The Metropolitan Atlanta Congenital Defects Program: 35 years of birth defects surveillance at the Centers for Disease Control and Prevention

Birth Defects Res A Clin Mol Teratol. 2003 Sep;67(9):617-24. doi: 10.1002/bdra.10111.


Background: The Metropolitan Atlanta Congenital Defects Program (MACDP) is a population-based birth defects surveillance program administered by the Centers for Disease Control and Prevention (CDC) that has been collecting, analyzing, and interpreting birth defects surveillance data since 1967. This paper presents an overview of MACDP current methods and accomplishments over the past 35 years.

Methods: MACDP actively monitors major birth defects among infants born to residents of five counties of metropolitan Atlanta, an area with approximately 50,000 annual births. Cases are ascertained from multiple sources, coded using a modified British Pediatric Association six-digit code, and reviewed and classified by clinical geneticists.

Results: MACDP has monitored trends in birth defects rates and has served as a case registry for descriptive, risk factor, and prognostic studies of birth defects, including studies of Agent Orange exposure among Vietnam War veterans, maternal use of multivitamins, diabetes, febrile illnesses, and survival of children with neural tube defects. MACDP has served as a data source for one of the centers participating in the National Birth Defects Prevention Study, and for developing and evaluating neural tube defects prevention strategies related to the periconceptional use of folic acid supplements.

Conclusions: Since its inception, MACDP has served as a resource for the development of uniform methods and approaches to birth defect surveillance across the United States and in many other countries, monitoring birth defects rates, and as a case registry for various descriptive, etiologic, and survival studies of birth defects. MACDP has also served as a training ground for a large number of professionals active in birth defects epidemiology.

MeSH terms

  • 2,4,5-Trichlorophenoxyacetic Acid / toxicity
  • 2,4-Dichlorophenoxyacetic Acid / toxicity
  • Agent Orange
  • Centers for Disease Control and Prevention, U.S.* / standards*
  • Congenital Abnormalities / classification
  • Congenital Abnormalities / diagnosis*
  • Congenital Abnormalities / epidemiology*
  • Congenital Abnormalities / etiology
  • Congenital Abnormalities / prevention & control
  • Defoliants, Chemical / toxicity
  • Diabetes Mellitus / physiopathology
  • Environmental Exposure / adverse effects
  • Folic Acid / therapeutic use
  • Forms and Records Control / standards
  • Georgia / epidemiology
  • Medical Records
  • Neural Tube Defects / prevention & control
  • Polychlorinated Dibenzodioxins / toxicity
  • Prognosis
  • Registries / statistics & numerical data
  • Retrospective Studies
  • Risk Factors
  • Seizures, Febrile / physiopathology
  • Sentinel Surveillance*
  • United States
  • Urban Population
  • Veterans / statistics & numerical data
  • Vitamins / therapeutic use


  • Defoliants, Chemical
  • Polychlorinated Dibenzodioxins
  • Vitamins
  • 2,4-Dichlorophenoxyacetic Acid
  • Agent Orange
  • Folic Acid
  • 2,4,5-Trichlorophenoxyacetic Acid