Temporal Trends in Fetal Congenital Heart Disease: Is There a Potential Link With Air Quality?

Congenital heart disease (CHD) is the most common birth defect. Environmental risk factors, including air pollution, are increasingly identified as contributors to the risk profile of CHD. We sought to investigate the temporal association between frequency and severity of fetal CHD with air quality in the D.C. metropolitan region.

We queried all fetal diagnoses of CHD at a tertiary care center over a 5-year period, inclusive of a wildfire smoke event. We categorized each case as critical or non-critical CHD and assigned the case to the estimated month of delivery. We used descriptive statistics to show temporal trends in fetal CHD and the relationship with publicly available air quality data.

Of the 685 CHD cases, approximately 60% were considered critical CHD. The highest number of cases occurred in March 2024 (coincident with a periconception period in June 2023 during peak wildfire smoke exposure). An additional peak in CHD cases in February 2023 also coincided with a worse air quality peak during the cardiac embryonic period. However, there was no change in the percentage of critical CHD during these peaks.

Our work highlights the possibility of environmental pollution, specifically wildfire smoke exposure, as a risk factor for fetal CHD.