses led by an NYS author. The NYSCBDRP is well-positioned to continue successfully implementing BD-STEPS, helping to increase knowledge of risk factors for birth defects and inform prevention strategies.