McKeown, Record, and the epidemiology of malformations

Thomas McKeown and RG Record were colleagues in Birmingham, England, from 1947 to 1977. During their first decade together, they laid the foundations of epidemiological research on malformations with a series of case-control studies of the commoner major defects. They found evidence of numerous trends of birth prevalence with variables such as season and year of birth, maternal age, birth rank, and socioeconomic status, suggesting that environmental factors played an important part in causation. The work that has led recently to the use of folate to reduce the risk of neural tube defects is among the lines of research that can be traced back to these case-control studies. McKeown and Record also initiated, in Birmingham, the first population-based register of malformations to be set up as an on-going activity. As well as paving the way for the international networks of registers that now exist, the Birmingham register has been used in a variety of cohort studies. This work has confirmed many of the case-control study findings and continues to yield new observations, including evidence that enteroviruses are involved in aetiology.