Association between maternal exposure to gaseous pollutants and atrial septal defect in China: A nationwide population-based study

Fangyuan Yan; Hanmin Liu; Hanyue Zhang; Ling Yi; Yangyang Wu; Changfei Deng; Yang Qiu; Xia Ma; Qi Li; Fumo Yang; Wenli Xu; Jing Tao; Jonathan J Buonocore; Yu Zhan; Li Dai

doi:10.1016/j.envres.2021.111472

Association between maternal exposure to gaseous pollutants and atrial septal defect in China: A nationwide population-based study

Environ Res. 2021 Sep:200:111472. doi: 10.1016/j.envres.2021.111472. Epub 2021 Jun 9.

Authors

Fangyuan Yan¹, Hanmin Liu¹, Hanyue Zhang², Ling Yi³, Yangyang Wu², Changfei Deng³, Yang Qiu², Xia Ma³, Qi Li³, Fumo Yang⁴, Wenli Xu³, Jing Tao³, Jonathan J Buonocore⁵, Yu Zhan⁶, Li Dai⁷

Affiliations

¹ Department of Environmental Science and Engineering, Sichuan University, Chengdu, Sichuan, 610065, China; The Joint Laboratory for Pulmonary Development and Related Diseases, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
² Department of Environmental Science and Engineering, Sichuan University, Chengdu, Sichuan, 610065, China.
³ National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China.
⁴ Department of Environmental Science and Engineering, Sichuan University, Chengdu, Sichuan, 610065, China; National Engineering Research Center for Flue Gas Desulfurization, Chengdu, Sichuan, 610065, China.
⁵ Center for Climate, Health, and the Global Environment at Harvard T.H. Chan School of Public Health, Boston, MA, 02115, United States.
⁶ Department of Environmental Science and Engineering, Sichuan University, Chengdu, Sichuan, 610065, China; National Engineering Research Center for Flue Gas Desulfurization, Chengdu, Sichuan, 610065, China; Med-X Center for Informatics, Sichuan University, Chengdu, Sichuan, 610041, China. Electronic address: yzhan@scu.edu.cn.
⁷ The Joint Laboratory for Pulmonary Development and Related Diseases, West China Institute of Women and Children's Health, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China; Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, Sichuan, 610041, China; National Center for Birth Defects Monitoring, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, 610041, China; Med-X Center for Informatics, Sichuan University, Chengdu, Sichuan, 610041, China. Electronic address: daili@scu.edu.cn.

PMID: 34097890
DOI: 10.1016/j.envres.2021.111472

Abstract

Background: The association between maternal exposure to gaseous air pollutants and congenital heart defects (CHD) remains unclear. The concentration-response relationship and the time windows of susceptibility to gaseous pollutants may vary by pollutant species and CHD subtypes.

Objective: We aimed to examine the relationship between maternal exposures to four species of gaseous pollutants (NO₂, O₃, SO₂, and CO) and atrial septal defect (ASD), which is a common subtype of CHD, and to determine the critical time windows of susceptibility for each gaseous pollutant.

Methods: Among 1,253,633 infants born between October 1, 2013 and December 31, 2016 in China, 1937 newborns were diagnosed with isolated ASD, a prevalence of 1.55‰. Maternal exposures to the gaseous pollutants were estimated by matching the geocoded maternal addresses with the gridded ambient concentrations. The adjusted odds ratios (aOR) between exposures and ASD were quantified by using mixed-effects logistic regression models.

Results: We found significantly positive associations between ASD and maternal exposures to NO₂, O₃, SO₂, and CO during entire pregnancy, first-, second-, and third-trimester. However, no statistically significant association was found between maternal exposure to PM_2.5, PM_2.5-10 and ASD risk (P > 0.05). In the fully adjusted model with respect to average exposure over entire pregnancy, the adjusted odds ratios (aOR) for each 10 μg/m³ increment of NO₂, O₃, SO₂ were 1.33 (95% CI: 1.22-1.45), 1.13 (95% CI: 1.10-1.16), 1.28 (95% CI: 1.20-1.35), respectively; the aOR for each 100 μg/m³ increment of CO was 1.10 (95% CI: 1.06-1.15). The observed concentration-response relationships varied by exposure periods and pollutants, with the strongest association for NO₂ during the 1st-8th embryology weeks, for O₃ during the third trimester, for SO₂ during the second trimester, and for CO without obvious variation.

Conclusions: The findings suggest an increased risk of ASD in association with maternal exposures to four common gaseous pollutants. From the perspective of birth defects prevention and ASD risk mitigation, it is critical to reduce maternal exposure to gaseous pollutants especially during the most susceptible time windows.

Keywords: Air pollution; Congenital heart defects; Mixed-effects model; Newborn health; Sensitive window.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Air Pollutants* / analysis
Air Pollutants* / toxicity
Air Pollution* / adverse effects
Air Pollution* / analysis
China / epidemiology
Environmental Pollutants*
Female
Gases
Heart Septal Defects, Atrial* / chemically induced
Heart Septal Defects, Atrial* / epidemiology
Humans
Infant
Infant, Newborn
Maternal Exposure / adverse effects
Particulate Matter / toxicity
Pregnancy

Substances

Air Pollutants
Environmental Pollutants
Gases
Particulate Matter