defects, and the prevalence of some types of heart defects are increasing while the rates of others remain steady (CDC, 2021, April 6). In Illinois, APORS hospital discharge case-finding and universal pulse oximetry screening for critical congenital heart defects may explain some of the increase seen during 2013-2018. Of note is a marked (nonsignificant) decrease in prevalence of tricuspid atresia/stenosis and other anomalies during the 2013 to 2018 time period which is in line with findings from Salemi et al. who reported an immediate decrease in the prevalence for this defect as a result of the conversion from ICD-9 to ICD-10 coding. Rectal and large intestinal atresia/stenosis rates decreased significantly between 2002 and 2012. However, between 2013 and 2018 the rates showed a nonsignificant increase. Gastrointestinal defects may be associated with chromosomal anomalies including Down syndrome, which also showed a slight nonsignificant decrease during the first time period. During the latter time period it is possible that hospital discharge case finding contributed to the increased rates. 9 Renal agenesis/hypoplasia rates increased significantly from 2002 to 2012. Between 2013 and 2018 the rate also increased, but not significantly. These conditions are largely genetic in nature. The increase in rates is in part due to improved chart abstraction, with the identification of additional cases of hypoplasia. Additionally, hospital discharge case-finding and the conversion from ICD-9 to ICD-10 during the latter period may also explain an increase in rates. Hypospadiasrates increased during both periods of study (2002 to 2012 and 2013 to 2018). The specific causes of most cases of hypospadias remain unknown, although certain factors have been identified that may increase the risk of having a child with this condition. These include older maternal age, obesity, use of assisted reproductive technology (ART), and use of hormones (CDC, 2021, April 8). In Illinois, the proportion of births in Illinois to women ages 35 and older has increased from 14.5% in 2002 to 20.1% in 2018. Use of ART has increased steadily in the United States since it was introduced in the early 1980s, and Illinois is one of a number of states consistently reporting the highest use of ART nationally (Sunderam et al., 2017; Wright et al., 2005). Multistate studies using the Pregnancy Risk Assessment Monitoring System and U.S. National Vital Statistics System natality data have revealed an increase in the prevalence of prepregnancy obesity nationwide during the years 2003 to 2015 (Deputy et al., 2018). While overall rates of Down syndrome are higher as maternal age increases (see Figure 10), no significant changes were seen in the rates over either study periods for this report. It is noteworthy to mention that the (nonsignificant) increase in prevalence rates of microcephalus starting in 2015 (see Figure 1) correlates directly with APORS’ participation in CDC’s enhanced rapid data collection efforts (active case finding and standard case definition) used to gather information nationwide about birth defects possibly related to the Zika virus. A regression line is not shown for this defect for the time period of 2013 to 2018. ASSOCIATION BETWEEN CONGENITAL MALFORMATION AND NEONATAL AND MATERNAL VARIABLES IN NEONATAL UNITS OF A NORTHEAST BRAZILIAN CITY Fabíola Chaves Fontoura1 , Maria Vera Lúcia Moreira Leitão Cardoso2 1 Part of a dissertation - Newborns with congenital malformations: prevalence and nursing care in a neonatal unit, presented to the Postgraduate Program in Nursing at Universidade Federal do Ceará (UFC), in 2012 2 Doctoral student of the Postgraduate Program in Nursing at UFC. Fortaleza, Ceará, Brazil. E-mail: fabi_fontoura@yahoo.com. br 3 Ph.D. in Nursing. Full professor of the UFC Department of Nursing. Fortaleza, Ceará, Brazil. E-mail: cardoso@ufc.br ABSTRACT: Congenital malformations occur due to genetic, environmental, and mixed factors or unknown causes. This study aimed to investigate the existence of a relationship between the type of congenital malformation and maternal and neonatal variables. This prospective, quantitative study was conducted in three public neonatal units in Fortaleza, Ceará, Brazil. Data were collected from the medical records of 159 malformed neonates and analyzed using the Chi-square test (χ2), significance level of 5% (p< 6 64 40 5.94±2.44 ≥ 6 91 57 No prenatal care 1 1 Not registered 3 2 Use of licit and/or illicit drugs No 134 84 Yes 19 12 Not registered 6 4 No. of pregnancies 1 67 42 2.5±1.96 2 – 3 55 35 ≥ 4 37 23 Order of children with CM† 1st child 149 94 1.03±0.33 2nd child 9 6 Not registered 1 1 Source: medical records of the newborns; *SD = Standard Deviation; † CM = Congenital Malformation. The categories of congenital malformations are presented in Table 2, according to the ICD-10. Malformations of the Musculoskeletal System and CNS were more prevalent, with 30% (84) and 21.1% (59), respectively. Table 2 - Categories of congenital malformations in newborns delivered in hospital institutions. Fortaleza, Ceará, Brazil, 2012 Malformation categories n % Musculoskeletal system CM* 84 30 Central nervous system 59 21.1 Circulatory system 27 9.6 Eye, ear, face and neck CM 20 7.1 Chromosomal abnormalities 19 6.8 Cleft Lip and/or palate 16 5.7 Other