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Discussion In this nationwide population-based cohort study of more than 12 million live births in the USA, we found that maternal cigarette smoking, even at a low intensity (15 cigarettes per day), before pregnancy or during each trimester of pregnancy significantly increased the risk of six specific subtypes of congenital anomalies (i.e., congenital diaphragmatic hernia, gastroschisis, limb reduction defect, cleft lip with or without cleft palate, cleft palate alone, and hypospadias)