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Risk of major...
Risk of major congenital malformations in relation to maternal overweight and obesity severity: cohort study of 1.2 million singletons
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BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j2563 (Published 14 June 2017) Cite this as: BMJ 2017;357:j2563
Martina Persson, consultant1 2,
Sven Cnattingius, professor1,
Eduardo Villamor, professor1 3,
Jonas Söderling, statistician1,
Björn Pasternak, senior researcher1 4,
Olof Stephansson, consultant1 5,
Martin Neovius, professor1
1Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, SE-171 76 Stockholm, Sweden
2Department of Diabetes and Endocrinology, Sachsska Children's Hospital, Södersjukhuset, Stockholm, Sweden
3Department of Epidemiology, School of Public Health and Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
4Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
5Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
Correspondence to: M Persson Martina.Persson{at}ki.se
Objective To estimate the risks of major congenital malformations in the offspring of mothers who are underweight (body mass index (BMI) <18.5), overweight (BMI 25 to <30), or in obesity classes I (BMI 30 to <35), II (35 to <40), or III (≥40) compared with offspring of normal weight mothers (BMI 18.5 to <25) in early pregnancy.
Design Population based cohort study.
Setting Nationwide Swedish registries.
Participants 1 243 957 liveborn singleton infants from 2001 to 2014 in Sweden. Data on maternal and pregnancy characteristics were obtained by individual record linkages.
Exposure Maternal BMI at the first prenatal visit.
Main outcome measures Offspring with any major congenital malformation, and subgroups of organ specific malformations diagnosed during the first year of life. Risk ratios were estimated using generalised linear models adjusted for maternal factors, sex of offspring, and birth year.
Results A total of 43 550 (3.5%) offspring had any major congenital malformation, and the most common subgroup was for congenital heart defects (n=20 074; 1.6%). Compared with offspring of normal weight mothers (risk of malformations 3.4%), the proportions and adjusted risk ratios of any major congenital malformation among the offspring of mothers with higher BMI were: overweight, 3.5% and 1.05 (95% confidence interval 1.02 to 1.07); obesity class I, 3.8% and 1.12 (1.08 to 1.15), obesity class II, 4.2% and 1.23 (1.17 to 1.30), and obesity class III, 4.7% and 1.37 (1.26 to 1.49). The risks of congenital heart defects, malformations of the nervous system, and limb defects also progressively increased with BMI from overweight to obesity class III. The largest organ specific relative risks related to maternal overweight and increasing obesity were observed for malformations of the nervous system. Malformations of the genital and digestive systems were also increased in offspring of obese mothers.
Conclusions Risks of any major congenital malformation and several subgroups of organ specific malformations progressively increased with maternal overweight and increasing severity of obesity. For women who are planning pregnancy, efforts should be encouraged to reduce adiposity in those with a BMI above the normal range.
Obesity has reached epidemic proportions globally and is now a major health concern in pregnancy, in both high and low income countries.1 In particular the prevalence of severe obesity, commonly defined as obesity classes II and III (body mass index (BMI) ≥35) is rapidly increasing.234 In the US, approximately half of the women are overweight or obese at the first antenatal visit,5 and the high prevalence of obesity class III (BMI ≥40; 10-12%) in women of reproductive age is of concern.6 In Sweden, the prevalence of early pregnancy obesity (BMI ≥30) increased from 6.0% to 12.9% from 1992 to 2014.7 Globally, it was recently reported that the number of women aged 18 years and older with a BMI ≥35 doubled from approximately 50 million to 100 million between 2000 and 2010.8
Obesity in pregnancy adversely influences both fetal and neonatal outcomes,9101112131415 including increased risks of major congenital malformations, which are a common cause of stillbirth16 and a major cause of infant mortality and long term morbidity.1417 A meta-analysis reported that the offspring of obese mothers are at increased risk of a wide range of congenital malformations, including neural tube defects, cardiovascular anomalies, cleft lip and palate, anorectal atresia, and limb reduction anomalies.18 However, associations between increasing severity of obesity and risks of malformations were not analysed and it is not clear if risks are also increased in the offspring of overweight mothers. Several of the included studies also used non-standard definitions of normal weight, overweight, and obesity.192021222324 Since the prevalence of severe obesity is increasing among women of reproductive age, it is of interest to investigate whether risks of major congenital malformations increase with severity of obesity in mothers.
In this study we included information on 1 243 957 live singleton births in Sweden recorded in the medical birth register between 2001 and 2014. We investigated associations between maternal BMI in early pregnancy and risks of any major congenital malformation as well as risks of the most prevalent subgroups of organ specific malformations.
The study was performed in Sweden, where prenatal and delivery care is publicly funded, and participation in the standardised prenatal care programme is almost 100%. The Swedish medical birth register includes information on close to 100% of all births in Sweden since 1973. Using standardised prenatal, obstetrical, and neonatal records, information is prospectively collected during pregnancy, delivery, and the neonatal period.25 Individual information on maternal height and weight has been included since 1992.
By using the unique personal identification number assigned to each Swedish resident,26 we linked data from the medical birth register to the national patient register,27 cause of death register, education register, and total population register.28 The national patient register includes diagnoses and dates on visits for hospital based inpatient and outpatient care. Diagnoses are coded according to the Swedish version of the ICD-10 (international classification of diseases, 10th revision). In Sweden, all pregnant women are offered an ultrasound examination at around 18 weeks of gestation. Abortion after 18 until 22 completed weeks must be approved by the National Board of Health and Welfare. Severe birth defects as indication for late abortion are generally approved. In 2015, the rate of abortions in Sweden was 20.9/1000 women (aged 15-44 years; 93% of abortions were performed before 12 weeks of gestation and 83% before nine weeks of gestation).
From 1 January 2001 to 31 December 2014, we retrieved information on 1 480 892 deliveries recorded in the Swedish medical birth register. We excluded 42 638 (2.9%) multiple births (since they differ from single births for malformation outcomes29) and 4598 (0.3%) stillbirths (where diagnosis and registration of malformations is poor or missing). Of the remaining 1 433 656 live singleton births, 19 863 (1.4%) were excluded owing to lack of valid personal identification numbers (18 929 for the mother and 934 for the infant), as these births could not be linked to other registries. Because we assumed that adiposity is unlikely to cause malformations for which another cause is known, we also excluded 7514 (0.5%) infants with chromosomal aberrations, genetic syndromes, malformation syndromes with known causes, and viral infections having a possible association with malformations (see supplementary eMethods).30 Finally, seven infants did not have data on sex and were therefore excluded. After these exclusions, 1 406 272 singletons remained, of whom 1 243 957 (88.5%) had complete data on all covariates.
Women missing data on BMI were more likely to have missing data on smoking status and family situation (see supplementary eTable 1). Maternal age, level of education, parity, and proportion of women of Nordic origin were similar in women with missing BMI data compared with normal weight women. However, women missing BMI data were more likely to have high education and to be primiparous compared with obese women.
No patients were involved in setting the research question or the outcome measures, nor were they involved in developing plans for design, or implementation of the study. No patients were asked to advise on interpretation or writing up of results. There are no plans to disseminate the results of the research to study participants or the relevant patient community.
Main exposure
We calculated early maternal pregnancy BMI from measured weight and self reported height at the first prenatal visit, which takes place during the first trimester (first 14 weeks of gestation) for 90% of all women.12 We calculated the median height of each mother using information from all available pregnancies.31 Data on maternal height and/or weight were missing in 9.6% of live singleton births (see supplementary eTable 1). Based on BMI, we categorised the women as underweight (BMI <18.5), of normal weight (18.5 to <25), overweight (25 to <30), or in obesity class I (30 to <35), obesity class II (35 to <40), or obesity class III (≥40).32
Data on parity, whether the mother cohabited with a partner or not, and self reported smoking were registered at the first prenatal visit. Information on maternal age was obtained at delivery, highest attained education was retrieved from the education register, and mother's country of birth was retrieved from the total population register.
The main outcome was presence of any major congenital malformations in liveborn infants (from 22 completed gestational weeks), as recorded in either the medical birth register, the national patient register within one year of birth (including inpatient and hospital based outpatient care), or the cause of death register. Major congenital malformations were coded according to the ICD-10 classification and were defined according to the European Surveillance of Congenital Anomalies classification (EUROCAT; www.eurocat-network.eu; see supplementary eTables 2 and 3 for ICD-10 codes).
We analysed the most common subgroups of major congenital malformations with a prevalence of ≥0.1% as additional outcomes. These included major congenital malformations of the heart, limbs, genital organs, urinary system, digestive system, orofacial clefts, eye, nervous system, and other malformations. In keeping with the EUROCAT definition, patent ductus arteriosus in preterm infants and persistent pulmonary stenosis were not considered as major congenital malformations. Other minor malformations were also excluded in accordance with the EUROCAT classification.
Using generalised linear models with a robust sandwich estimator, we estimated risk ratios and 95% confidence intervals for the outcomes in offspring of underweight mothers (BMI <18.5), overweight mothers (25 to <30), and mothers in obesity classes I (30 to <35), II (35 to <40), and III (≥40) compared with the offspring of normal weight mothers (18.5 to <25). To adjust for the possible dependence in outcome introduced by repeated births in the same mother, we constructed models with mother's identification number as a cluster. The outcome was assumed to follow a Poisson distribution. We made adjustments for maternal age, height, parity, early pregnancy smoking status (0, 1-9, or ≥10 cigarettes daily), educational level, mother's country of birth, family situation (living or not living with a partner), and sex of offspring.
Subgroup analyses—sex specific subgroup analyses were performed for any congenital malformations as well as for subgroups of major congenital malformations.
Sensitivity analyses—diabetes is a known teratogen333435 and may also be in the causal pathway between obesity and major congenital malformations. In sensitivity analyses, we excluded women with pregestational diabetes to investigate whether the associations between BMI and major congenital malformations were affected. Although gestational diabetes generally develops after the developmentally critical period for malformations, we also performed an analysis where we excluded both women with pregestational diabetes and women with gestational diabetes.
An additional analysis was performed for the association between BMI and the outcome of any chromosomal aberration, genetic syndrome, malformation syndrome with known causes, and viral infection having a possible association with malformations (infants with these conditions were excluded from the study population of the main analyses; n=7514, of whom 6495 had complete data on all variables).
Data were analysed using SAS (version 9.4). We considered two sided P values <0.05 to be statistically significant. No adjustment was made for multiple comparisons.
Major congenital malformations
During the study period a total of 1 243 957 liveborn singleton infants were included in the cohort, 43 550 (3.5%) of whom had any major congenital malformation. Congenital heart defects were the most common malformation subtype (1.6%) followed by malformations of the genital organs (0.5%), limbs (0.4%), urinary system (0.3%), other (0.2%), eye (0.2%), digestive system (0.2%), orofacial clefts (0.1%), and nervous system (0.1%; fig 1⇓).
Fig 1 Prevalence of major congenital malformations in Swedish live singleton births between 2001 and 2014 (n=1 243 957)
BMI and major congenital malformations
The proportions of offspring with any major congenital malformation were 3.4% for underweight mothers, 3.4% for normal weight mothers, 3.5% for overweight mothers, and 3.8% for mothers in obesity class I, 4.2% in obesity class II, and 4.7% in obesity class III (table 1⇓). In unadjusted analyses, risk ratios of any malformation were increased in offspring of overweight mothers, and increased with severity of obesity. A weak U-shaped relation was found between maternal age and risk of any major congenital malformation. Risks of any major congenital malformations were higher in boys than in girls and in offspring of smokers, primiparous women, mothers of low stature, and mothers who were not cohabiting with their partner (table 1⇓). Supplementary eTable 1 provides maternal characteristics by BMI categories.
Maternal and birth characteristics and major congenital malformations in live singleton births in Sweden
The adjusted risk ratios of any major congenital malformation increased with maternal overweight and severity of obesity (fig 2⇓). Compared with offspring of normal weight mothers, the adjusted risk ratios for any major congenital malformation increased with maternal BMI: 1.05 (95% confidence interval 1.02 to 1.07) in overweight mothers, 1.12 (1.08 to 1.15) in mothers in obesity class I, 1.23 (1.17 to 1.30) in mothers in obesity class II, and 1.37 (1.26 to 1.49) in mothers in obesity class III (fig 2⇓).
Fig 2 Major congenital malformations in liveborn singletons by maternal body mass index (BMI) in underweight (BMI <18.5; n=29 864), normal weight (BMI 18.5 to <25; n=756 432), and overweight (BMI 25 to <30; n=311 339) women, and in women in obesity classes I (BMI 30 to <35; n=103 085), II (BMI 35 to <40; n=31 883), and III (BMI ≥40; n=11 354). Adjustment was made for maternal age (13-24, 25-29, 30-34, ≥35 years), height (130-154, 155-159, 160-164, 165-169, 170-174, 175-200 cm), parity (primiparous, multiparous), early pregnancy smoking status (non-smoker, 1-9, ≥10 cigarettes daily), educational level (<10, 10-12, >12 years), maternal country of birth (Nordic (Sweden, Denmark, Finland, Iceland, and Norway), non-Nordic), family situation (living with partner, not living with partner), and sex of offspring
The overall risk of any major congenital malformation was higher in boys (4.1%) than in girls (2.8%). In analyses stratified by sex of offspring, the risk of any malformation in boys of underweight mothers was 4.0%, normal weight mothers was 4.0%, and overweight mothers was 4.3% and in offspring of mothers in obesity classes I, II, and III was 4.5%, 4.9%, and 5.3%, respectively (fig 2⇑). The corresponding risks in girls were 2.8%, 2.8%, 2.8%, 3.0%, 3.4%, and 4.0%. The risk ratios of any malformation increased with maternal severity of obesity in both boys and girls (fig 2⇑).
BMI and specific types of major congenital malformations
The adjusted risk ratios of malformations of the nervous system, heart, digestive system, genital organs, limbs, and other malformations all increased with increasing maternal BMI (P for trend ≤0.03 in all analyses; figs 3 and 4⇓).
Fig 3 Major congenital malformations in nervous system, eye, heart, and oral clefts in liveborn singletons by maternal body mass index (BMI) in underweight (BMI <18.5; n=29 864), normal weight (BMI 18.5 to <25; n=756 432), and overweight (BMI 25 to <30; n=311 339) women, and in women in obesity classes I (BMI 30 to <35; n=103 085), II (BMI 35 to <40; n=31 883), and III (BMI ≥40; n=11 354). Adjustment was made for maternal age (13-24, 25-29, 30-34, ≥35 years), height (130-154, 155-159, 160-164, 165-169, 170-174, 175-200 cm), parity (primiparous, multiparous), early pregnancy smoking status (non-smoker, 1-9, ≥10 cigarettes daily), educational level (<10, 10-12, >12 years), maternal country of birth (Nordic (Sweden, Denmark, Finland, Iceland, and Norway), non-Nordic), family situation (living with partner, not living with partner), and sex of offspring
Fig 4 Major congenital malformations in digestive, urinary, and genital systems; limbs; and other malformations anliveborn singletons by maternal body mass index (BMI) in underweight (BMI <18.5; n=29 864), normal weight (BMI 18.5 to <25; n=756 432), and overweight (BMI 25 to <30; n=311 339) women, and in women in obesity classes I (BMI 30 to <35; n=103 085), II (BMI 35 to <40; n=31 883), and III (BMI ≥40; n=11 354). Adjustment was made for maternal age (13-24, 25-29, 30-34, ≥35 years), height (130-154, 155-159, 160-164, 165-169, 170-174, 175-200 cm), parity (primiparous, multiparous), early pregnancy smoking status (non-smoker, 1-9, ≥10 cigarettes daily), educational level (<10, 10-12, >12 years), maternal country of birth (Nordic (Sweden, Denmark, Finland, Iceland, and Norway), non-Nordic), family situation (living with partner, not living with partner), and sex of offspring
The adjusted risk ratios for congenital heart defects by maternal BMI were 1.05 (95% confidence interval 1.01 to 1.08) for overweight mothers, 1.15 (1.09 to 1.20) for mothers in obesity class I, 1.26 (1.16 to 1.37) for mothers in obesity class II, and 1.44 (1.27 to 1.63) for mothers in obesity class III. The largest organ specific increases in risk ratios related to overweight and severity of obesity were observed for malformations of the nervous system. Compared with offspring of normal weight mothers, the adjusted risk ratios for malformations in the nervous system were 1.15 (95% confidence interval 1.00 to 1.31) for overweight mothers, 1.44 (1.20 to 1.73) for mothers in obesity class I, 1.65 (1.23 to 2.21) for mothers in obesity class II, and 1.88 (1.20 to 2.94) for mothers in obesity class III (fig 3⇑).
When comparing subgroups of malformations in boys and girls, the largest sex difference (with higher proportions for boys) was noted for genital malformations (boys 0.9% and girls 0.04%) and malformations in the urinary system (boys 0.5% and girls 0.2%; see supplementary eFigure 1). In the sex stratified analyses of malformation subtypes, comparisons were hampered by reduced statistical power in the different BMI categories, especially in girls. The risks of congenital heart defects increased with maternal overweight and severity of obesity for boys, whereas only female offspring of mothers in obesity classes I to III were at increased risks. Maternal BMI was associated with statistically significant increased risks of malformations in the digestive system in boys but not in girls (see supplementary eFigure 2).
Overall, 0.5% of infants who had diagnoses associated with increased risk of malformations were excluded from the main analyses, with a range from 0.5% in the offspring of normal weight mothers to 0.8% in the offspring of mothers in obesity class III. Risks of these malformations also generally increased with maternal overweight and severity of obesity (see supplementary eTable 4).
Sensitivity analysis: exclusion of women with diabetes—after exclusion of women with pregestational and gestational diabetes, the associations between BMI and overall major congenital malformations were materially unchanged (see supplementary eTable 5).
This large population based study found that overall risks of major congenital malformations and risks of several organ specific groups of malformations progressively increase with maternal overweight and severity of obesity. By finding a dose-response relation throughout the spectrum of an above normal body mass index (BMI) and associations between maternal overweight and a range of malformation subgroups, this study substantially expands on previous data, which largely rest on a meta-analysis of pooled studies with varying definitions of obesity and no information on severity of obesity.18
Congenital heart defects were the most prevalent subtype of organ specific malformation, and risks increased with maternal overweight and increasing obesity in a dose-response pattern. This is consistent with findings from a meta-analysis focused on congenital heart defects, reporting increasing risks with maternal overweight, and with women in obesity class I (BMI 30 to <35) and obesity classes II and III (BMI ≥35).36
The largest organ specific risk ratios related to increasing maternal obesity were observed for malformations of the nervous system. Compared with offspring of normal weight mothers, offspring of mothers in obesity class III had an almost doubled risk of major congenital malformations of the nervous system. In line with the present finding, a meta-analysis on maternal BMI and risk of malformations reported a close to twofold increased risk of neural tube defects in offspring of obese mothers.18 However, the obesity related risks of malformations in the nervous system must be interpreted with caution as antenatal detection of these malformations might be more difficult in obese women compared with normal weight women.
Strengths of the present study include the population based study design, with more than one million singleton births. The large sample size enabled us to investigate the effects of overweight and severity of obesity on risks of major congenital malformations and several specific malformation subgroups. Data on exposures and outcomes were prospectively collected within the universally accessible Swedish healthcare system. Maternal BMI was calculated based on measured weight, which limits recall bias, but height was self reported. We used standard BMI categories as defined by WHO.32 Major congenital malformations were classified according to the EUROCAT categorisation. Because we used data from several nationwide registries, we had an opportunity to identify the majority of infants with a diagnosis of a major congenital malformation within the first year of life. Furthermore, we were able to adjust risk estimates for important confounders.
Our study was restricted to live births. Malformations are more common in pregnancies ending in miscarriage or stillbirths, and some prenatally diagnosed malformations may also lead to induced abortions. In particular, most pregnancies complicated by neural tube defects are terminated by induced abortion.7 The Swedish national registries with patient level data do not include individual data on malformations in pregnancies with miscarriages, stillbirths, and induced abortions. However, aggregated data for Sweden reported on the EUROCAT website for the period 2007-13 show that there were 551 cases of neural tube defects, of which 396 (72%) were classified as termination of pregnancy for fetal anomaly.37
Antenatal detection of congenital malformations may be more difficult in obese than in normal weight women.38 If some malformations in offspring of obese women (notably neural tube defects) were less likely to be diagnosed prenatally and the women underwent an induced abortion, we may have overestimated the risks of malformations in offspring of obese mothers. However, risks may be underestimated if obesity is associated with malformations leading to spontaneous abortion. This hypothesis is supported by findings from studies including information about pregnancy terminations and reporting a doubled risk of neural tube defects and a 50% increased risk of cardiovascular anomalies in pregnancies with obesity.18 In this study we used BMI as a proxy for adiposity. This is a reasonable assumption given the strong correlation between BMI and fat mass in early pregnancy.39 We did not have information on the fat distribution, which may be of interest to further explore the association between overweight and severity of obesity and risks of malformations. In addition, we cannot rule out the possibility of residual confounding by unknown or unmeasured factors, such as alcohol use. Power was limited for analyses of less prevalent malformation subgroups by increasing severity of maternal obesity.
Potential mechanisms
The pathophysiology of malformations is multifactorial, with interactions between genetic and environmental factors. Other environmental factors associated with increased risks of malformations include maternal smoking, alcohol use, socioeconomic factors, antiepileptic drugs, deficiency of folic acid and other vitamins, and diabetes.40414243 In the present study, we excluded malformations with a known cause other than maternal overweight or obesity.
Diabetes and abnormal glucose tolerance are common complications of obesity.44 There is a statistically significant increase in risks of congenital malformations in offspring of women with pregestational diabetes,45 and risks increase with degree of maternal hyperglycaemia.46 Experimental studies suggest that hyperglycaemia induces oxidative stress and increased production of free radical species, which may have a teratogenic effect.47 However, in a recent meta-analysis of maternal BMI and risks of malformations, inclusion of mothers with diabetes had limited impact on the effect size.18 Furthermore, risks of malformations are reported to remain increased in obese women after excluding women with diabetes,48 and when adjusting for abnormal glucose tolerance in women with glucose values below the threshold of diabetes.49 This is in line with our findings of essentially unchanged risks of malformations after exclusion of mothers with diabetes. The possible teratogenic role of other metabolic derangements associated with obesity, such as insulin resistance, hyperlipidemia, and inflammation, is unclear. The adipose tissue is an active metabolic and endocrine organ,50 distributed subcutaneously and in the visceral compartment. Visceral obesity in pregnancy is associated with a state of inflammation, vascular dysfunction, and abnormal placental metabolism,51 which may adversely influence organogenesis and fetal development.
We found higher risks of several subtypes of malformations in boys than in girls. In particular, risks of genital malformations were markedly higher in boys. One might speculate that this difference may be partly attributed to the clinically more available evaluation of genital structures in boys compared with girls. Data from experimental studies show higher growth rate and substantially higher glucose consumption in males at the embryonal stage, even before sexual differentiation.5253 Furthermore, male preimplantation embryos are more vulnerable to heat stress induced production of radical oxygen species than female preimplantation embryos.54 One might hypothesize that male embryos are more prone than female embryos to respond with enhanced oxygen radical production to different environmental insults, which in turn could contribute to their increased risk of malformations.
Folic acid supplementation has been associated with decreased risks of neural tube defects and congenital heart malformations.5556 In the present study we did not have information on folic acid supplementation in early pregnancy. However, folic acid deficiency is common in obesity,57 and according to a recent national survey from the US, overweight and obese women are less likely to take multivitamins before pregnancy compared with normal weight women.58 Thus it is possible that the increased risks of neural tube defects and congenital heart defects in offspring of obese mothers may be partly due to folic acid deficiency.
We found that risks of major congenital malformations in offspring progressively increase with maternal overweight and severity of obesity. This underlines the importance of having a maternal BMI in the normal range before pregnancy. Preventive effects of weight reduction in early pregnancy cannot be expected as organogenesis occurs within the first eight weeks of gestation. Thus, efforts should be made to encourage women of reproductive age to adopt a healthy lifestyle and to obtain a normal body weight before conception.
What is already known on this topic
Maternal obesity increases risks of congenital malformations
It is not known if risks are increased in offspring of overweight mothers and if risks increase with increasing severity of obesity
What this study adds
Risks of major congenital malformations in offspring progressively increase with maternal overweight and severity of obesity
Contributors: MN and JS had full access to all of the data in the study and take full responsibility for the integrity of the data and the accuracy of the data analysis. SC, MN, BP, MP, OS, and EV conceived and designed the study. All authors acquired, analysed, and interpreted the data and critically revised the manuscript for important intellectual content. SC, MN, and MP drafted the manuscript. MN and JS carried out the statistical analysis. SC, MN, and OS obtained funding and provided administrative, technical, or material support. MN and JS are the guarantors.
Funding: Research reported in this publication was supported by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under award number R01DK105948. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funders were not involved in the design and conduct of the study; collection, management, analysis, or interpretation of the data; and preparation, review, or approval of the manuscript. This study was also funded by the Swedish Research Council for Health, Working Life and Welfare (grant No 2014-0073) and an unrestricted grant from Karolinska Institutet (distinguished professor award to SC). MP was supported by Stockholm County Council (clinical post-doctoral position). OS was supported by the Swedish Research Council (grant No 2013-2429). BP was supported by the Danish Medical Research Council. MN was supported by the Swedish Research Council (grant No 2013-3770) and the National Institutes of Health (award No R01DK105948).
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: no support from any organisation for the submitted work; no financial relationships with any organizations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work. MN reports being a member of the scientific advisory board for Itrim (<$5000 (£3876; €4430)/year).
Ethical approval: This study was approved by the regional research ethics committee in Stockholm, Sweden (No 2012/1813-31/4).
Data sharing: No additional data available.
Transparency The lead author (MP) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
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De-Regil LM, Peña-Rosas JP, Fernández-Gaxiola AC, Rayco-Solon P. Effects and safety of periconceptional oral folate supplementation for preventing birth defects. Cochrane Database Syst Rev2015;357:CD007950.pmid:26662928.
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Masho SW, Bassyouni A, Cha S. Pre-pregnancy obesity and non-adherence to multivitamin use: findings from the National Pregnancy Risk Assessment Monitoring System (2009-2011). BMC Pregnancy Childbirth2016;357:210.pmid:27496139.
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Martina Persson consultant, Sven Cnattingius professor, Eduardo Villamor professor, Jonas Söderling statistician, Björn Pasternak senior researcher, Olof Stephansson consultant et al
Persson Martina, Cnattingius Sven, Villamor Eduardo, Söderling Jonas, Pasternak Björn, Stephansson Olof et al. Risk of major congenital malformations in relation to maternal overweight and obesity severity: cohort study of 1.2 million singletons BMJ 2017; 357 :j2563
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Trademark Office Clarifies U.S. Attorney Requirement
Josh Conley \ March 03, 2020
Last month the U.S. Trademark Office removed any ambiguity that may have existed with its new rule that requires foreign entities to use U.S. attorneys when working with the Trademark Office.
For those unaware, last summer, the Trademark Office announced a new rule requiring any foreign entity to work with a licensed U.S. attorney in order to appear before the Trademark Office. The measure was taken in response to a flood of improper and fraudulent applications that were being filed by foreign entities.
Our neighbor to the North found this out the hard way. In December of 2019, a Toronto-based company requested that a U.S. trademark be canceled. The petition for cancellation was filed by Canadian attorney/agent who was under a unique reciprocity between the Canadian Intellectual Property Office and the United States Patent and Trademark Office. Even though this reciprocal relationship existed, the Trademark Office said that wasn't enough to fall under the newly adopted rule.
Rather, "a qualified attorney licensed to practice law in the United States" must be appointed. The Trademark Office noted that once the U.S. practitioner is in place, the Canadian representative can be appointed in addition to the U.S. attorney, but the reciprocity itself is not enough to satisfy the rule.
The Trademark Office's decision coincides with other efforts to tighten up and streamline its operations going into 2020.
Letter To Our Clients RE: Coronavirus
The coronavirus is having an impact all over the world. In order to ensure the safest conditions for our clients and our team, we have made the decision to..
French fashion house Louis Vuitton Malletier SA (LV) has responded to a..

redpajama_set_name: RedPajamaCommonCrawl


QUESTION: Are you aware of the signature element of those documents? Didn't they all say "in the year of our lord"? Do you think that means some sinister thing?
ANSWER: That was a standard form signature for public documents during that time frame and for many years after that. It does not change a secular document into any kind of religious document. It doesn't compare to Congress taking a secular document and adding the words "under God" to it with the religious intent that their own words reveal It doesn't compare to state written and/or mandated prayers, teacher or student led prayers in classrooms of govt ruin schools during class time.
QUESTION: Isn't Sunday being recognized as a Christian day of rest and thus a recognition of and union with Christianity in the Constitution? ..
There is nothing in the historical record of the debates in Congress that indicates that Joseph Story in his Commentaries on the Constitution of the United States of America, doesn't mention the words "Sundays Excepted," nor give any explanation of them. You will not find any explanation of those words or mention of those words in any primary source material -- i.e., records of debates, newspaper articles, letters, private journals and diaries, etc., of the time.
Thus, you are left with speculation, and you can speculate till the cows come home. But speculation is not evidence, speculation is not proof, speculation is just that, speculation, i.e. guessing. Your guessing is no better than the guessing of others on this matter.
"The Constitution says in the Year of our Lord; thus, it is a Christian document."
"The use of conventional dating practice doesn't have any bearing on the actual body of the document, from the Preamble through the Articles. The word God is not mentioned once, and this was a marked departure from comparable documents that preceded it, enough to have the Const declared "Godless" by many contemporaries. Clearly THEY didn't think a dating convention was enough to bestow any Christian blessing on the document."
"(That most important documents up to that time were effusive with divine references, acknowledging God's mercy and Providence, seeking divine favor and support, the absence of ANY similar phrases was shocking by comparison, and didn't go unnoticed by those who DID want such language included.)"
"The word SUNDAY is also mentioned; this was one of the pagan days, devoted to worship of the Sun (Latin dies solis, meaning "sun's day": the name of a pagan Roman holiday). Conventional usage also includes dedication and acknowledgment of the Moon and Monday being sacred to the Moon Goddess; Tuesday for Tiu or Tyr, Norse god of war (Mars); Woden (Odin, Mercury); Thor (Jupiter); Frigg (Venus); Saturn on Saturday."
"If you wish to persist in your silliness, then acknowledge that the Const, by mentioning Sunday, is a pagan Roman document; mention of the months of March (God Mars), January (God Janus) confirm this, and outweigh the single AD reference; plus, THEY are IN the body of the Const, not appended."
"You may wish to consider that every time a professing Christian mentions any of the above named days or months, he is recognizing and honoring those pagan deities. Or you can drop your silly claim."
(1) Sunday literally means "The Day of the Worship of the Sun", but was shortened to "Sunday" for convenience. Monday likewise means "The Day of the Worship of the Moon".
These names, since they are shortened derivatives of pagan names dedicating each day to a different idol, are incompatible with Christianity, as far as use within the Church is concerned.
(2) The calender used by the world today is even worse yet and should be exposed for what it is. Some people try to candy coat the fact that it is a pagan calender by calling it a 'civil' or 'common' calender but make no mistake, it is pagan to the core!
(3) Does it bother you to go to church on "Sunday," a day named by idolatrous pagans who worshipped the Sun as a god? It should! What about Bible Study on "Wednesday" night? "Wednesday" was named after Wodin, a warlike god worshipped by primitive Scandinavians (who today are notorious atheists and have the highest suicide rate in the world). In fact, if you go down the list of the days of the week and the months of the year, ALL of the names, every one of them, have pagan roots. THERE IS NOT ONE SINGLE CHRISTIAN NAME IN ALL OF THE DAYS OF THE WEEK AND MONTHS!
(4) The first reform of the pagan calendar in Europe was in 45 BC by Julius Caesar, with further reforms in 8 BC by Caesar Augustus, the first Roman emperor and successor of Julius Caesar.
The Romans gave one day of the week to each planet known to them, considering the sun and moon as planets.
(5) Pagan names were given to the months of the year.
JANUARY: Named for Janus, the Roman mighty one of portals and patron of beginnings and endings, to whom this month was sacred. He is shown as having two faces, one in front, the other at the back of his head, supposedly to symbolize his powers.
FEBRUARY: This name is derived from Februa, a Roman festival of purification. It was originally the month of expiation.
MARCH: It is named for Mars, the Roman mighty one of war.
APRIL: This name comes from the Latin APRILIS, indicating a time of Fertility. It was believed that this month is the month when the earth was supposed to open up for the plants to grow.
MAY: This month was named for Maia, the Roman female deity of growth or increase.
JUNE: This name is sometimes attributed to June, the female mighty one of the marriage, the wife of Jupiter in Roman mythology. She was also called the "Queen of heaven" and " Queen of mighty ones." The name of this month is also attributed to Junius Brutus, but originally it most probably referred to the month in which crops grow to ripeness.
JULY: Named for the Roman emperor Julius Caesar, this is the seventh month of the Gregorian year.
AUGUST: Named for Octavius Augustus Caesar, emperor of Rome; the name was originally from augure, which means, "to increase."
SEPTEMBER: This name is derived from the Latin septem, meaning "seven."
OCTOBER: This name comes from the Latin root octo, meaning "eight."
NOVEMBER: This name is derived from Latin novem, meaning "ninth."
DECEMBER: This name is derived from the Latin decem, meaning "ten."
Sabbath laws that existed during this time period were pretty strict. Why, even President George Washington was once detained by the Sabbath police for traveling on Sunday. Do you really think that if they were trying to somehow establish a connection or recognition of religion, God, Jesus Christ, Christian religion, Christian sabbath that they would be so lax, when laws existing then were so strict?
Exactly what recognition was being given to Sunday? Was there any requiring it to be a day of worship, pious, humiliation, prayer, or even of rest? No there wasn't.
To the information I have already offered you I will add the following little item, because it too supports the idea that all this religious stuff was added after the founding period and not by the founders and their contemporaries.
In fact, "Sundays Excepted," "Year of Our Lord" (a common form of dating official papers etc of that time) "are endowed by their Creator with (inherent) certain (inalienable) unalienable rights; " all became "issues," i.e. took on their "religious connections," after the founding period by people who came later--people who were not generally part of the founders, framers or their contemporaries.
To many of that time period, the Constitution was a "Godless" document, so much so in fact, that as early as 1787-88 suggestions were circulating about adding an amendment to the preamble of the Constitution mentioning God or Christianity or Jesus Christ. Such efforts to amend the Constitution continued at various times throughout the 1800s and 1900s.
Those facts alone pretty much shoots down any accepted idea that the two phrases you selected to offer from the Constitution recognizes Christianity or religion, connects the Constitution to Christianity or religion, etc.
The Rhetoric And Reality of The "Christian Nation" Maxim in American Law, 1810-1920 by Steven Keith Green A unpublished dissertation submitted to the Faculty of the University of North Carolina at Chapel Hill in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the Department of History. Chapel Hill, 1997 p 22.
When the wording of the new constitution began to be published and read by the public, a conflict arose over what many perceived as a rejection of religion. They saw the no religious test clause and the lack of any references to God, Jesus, Christianity, etc. as dangerous, a threat to what many felt was a necessary union between government and religion.
"The United States of America have exhibited, perhaps, the first example of governments erected on the simple principles of nature; and if men are now sufficiently enlightened to disabuse themselves of artifice, imposture, hypocrisy, and superstition, they will consider this event as an era in their history. Although the detail of the formation of the American governments is at present little known or regarded either in Europe or in America, it may hereafter become an object of curiosity. It will never be pretended that any persons employed in that service had interviews with the gods, or were in any degree under the influence of Heaven, more than those at work upon ships or houses, or laboring in merchandise or agriculture; it will forever be acknowledged that these governments were contrived merely by the use of reason and the senses.. . . Thirteen governments [of the original states] thus founded on the natural authority of the people alone, without a pretence of miracle or mystery, and which are destined to spread over the northern part of that whole quarter of the globe, are a great point gained in favor of the rights of mankind. The experiment is made, and has completely succeeded: it can no longer be called in question, whether authority in magistrates, and obedience of citizens, can be grounded on reason, morality, and the Christian religion, without the monkery of priests, or the knavery of politicians."
Excerpts from the Preface, Grosvenor Square, January 1, 1787. A Defence of the Constitutions of the Government of the United States of America, By John Adams, LL. D. And a Member of The Academy of Arts and Sciences at Boston. All nature's difference keeps all nature's peace. Pope. London: Minted for C. Dilly, in the Poultry. M.DCC.LXXXVII.
An anonymous writer in the Virginia Independent Chronicle cautioned in October 1787 about "the pernicious effects" of the Constitution's general disregard of religion," its "cold indifference towards religion."
Thomas Wilson, also of Virginia, insisted that the "Constitution is de[i]stical in principle, and in all probability the composers had no thought of God in all their consultations."
The Godless Constitution, The Case Against Religious Correctness. By Isaac Kramnick and R. Laurence Moore. W. W. Norton & Company New York/London.(1996) pp 33-34.
The prohibition of religious tests was seen by many opponents as the operative sign of the Constitution's more basic flaw--its general godless quality, its seeming indifference to religion.
Disputants around America complained, as the writer "Philadelphiensis" did in November 1787, of the framers' "silence" and indifference about religion."
The Godless Constitution, The Case Against Religious Correctness. By Isaac Kramnick and R. Laurence Moore. W. W. Norton & Company New York/London.(1996) pp 33.
An Antifederalist writer warned in a Boston newspaper on January 10, 1788, that since God was absent from the Constitution, Americans would suffer the fate that the prophet Samuel foretold to Saul: "because thou hast rejected the word of the Lord, he hath also rejected thee."
The Godless Constitution, The Case Against Religious Correctness. By Isaac Kramnick and R. Laurence Moore. W. W. Norton & Company New York/London.(1996) pp 34-35.
*We the people of the United Slates, in a firm belief of the being and perfections of the one living and true God, the creator and supreme Governor of the world, in His universal providence and the authority of His laws: that He will require of ail moral agents an account of their conduct, that all rightful powers among men are ordained of, and immediately derived from God, therefore in a dependence oil His blessing and acknowledgment of His efficient protection in establishing our Independence, whereby it is become necessary to agree upon and settle a Constitution of federal government for ourselves,* and in order to form a more perfect union, etc., as it is expressed in the present introduction, do ordain, etc.
And instead of none, that no other religious test should ever he required, etc. And that supposing, but not granting, this would be no security at all, that it would make hypocrites etc.;: yet this would not be a sufficient reason against it, as it would be a public declaration against, and disapprobation of, men who did not, even with sincerity, make such a profession, and they must be left to the Searcher of Hearts; that it would, however, be the voice of the great body of the people and an acknowledgment proper and highly becoming them to express on this great and only occasion, and, according to the course of Providence, one means of obtaining blessings from the Most High. . .
Letter written by William Williams to the Printer American Mercury and published in same on February 11, 1788. It was also published in the Connecticut Courant March 3, 1788.The Documentary History of the Ratification of the Constitution, Vol. III. Ratification of the Constitution by the States, Pennsylvania, Edited by Merrill Jensen, Madison State Historical Society of Wis, 1978, pp 588-590.
"A discourse in two parts: delivered July 23, 1812, on the public fast, in the chapel of Yale College by Timothy Dwight..." ( I also note that he is Timothy Dwight, D.D., L.L.D., President of that Seminary; Published at the request of the students, and others; New Haven; Published by Howe and Deforest; Sold also by A.T. Goodrich and Co. No, 124, Broadway, New-York; Printed by J.Seymour, 49 John Street, New York.
We formed our Constitution without any acknowledgement of God; without any recognition of his mercies to us, as a people, of his government, of even his existence. The [Constitutional] Convention, by which it was formed, never asked, even once, his direction, or his blessing upon his labours. Thus we commenced our national existence under the present system, without God.
In the words of America's most distinguished church historian of the nineteenth century, Philip Schaff, the Constitution is neither hostile nor friendly to any religion; it is simply silent on the subject, as lying beyond the jurisdiction of the general government."
Church and State in the United States or The American Idea of Religious Liberty and It's Practical Effects, Philip Schaff, Arno Press, New York Times Company, New York: (1972) pp. 39-40.
Title: Church and State in the United States: or, The American idea of religious liberty and its practical effects, with official documents / by Philip Schaff. New York & London : G. P. Putnam's Sons, 1888.
The following are excerpts from James E. Wood, Jr.'s very fine article that appeared in the Journal of Church and State 29 (Spring 1987), which sums this up quite nicely.
The only reference to religion in the original Constitution, Article VI is written in the form of an unequivocal denial of any place to be given to religious considerations in determining qualifications for public office. The prohibition applied at this time, of course only to federal office, not state or local. The adoption of this proposal in effect, precluded the possibility of any church-state union or the establishment of a state church in the absence of any religious test for public office.
James E. Wood, Jr., " 'No Religious Test Shall Ever Be Required': Reflections on the Bicentennial of the U.S. Constitution," Journal of Church and State 29 (Spring 1987): 200.
The adoption of the ban on religious tests by the Constitutional Convention of 1787 was historically without precedent. For centuries, some form of religious belief, at least in a Supreme Being, or some formal religious affiliation, had been a well-established requisite for holding public office throughout the world. Even John Locke, of all political philosophers perhaps the one who most influenced Thomas Jefferson and the American Founding Fathers, particularly James Madison, in his Letter Concerning Toleration denied the right of public office to atheists and Catholics. "Those are not at all to be tolerated," Locke wrote, "who deny the being of God."
James E. Wood, Jr., " 'No Religious Test Shall Ever Be Required': Reflections on the Bicentennial of the U.S. Constitution," Journal of Church and State 29 (Spring 1987): 201.
The elimination of religious tests for public office by the Constitutional Convention of 1787 represented a major achievement for the future course of American church-state relations. Article VI not only removed the basis for any preferential treatment of one religion over another for holding public office, but also denied the right of any preferential status of religion over nonreligion in matters of one's political participation in the life of the Republic. William Lee Miller appropriately noted in his recent historical review of religion and the Constitution, The First Liberty: Religion and the American Republic, that "in the framing of Article VI ...the new nation was electing to be nonreligious in its civil life." On the subject of religion, Miller finds "more striking than what the Federal Constitution did include is what it did not." Unlike other legal documents of the period and throughout history, there art no references in the Constitution to the Deity, to God, to "Providence." or even to the Creator, as in the case of the Declaration of Independence, which, unlike the Constitution, was not a formal legal document.
The prohibition of any religious test for public office came not only out of a religious pluralism that was rampant at the time of the nation's founding, but also out of the concept of the new Republic as a secular state. The very exclusion of any religious test for office was itself a profound acknowledgment of the secular character of the new Republic, to use Miller's phrase, "to be nonreligious in its civil life."
The secular state, by its very nature, is a limited state in which the people have denied the jurisdiction of civil authority over religious affairs. The secular state is not born out of hostility to religion, any more than Article VI, as noted earlier, is to be viewed as adverse to religion. In the words of America's most distinguished church historian of the nineteenth century, Philip Schaff, the Constitution is neither hostile nor friendly to any religion; it is simply silent on the subject, as lying beyond the jurisdiction of the general government."
As a secular state, America is a nation in which neither religion nor irreligion enjoys any official status and where no church or religion is to enjoy any advantages or to suffer any disadvantages because of an establishment of religion. Religious identity is made irrelevant to one's rights of citizenship, e.g., the right to vote and to hold public office. One's religion or irreligion may not be made the basis of political privilege or discrimination. At a time when there is a resurgence of the notion of a "Christian America" in the body politic, the Bicentennial of the Constitution is an especially appropriate time to reflect on the meaning and significance of church and state in American public life. In doing so, proper attention needs to be given to the importance of Article VI in America's body politic and nationhood. In recent years, the growing tendency of candidates for public office to stress their religious credentials, to use religion to serve their own political purposes, and to use political means for the advancement of religious interests needs to be seen in the context of America as a secular state--"to be nonreligious in its civil life."
"No Religious test Shall Ever Be Required: Reflections on the Bicentennial of the U. S. Constitution", James E, Wood, Jr. Journal of Church and State 29, Spring. 1987, Number 2 pp 206-207.
The propriety and constitutionality of Christian political activism was the subject of rancorous debate in the late 1820s and early 1830s. The defeat of the anti-Sunday mail campaign strengthened the conviction of many religious citizens that infidelity and radical secularism had gained ascendancy in national politics under a banner of liberal political reform. This was a bitter reversal for religious traditionalists who believed that the United States was a Christian nation, and it impressed upon them the urgency of mobilizing all their resources, including a potential army of conservative Christian voters and partisan activists, to save the country from political atheism and to reestablish Christian values and morality in public life.
Religion and Politics in the Early Republic, Jasper Adams and the Church-State Debate, Edited by Daniel L. Dreisback, The University Press of Kentucky, (1996) p. 7.
The struggle between democracy and theocracy, which seemed to have been settled when the U.S. Constitution was ratified, is far from over.. .
Although the United States was the first nation in history founded without the sanction of an official God or an official church, the national ethos of religious pluralism and equality is under attack. It is an attack rooted in struggles between advocates of democratic values and the established theocracies of 17"' and 18th century colonial America. Much of the contemporary Christian Right is looking back to what their religious and political ancestors lost when the Constitution was ratified. . .
Right in the 1980s, an animating, underlying theme of the American experience has been the struggle between democratic and theocratic values. The descendants of the losing side have not forgotten. Self-proclaimed "orthodox" Christians have opposed democracy, pluralism, and religious freedom for hundreds of years. Having regrouped after losing most of the major battles since the ratification of the Constitution, they are attempting a comeback.
This change in political strategies over time reflects the regrouping of the theocrats after a steady two century decline. A principal catalyst is the advent of the politically oriented theology of Christian Reconstructionism-the effort to replace Constitutional law with "God's law." However outlandish it appears, it is one of the most significant, but least remarked-upon events in modem politics -and it is the driving ideology of the resurgent Christian Right. Not only is Reconstructionism explicitly anti-democratic and anti-pluralist, but adherents of other religions are viewed as heretics at best, and unfit to hold public office. So narrowly intolerant is the movement of Reconstructionism that even those who profess Christianity but hold differing religious or theological views are often castigated as "antiChristian" and agents of Satan.
3. John Wilson, "Church and State in America," in James Madison on Religious Liberty, Robert S. Alley, editor, Prometheus Books, 1985. p. 99.
4. Robert Boston, Why the Religious Right is Wrong About Separation of Church & State, Prometheus Books, 1993. p. 87.
Eternal Hostility, The Struggle between Theoracy and Democracy. Frederick Clarkson. Common Courage press, (1997) pp 2-7.
"Resolved, That the Committee on the Post Office and Post Roads be instructed to report a bill, repealing so much of the act on the regulation of post offices as requires the delivery of letters, packets, and papers, on the Sabbath, and further to prohibit the transportation of the mail on that day."
. . . Our predecessors have acted upon a true, republican principle, that the feelings and opinions of the majority were to be consulted. And where a collision might arise, inasmuch as only one day could be thus appropriated, they wisely determined, in accordance with the sentiments of at least nine-tenths of our people, that the first day of the week should be the sabbath of our Government.
This public recognition is accorded to the Sabbath in our Federal Constitution. The President of the United States in the discharge of the hight functions of his legislative department is expressly relieved from all embarrassment on Sunday. The business of the Supreme court, the highest judicial tribunal of the country, is by law directed to suspend its session on Sunday. Both houses of Congress, the offices of the State, Treasury, War, and Navy Departments, are all closed on Sunday. And all the States of the Union I believe, (twenty three of them certainly) by explicit legislative enactments, acknowledge and declare the religious authority of Sunday.
A message from the House of Representatives informed the Senate that the House have passed the bill, sent from the Senate entitled "An act for the relief of Richard Tervin, William Coleman, Edwin Lewis, Samuel Mims, Joseph Wilson;" wih an amendment in which they desire the concurrence of the Senate.
The Senate proceeded to consider the amendment of the House of Representatives to the bill entitled, "An Act for the relief of Richard Tervin, William Coleman, Edwin Lewis, Samuel Mims, Joseph Wilson," and concurred therein.
The Debates and Proceedings of the Congress of the United States with an Appendix containing Important State papers and The Public Documents, and all The Laws of a Public Nature; with a Copious Index. Eleventh Congress-Third Session. Comprising the Period from December 3, 1810 to March 3, 1811, Inclusive. Compiled from Authentic Materials. Washington: Printed and published by Gales and Seaton, (1853) pp 367.
1. Jasper Adams, The Relation of Christianity to Civil Government in the United States. A Sermon, Preached in St. Michael's Church, Charleston, February 13th, 1833, before the Convention of the Protestant Episcopal Church of the Diocese of South-Carolina, 2d ed. (Charleston, S.C.: A.E. Miller, 1833). The text of the second edition reaches page 64, but page numbers 2 and 3 were skipped. The actual sermon is twenty-six pages in length with footnotes, followed by thirty-six pages of endnotes, also with footnotes.
4. See, for example, B.F. Morris, Christian Life and Character of the Civil Institutions of the United States, Developed in the Official and Historical Annals of the Republic (Philadelphia: George W Childs, 1864), pp. 237-38, 256-57, 264-65. Adams's printed sermon was noticed in publications of the time, including the Charleston, South Carolina, Gospel Messenger, and Southern Episcopal Register 10, no. 113 (May 1833): 156-58, and no. 120 (Dec. 1833): 380-81; American Quarterly Register 5, no. 4 (May 1833): 334; and Churchman 3, no. 10 (25 May 1833): 455.
9. Adams, Relation, p. 7 .
I just happened to get it at a used book auction. At the time I didn't realize what a find it was.
I'II tell you right now that there aren't a whole lot of references other than maybe the authors' names. A little while back I did a little research trying to find the sources in this book, hoping to possibly republish it. It was quite a challenge. The ones that I did find were often quoted sloppily or misquoted. In the end, the book was so bad that I gave up altogether. That's not to say that I think it only has lies and error, it does have some good stuff also.
I once tried to see if the Wallbuilders [the David Barton outfit, LOL ] might want it, at which time I mentioned its inaccuracies. When they replied and told me that they had the book and that they found out the same thing. They also said that while it has its inaccuracies, it could be useful to give leads.
An E-Newsletter on America's Christian Heritage.
lf you don't have web access, e-mail me and I'II put you on the list.
There were several things that prompted Rev. Jasper Adams to write, publish and send out his sermon, that introduced the first significance being given YEAR OF OUR LORD and his comments regarding SUNDAYS EXCEPTED.
*The publication of a private letter from Thomas Jefferson to a friend whereby Jefferson claimed that Christianity was not part of the Common Law. The publication of this letter by the friend, not by Jefferson, created quite a stir, headed in large part by Joseph Story trying to show that Christianity was part of the Common Law.
Excerpting and paraphrasing some of the sub-topics, Religion and Politics in the Early Republic, Jasper Adams and the Church-State Debate, Edited by Daniel L. Dreisback, The University Press of Kentucky, (1996) pp. 3-14.
faith.(10) The Constitution of Vermont declares, that "every sect or denomination of Christians, ought to observe the Sabbath or Lord's Day, and keep up some sort of religious worship, which to them shall seem most agreeable to the revealed will of God."(11) The Constitutions of Massachusetts and Maryland, are among those which do not prescribe the observance of Sunday: yet the former declares it to be "the right, as well as the duty of all men in society, publicly and at stated seasons, to worship the Supreme Being, the great Creator and Preserver of the Universe;"(12)- and the latter requires every person appointed to any office of profit or trust, to "subscribe a declaration of his belief in the Christian religion."(13) Two of them concur in the sentiment, that "morality and piety, rightly grounded on Evangelical principles, will be the best and greatest security to government; and that the knowledge of these is most likely to be propagated through a society, by the institution of the public worship of the Deity, and of public instruction in morality and religion."(14) Only a small part of what the Constitutions of the States contain in regard to the Christian religion, is here cited; but my limits do not permit me to cite more.(15) At the same time, they all grant the free exercise and enjoyment of religious profession and worship, with some slight discriminations, to all mankind.
INSTITUTIONS; WHILE THEY HAVE REFUSED TO CONTINUE A LEGAL PREFERENCER TO ANY ONE OF ITS FORMS OVER THE OTHER. In the same spirit of practical wisdom, moreover, they have consented to tolerate all other religions.
(9) The author has not seen the new Constitution of Mississippi, and, therefore, this assertion may possibly not apply to that document.
In Art. 7th of the Constitution of the United States, that instrument is said to have been framed, "by the unanimous consent of the States present, the seventeenth day of September, in the year of our Lord, 1787, and of the independence of the United States of America, the twelfth." In the clause printed in Italic letters, the word Lord means the Lord Jesus Christ, and the word our preceding it, refers back to the commencing words of the Constitution; to wit, "We the people of the United States." The phrase, then, our Lord, making a part of the dating of the Constitution when compared with the commencing clause, contains a distinct recognition of the authority of Christ, and of course, of his religion by the people of the United States. This conclusion is sound, whatever theory we may embrace in regard to the Constitution;--whether we consider it as having been ratified by the people of the United States in the aggregate, or by States, and whether we look upon the Union in the nature of a government, a compact or a league. The date of the Constitution is twofold;--it is first dated by the birth of our Lord Jesus Christ; and then by the Independence of the United States of America. Any argument which should be supposed to prove, that the authority of Christianity is not recognised by the people of the United States in the first mode, would equally prove that the Independence of the United States is not recognised by them in the second mode. The fact is, that the Advent of Christ and the Independence of the country, are the two events in which of all others, we are most interested; the former in common with all mankind, and the latter as the Birth of our Nation. This twofold mode, therefore, of dating so solemn an instrument, was singularly appropriate and becoming. The Articles of Confederation are dated in the same twofold way.
The recognitions of Christianity in the State Constitutions are of three kinds. 1. These instruments are usually dated in the year of our Lord, and the same observations which were made on this phrase in the case of the Constitution of the United States, are no less applicable, mutatis mutandis, to the Constitutions of the respective States. 2. Nearly all of them refer to the observance of Sunday by the Chief Executive Magistrate, in the same way in which such observance is referred to, in the Constitution of the United States; and, therefore, in regard to them, no further observations are required. 3. Definite constitutional provisions not only recognising the Christian religion, but affording it countenance, encouragement and protection: the principal of which are quoted in the text P. 12, and in Note B.
(14) The quotation here is from the Constitution of New Hampshire; (part i Art. 6.) And the concurrence is substantial, not verbal. The parallel passage in the Constitution of Massachusetts runs thus:-"The happiness of a people, and the good order and preservation of civil government, essentially depend upon piety, religion and morality, and these cannot be generally diffused through the community but by the institution of a public worship of God, and the public institutions, (instructions) in piety, religion and morality, " part i, Art . 3.
Some further quotations are, made for the benefit of those who may not have a copy of the American Constitutions at hand.
Constitution of Massachusetts, Part i. Art. 3.--"As the happiness of a people, and the good order and preservation of civil government, essentially depend upon piety, religion and morality; and as these cannot be generally diffused through the community, but by the institution of a public worship of God, and of public institutions (instructions) in piety, religion and morality; therefore, to promote their happiness, and to secure the good order and preservation of their government, the people of this Commonwealth have a right to invest their Legislature with Power to authorize and require, and the Legislature shall, from time to time, authorize and require the several towns, parishes, precincts, and other bodies politic, or religious societies, to make suitable provision at their own expense, for the institution of the public worship of God, and for the support and maintenance of public Protestant teachers of piety, religion and morality, in all cases, where such provision shall not be made voluntarily.
And the people of the Commonwealth have also a right to, and do, invest their Legislature with authority to enjoin upon all the subjects, an attendance upon the instructions of the public teachers, as aforesaid, at stated times and seasons, if their be any one whose instructions they can conscientiously and conveniently attend. All moneys paid by the subject to the support of public worship, and of the public teachers aforesaid, shall, if he require it, be uniformly applied to the support of the public teacher or teachers of his own religious sect or denomination, provided there be any, on whose instructions he attends; otherwise, it may be paid towards the support of the teacher or teachers of the parish or precinct in which the said moneys are raised. And every denomination of Christians, demeaning themselves peaceably, and as good subjects of the Commonwealth, shall be equally under the protection of the law; and no subordination of any sect or denomination to another, shall ever be established by law." Part ii. Ch. v. Sec, i. Art. I.--"Whereas our wise and pious ancestors so early as the year 1636, laid the foundation of Harvard College, in which University many persons of great eminence have, by the blessing of God, been initiated into those arts and sciences which qualified them for public employments, both in Church and State; and whereas the encouragement of arts and sciences, and all good literature, tends to the honor of God, the advantage of the Christian religion, and the great benefit of this and the other United States of America, it is declared that the President and fellows of Harvard College," &C.
New, Hampshire.--The Constitution of this State contains provisions, in regard to the Christian Religion, substantially the same with those just quoted from the Constitution of Massachusetts, except so far as these relate to Harvard University. See p. 12. The Constitutions of Vermont and Rhode island have been sufficiently quoted. See pp. 9. 12.
Connecticut, Art. 7 Sec. 1.-"it being the duty of all men to worship the Supreme Being, the great Creator and Preserver of the universe, and their right to render that worship in the mode most consistent with the dictates of their consciences; no person shall, by law, be compelled to join or support, nor be classed with, or associated to, any congregation, church, or religious association. But every person now belonging to such congregation, church, or religious association, shall remain a member thereof, until he shall have separated himself there from, in the manner hereinafter provided. And each and every society or denomination of Christians in this State, shall have and enjoy the same and equal powers, rights, and privileges; and shall have power and authority to support and maintain the ministers or teachers of their respective denominations, and to build and repair houses for public worship, by a tax on the members of any such society only, to be laid by a major vote of the legal voters assembled at any society meeting, warned and held according to law, or in any other manner.
New-Jersey-The Constitution of this State declares, (Art. xix.) "that there shall be no establishment of any one religious sect in this province (this constitution was formed in 1776,) in preference to another, and that no protestant inhabitant of this colony shall be denied the enjoyment of any civil right, merely on account of his religious principles; but that all persons professing a belief in the faith of any protestant sect who shall demean themselves peaceably under the government, as hereby established, shall be capable of being elected into any office of profit or trust, or being a member of either branch of the Legislature, and shall fully and freely enjoy every privilege and immunity enjoyed by others their fellow subjects.
Delaware.- The Constitution of this State assumes, (Art. I. Sec. I. ) that "it is the duty of all men frequently to assemble together for the public worship of the Author of the Universe; and piety and morality, on which the prosperity of communities depends, are thereby promoted."
Maryland.-The declaration of rights says, (Art. xxxiii.) "that as it is the duty of every man to worship God in such manner as he thinks most acceptable to him, all persons professing the Christian religion are equally entitled to protection in their religious liberty." And again, (Art. xxxv.) "that no other test or qualification ought to be required, on admission to any office of trust or profit than such oath of support and fidelity to this State, and such oath of office, as shall be directed by this Convention or the Legislature of this State, and a declaration of belief in the Christian religion." See also p.12.
North-Carolina in her Constitution (Art. xxxii.) says, "that no person who shall deny the being of a God, or the truth of the Protestant religion, or the divine authority of either the Old or New Testament, or shall hold religious principles incompatible with the freedom and safety of the State, shall be capable of holding any office, or place of trust or profit, in the civil department within this State.
So far as these quotations make any distinction between denominations of Christians, the author does not concur with them, but they conclusively shew, that the constitutions from which they are taken, unequivocally sustain the Christian religion.
It is mentioned above by the author, that a very suitable concern has, in general, been manifested by the Federal Government, to prevent the desecration of Sunday. The rules and regulations of the Army of the United States, present an instance in point. By Art. 2nd of these rules and regulations, which every officer, before he enters on the duties of his office, is required to subscribe: "it is earnestly recommended to all officers and soldiers diligently to attend divine service; and all officers who shall behave indecently or irreverently at any place of divine worship, shall, if commissioned officers, be brought before a general court-martial, there to be publicly and severely reprimanded by the President; if non-commissioned officers or soldiers, every person so offending, shall for his first offence, forfeit one-sixth of a dollar, to be deducted out of his next pay; for the second offence, he shall not only forfeit a like sum, but be confined twenty-four hours; and for every like offence, shall suffer and pay in like manner. (Act of April 10th , 1806, Sec. 1.) (Gordon's Digesl, Art. 3269.) This Art. is taken almost verbatim from the "rules and orders" enacted by the Old Congress on the same subject. (See Journal of 30th June, 1775.) Will it be arrogating too much, if the author respectfully asks any military commander into whose hands these pages may come, candidly to examine the bearing which the above regulation may rightfully have upon military reviews held on Sunday, and upon marching on Sunday, when the exigencies of the service do not require it? He is under a belief, that military reviews are quite as common on Sunday as upon any other day of the week. He also within a few weeks observed, with regret, a statement in the newspapers, that certain of our citizens went from the city to a neighbouring island, for the purpose of attending a military review on Sunday.
(18) All the States of the Union, I believe, (twenty-three of them certaintly, by explicit legislative enactments, acknowledge and declare the religious authority of Sunday." Speech of Mr. Frelinghuysen of New-Jersey, in the Senate of the United States, in the session of 1829-1830.
Excerpt from The Relation of Christianity to Civil Government in the United States. A Sermon, preached by Jasper Adams in St. Michael's Church, Charleston, February 13th, 1833, before the Convention of the Protestant Episcopal Church of the Diocese of South-Carolina, 2d ed. (Charleston, S.C.: A.E. Miller, 1833). Copy of said Sermon received from The William L. Clements Library, Univertisy of Michigan, Ann Arbor, Michigan. April 28, 1998.
Two years later an article was published taking the Rev Jasper Adams to task on those points, and others he had made in his published sermon.
is allowed to any religious denomination-whether it consist of Jews, Christians, Pagans, or Turks. The principle obtained from the foregoing examination is then this--viz.
DESTROY ALL CONNEXIONS BETWEEN CHURCH AND STATE. Of course, we except those who have, in spite of reason and the experience of more than fifteen centuries, established a preference for certain sects--a preference which Mr. Adams himself affects to deprecate.
"In order to complete our examination of the constitutions, we must refer to the Constitution of South Carolina and the Constitution of the United States. Before we do so more particularly, we will notice how expressions which are to be found not only in those constitutions, but in several already examined. We do this, not because the expressions themselves call for any comment--but because an ingenious though sophistical argument has been built upon them.
"The expressions are: 1. "If any bill shall not be returned by the president (or governor) within ten days, (the number differs in different states,) SUNDAYS EXCEPTED" &c. 2. "Done in Convention, &c., in the YEAR OF OUR LORD" &c.
"Upon the first expression, Mr. Adams has borrowed the argument of Mr. Frelinghuysen in the United States' Senate. Upon the second, so far as we are informed, he is entitled to the credit of originality. Both expressions, he contends, are recognitions of Christianity.
"We have already remarked, that many of the state constitutions were framed in the midst of war and confusion--when the public mind was engrossed with political subjects. Ninety-nine hundredths of the people were, and still are thoroughly convinced of the truth of the Christian scriptures. The exception of Sundays, above cited, notwithstanding the many political reasons which may be urged in its favour, is to be attributed to this general conviction. Public opinion will have its effect; and we are only surprised that more expressions of this occasional kind are not to be found in the constitutions. But to infer from this that the people of the several states have retained the Christian religion as the foundation of their civil, legal, and political institutions, is worse than absurd. It is building up weakness. It is like an attempt to construct an inverted pyramid--to rear an immense superstructure with a point for a base. But if we are shocked at so sweeping an inference from such premises, what must we think, when we reflect that the inference is directly contradicted by the various provisions already cited from the constitutions themselves!
"These remarks will apply with equal, perhaps greater force, to the dates of some constitutions-"Done, &c., &c., in the year of our Lord." Besides, it has become a sort of fashion in dating papers to say, "in the year of our Lord." C'est une facon de parler--a mere mode of speech. This perhaps may be traced to the fact, that we are Christians. It does not show that Christianity is the foundation of our civil, legal, and political institutions. On the contrary, assuming with our author that the date of the Constitution of the United States--"in the year of our Lord"--refers back to the words, "We the people of the United States," it would only amount to this, that the people of the United States, although professing themselves Christians, were so thoroughly convinced of the impropriety of any and every connexion between church and state, that they laid it down as a fundamental law, "Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof."
"Mr. Adams, having noticed the common law, proceeds to quote an act passed by South Carolina in 1712, prohibiting persons from traveling on Sunday, or employing their slaves at work on that day. But this law is obsolete. Persons are continually traveling on Sunday. The mail is carried and opened on Sunday. Passengers crowd the stages on Sunday. In fact, this act of 1712 is repealed by the Constitution of 1790. With regard to not employing slaves at work on Sunday, we would observe, that public opinion--which is stronger than the law--causes this to be observed.
the poor an opportunity to prepare for its enjoyment. It insures them a period of rest, which would otherwise depend on the caprice of the task-master. Sunday is indeed a day of jubilee and rest, of enjoyment and ease. Ordinary occupations are suspended: and if a cheerful heart be pleasant in the sight of God, to that day HE must look with peculiar delight! It is unnecessary to dwell on the advantages of Sunday as a period of rest for cattle--for horses, mules, oxen, &c.
"These and other considerations, make it politic to have a fixed day of rest: and no reason can be given for preferring any other day to Sunday.
"Mr. Adams seems to have a high relish for old laws on the subject of religion; and, we have no doubt, will pay equal reverence to those which regulate the conduct, and those which regulate the belief of individuals. There is an act intended to provide for the security of the province of South Carolina, and more especially of church-going people. It is to be found in pages 185 and 186, Grimke's Public Laws, It was enacted in 1743, made perpetual by revival act of 1783, and has never since been repealed. We commend it to Mr. Adams' notice. It enacts that "all male persons, under sixty years of age, who shall go on Sunday or Christmas-day, to any church or place of worship, without a gun or a good pair of horse-pistols in good order and fit for service, with at least six chargers of gunpowder and ball; or who shall not carry the same into the church or other places of Divine worship, shall forfeit and pay the sum of 20s. current money." We trust that hereafter Mr. Adams will not neglect the duty prescribed by this act, and that every Sunday he will be seen with a gun on his shoulder, in conformity with the law.
Excerpt from "Immunity of Religion," American Quarterly Review 17, No 34 (June 1835) pp. 332-33, 339-40. Microforms Room, Library of American Civilization: LAC 30257-72, Regent University, Va Beach, Va. The aforementioned article was written rebutting, Jasper Adams, The Relation of Christianity to Civil Government in the United States. A Sermon, Preached in St. Michael's Church, Charleston, February 13th, 1833, before the Convention of the Protestant Episcopal Church of the Diocese of South-Carolina, 2d ed. (Charleston, S.C.: A.E. Miller, 1833.
"By inserting this parenthetical expression, the framers of the Constitution doubtless intended merely to recognize the right of the President, in harmony with a prevailing custom, to observe a weekly day of rest if he chose to do so, and not to establish a Sabbath by law, or in any way make its observance mandatory. As a matter of fact, many bills have been signed on Sunday. But the advantage which the advocates of a union of church and state have taken of this brief parenthetical expression, shows the danger there is in giving the slightest ground or pretext for their claims in any law or legal document. At once they say: "This shows this to be a Christian nation; Christianity is the religion of the nation; and Sunday laws are proper and constitutional." This is an excellent illustration of how a little leaven is made to leaven the whole lump. With the advocates of religious legislation, this slight peg is sufficient to hang a whole religious establishment upon. Through this they would confer upon Congress inferential powers of such character and magnitude as to subvert the Government itself and enact laws directly forbidden by the Constitution.
American State Papers on Freedom in Religion. 4th Revised Edition. Published in 1949 for The Religious Liberty Association, Washington, D.C. First Edition Compiled by William Addison Blakely, of the Chicago Bar. (1890) under the Title American State Papers Bearing on Sunday Legislation. p. 650.