TY - JOUR
T1 - Maternal exposure to ambient air pollution and congenital heart defects in China
AU - Yang, Bo-Yi
AU - Qu, Yanji
AU - Guo, Yuming
AU - Markevych, Iana
AU - Heinrich, Joachim
AU - Bloom, Michael S.
AU - Bai, Zhipeng
AU - Knibbs, Luke C.
AU - Li, Shanshan
AU - Chen, Gongbo
AU - Jalaludin, Bin
AU - Morawska, Lidia
AU - Gao, Meng
AU - Han, Bin
AU - Yu, Yunjiang
AU - Liu, Xiao-Xuan
AU - Ou, Yanqiu
AU - Mai, Jinzhuang
AU - Gao, Xiangmin
AU - Wu, Yong
AU - Nie, Zhiqiang
AU - Zeng, Xiao-Wen
AU - Hu, Li-Wen
AU - Shen, Xubo
AU - Zhou, Yuanzhong
AU - Lin, Shao
AU - Liu, Xiaoqing
AU - Dong, Guang-Hui
PY - 2021/8
Y1 - 2021/8
N2 - Background: Evidence of maternal exposure to ambient air pollution on congenital heart defects (CHD) has been mixed and are still relatively limited in developing countries. We aimed to investigate the association between maternal exposure to air pollution and CHD in China. Method: This longitudinal, population-based, case-control study consecutively recruited fetuses with CHD and healthy volunteers from 21 cities, Southern China, between January 2006 and December 2016. Residential address at delivery was linked to random forests models to estimate maternal exposure to particulate matter with an aerodynamic diameter of ≤ 1 µm (PM1), ≤2.5 µm, and ≤10 µm as well as nitrogen dioxides, in three trimesters. The CHD cases were evaluated by obstetrician, pediatrician, or cardiologist, and confirmed by cardia ultrasound. The CHD subtypes were coded using the International Classification Diseases. Adjusted logistic regression models were used to assess the associations between air pollutants and CHD and its subtypes. Results: A total of 7055 isolated CHD and 6423 controls were included in the current analysis. Maternal air pollution exposures were consistently higher among cases than those among controls. Logistic regression analyses showed that maternal exposure to all air pollutants during the first trimester was associated with an increased odds of CHD (e.g., an interquartile range [13.3 µg/m3] increase in PM1 was associated with 1.09-fold ([95% confidence interval, 1.01–1.18]) greater odds of CHD). No significant associations were observed for maternal air pollution exposures during the second trimester and the third trimester. The pattern of the associations between air pollutants and different CHD subtypes was mixed. Conclusions: Maternal exposure to greater levels of air pollutants during the pregnancy, especially the first trimester, is associated with higher odds of CHD in offspring. Further longitudinal well-designed studies are warranted to confirm our findings.
AB - Background: Evidence of maternal exposure to ambient air pollution on congenital heart defects (CHD) has been mixed and are still relatively limited in developing countries. We aimed to investigate the association between maternal exposure to air pollution and CHD in China. Method: This longitudinal, population-based, case-control study consecutively recruited fetuses with CHD and healthy volunteers from 21 cities, Southern China, between January 2006 and December 2016. Residential address at delivery was linked to random forests models to estimate maternal exposure to particulate matter with an aerodynamic diameter of ≤ 1 µm (PM1), ≤2.5 µm, and ≤10 µm as well as nitrogen dioxides, in three trimesters. The CHD cases were evaluated by obstetrician, pediatrician, or cardiologist, and confirmed by cardia ultrasound. The CHD subtypes were coded using the International Classification Diseases. Adjusted logistic regression models were used to assess the associations between air pollutants and CHD and its subtypes. Results: A total of 7055 isolated CHD and 6423 controls were included in the current analysis. Maternal air pollution exposures were consistently higher among cases than those among controls. Logistic regression analyses showed that maternal exposure to all air pollutants during the first trimester was associated with an increased odds of CHD (e.g., an interquartile range [13.3 µg/m3] increase in PM1 was associated with 1.09-fold ([95% confidence interval, 1.01–1.18]) greater odds of CHD). No significant associations were observed for maternal air pollution exposures during the second trimester and the third trimester. The pattern of the associations between air pollutants and different CHD subtypes was mixed. Conclusions: Maternal exposure to greater levels of air pollutants during the pregnancy, especially the first trimester, is associated with higher odds of CHD in offspring. Further longitudinal well-designed studies are warranted to confirm our findings.
KW - Case-control study
KW - Congenital heart defects
KW - NO
KW - Particulate matter
KW - PM
UR - http://www.scopus.com/inward/record.url?scp=85103976082&partnerID=8YFLogxK
U2 - 10.1016/j.envint.2021.106548
DO - 10.1016/j.envint.2021.106548
M3 - Article
C2 - 33838617
AN - SCOPUS:85103976082
VL - 153
JO - Environment International
JF - Environment International
SN - 0160-4120
M1 - 106548
ER -
