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Association between gestational exposure and risk of congenital heart disease: A systematic review and meta-analysis
Zhao Ma1, Xue Cao1, Ying Chang2
1Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, No. 22 Meteorological Station Road, Heping District, Tianjin, 300070, China; Tianjin Key Laboratory of Environment, Nutrition and Public Health, Tianjin, 300070, China; Center for International Collaborative Research on Environment, Nutrition and Public Health, Tianjin, 300070, China.
Insights
Exposure to ambient air pollution during pregnancy is linked to congenital heart defects. Specifically, PM10, PM2.5, and ozone show a positive association with ventricular septal defects, while SO2 may negatively impact atrial septal defects.
Area of Science:
- Environmental Health
- Pediatric Cardiology
- Epidemiology
Background:
- Congenital heart disease (CHD) is a major cause of infant mortality and the most common congenital anomaly.
- Simultaneous analysis of multiple ambient air pollutants and diverse CHD subtypes is limited.
- Understanding the impact of gestational air pollution exposure on specific CHD subtypes is crucial for public health.
Purpose of the Study:
- To conduct a meta-analysis exploring the association between ambient air pollution during pregnancy and congenital heart disease subtypes.
- To identify specific air pollutants linked to increased risk for different types of CHD.
Main Methods:
- Systematic literature search of PubMed, Embase, and Web of Science databases.
- Meta-analysis utilizing Newcastle Ottawa Scale for quality assessment.
- Publication bias assessed using funnel plots and Egger's regression; heterogeneity evaluated using chi-square and I² statistics.
Main Results:
- A positive association was found between particulate matter (PM10, PM2.5) and ozone (O3) exposure and ventricular septal defects (VSD).
- Sulfur dioxide (SO2) exposure showed a negative association with atrial septal defects (ASD).
- Carbon monoxide (CO) and SO2 were the only pollutants with a statistically significant association with overall CHD in preliminary analysis.
Conclusions:
- Gestational exposure to specific ambient air pollutants, including PM2.5, PM10, O3, and SO2, is associated with certain congenital heart disease subtypes.
- Findings highlight the need for further research into the etiological relationship between air pollution and CHD.
- Study area and exposure duration were identified as sources of heterogeneity, informing future research designs.
Abstract:
Congenital heart disease (CHD) is the most common congenital anomaly and one of the leading causes of newborn death. Few studies analyze multiple ambient air pollutants and different congenital heart disease subtypes at the same time. We conducted a meta-analysis to explore the association between gestational air pollution exposure and CHD subtypes. We searched PubMed, Embase, Web of Science from inception till July 31, 2020. Newcastle Ottawa Scale (NOS) was used to evaluate the quality of the literature. Funnel plots and Egger's regression were used to estimate publication bias. Heterogeneity was evaluated by the chi-square test and the coefficient of inconsistency I2 in this study. Finally, we performed a subgroup analysis to find reasons for heterogeneity. In the preliminary analysis, the result shows that the association between air pollutants and congenital heart disease was not statistically significant, except for CO and SO2. There is a positive association between air pollutants and ventricular septal defect (VSD) in our subtype analysis, the OR (95%CI) for PM10, PM2.5, and O3 was 1.057(1.005-1.109), 1.208(1.080-1.337), and 1.205(1.101-1.310), respectively. In addition, we also observed a negative association between SO2 and atrial septal defect (ASD) (OR: 0.817, 95%CI: 0.743-0.890) in subgroup analysis. The source of heterogeneity in our study mainly included study area and exposure time. These findings have implications for researchers to further study the relationship between air pollution and congenital heart disease.
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