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Attributable fraction for cardiac malformations
P D Wilson1, C A Loffredo, A Correa-Villaseñor
1Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore 21201, USA.
Insights
This study quantifies the proportion of cardiac malformations potentially preventable by addressing specific risk factors. Findings highlight key exposures like paternal marijuana use and environmental factors that could inform prenatal interventions.
Area of Science:
- Cardiovascular Epidemiology
- Birth Defects Research
- Public Health
Background:
- Cardiac malformations are a significant cause of infant mortality and morbidity.
- Previous research identified factors associated with cardiac malformations but did not quantify their attributable fractions.
- The Baltimore-Washington Infant Study provided a valuable dataset for investigating these associations.
Purpose of the Study:
- To calculate attributable fractions for specific risk factors associated with major cardiac malformations.
- To identify potentially preventable proportions of these birth defects.
- To inform public health strategies for the prevention of congenital heart disease.
Main Methods:
- Utilized data from the Baltimore-Washington Infant Study (1981-1989).
- Calculated summary attributable fractions and extra attributable fractions for eight major cardiac malformations.
- Analyzed the contribution of individual factors, considering both prevalence and relative risk.
Main Results:
- Summary attributable fractions ranged from 13.6% (hypoplastic left heart) to 30.2% (transposition of great arteries with intact ventricular septum).
- Largest extra attributable fractions were linked to paternal marijuana use (7.8%), painting (5.1%), and pesticide exposure (5.5%).
- The proportion of cases exposed was a dominant factor in the attributable fraction calculations.
Conclusions:
- Specific environmental and lifestyle factors may be causally linked to cardiac malformations.
- Significant proportions of certain cardiac malformations may be preventable through targeted interventions.
- These findings underscore the potential for primary prevention strategies during the prenatal period.
Abstract:
To the authors' knowledge, attributable fractions for cardiac malformations have not been reported before. The Baltimore-Washington Infant Study published factors associated with several major cardiac malformations in Maryland, the District of Columbia, and adjacent counties of northern Virginia in 1981-1989. For eight of these malformations, the authors provide attributable fractions of those factors that are potentially causal. Summary attributable fractions range from 13.6% (four factors) for hypoplastic left heart to 30.2% (seven factors) for transposition of great arteries with intact ventricular septum. Extra attributable fraction for factor x, defined as summary attributable fraction for all factors minus that for all but x, is largest for: 1) paternal marijuana use in transposition of great arteries with intact ventricular septum, 7.8%; 2) paternal anesthesia in tetralogy of Fallot, 3.6%; 3) painting in atrioventricular septal defect with Down syndrome, 5.1 %; 4) solvent/degreasing agent exposure in hypoplastic left heart, 4.6%; 5) sympathomimetics in coarctation of aorta, 5.8%; 6) pesticide exposure in isolated membranous ventricular septal defect, 5.5%; 7) hair dye in multiple/multiplex membranous ventricular septal defect, 3.3%; and 8) urinary tract infection in atrial septal defect, 6.4%. Percent-of-cases-exposed dominates relative risk in attributable fraction. If these factors are causal, the larger extra attributable fractions suggest the potential for prevention by specific interventions before/during pregnancy.