Genetic Variants in Nicotinamide Adenine Dinucleotide (NAD) Synthesis Pathway

Inclusion Criteria: 1. Adults with confirmed or putative diagnosis of VACTERL association; 2. Families (mother, father, biological offspring) with a history of VACTERL-associated malformations 3. Gravid or non-gravid women with a history of miscarriage and/or offspring with non-VACTERL-associated malformations 4. Willingness to abstain from red meat, meat products, chicken, peanuts, or brewer's yeast (including beer) at least 24 hours prior to blood and urine collection Exclusion Criteria: 1\) Parents of non-biological children 3) Children with congenital malformations associated with an identifiable environmental or lifestyle exposure 4) Children with congenital malformations associated with confirmed chromosomal disorders 5) Failure to abstain from red meat, meat products, chicken, peanuts, or brewer's yeast (including beer) at least 24 hours prior to blood and urine collection.