Maternal air pollution exposure and neonatal congenital heart disease: A multi-city cross-sectional study in eastern China

Die Li; Weize Xu; Yunxiang Qiu; Feixia Pan; Hongliang Lou; Jing Li; Yueqin Jin; Ting Wu; Lulu Pan; Jing An; Junqiu Xu; Wei Cheng; Linghua Tao; Yongliang Lei; Chengyin Huang; Fei Yin; Qiang Shu

doi:10.1016/j.ijheh.2021.113898

Maternal air pollution exposure and neonatal congenital heart disease: A multi-city cross-sectional study in eastern China

Int J Hyg Environ Health. 2022 Mar:240:113898. doi: 10.1016/j.ijheh.2021.113898. Epub 2021 Dec 4.

Authors

Die Li¹, Weize Xu², Yunxiang Qiu³, Feixia Pan¹, Hongliang Lou⁴, Jing Li⁵, Yueqin Jin⁶, Ting Wu⁷, Lulu Pan⁸, Jing An⁹, Junqiu Xu¹⁰, Wei Cheng¹¹, Linghua Tao¹², Yongliang Lei¹³, Chengyin Huang¹⁴, Fei Yin¹⁵, Qiang Shu¹⁶

Affiliations

¹ Department of Cardiac Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 310000, Hangzhou, China.
² Department of Cardiac Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 310000, Hangzhou, China. Electronic address: weizexu@zju.edu.cn.
³ Department of Intensive Care Unit, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 310000, Hangzhou, China.
⁴ Jinhua Maternal and Child Health Care Hospital, 321000, Jinhua, China.
⁵ Jiaxing Maternity and Child Health Care Hospital, 314000, Jiaxing, China.
⁶ Shaoxing Maternity and Child Health Care Hospital, 312000, Shaoxing, China.
⁷ Hangzhou Women's Hospital, 310000, Hangzhou, China.
⁸ Wenzhou Guidance Center for Maternity and Child Health, 325000, Wenzhou, China.
⁹ Huzhou Maternity and Child Health Care Hospital, 313000, Huzhou, China.
¹⁰ Zhoushan Women and Children Hospital, 316000, Zhoushan, China.
¹¹ Ningbo Women and Children Hospital, 315000, Ningbo, China.
¹² Taizhou Women and Children's Hospital, 318000, Taizhou, China.
¹³ Lishui Maternity and Child Health Care Hospital, 323000, Lishui, China.
¹⁴ Quzhou Maternity and Child Health Care Hospital, 324000, Quzhou, China.
¹⁵ Binjiang Institute of Zhejiang University, 310000, Hangzhou, China.
¹⁶ Department of Cardiac Surgery, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 310000, Hangzhou, China. Electronic address: shuqiang@zju.edu.cn.

PMID: 34875582
DOI: 10.1016/j.ijheh.2021.113898

Abstract

Objective: To examine the association between air pollution and neonatal congenital heart disease (CHD), and evaluate the cumulative burden of CHD attributed to above certain level for ambient air pollution exposure.

Methods: We identified newborns who were diagnosed as CHD by echocardiography in Network Platform for Congenital Heart Disease (NPCHD) from January 2019 to December 2020 in 11 cities eastern China. The exposure lag response relationship between air pollutants (PM_2.5, PM₁₀, SO₂, NO₂, CO, and O₃) concentration and CHDs was calculated by the distributed lag nonlinear model (DLNM). We further calculated the cumulative risk ratios (CRRs) of each air pollutant above reference concentrations on CHDs.

Results: A total of 5904 CHDs from 983, 523 newborns were enrolled in this study. A 10 μg/m³ increase in PM_2.5, PM₁₀, SO₂, NO₂, CO and O₃ exposure was associated with an increased risk of higher CHD incident RR = 1.025, 95% CI: 1.016-1.038 for PM_2.5 in the third trimester, RR = 1.001, 95% CI: 1.000-1.002 for PM₁₀ in the third trimester, 1.020, 95%CI: 1.004-1.036 for NO₂ in the third trimester, RR = 1.001, 95%CI: 1.000-1.002 for O₃ in the first trimester, all P value < 0.05). Cumulative effect curves of PM_2.5, PM₁₀, SO₂, NO₂, CO, and O₃ were observed as sub-linear with a maximum of 1.876 (95%CI:1.220-2.886), 1.973 (95%CI:1.477,2.637), 2.169 (95%CI:1.347-3.493), 2.902 (95%CI:1.859-4.530), 1.398 (95%CI:1.080-1.809), 2.691 (95%CI:1.705-4.248), respectively. Significant associations were observed for air pollutants and CHDs in cities with higher average education years and babies concepted in cold season.

Conclusions: Our findings could provide growing evidence regarding the adverse health effects of air pollution on CHD, thereby strengthening the hypothesis that air pollutants have harmful impacts on cardiac development. Further studies are needed to verify the associations.

Keywords: Air pollutant; Congenital heart disease; Distributed lag nonlinear model; Multivariate meta analysis.

Publication types

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

MeSH terms

Air Pollutants* / analysis
Air Pollution* / adverse effects
Air Pollution* / analysis
China / epidemiology
Cities / epidemiology
Cross-Sectional Studies
Female
Heart Defects, Congenital* / chemically induced
Heart Defects, Congenital* / epidemiology
Humans
Infant, Newborn
Particulate Matter / analysis

Substances

Air Pollutants
Particulate Matter